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522 (dog & cat class) > Resp med > Flashcards

Resp med Flashcards

1
Q

what are the common C/S with nasal disease? what 2 are the most definitive?

A

nasal D/C, sneezing

stertor, pawing or rubbing at muzzle, facial deformity/asymmetry, CNS signs, breathing with mouth

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2
Q

where does the nasal discharge come from with nasal disease?

A

nasal cavity, frontal sinuses, nasopharynx

less commonly from oral cavity, vomiting/regurg, systemic dz

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3
Q

tumors most commonly have a hx of _____ nasal D/C that may progress to ____ with chronicity. this can also occur with _____ disease.

A

unilateral, bilateral, fungal

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4
Q

with localized nasal dz, a CBC, chem, and UA will most likely be ____.

A

normal

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5
Q

what do you have to keep in mind when doing cultures for nasal disease?

A

nares are not sterile, so take findings with a grain of salt

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6
Q

if there is epistaxis present or you’re doing a nasal biopsy, what type of testing must you pursue before?

A

coagulation tests

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7
Q

a combo of these 3 diagnostic tests are typically required for diagnosis of chronic nasal diseases:

A

CT, rhioscopy, biopsy

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8
Q

true or false: primary bacterial nasal disease is pretty common in both dogs and cats.

A

false! it is uncommon. there are far more likely primary etiologies in patients presenting with mucopurulent d/c

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9
Q

which is better for bacterial diagnosis, deep tissue biopsies and/or nasal flush, or superficial or mucous cultures?

A

the first one, deep and nasal flush

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10
Q

what is the etiology and pathophys of canine sinonasal aspergillosis?

A

Aspergillus fumigatus

disease –> large dose or resistance to infection overcome (we are always breathing it in)

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11
Q

what is the typical signalment for SNA? (sinonasal aspergillosis)

A

young male dogs
German shepherds, Rotties
normal to longer muzzle dogs

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12
Q

what does aspergillosis cause in the nasal cavity and/or frontal sinus?

A

fungal plaques

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13
Q

what are the clinical features of canine sinonasal aspergillosis?

A

unilateral or bilateral mucoid to muco-hemorrhagic discharge, sneezing

± facial pain, nasal depigmentation with chronicity

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14
Q

how do you dx canine sinonasal aspergillosis?

A

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

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15
Q

how do you treat canine sinonasal aspergillosis?

A

debridement, topical antifungals in the nasal cavity ± sinuses

± systemic antifungals
multiple treatments often necessary

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16
Q

what are the two classifications of canine inflammatory rhinitis?

A

lymphoplasmacytic
eosinophilic

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17
Q

what are the C/S of canine inflammatory rhinitis?

A

sneezing, nasal D/C (mucoid to mucopurulent), typically bilateral, no signs of systemic illness

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18
Q

how do you diagnose canine inflammatory rhinitis?

A

exclude other treatable diseases!!

CT (inflammation, mucus), rhinoscopy (mucosal hyperaemia + edema, D/C), biopsy (inflammation)

diagnosis of exclusion

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19
Q

for canine inflammatory rhinitis, how do you treat?

A

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

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20
Q

what is the etiology of canine nasal mites?

A

Pneumonyssoides caninum

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21
Q

what are the C/S of canine nasal mites?

A

sneezing, reverse sneezing, ± mild serous nasal D/C

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22
Q

how do you treat canine nasal mites?

A
  • milbemycin oxime
  • Ivermectin
  • Selamectin
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23
Q

you see a dog with unilateral mucoid discharge and do a rhinoscopy. you see this. what is your diagnosis?

A

canine sinonasal aspergillosis

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24
Q

you see a dog for excessive sneezing and see this on rhinoscopy. what is it and how do you treat?

A

nasal mites

Milbemycin, ivermectin, or selamectin

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25
Q

foreign bodies in the nose are most common in what signalment?

