Respiratory Flashcards
What is the difference between aspiration pneumonia and aspiration pneumonitis?
Aspiration pneumonia = bacterial
Aspiration pneumonitis = sterile
JVIM 2021, Howard
What are at least 4 criteria to diagnose aspiration pneumonia in vet med?
–Fever
–Neutrophilia or -penia
–CXR
–BAL cytology (cytospin) – >2 intracellular bacteria on any hpf
–Positive culture (at least 1.7x10^3 CFU)
**This is looser criteria than used in humans.
JVIM 2021, Howard
Which typically had higher CRP, dogs with chronic bordetella or chronic aspiration pneumonia? For which one does CRP not differentiate from healthy dogs?
Chronic aspiration pneumonia median CRP >55
Chronic bordetella median CRP 20 – some measured WNL thus it’s not a good test to differentiate from healthy dogs
JVIM 2021, Canonne
For ETW vs TTW, was there higher/lower/no difference in:
–Nondiagnostic cytology
–Oral contamination
–ETW nondiagnostic 16% (r/o anesth –> unable to cough) vs TTW 6%
–No difference oral contamination (both 20%)
JVIM 2021, Graham
True or False:
Airway wash cytology neg/culture positive discordancy was usually associated with minimal bacterial growth potentially consistent with contamination.
True
JVIM 2021, Graham
True or False:
In a study of 281 airway washes, recent abx use did not affect culture results or increase discordancy.
True – but very heterogenous group, may be important for some diseases or specific abx
JVIM 2021, Graham
Which bronchi are most significantly narrowed in dogs with L sided heart enlargement and cough?
LPB, LB2 > RPB, RB2, RB4 > others
JVIM 2021, Lebastard
In dogs with L sided heart enlargement and cough, the larger the ____ or ____ (imaging measurements), the narrower the bronchi.
LA/Ao, VHS
JVIM 2021, Lebastard
In cats presented to ER for respiratory distress, which were most predictive of asthma/chronic bronchitis vs other causes?
Hx cough
Respiratory effort
Presence of pleural effusion
Blood gas
–Hx cough, expiratory push, and lack of pleural effusion –> usually asthma/chronic bronchitis.
–Cough was rare for other resp diseases.
–No difference in blood gas.
JVIM 2021, Chalifoux
What proportion of cats with respiratory distress due to asthma/chronic bronchitis survive to discharge?
94%
JVIM 2021, Chalifoux
True or False:
Doxepin offers modest improvement in lar-par signs.
False – no difference doxepin vs placebo.
JVIM 2021, Rishniw
True or False:
Aerodawg + canine mask offers the best delivery of nebulized medication compared with human products (ex: Aerochamber) and custom masks.
False – both worked well
JVIM 2021, Valencia
How did nebulization time (1 min, 3 min, 5 min) affect extrapulmonary drug uptake? Does this make longer nebulization desirable or detrimental?
Incr extrapulmonary uptake at 3min, no further change at 5min. NOT desirable – could have incr systemic side effects.
JVIM 2021, Valencia
What is chest physiotherapy?
Application of external force to incr expiration and maximize mucus transport (ex: prolonged slow expiration, assisted cough)
JVIM 2021, Pouzot-Nevoret
In dogs with aspiration pneumonia treated with chest physiotherapy q4hr, what effect did it have on hypoxia and O2 requirement?
–Improved hypoxia within 48hrs
–Decr O2 days by 37%
JVIM 2021, Pouzot-Nevoret
Gastroesophageal intussusception is usually an (acute / chronic intermittent) problem that is (potentially / rarely) life threatening and is typically treated (medically / surgically).
Acute, potentially, surgically
JVIM 2021, Tayler
What disease is ADAMTS3 mutation associated with? What is the proposed mechanism? What are some features of the disease?
–Norwich terrier upper airway syndrome (NTUAS)
–Mutated ADAMTS3 –> decr lymphangiogenesis –> lymphedema
–Similar signs to BOAS
–Morphology: excessive/swollen supraglottic tissue, medially displaced cuneiform processes, and narrow or V-shaped infraglottic lumen
JVIM 2021, Johnson
What is the general prognosis of NTUAS patients with mild or severe disease, with or without surgery?
Overall seem to do well (survive >9yrs post dx) with good QoL. No improvement in signs post sx (though only severely affected dogs had sx in this study). Even dogs with severe obstruction did remarkably well without aggressive sx (laryngeal stent, permanent trach).
