Pulmonary Parenchymal Diseases Flashcards
List conditions that can predispose a patient to aspiration pneumonia
- Regurgitation (megaesophagus)
- Impaired consciousness (sedation, seizures, coma, anesthesia)
- Laryngeal paralysis, myasthenia gravis
- Vomiting
- Force feeding
- Gastic overdistension
List the 3 main pulmonary parenchymal diseases
- Pneumonia
- Pulmonary fibrosis
- Non-cardiogenic pulmonary edema
Describe the classical appearance of bacterial pneumonia
ventral alveolar infiltrates (uni or bilateral)
Unilateral if associated with aspiration, FB, or tumor
List the common opportunistic pathogens associated with bacterial pneumonia
Dogs -
Cats -
Dogs:
- E.coli, pasteurella, klebsiella, Staphylococcus, Streptococcus, Bordetella, Mycoplasma
Cats:
- Mycoplasma, pasteurella, Streptococcus, Bordetella, e.coli
List the common virulent primary pathogens associated with bacterial pneumonia
- Strep equi subsp zooepidemicus
- Extraintestinal E.coli
Describe the common radiographic patterns/findings suggestive of mycotic pneumonia
- Nodular or miliary interstitial pattern
- Perihilar lymphadenopathy
What breeds are predisposed to pulmonary fibrosis?
- West highland terrier
- Staffordshire bull terrier
Describe the common radiographic patterns/findings that can be seen in patients with pulmonary fibrosis
- Diffuse bronchointerstitial pattern in Dogs
- Bronchial, interstitial, and/or alveolar in cats
If mod-severe PH:
- R side cardiomegaly
- PA enlargement
Acute hemorrhagic or necrotizing pneumonia is usually seen as a result of a __________
A. Opportunistic bacterial infection
B. Virulent pathogens
C. Fungal infection
D. MDR bacterial infection
B. Virulent (primary) pathogens
Pneumonia due to ____________ is usually associated with a high mortality rate
A. Opportunistic bacterial infection
B. Virulent pathogens
C. Fungal infection
D. MDR bacterial infection
B. Virulent (primary) pathogens
What are the 3 classifications of bacterial pneumonia?
- Community acquired (CAP)
- Hospital acquired (HAP)
- Aspiration pneumonia
Pneumonia associated with ____________ (3) may only affect 1 lung lobe
- Aspiration
- FB
- Tumor
Definitive diagnosis of bacterial pneumonia requires ____________
ID of sepsis (Neutrophilic inflammation + intracellular bacteria present) from lower airway samples
(obtained w transtracheal wash or bronchoalveolar lavage)
When is not obtaining a lower airway sample ok in a patient with suspect pneumonia?
If P has CAP, no history of pneumonia, and no recent history of receiving antibiotic therapy
you likely know the pathogen already with CAP and can treat with broad spectrum Abx
What is the antibiotic treatment protocol for a patient with HAP?
Dog:
Cat:
(Hospital acquired pneumonia)
MDR bacterial infection
Dogs:
1. 1st gen cephalosporins + 2nd or 3rd gen cephalosporins
2. Carbapenem (broad spectrum beta lactam)
OR
3. Amikacin + amoxi/sulbactam (Clavamox)
Cats:
Same as above +/- enrofloxacin or Doxy to tx mycoplasma
What is the antibiotic treatment protocol for a patient with severe, unstable CAP or aspiration pneumonia?
Beta lactam + Fluoroquinolone or
Beta lactam + Aminoglycoside
What is the antibiotic treatment protocol for a patient with moderate, stable CAP or aspiration pneumonia?
Monotherapy:
- Amoxi/Clav or TMS
Combo therapy:
- Beta lactam + Fluoroquinolone
- Clindamycin + fluoroquinolone
What is the antibiotic treatment protocol for a patient with mild, stable CAP or aspiration pneumonia?
- Amoxi/Clav
- Fluoroquinolone
- TMS
What other treatments are involved in bacterial pneumonia other than antibiotic therapy?
- Supplemental O2
- Fluid therapy
- Nebulization + coupage
Common pathogens associated with mycotic pneumonia?
