Resp med Flashcards
what are the common C/S with nasal disease? what 2 are the most definitive?
nasal D/C, sneezing
stertor, pawing or rubbing at muzzle, facial deformity/asymmetry, CNS signs, breathing with mouth
where does the nasal discharge come from with nasal disease?
nasal cavity, frontal sinuses, nasopharynx
less commonly from oral cavity, vomiting/regurg, systemic dz
tumors most commonly have a hx of _____ nasal D/C that may progress to ____ with chronicity. this can also occur with _____ disease.
unilateral, bilateral, fungal
with localized nasal dz, a CBC, chem, and UA will most likely be ____.
normal
what do you have to keep in mind when doing cultures for nasal disease?
nares are not sterile, so take findings with a grain of salt
if there is epistaxis present or you’re doing a nasal biopsy, what type of testing must you pursue before?
coagulation tests
a combo of these 3 diagnostic tests are typically required for diagnosis of chronic nasal diseases:
CT, rhioscopy, biopsy
true or false: primary bacterial nasal disease is pretty common in both dogs and cats.
false! it is uncommon. there are far more likely primary etiologies in patients presenting with mucopurulent d/c
which is better for bacterial diagnosis, deep tissue biopsies and/or nasal flush, or superficial or mucous cultures?
the first one, deep and nasal flush
what is the etiology and pathophys of canine sinonasal aspergillosis?
Aspergillus fumigatus
disease –> large dose or resistance to infection overcome (we are always breathing it in)
what is the typical signalment for SNA? (sinonasal aspergillosis)
young male dogs
German shepherds, Rotties
normal to longer muzzle dogs
what does aspergillosis cause in the nasal cavity and/or frontal sinus?
fungal plaques
what are the clinical features of canine sinonasal aspergillosis?
unilateral or bilateral mucoid to muco-hemorrhagic discharge, sneezing
± facial pain, nasal depigmentation with chronicity
how do you dx canine sinonasal aspergillosis?
CT (supportive lesions), rads (supportive lesions), serology
rhinoscopy –> biopsy of fungal plaques –> cytology + histopathology
supportive lesions: nasal turbinate destruction, periostea changes, ST in cavity, invasion of cribriform plate
how do you treat canine sinonasal aspergillosis?
debridement, topical antifungals in the nasal cavity ± sinuses
± systemic antifungals
multiple treatments often necessary
what are the two classifications of canine inflammatory rhinitis?
lymphoplasmacytic
eosinophilic
what are the C/S of canine inflammatory rhinitis?
sneezing, nasal D/C (mucoid to mucopurulent), typically bilateral, no signs of systemic illness
how do you diagnose canine inflammatory rhinitis?
exclude other treatable diseases!!
CT (inflammation, mucus), rhinoscopy (mucosal hyperaemia + edema, D/C), biopsy (inflammation)
diagnosis of exclusion
for canine inflammatory rhinitis, how do you treat?
it’s a disease you manage, not cure
air humidification, ID possibly allergens, treat dental dz, trial anti-parasitic meds
cyclosporin + immunotherapy = can be really successful
treat for nasal mites bc easy and cheap to do
what is the etiology of canine nasal mites?
Pneumonyssoides caninum
what are the C/S of canine nasal mites?
sneezing, reverse sneezing, ± mild serous nasal D/C
how do you treat canine nasal mites?
- milbemycin oxime
- Ivermectin
- Selamectin
you see a dog with unilateral mucoid discharge and do a rhinoscopy. you see this. what is your diagnosis?
canine sinonasal aspergillosis
you see a dog for excessive sneezing and see this on rhinoscopy. what is it and how do you treat?
nasal mites
Milbemycin, ivermectin, or selamectin
foreign bodies in the nose are most common in what signalment?
large breed dogs
what are the typical C/S for a foreign body in the nose
- acute onset sneezing, pawing at face, hemorrhagic discharge or epistaxis (unilateral!!!!)
- with chronicity, mucopurulent d/c
what does FURD stand for?
feline upper respiratory disease
not a specific thing, can be infectious, neoplastic, inflammatory, or structural
what are the typical clinical signs of FURD?
ocular or nasal d/c, epistaxis, sneezing, conjunctivitis
what is the difference b/t FURD and URI in cats?
FURD: feline upper resp disease, very general
URI: one or more agents of viral, bacterial, or fungal
what are the primary agents of URI in cats?
viral: calici (FCV), herpes (FHV-1)
bacterial: mycoplasma, bordetella, chlamydophila, Streptococcus
URI in cats incidence increases dramatically… when?
in multi-cat environments
what is URI in cats transmission?
resp, ocular, oral, contact w contaminated environment (FCV esp), carrier cats with FCV, latent infection with FHV
aerosol not major route
what are the most common clinical signs of a cat with acute FCV?