JVIM 2021, Johnson
A 4mo MI mixed breed puppy presents with acute respiratory distress. CXR shows a hyperinflated R middle lung lobe. What are you most concerned for?
Congenital lobar emphysema
JVIM 2021, Warwick
What is the age distribution for lobar emphysema?
Bimodal – most young, some old
JVIM 2021, Warwick
What is the basic cause for lobar emphysema?
Bronchial obstruction and air trapping due to 1-way valve effect. Congenital –> usually cartilage deformation. Acquired –> can be intra- or extraluminal (neoplasia, diaphragmatic hernia, other).
JVIM 2021, Warwick
What is the treatment of choice for lobar emphysema? What prognosis does this have? What if this treatment isn’t pursued?
Surgery (lung lobectomy), generally good prognosis if congenital or other non-neoplastic. No sx –> may do okay or horrible.
JVIM 2021, Warwick
A defect in NAT10 results in abnormal microtubules. Which two body systems will be most significantly affected and why?
Ciliary dyskinesia and/or aplasia, cell cycle arrest (can’t mitosis) –> respiratory issues (ex: chronic infection) and GI issues
JVIM 2021, Hedgespeth
What is the difference between malformation type tracheal collapse and traditional? What are the signalment (age, +/- breed) characteristics for each?
MTC – rigid/static narrowing, younger (median 7yrs), yorkies
TTC – dynamic narrowing, older (median 9yrs)
JVIM 2020, Lesnikowski
Regarding positive culture associated with collapsing trachea +/- stent:
–Overall prevalence? Percent due to true infection?
–At least two factors that increase risk and two that decrease risk?
–83% positive culture, ~60% true infection (similar pre and post stent)
–Incr risk: older (pre-stent), comorbidities (hx pneumonia, heart disease), younger+hepatomegaly
–Decr risk: older (post-stent), TTC (post-stent), +/- stent placement (since most cultures post placement were due to stent complications, so those without may have been at lower risk)
JVIM 2020, Lesnikowski
What are the two most common bacteria cultured from dogs with tracheal collapse, and what problem is likely underlying? What is the most common effective empiric abx combo?
–E. coli, Pseudomonas
–Poor clearance of pharyngeal and enteric organisms
–Clavamox/Baytril
JVIM 2020, Lesnikowski
What are at least three strategies that allow Bordetella to become chronic/refractory to oral abx?
Adherence to cilia
Ciliostasis
Biofilm
Local immunosuppression
JVIM 2020, Canonne
Regarding gentamycin nebulization for chronic Bordetella infection:
–Which was more effective, 4mg/kg BID or 10 min nebulization undiluted BID? For the more effective protocol, what proportion were cured and how many weeks did it take?
–Was mask vs box vs neither more effective?
–What BAL characteristic was prognostically useful?
–10 min, 58% cured, 3-4 weeks
–Equally effective
–Total cell count <1000 –> higher cure rate
JVIM 2020, Canonne
Vit D is (higher, lower, not different) in shelter dogs with CIRDC vs healthy dogs? What are two possible reasons for this?
Lower – but unclear if clinically significant.
Possibly a cause of CIRDC (polymorphisms in vit D handling proteins or receptor binding affinity –> immunocompromise) or effect (vit D binding protein and albumin are acute phase proteins).
JVIM 2020, Jaffey
Regarding matrix metalloproteinasis (MMPs):
–On a basic level, what do they do?
–Are MMPs high or low in healthy tissue? How does this relate to activation of MMPs?
–Involved in remodeling and repair. Degradation of ECM, cytokines, growth factors, etc.
–Low to none in healthy tissues. MMPs are secreted in an inactivated form and require activation by unhealthy tissues.
JVIM 2020, Maatta
A study investigated matrix metalloproteinases (MMPs) in Westies.
–In relation to what disease?
–Which MMP was most diagnostically helpful, and what was the sample type?
–Were any of the studied MMPs prognostically useful?
–Idiopathic pulmonary fibrosis
–Tended to have higher serum pro-MMP-7
–Not prognostically helpful (unlike in people)
JVIM 2020, Maatta
Regarding pneumocystis pneumonia:
–Type of organism?
–Basic major risk factor for disease?
–Two predisposed breeds?
