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pneumonia Flashcards

1
Q

Radiographic lung patterns: interstitial pattern

A

blood vessel margins are indistinct/hazy

infiltration within extracellular space of lung

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2
Q

Radiographic lung patterns: bronchial pattern

A

doughnut, tramlines

thickening of airway walls, infiltrates in or around airway walls

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3
Q

radiographic lung patterns: alveolar pattern

A

air bronchograms

fluid/infiltrate within airspace, alveolar space

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4
Q

pneumonia

A

inflammation of pulmonary parenchyma

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5
Q

types of pneumonia

A

broncho

interstitial

granulomatous (fungal)

mixed: bronchinterstitial (viral)

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6
Q

bronchopneumonia

A

grossly affects cranial ventral lung

consolidation

micro lesions: inflammatory exudative airway

bacterial, aspiration

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7
Q

interstital pneumonia

A

grossly diffuse, locally extensive

micro lesions: alveolar septa

causes: viral, toxoplasmosis, toxin, sepsis, Leptosporosis, hypersensitivity

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8
Q

etiology of pneumonia

A

bacterial

fungal

aspiration

viral

parasitic

protozoal

trauma/hemorrhage

allergic/immune mediated

foreign body

neoplasia

uremia

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9
Q

causes of viral pneumonia

A

Canine distemper virs

FIP

FCV

CAV2

Canine parainfluenza virus

canine influenza

H1N1-cats

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10
Q

Canine influenza virus

A

caused by type A Orthomyxovirus

first outbreak in 2004 in FL

winter and summer to early fall

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11
Q

Canine influenza virus transission

A

aerosolized resp secretion

contaminated fomites

2-5 day incubation period

almost all exposed dogs become infected

80% develop clin sxs

other 20% shed virus

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12
Q

Canine inluenza virus clinical signs

A

DDx: kennel cough

mild form-Cough for 2-3 weeks, purulent nasal d/c, low grade fever, most common

severe form-high grade fever, pneumonia (bacterial), tachypnea, dyspnea

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13
Q

Canine influenza: dx

A

no reliable rapid dx test

serology-most reliable and sensitive

PCR on TTW, oropharyngeal swab-use early in inf

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14
Q

Canine influenza: tx

A

supportive care

broad spectrum abx with severe nasal d/c, pneumonia

fluid and nutritional support

isolation

disinfection

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15
Q

canine influenza: px

A

80% morbidity

5-8% mortality

vax

easily killed by common disinfectants

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16
Q

bacterial pneumonia causes

A

combo of factors

compromise of defense mechanisms

pathogenic potential of offending bacteria

nature of exposure to bacteria

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17
Q

Bacterial pneumonia: pathogens

A

primary: Bordetella, Mycoplasma (cats)
secondary: Strep, Saph, Pasteurella, E coli, Klebsiella, mixed, anaerobes

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18
Q

Bacterial pneumonia: routes of infection

A

aspiration of various substances

hematogenous spread

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19
Q

Bacterial pneumonia: predisposing factors

A

primary resp innf

d/o of swallowing

trauma

recumbency, CNS dz

smoke inhalation

FB rxn

noeplasia

sepsis

ciliary dyskinesia

immune suppression

breed predisposition

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20
Q

Bacterial pneumonia: hx and clin sxs

A

soft, moist cough during daytime

tachypnea, poss dyspnea

nasal d/c

anorexia, lethargy

hx of v, regurg

ADR

fever

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21
Q

Bacterial pneumonia: PE findings

A

Depression, dehydration

fever (<50%)

cyanosis

crackles, wheezes, decreased lung sounds

chest auscultation may be normal

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22
Q

Bacterial pneumonia: dx

A

CBC

chest rads

arterial blood gas

airway sampling

PCR

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23
Q

T/F: the absence of fever rules out bacterial pneumonia

A

False, only 50% of case report fevers

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24
Q

True or false: an alveolar pattern is usually present in a dog with bacterial pneumonia