- depression, pyrexia
- oral ulceration
- sneezing, conjunctivitis, ocular and nasal D/C (not as severe at with FHV)
what are the most common clinical signs of a cat with acute FHV?
- sneezing, serous ocular and nasal D/C (often becomes mucopurulent)
- systemic signs (inappetence, pyrexia)
- ocular (conjunctivitis, ulcerative keratitis)
Chlamydophila in cats C/S usually limited to ____.
conjunctivitis
mycoplasma in cats C/S:
conjunctivitis, URT infections
bordetella in cats: primary
C/S?
primary: nasal D/C and pneumonia
you have a cat with acute URI. what is your approach to diagnostics?
- hx + PE
- culture and pcr panels –> pros and cons to this
- may not ID a definitive dx… figure out when to ID one
you have a cat with acute URI. you don’t know the exact cause of it… how will you treat it? can you treat it without knowing the exact cause?
yes you can treat without knowing the etiology
most often self-limiting = supportive care
general strategies:
- restoration of fluid balance (saline nebulization)
- reduce food intake (warm stinky food, appetite stimulants, clean nasal secretions)
- Lysine: interferes with herpes, better for chronic cases
- antiviral: Famciclovir
- probiotics
- stress relief mgmt
- Abx only if >10d, fever, lethargy, anorexia with mucopurulent d/c (not based on presence of mucopurulent d/c alone!!!) [doxycycline good first choice]
what are some control strategies to limit feline URI?
- increase immunity –> vaccination, general health
- decrease exposure
what is the prognosis for acute URI with cats?
good
what is the most common etiology of feline chronic rhinosinusitis?
viral (secondary to FHV1 epithelial/turbinate damage)
bac t maybe consequence of viral disease
signs often assoc with stressors
what are the common clinical findings with feline chronic rhino sinusitis?
sneezing, stertor, nasal d/c, preservation of airflow, typically healthy (maybe inappetence if copious nasal dc)
feline chronic rhino sinusitis is a diagnosis of _____.
exclusion!!
how do you diagnose feline chronic rhinosinusitis?
non-invasive:
- PE
- MEDB
- retroviral status
- PCR panels
- otic exam
- travel or suspicious
More invasive:
- complete oral exam
- imaging
- rhinoscopy
- nasal biopsy
how do you treat feline chronic rhinosinusitis?
- Abx
- air humidification = lowers viscosity of secretions
- lysine
- antivirals
- probiotics
- nasal flushing if sig d/c
- address dental dz if present
- intranasal vaccine
- steroids?
basically, control it, not cure it
what are the etiologies of feline nasal cryptococcus?
Cryptococcus neoformans
C. gattii
what is the transmission of feline nasal cryptococcus?
inhalation of spores
what are the C/S of feline nasal cryptococcus?
URT manifestations
nasal signs ± granulomatous lesions on nasal bones or extending into nasal ca city
neuro, skin, systemic and ocular dz may occur
how do you dx feline nasal cryptococcus?
LCAT: latex capsular agglutination test
- sensitive and specific
cytology
how do you tx feline nasal cryptococcus?
- oral* or injectable antifungals (at least 6mo)
- therapeutic monitoring (titres, LCAT)
what is the px of feline nasal cryptococcus/
good for cases without neuro involvement
can relapse
tell me about the behaviour of nasal planum squamous cell carcinomas in cats? what signalment is more likely to get it?
locally invasive, slow to metastasize
white-haired cats (uncommon in dogs)
how do you dx nasal planum SCC?
biopsy
how do you tx nasal planum SCC?
sx
oncologist referral (radiation ± chemo)
aspergillosis ____ airflow, and neoplasia _____ airflow (for nasal disease)
increases, decreases
tell me about the flow chart for diagnosis nasal disease
nasal d/c –> unilateral or bilateral?
unilateral:
- FB
- tooth root abscess
- local neoplasia
- inflammatory
- fungal
bilateral:
- inflammatory
- infectious
- fungal
- systemic (coagulopathy, hypertension, hyperviscosity)
- progressive neoplasia
what is tracheal collapse?
dorsoventral flattening of tracheal rings
can be intra or extra thoracic trachea
can extend to mainstem bronchi: tracheobronchial collapse
what is the etiology of tracheal collapse? what factors can exacerbate disease?
etiology: softening of cartilaginous rings
factors: obesity, chronic coughing, increased resp effort/pressure (BOAS)
tell me about how inspiration vs expiration affects tracheal collapse?
inspiration: lungs expand, trachea collapses
expiration: lungs deflate, trachea expands
what signalment is common for tracheal collapse?
small breed dogs, narrow muzzle + domed heat (chihuahua, poms, yorkies, toy poodles)
often middle-aged or older
complicating or comorbid dz: cardiac dz, chronic bronchitis
what are the C/S for tracheal collapse?
intermittent or chronic cough (goose honk, worse with excitement or exercise)
± resp distress (often brought on my coughing, heat, stress) (may see cyanosis, inspiratory and/or expiratory dyspnea)
how do you diagnose tracheal collapse?