A

large breed dogs

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26
Q

what are the typical C/S for a foreign body in the nose

A
  • acute onset sneezing, pawing at face, hemorrhagic discharge or epistaxis (unilateral!!!!)
  • with chronicity, mucopurulent d/c
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27
Q

what does FURD stand for?

A

feline upper respiratory disease

not a specific thing, can be infectious, neoplastic, inflammatory, or structural

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28
Q

what are the typical clinical signs of FURD?

A

ocular or nasal d/c, epistaxis, sneezing, conjunctivitis

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29
Q

what is the difference b/t FURD and URI in cats?

A

FURD: feline upper resp disease, very general
URI: one or more agents of viral, bacterial, or fungal

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30
Q

what are the primary agents of URI in cats?

A

viral: calici (FCV), herpes (FHV-1)
bacterial: mycoplasma, bordetella, chlamydophila, Streptococcus

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31
Q

URI in cats incidence increases dramatically… when?

A

in multi-cat environments

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32
Q

what is URI in cats transmission?

A

resp, ocular, oral, contact w contaminated environment (FCV esp), carrier cats with FCV, latent infection with FHV

aerosol not major route

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33
Q

what are the most common clinical signs of a cat with acute FCV?

A
  • depression, pyrexia
  • oral ulceration
  • sneezing, conjunctivitis, ocular and nasal D/C (not as severe at with FHV)
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34
Q

what are the most common clinical signs of a cat with acute FHV?

A
  • sneezing, serous ocular and nasal D/C (often becomes mucopurulent)
  • systemic signs (inappetence, pyrexia)
  • ocular (conjunctivitis, ulcerative keratitis)
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35
Q

Chlamydophila in cats C/S usually limited to ____.

A

conjunctivitis

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36
Q

mycoplasma in cats C/S:

A

conjunctivitis, URT infections

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37
Q

bordetella in cats: primary
C/S?

A

primary: nasal D/C and pneumonia

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38
Q

you have a cat with acute URI. what is your approach to diagnostics?

A
  • hx + PE
  • culture and pcr panels –> pros and cons to this
  • may not ID a definitive dx… figure out when to ID one
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39
Q

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?

A

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]

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40
Q

what are some control strategies to limit feline URI?

A
  1. increase immunity –> vaccination, general health
  2. decrease exposure
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41
Q

what is the prognosis for acute URI with cats?

A

good

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42
Q

what is the most common etiology of feline chronic rhinosinusitis?

A

viral (secondary to FHV1 epithelial/turbinate damage)

bac t maybe consequence of viral disease

signs often assoc with stressors

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43
Q

what are the common clinical findings with feline chronic rhino sinusitis?

A

sneezing, stertor, nasal d/c, preservation of airflow, typically healthy (maybe inappetence if copious nasal dc)

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44
Q

feline chronic rhino sinusitis is a diagnosis of _____.

A

exclusion!!

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45
Q

how do you diagnose feline chronic rhinosinusitis?

A

non-invasive:
- PE
- MEDB
- retroviral status
- PCR panels
- otic exam
- travel or suspicious

More invasive:
- complete oral exam
- imaging
- rhinoscopy
- nasal biopsy

46
Q

how do you treat feline chronic rhinosinusitis?

A
  • 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

47
Q

what are the etiologies of feline nasal cryptococcus?

A

Cryptococcus neoformans
C. gattii

48
Q

what is the transmission of feline nasal cryptococcus?

A

inhalation of spores

49
Q

what are the C/S of feline nasal cryptococcus?

A

URT manifestations

nasal signs ± granulomatous lesions on nasal bones or extending into nasal ca city

neuro, skin, systemic and ocular dz may occur

50
Q

how do you dx feline nasal cryptococcus?

A

LCAT: latex capsular agglutination test
- sensitive and specific

cytology

51
Q

how do you tx feline nasal cryptococcus?