–Extracellular yeast-like fungal organism – small numbers in the respiratory tract are normal
–Immunocompromise –> pneumonia
–Mini dachshunds, CKCS
JVIM 2020, Merrill
What is the immunoglobulin profile of an individual with defective CD40 ligand?
Lack of class switching. Normal to high IgM, low IgG and IgA.
JVIM 2020, Merrill
Which were different between cats with eosinophilic airway inflammation (asthma) vs mixed/neutrophilic (chronic bronchitis)?
–Age
–Duration of signs
–Quality of signs (and at least two signs that were most common?)
–CXR pattern
–Peripheral eosinophilia
Asthma: younger, tendency toward higher peripheral eosinophils (did not reach statistical significance)
Otherwise no clinical differences between asthma and chronic bronchitis
Most common signs: cough (84%), tachypnea, oculonasal discharge/sneezing (39%)
JVIM 2020, Lee
Regarding serum IgE testing:
–Asthmatic cats have (more, less, no difference in) positive IgE results compared with healthy cats.
–Asthmatic cats reacted to (more, fewer, similar) types of things compared with healthy cats.
Asthmatic cats have more positive IgEs and reacted to more types of stuff (esp mites, grass). Half of healthy cats reacted, and only to fungi.
JVIM 2020, Buller
Regarding aspiration pneumonia vs bronchopneumonia presentation and workup:
–At least 4 factors that make AP more likely, and 2 that make it less likely?
–At least three factors that make BP more likely?
AP
More likely:
–Shorter duration of signs (<2 weeks)
–PE: tachypnea, hypothermia, low BCS
–GI disease (esp esophageal)
–Recent anesthesia
–Neutrophilia
Less likely:
–Cough
–Septic BAL cytology (even if positive culture)
BP
More likely:
–Longer duration of signs (6-9mo)
–Wheezing
–Septic BAL cytology (87%)
–Positive anaerobic culture
–Mycoplasma
JVIM 2020, Dear
Regarding bronchopneumonia vs inflammatory airway disease in cats, how did they differ in:
–Duration of signs
–Prevalence of R middle lung lobe collapse
No difference – have to BAL/cyto/culture to differentiate!
JVIM 2020, Dear
What is a common presenting complaint of tracheal pseudomembrane, why does this clinical sign occur, and what is a risk factor for its formation?
–Acute respiratory distress
–Occurs when the pseudomembrane detaches
–Recent intubation is a risk factor
JVIM 2020, Nivy
Which imaging modality has a greater sensitivity for cranial pulmonary lesions? Caudal? Which one is more sensitive overall?
CXR
T-FAST
T-FAST – cranial lung fields; overall higher sensitivity
CXR – Caudal lung fields
JVECCS 2019 Ward
What is the most common cause of ARDS in dogs vs cats? Relative mortality rate for both?
Dogs - aspiration pneumonia, 84% died
Cats - SIRS +/- sepsis, 100% died
JVECCS 2019 Boiron
In dogs with pneumonia, which normalized quickest? Slowest? What does this imply about duration of abx?
CRP
SAA
CXR
CRP and serum amyloid A (both are acute phase proteins) normalize at ~1 week. Rads ~2 weeks (~1mo in the study that looked at asp pneumonia specifically).
We are probably giving abx too long.
JAVMA 2022 Menard
JVIM 2022 Rodrigues
True or False: Abnormally high BAL bile acids is common in Westies with and without pulmonary fibrosis, and may play a role in pathogenesis.
True
JVIM 2018 Maatta
Which are positive prognostic indicators in dogs with pneumonia?
A) Higher total WBC count
B) Higher lymphs count
C) Higher neutrophil-to-lymphocyte ratio
D) Higher % bands
E) Lower % bands
F) Absence of SIRS
B, E
The rest were not associated with prognosis
JVECCS 2021 Conway
True or False: BAL culture >1.7K CFU always indicates a need for antibiotics.
False – can be seen in healthy dogs. Use the entire clinical picture.
JVIM 2022 Lebastard
2mo FI Irish wolfhound with chronic nasal discharge and sneezing since birth.
What does she probably have? What are the two proposed underlying causes?
What is a likely respiratory sequela in her future?
Rhinitis and bronchpneumonia syndrome
Ciliary dyskinesia or primary immune deficiency
Recurrent bronchopneumonia
JVIM 2019 Viitanen
What is the best test for bronchiectasis?