A

True

cats usually have bronchial pattern

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25
Bacterial pneumonia: dx-airway sampling
TTW, bAL septic inflammation intracellular bacteria
26
Bacterial pneumonia: dx- arterial blood gas
-hypoxemia, hypocapnea
27
bacterial pneumonia: dx-chest rads
alveolar pattern (cats-bronchial pattern), ventral region of cranial and middle lobes, localized if lobar, lung lobe consolidation, caudodorsal if hematogenous
28
Bacterial pneumonia: dx-CBC
- leukocytosis, left shift
29
Bacterial pneumonia: dx-PCR
Canine infectious respirator PCR panel includes Bordetella, Strepococcus zooepidemicus, plus viral pathogens nasal, conjunctiva swabs pharyngeal swabs airway wash sample
30
Bacterial pneumonia: tx
Abx fluid therapy oxygen therapy humidification of airways physical therapy poss bronchodilators address underlying cause
31
Bacterial pneumonia: tx-abx
-based on C&S, bactericidal preferred mild to modrate case: doxy, clavamox, TMPS, cephelosporins Severe cases: flouroquinolones + amp/clavamox cats: doxy lifethreatening: Unisyn + flouroquinolone or aminoglycoside all IV initially cont 1-2 weeks after resolution of sxs
32
Bacterial pneumonia: patient monitoring
expect clin improvement within 3-5 d daily auscultation monitor temp follow up chest rad-esp prior to stopping abx blood gas analysis-improvement in PaO2 improvement on CBC
33
Bacterial pneumoia: Px
good in general poss recurrence prevention: fasting prior to sedation, PEG tube feedings, etc
34
Aspiration pneumonia-causes and predisposing factors
entry of foreign material into airway esophageal dz, oropharyngeal dz, CNS dz, anesthesia, chronic V, iatrogenic
35
Aspiration pneumonia: Clinical findings
cough, tachypnea, dyspnea acute resp distress chronic cough poss crackles, wheezes, esp cranial ventral (absence of resp sxs poss) fever poss neurologic deficits poss oral cavity abn
36
Aspiration pneumonia: Chest rads
alveolar pattern most common (esp right middle and right cranial) interstitial pattern 2nd most common lung lobe consolidation poss mineral oil can cause diffuse interstitial or nodular pattern
37
Aspiration pneumonia: airway fluid analysis
inflammatory cels intracellular bacteria foreign debris use in chronic pneumonia cases
38
Aspiration pneumonia: tx
bronchoscopy airway suctioning and flushing oxygen therapy abx therapy proper feeding techniques
39
Aspiration pneumonia: Px
variable but usually good
40
Blastomycosis
most common respiratory fungal inf in MN and great lakes region soil saprophyte
41
Blastomycosis: hx and clin sxs
travel to endemic area cough, dyspnea depression, lethargy ocular signs: choriorenititis, blindness, glaucoma skin lesions fever-104.5-105 lymphadenopathy lameness
42
Blastomycosis: pathogenesis
spores inhaled and deposited in alveoli phagocytized by macs transformed from mycelial to yeast phase multiplies in macs yeast cells released into alveoli--\> infl incubation time: 5-12 weeks
43
Blastomycosis: clinical forms
Primary pulmonary disseminated-hematogenous, lymphatic local cutaneous
44
Blastomycosis: rad findings
small or large interstital nodules alveolar pattern masses unstrcutred perihilar infiltrate lymphadenopathy lung lobe consolidation pleural effusion
45
Blastomycosis: Dx
consider geography Cytology of lung node skin or bone-most common histopath fungal culture fungal titers urine ag test response to tx
46
Blastomycosis: Dx-cytology
pyogranulomatous inflammation large, thick-walled budding yeast
47
Blastomycosis: antifungal drug therapy
imidazole drugs-expensive, given with food, poss liver and GI toxicity, Itraconazole Amphotericin B-risk of renal toxicity, must be infused with IV fluids, poor penetration, combine with Itraconazole
48
Blastomycosis: supportive care
IV fluid therapy oxygen therap anti-inflammatory meds-NSAIDs, low dose steroids nutritional support
49
Blastomycosis: patient monitoring
repeat chest rads in 4-6 weeks recheck rad no shorter than monthly rad lesions resolve within 185 days urine ag test
50
blastomycosis: Px
~60% survival rate poor for dogs in resp distress at presentation poor with CNS dz fair for dogs treated early in dz course relapse common enucleation may be necessary
51
Noncardiogenic Pulmonary Edema
abnormal accumulation of lfuid within the lung caused by increased vascular endothelial permeabiilty high protein fluid
52
Noncardiogenic Pulmonary Edema: etiology
lung injury-examples: aspiration of gastric contents, smoke inhalation, near drowning, trauma, handing, choking, prolonged high conc oxygen inspiration Extrapulmonary causes: SIRS, sepsis, neurologic dz, pulmonary thromboembolism, pancreatitis, uremia
53