- Blastomyces
- Histoplasma
- Coccidioides
Perihilar lymphadenopathy is a radiographic finding seen with _________
A. Viral pneumonia
B. Opportunistic bacterial pneumonia
C. MDR bacterial pneumonia
D. Mycotic pneumonia
D. Mycotic pneumonia
What is the treatment protocol for a patient with mycotic pneumonia?
Intraconazole
(can use fluconazole for coccidiodes)
___________ is a pathogen causing a non-bacterial pneumonia with severe morbidity and mortality in immunocompromised patients
Pneumocystis carinii
Pneumocystis carinii is common in what dog breeds?
- Mini dachshund
- King charles spaniel
Which of the following is usually contagious?
A. Viral pneumonia
B. Opportunistic bacterial pneumonia
C. MDR bacterial pneumonia
D. Mycotic pneumonia
A. Viral pneumonia
History of recent exposure such as being at a dog park, boarding, or going to daycare help make a presumptive diagnosis of
A. Viral pneumonia
B. Opportunistic bacterial pneumonia
C. MDR bacterial pneumonia
D. Mycotic pneumonia
A. Viral pneumonia
(contagious cause!)
What is required for the definitive diagnosis of pulmonary fibrosis?
Lung biopsy and histo
(risky af and not usually performed)
What is the treatment protocol for a patient with pulmonary fibrosis?
- Corticosteroid + Bronchodilator (theophylline)
- Cough suppressant (hydrocodone)
- Sildenafil for P with mod-severe PH
- Weight loss, exercise restriction
What are the presenting complaints in a patient with suspect pulmonary fibrosis, and what can be revealed on PE?
- Chronic cough, exercise intolerance
- Inspiratory (loud) crackles in all fields
- Signs of PH is mod-severe
What can sometimes be seen on CBC secondary to pulmonary fibrosis?
Polycythemia (secondary to hypoxia, triggers EPO to make more RBCs)
List the causes of NCPE (non-cardiogenic pulmonary edema)
- ARDS secondary to pulmonary dz
- Airway obstruction
- Seizure
- Electrocution
- Drowning
- Vasculitis
- Severe pulmonary hypertension
history is key to diagnosis
acute onset, fluid filled lungs from increased vascular permeability secondary to lung injury
What type of fluid is seen with NCPE (non-cardiogenic pulmonary edema)
Protein rich (modified transudate)
(cardiogenic pulmonary edema is a low protein transudate - helps R/O cardiogenic cause)
Acute onset of dyspnea, cough, cyanosis, and hemoptysis are CS seen with?
NCPE (non-cardiogenic pulmonary edema)
CS of respiratory disease often are chronic onset, exceptions are……
PTE or NCPE (non-cardiogenic pulmonary edema)
Describe the common radiographic patterns/findings that can be seen in patients with NCPE
Caudodorsal interstitial and/or alveolar infiltrates
Which of the following has a caudodorsal distribution that can be seen on radiographs?
A. Pulmonary fibrosis
B. NCPE
C. Bacterial pneumonia
D. Aspiration pneumonia
B. NCPE
What is a commonly involved mechanism involved in the development on NCPE?
Increased vascular permeability secondary to lung injury
(results in protein rich fluid)
Define ARDS
pulmonary inflammatory disorder characterized by non-cardiogenic pulmonary edema (NCPE), neutrophilic inflammation, and hypoxemia
______________ is a pulmonary inflammatory disorder characterized by non-cardiogenic pulmonary edema (NCPE), neutrophilic inflammation, and hypoxemia
ARDS
Most common pathogen causing protozoal pneumonia?
Toxoplasma gondii
List the drugs you should prescribe to a cat with HAP
- Cephalosporins, Carbapenem (B lactam), or amikacin + amoxi/clav
+ enrofloxacin or doxycycline (for mycoplasma)
Which of the following is not part of the drug protocol for a dog with HAP?
A. Beta lactam
B. Amoxi/Clav
C. Fluoroquinolone
D. 1st gen cephalosporin
C. Fluoroquinolone
Beta lactam and fluoroquinolone for CAP and aspiration pneumonia