- signalment, hx, PE
- rads (inspiratory and expiratory)
- tracheobronchoscopy (grade)
- fluoroscopy
remember that tracheal collapse is a dynamic disease
tell me the grades of tracheal collapse via tracheobronchoscopy
grade 1: 25% collapsed, cartilage rings circular
grade 2: 50% collapse, dorsal membrane stretched
grade 3: 75% collapse, dorsal membrane pendulous
grade 4: 95% collapsed
how do you treat tracheal collapse?
medical:
- environmental = weight loss, harness not collar, avoid excitement/stress
- pharmacologic = cough suppressants (butorphanol, loperamide, hydrocodan), bronchodilators?, anti-inflammatory steroids?
- concurrent condition = treat it
surgical/interventional:
- only if/when medical mgmt fails
- interventional = referral (intraluminal stents)
- surgical = extrathoracic rings
what is the px of tracheal collapse?
depends on severity and extent
progressive dz, but progression can be slowed
guarded px if poor response to medical therapy and intervention not pursued
who is predisposed to hypo plastic trachea?
English bulldogs, Bostons, French bulldogs
true or false: hypo plastic trachea is congenital
true
what is the tx of hypo plastic trachea?
correct concurrent dz if present (BOAS)
what does CIRDC stand for? what is it?
canine infectious respiratory disease complex
any contagious, acute onset infection
classically refers to Parainfluenza, Adenovirus 2, and Bordetella
other pathogens: distemper, canine influenza, pateurella, strep zooepidemicus
kennel cough!
what are the typical hx and clinical features associated with CIRDC?
- exposure to other animals
- vax (doesn’t prevent infection)
- dry “hacking” cough
- ± sneezing, nasal and/or ocular d/c, febrile, inappetant, lethargic
how do you dx CIRDC?
- hx + PE
- sampling (situation dependent, often not necessary)
how do you tx CIRDC?
- Abx if complicated infection (fever, lethargy, inappetence with mucopurulent d/c) —> use doxycycline
- dx work up if no improvement within 7 days, signs of pneumonia, other concerns
- avoid neck lead, minimize activity, excitement
- supportive therapy if systemically ill
- treat pneumonia if present
how do you prevent CIRDC?
strengthen immunity (vax)
decrease exposure
tracheal rupture is most commonly seen when?
after ET intubation in cats
tracheal rupture results in ?
pneumomediastinum, subq emphysema
how do you dx tracheal rupture?
rads
how to you tx tracheal rupture?
most heal without intervention
monitor pt for changes in resp status
what is the etiology of canine chronic bronchitis?
inflammatory infiltrate of lower airways
what is the signalment of canine chronic bronchitis?
middle aged to older dogs
small breeds
what are the C/S of canine chronic bronchitis?
harsh cough (daily >2 mo)
± exercise intolerance, increased resp effort
how do you dx canine chronic bronchitis?
excuse other causes of cough
- MEDB, heart worm testing, fecal
- thoracic rads (may be normal)
- airway cytology and culture
- ± bronchoscopy
how do you tx canine chronic bronchitis?
- glucocorticoids (tx inflammation) –> oral prednisone 1mg/kg/day then taper to lowest effective dose; inhaled fluticasone (typically start with oral if institute inhalational)
- bronchodilators (albuterol, methylxanthines)
- maintain ideal BCS
- avoid environmental irritants/stress
- airway humidification
- Abx if concurrent infection
what is the px of canine chronic bronchitis?
control, not cured
want to tx to control ongoing inflammation/inflammatory mediators
what are the two broad categories of feline bronchial disease?
feline asthma
feline chronic bronchitis
what is the pathogenesis of feline asthma?
airway inflammation –> excessive mucous secretion –> bronchial wall edema/remodelling –> bronchoconstriction –> airway narrowing
clinical signs result of airway narrowing
- 50% reduction in airway diameter = 16-fold decrease in airflow!!!
- smooth muscle contraction, airway edema, mucus, cellular infiltrates/inflammation
asthma = spasmodic bronchoconstriction during episodes but will lead to chronic bronchial changes over time
what is the typical presentation of feline asthma?
signalment: any age or breed
- typically young to middle aged
- Siamese predisposed?