Noncardiogenic Pulmonary Edema: Clinical sxs
acute dyspnea, tachypnea diffuse crackles poss cardiac abn fever CNS signs burns in oral cavity evidence of strangulation
54
Noncardiogenic Pulmonary Edema: Dx workup
chest rads if stable arterial blood gas ECG CBC, chem UA
55
Noncardiogenic Pulmonary Edema: Dx-Chest rads
early signs: interstitial pulmonary edema progression to mixed insterstitial-alveolar or alveolar typically caudodorsal lung lobes symmetric cahnges with extrapulmonary causes asymmetrical with primary lung insult
56
Noncardiogenic Pulmonary Edema: dx-arterial blood gas
hypoxemia intially hypocapnia later hypercapnia
57
Noncardiogenic Pulmonary Edema: Tx
eliminate underlying cause descrease vascular infl with steroids, other anti-inflammatories support resp and cardiac function-oxygen, ventilator, fluid therapy (colloids) diuertic therapy vasodilators support bp-dopamine dobutamine
58
Noncardiogenic Pulmonary Edema: Px
fair to poor
59
Pulmonary thromboembolism
thrombus formation in pulmonary artery
60
pulmonary thromboembolism: cause
injury to vessel endothelium impairment of blood flow development of pro-thrombotic tendencies in blood
61
pulmonary thromboembolism: Risk factors
hypercoaguable state IV catheters prolonged recumbency blood transfusions glucocorticoid excess-endogenous or exogenous
62
pulmonary thromboembolism: disease association
Heartworm dz IMHA, ITP pancreattitis PLE PLN cardiac dz sepsis DIC Cushing's DM Polycythemia vasculitis hyperlipidemia
63
pulmonary thromboembolism: Clinical presentation
acute onset tachypnea, dyspnea cyanosis lethargy hemopytsis increased bronchovesicular sounds known predisposing conditions
64
pulmonary thromboembolism: Dx
high index of suspicion CBC, coag arterial blood gas-hypoxemia, hypocapnia Chest rads D-Dimer ventilation perfusion scan angiography CT scan with angiography necropsy
65
pulmonary thromboembolism: Dx-chest rads
may be normal hyperlucency pulmonary infiltrates pleural effusion PA changes severe of changes may not match severity of signs
66
pulmonary thromboembolism: Dx-D-dimer
fibrin degradation product elevation signify active coag and fibrinolysis short half life not specific
67
pulmonary thromboembolism: Tx
ICU care oxygen therapy thrombolytic therapy address underlying cause vasodilator therapy
68
pulmonary thromboembolism: Cats
rare severe concurrent clinical dz
69
pulmonary thromboembolism: prevention
ID at risk patients heparin therapy low molecular weight heparin Plavix low dose aspirin warfarin
70
7 yo MC Rottweiler presenting complaint: anemia, recurrent IMHA Current therapy: SID Pred PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal problem list?
IMHA Iatrogenic Cushing's leukocytosis increased liver enzymes increased biliruing tachycardia panting
71
7 yo MC Rottweiler presenting complaint: anemia, recurrent IMHA Current therapy: SID Pred PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal tx plan?
blood transfusion increase pred dose add cyclosporine ICU monitoring
72
7 yo MC Rottweiler presenting complaint: anemia, recurrent IMHA Current therapy: SID Pred PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal. next night: HCT:23%, panting more heavily, cyanotic, uncomfortable, unable to walk outside, harsh lung sounds bilateral DDx?
Pulmonary thromboembolism noncardiogenic pulmonary edema heart failure pleural space dz pneumnoia cushing's lung lobe torsion laryngeal dz
73
7 yo MC Rottweiler presenting complaint: anemia, recurrent IMHA Current therapy: SID Pred PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal. next night: HCT:23%, panting more heavily, cyanotic, uncomfortable, unable to walk outside, harsh lung sounds bilateral Next step?
pulse oximeter arterial blood gas chest rads
74
7 yo MC Rottweiler presenting complaint: anemia, recurrent IMHA Current therapy: SID Pred PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal. next night: HCT:23%, panting more heavily, cyanotic, uncomfortable, unable to walk outside, harsh lung sounds bilateral chest rads-normal; arterial blood gas: pH7.39, pO2=64, pCO2=36
alkalosis pO2 very low-hypoxemia pCO2 decrease-hypocapnia
75
7 yo MC Rottweiler presenting complaint: anemia, recurrent IMHA Current therapy: SID Pred PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal. next night: HCT:23%, panting more heavily, cyanotic, uncomfortable, unable to walk outside, harsh lung sounds bilateral chest rads-normal; arterial blood gas: pH7.39, pO2=64, pCO2=36 Most likely dx?
pulmonary thromboembolism
76
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Cardiopulmonary test 1 (9 decks)

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