T-FAST
CXR
CT
Bronchoscopy
CT»_space; bronch»_space;» CXR
JVIM 2019 Viitanen
Which is true about recurrent bronchopneumonia in Irish Wolfhounds?
A) It is always accompanied by rhinitis
B) It is due to immunoglobulin deficiency
C) It is due to Th2 deficiency
D) It is due to ciliary dyskinesia
E) Onset is later in life (5yrs) and usually does not limit lifespan (6-8yrs for breed)
E
Unknown cause. May be acquired (since onset later in life) and bronchiectasis was common (but probably effect > cause).
JVIM 2019 Viitanen
Which can speciate respiratory mycoplasma?
A) PCR
B) Serology
C) Cytology
D) Culture
A only
No cell wall, fragile, difficult to culture, can’t speciate based on morphology alone
JVIM 2019 Jambhekar
What is the only mycoplasma species with significant evidence of being a primary pathogen?
Does a carrier state exist?
M. cynos
Yes
JVIM 2019 Jambhekar
True or False: CT is superior to CXR for diagnosing canine chronic bronchitis.
False – low sensitivity of CT and bronchial wall thickness to pulmonary artery diameter (BWPA) ratio
JAVMA 2018 Mortier
7yr MN Shih tzu presented for workup of polycythemia (PCV chronically 68-72%). Without any additional information, do you rank hypoxic pulmonary disease high or low on your ddx list?
Low – hypoxic pulmonary disease uncommonly causes polycythemia, and even then it’s mild (never >65%)
JVIM 2022 Holopainen
Regarding eosinophilic lung diseases:
–Most common CS?
–Small or large breed more common?
–Differentiate based on bronchoscopy:
Eosinophilic bronchitis
Eosinophilic bronchopneumopathy
Enosinophilic granuloma (tx? px?)
Cough, large breed
EB: Minimal to no changes
EPB: nodules
EG: intraluminal granulomas; high dose pred + NAC or saline neb (to mobilie secretions); can do well; may be a component of HES
JVIM 2019 Johnson
JAVMA 2022 Bottero
BAL fluid was left on the counter overnight instead of being placed immediately in the fridge. If you still submit it, how will this potentially affect results?
If there are contaminants (ex: E. coli), they could overgrow and 1) look clinically relevant and 2) outcompete the respiratory pathogen
JVIM 2019 Curran
What type of inflammation on BAL is most commonly seen in dogs with airway collapse?
Lymphocytic
JVIM 2019 Johnson
What is the most common complication in feline bronchoscopy?
Hypoxia, esp if using tracheal cathether rather than ET tube or laryngeal mask
JFMS 2019 Tucker
There is a case report of a dog who bled to death after bronchoscopic bx of diffusely irregular bronchial wall. Turned out they biopsied an artery.
–What is different about bronchial vs rest of the pulmonary blood supply that contributed to bleeding?
–Why doesn’t this happen more often with bronchial bx?
–What can help you differentiate nodule vs artery (3 things)?
Bronchial aa. are part of the systemic, not pulmonary blood supply – so, high BP
Normal dogs don’t have arteries in the bronchial mucosa. This dog had hx heartworm.
Nodules:
–Don’t compress easily
–More irregularly spaced
–Usually more proximal in airways
JVIM 2019 Greenway
Match the following T-FAST findings with their most likely etiologies.
B line
Shred sign
Nodule sign
Bacterial pneumonia
CHF
Neoplasia
B line - CHF
Shred sign (lung consolidation) - pneum
Nodule sign - neoplasia
JAVMA 2019 Ward
True or False: Risk factors, treatment, and survival for aspiration pneumonia in cats are similar to those in dogs.
True
JSAP 2019 Levy
What is the difference between constrictive and proliferative bronchiolitis?
Both are incited by inflamm and ultimately cause narrow bronchioles
Constrictive: concentric fibrosis
Proliferative: intraluminal fibrosis
JVIM 2019 Reinero
True or false: Feline asthma affects bronchioles, not the larger airways.
False – affects both
JVIM 2019 Reinero
True or False: Noninvasive data (signalment, CS, bloodwork, CXR) cannot differentiate feline asthma vs bronchitis.
True
JFMS 2020 Grotheer
Which is true about serum allergen IgE testing in asthmatic cats?