A
  • oral* or injectable antifungals (at least 6mo)
  • therapeutic monitoring (titres, LCAT)
52
Q

what is the px of feline nasal cryptococcus/

A

good for cases without neuro involvement

can relapse

53
Q

tell me about the behaviour of nasal planum squamous cell carcinomas in cats? what signalment is more likely to get it?

A

locally invasive, slow to metastasize

white-haired cats (uncommon in dogs)

54
Q

how do you dx nasal planum SCC?

A

biopsy

55
Q

how do you tx nasal planum SCC?

A

sx
oncologist referral (radiation ± chemo)

56
Q

aspergillosis ____ airflow, and neoplasia _____ airflow (for nasal disease)

A

increases, decreases

57
Q

tell me about the flow chart for diagnosis nasal disease

A

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

58
Q

what is tracheal collapse?

A

dorsoventral flattening of tracheal rings

can be intra or extra thoracic trachea

can extend to mainstem bronchi: tracheobronchial collapse

59
Q

what is the etiology of tracheal collapse? what factors can exacerbate disease?

A

etiology: softening of cartilaginous rings
factors: obesity, chronic coughing, increased resp effort/pressure (BOAS)

60
Q

tell me about how inspiration vs expiration affects tracheal collapse?

A

inspiration: lungs expand, trachea collapses
expiration: lungs deflate, trachea expands

61
Q

what signalment is common for tracheal collapse?

A

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

62
Q

what are the C/S for tracheal collapse?

A

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)

63
Q

how do you diagnose tracheal collapse?

A
  • signalment, hx, PE
  • rads (inspiratory and expiratory)
  • tracheobronchoscopy (grade)
  • fluoroscopy

remember that tracheal collapse is a dynamic disease

64
Q

tell me the grades of tracheal collapse via tracheobronchoscopy

A

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

65
Q

how do you treat tracheal collapse?

A

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

66
Q

what is the px of tracheal collapse?

A

depends on severity and extent
progressive dz, but progression can be slowed

guarded px if poor response to medical therapy and intervention not pursued

67
Q

who is predisposed to hypo plastic trachea?

A

English bulldogs, Bostons, French bulldogs

68
Q

true or false: hypo plastic trachea is congenital

A

true

69
Q

what is the tx of hypo plastic trachea?

A

correct concurrent dz if present (BOAS)

70
Q

what does CIRDC stand for? what is it?

A

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!

71
Q

what are the typical hx and clinical features associated with CIRDC?

A
  • exposure to other animals
  • vax (doesn’t prevent infection)
  • dry “hacking” cough
  • ± sneezing, nasal and/or ocular d/c, febrile, inappetant, lethargic
72
Q

how do you dx CIRDC?

A
  • hx + PE
  • sampling (situation dependent, often not necessary)
73
Q

how do you tx CIRDC?

A
  • 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
74
Q

how do you prevent CIRDC?

A

strengthen immunity (vax)
decrease exposure

75
Q

tracheal rupture is most commonly seen when?

A

after ET intubation in cats

76
Q

tracheal rupture results in ?

A

pneumomediastinum, subq emphysema

77
Q

how do you dx tracheal rupture?

A

rads

78
Q

how to you tx tracheal rupture?

A

most heal without intervention
monitor pt for changes in resp status

79
Q

what is the etiology of canine chronic bronchitis?

A

inflammatory infiltrate of lower airways

80
Q

what is the signalment of canine chronic bronchitis?

A

middle aged to older dogs
small breeds

81
Q

what are the C/S of canine chronic bronchitis?

A

harsh cough (daily >2 mo)
± exercise intolerance, increased resp effort

82
Q

how do you dx canine chronic bronchitis?

A

excuse other causes of cough

  • MEDB, heart worm testing, fecal
  • thoracic rads (may be normal)
  • airway cytology and culture
  • ± bronchoscopy
83
Q

how do you tx canine chronic bronchitis?

A
  • 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
84
Q

what is the px of canine chronic bronchitis?