C/S:
- often episodic
- cough, wheeze
- acute distress –> expiratory dyspnea, tachypnea
- ± non-specific signs = ADR
how do you dx feline asthma?
no pathognomonic test :(
- Hx, C/S, excuse other diseases
- minimum database (may be peripheral eosinophilia)
rads!
- may be normal
- ± bronchial pattern
- ± collapse of R middle lung lobe
- ± hyperinflation
definitive dx: airway sampling
- cytology: increased eosinophils
increased ____ is typical of asthma. increased ____ is typical of bronchitis.
eosinophils
neutrophils
how do you tx feline asthma?
- stabilize if needed
- glucocorticoids = decrease airway inflammation
- bronchodilators = reduce bronchoconstriction
emergency:
- O2, sedation (butorphanol IV)
- bronchodilator (terbutaline IV, albuterol inhaled)
- inject steroid (dexamethasone)
- ± Abx (secondary airway infections possible)
- most cats stable within 24h
chronic:’
- glucocorticoids (oral prednisone, inhaled fluticasone which is not immediately effective)
- bronchodilators (salbutamol or albuterol)
- environmental mods
what is eosinophilic lung disease?
eosinophilic infiltration of bronchi and lungs, suspected to be a hypersensitivity reaction
rule out ddx for eosinophilic dz (parasites including HW, neoplasia)
what is the typical signalment for eosinophilic lung disease?
young to middle aged dogs
what are the typical C/S and hx for eosinophilic lung disease?
- cough
- gagging
- retching
- nasal d/c
- tachypnea
- dyspnea
- exercise intolerance
- systemic signs often absent or mild (anorexia, weight loss)
how do you diagnose eosinophilic lung disease?
rule out other ddx first before diagnosing with ELD
- CBC: eosinophilia
- Rads: bronchial to bronchointerstitial
- CT
- bronchoscopy: mucus, thick/irregular mucosa, granulomas
- airway sampling: increased cellularity with mainly eosinophils
how do you treat eosinophilic lung disease?
glucocorticoids (prednisone)
deworm, remove potential allergen source
what is the prognosis for eosinophilic lung disease?
fair to good, high relapse rate
true or false: it is unusual for young healthy pets to get bacterial pneumonia
true
what is the important fungal cause of pneumonia that we have to know?
Blastomycosis
what are some C/S for bacterial pneumonia?
cough, fever, dyspnea, systemically unwell, mucopurulent nasal discharge, abnormalities on auscultation
this depends on severity
in an animal with aspiration pneumonia, where does the lung tend to consolidate?
cranioventral
alveolar lesions
how do you dx pneumonia?
rads: interstitial to alveolar pattern, ventral distribution for aspiration, mild pleural effusion in some cases, recurrent lesions same location
CBC: leukocytosis, may be normal
airway cytology and culture: degenerate neutrophils, intracellular bacteria for bacterial pneumonia
how does cytology compare between a patient with bacterial pneumonia and inflammatory bronchitis?
presence of bac t
neutrophils vs eosinophils
degenerate neutrophils vs non-degenerate neutrophils
how do you treat bacterial pneumonia?
Abx (C+S), 1-2 weeks
IV fluids: maintain hydration
O2 if needed
nebulization, physiotherapy
what are the general C/S of pleural space disease?
- tachypnea (restrictive/paradoxical pattern)
- muffled heart and lung sounds
what is the typical signalment for chylothorax
idiopathic: Shiba Inu, Afghan, Himalayans, Persians
older patients more likely to have underlying neoplasia
what are some etiologies for chylothorax?
trauma, idiopathic, cardiac disease, mediastinal mass, thoracic duct anomalies
how do you diagnose chylothorax?
- C/S
- rads: see effusion
- POCUS: see effusion
- fluid analysis: small lymphocytes predominate, modified transudate or exudate
- triglyceride levels: fluid>serum
how do you treat chylothorax?
- treat underlying cause if ID’d
- thoracocentesis as necessary
- rutin (glycoside)
- low fat diet
- surgery?
what does chronic chylothorax predispose to?
fibrosing pleuritis
parenchyma fails to re-expand post thoracocentesis
see scalloped or irregular outline
persistent dyspnea in face of minimal fluid
what is the most common neoplasia in the mediastinum? what is another type mentioned in lecture?
most common: lymphoma
other type: thymoma
what are the C/S and PE of a patient with a mediastinal mass?
- resp compromise
- decreased lung sounds
- dysphagia
- cough
- Horner’s syndrome
- edema of head and neck
- cranial thoracic mass - loss of compressibility (cats)