A) Magnitude of elevation correlates with likelihood of causing CS.
B) Magnitude of elevation correlates with severity of CS.
C) Can be used to guide allergen avoidance regardless of magnitude of IgE elevation.
D) Most cats have a strong reaction to only one allergen.
C
Most asthma cats have IgE to a bunch of allergens and does not correlate with severity of CS or BAL
JFMS 2020 Eeden
In huskies, is congenital lar-par a localized issue or part of a more general polyneuropathy (megaesophagus, etc)?
What is the general prognosis depending on treatment?
Local in huskies, more general in other affected breeds
Generally do better with sx (can compete in sled racing) but can have some spontaneous improvement or stable disease. ~15% mortality from the disease.
JAVMA 2019 von Pfeil
For nasopharyngeal stenosis or imperforate nasopharynx, which have better outcome vs no difference? Which affect the overall complication rate?
Dog vs cat
NPS vs INP
Lesion location (rostral, middle, caudal third of NP)
Covered vs uncovered stent
Better px if cat, NPS, caudal third
Complications in general were common no matter what, but specific complications were associated with stent type and lesion location
JAVMA 2018 Burdick
Overall success rate of ballooning (1 or more procedures) vs uncovered stent for treatment of NP stenosis in cats?
50%, 67%
**Note - a small study found long term success in 5/6 cats treated with surgery (palatoplasty)
JAVMA 2019 Burdick
JSAP 2019 Seriot
True or False: Brachycephalic dogs with chronic GI signs will have clinical improvement with BOAS surgery.
True
JSAP 2019 Kaye
Brachycephalic dogs are at higher risk for aspiration pneumonia. What is the average age (puppy, young adult, middle aged to older) of onset for the following breeds?
Frenchie
Eng Bulldog
Pug
Frenchie and Eng BD 6-8mo
Pug 7yrs
JAVMA 2018 Darcy
What is most common for feline nasal polyps?
Male vs female
Meso vs brachycephalic
Presence vs absence of nasal discharge
Young, male, mesocephalic, no nasal discharge
JFMS 2020 Ferguson
Dogs with primary spontaneous pneumothorax:
–Success rate with sx?
–Most common complication within 1mo?
87%
Recurrence – r/o failure to ID lesions at original sx
JAVMA 2020 Dickson
9yr FS DLH with dyspnea. You diagnose pleural effusion and obtain a sample. It is grossly slightly turbid and microscopically predominated by lymphocytes. What are your two top differentials?
Grossly non chylous, microscopiclaly lymphocytic effusion
Most likely CHF»_space; neoplasia»_space;» other
JFMS 2019 Probo
12yr MN DSH presented for I-131. He is clinically well other than weight loss. Survey CXR showed a soft tissue opacity cranial to the heart. Thoracic U/S revealed a cystic structure. FNA was clear and acellular with minimal protein.
Next steps?
A) Proceed with I-131 since he is aclinical and the mediastinal cyst could be incidental
B) Drain it. Go to surgery if it recurs.
C) Go to surgery now.
D) I-131 and sx not recommended due to poor prognosis.
A would be reasonable. Can have incidental mediastinal cysts that never cause CS.
JFMS 2019 Camero
Regarding tracheal collapse managed with stent:
–Most common complication?
–Two most common major complications that require stent replacement?
–Bacterial tracheitis, pneumonia
–Stent fracture, tissue ingrowth
JAVMA 2019 Weisse
JAVMA 2021 Conquista
Regarding tracheal collapse managed with stent:
Which one(s) affect survival?
Stent fracture
Tissue ingrowth
Malformed vs traditional tracheal collapse
Mainstem bronchi collapse
Stent fx – shorter survival (MST 1.6yrs vs 3.5yrs) even when second stent is placed
The rest don’t affect outcome. Note – 70% have concurrent mainstem bronchi collapse and can still do fine!
JAVMA 2021 Conquista
JAVMA 2019 Weisse
JVIM 2019 Violette
What heart surgery could potentially help with pulmonary hypertension due to primary lung disease? How does it help?
Atrial septostomy
Creates a R–>L shunt to give blood someplace else to go
JVIM 2019 Allen
What are three benefits of high flow O2 over conventional nasal O2?
More than double the arterial PaO2
Humidified air
Warmed air
JSAP 2019 Pouzot-Nevoret