A

control, not cured

want to tx to control ongoing inflammation/inflammatory mediators

85
Q

what are the two broad categories of feline bronchial disease?

A

feline asthma
feline chronic bronchitis

86
Q

what is the pathogenesis of feline asthma?

A

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

87
Q

what is the typical presentation of feline asthma?

A

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

88
Q

how do you dx feline asthma?

A

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

89
Q

increased ____ is typical of asthma. increased ____ is typical of bronchitis.

A

eosinophils
neutrophils

90
Q

how do you tx feline asthma?

A
  • 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

91
Q

what is eosinophilic lung disease?

A

eosinophilic infiltration of bronchi and lungs, suspected to be a hypersensitivity reaction

rule out ddx for eosinophilic dz (parasites including HW, neoplasia)

92
Q

what is the typical signalment for eosinophilic lung disease?

A

young to middle aged dogs

93
Q

what are the typical C/S and hx for eosinophilic lung disease?

A
  • cough
  • gagging
  • retching
  • nasal d/c
  • tachypnea
  • dyspnea
  • exercise intolerance
  • systemic signs often absent or mild (anorexia, weight loss)
94
Q

how do you diagnose eosinophilic lung disease?

A

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
95
Q

how do you treat eosinophilic lung disease?

A

glucocorticoids (prednisone)

deworm, remove potential allergen source

96
Q

what is the prognosis for eosinophilic lung disease?

A

fair to good, high relapse rate

97
Q

true or false: it is unusual for young healthy pets to get bacterial pneumonia

A

true

98
Q

what is the important fungal cause of pneumonia that we have to know?

A

Blastomycosis

99
Q

what are some C/S for bacterial pneumonia?

A

cough, fever, dyspnea, systemically unwell, mucopurulent nasal discharge, abnormalities on auscultation

this depends on severity

100
Q

in an animal with aspiration pneumonia, where does the lung tend to consolidate?

A

cranioventral
alveolar lesions

101
Q

how do you dx pneumonia?

A

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

102
Q

how does cytology compare between a patient with bacterial pneumonia and inflammatory bronchitis?

A

presence of bac t

neutrophils vs eosinophils

degenerate neutrophils vs non-degenerate neutrophils

103
Q

how do you treat bacterial pneumonia?

A

Abx (C+S), 1-2 weeks

IV fluids: maintain hydration

O2 if needed

nebulization, physiotherapy

104
Q

what are the general C/S of pleural space disease?

A
  • tachypnea (restrictive/paradoxical pattern)
  • muffled heart and lung sounds
105
Q

what is the typical signalment for chylothorax

A

idiopathic: Shiba Inu, Afghan, Himalayans, Persians

older patients more likely to have underlying neoplasia

106
Q

what are some etiologies for chylothorax?

A

trauma, idiopathic, cardiac disease, mediastinal mass, thoracic duct anomalies

107
Q

how do you diagnose chylothorax?

A
  • C/S
  • rads: see effusion
  • POCUS: see effusion
  • fluid analysis: small lymphocytes predominate, modified transudate or exudate
  • triglyceride levels: fluid>serum
108
Q

how do you treat chylothorax?

A
  • treat underlying cause if ID’d
  • thoracocentesis as necessary
  • rutin (glycoside)
  • low fat diet
  • surgery?
109
Q

what does chronic chylothorax predispose to?

A

fibrosing pleuritis

parenchyma fails to re-expand post thoracocentesis

see scalloped or irregular outline

persistent dyspnea in face of minimal fluid

110
Q

what is the most common neoplasia in the mediastinum? what is another type mentioned in lecture?

A

most common: lymphoma
other type: thymoma

111
Q

what are the C/S and PE of a patient with a mediastinal mass?

A
  • resp compromise
  • decreased lung sounds
  • dysphagia
  • cough
  • Horner’s syndrome
  • edema of head and neck
  • cranial thoracic mass - loss of compressibility (cats)

522 (dog & cat class) (31 decks)

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