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small animal (fourth year) > Respiratory > Flashcards

Respiratory Flashcards

1
Q

what is the function of a cough?

A

permit removal of material from airways (assist mucociliary clearance, expel inhaled particulate, protect against irritants)

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2
Q

what are the two types of cough receptors?

A

mechanoreceptor
chemoreceptor

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3
Q

where are cough mechanoreceptors found?

A

larger airways

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4
Q

where are cough chemoreceptors found?

A

medium airways

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5
Q

where are cough receptors most numerous in the airways?

A

larynx then trachea then bronchi

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6
Q

what parts of the airway have no cough receptors in?

A

bronchioles and alveoli

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7
Q

what are the three general differentials for coughing?

A

compression of mainstream lobar bronchi
stimulation of cough receptors
excessive mucus/fluid/inflammation

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8
Q

what can cause compression of mainstem lobar bronchi?

A

left atrial enlargement
lymph node enlargement
neoplasia

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9
Q

how will heart rate change in dogs coughing due to cardiac disease?

A

normal or increased

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10
Q

how will heart rate change in dogs coughing due to respiratory disease?

A

normal or decreased

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11
Q

what will the heart rhythm be of a dog coughing due to cardiac disease?

A

regular sinus rhythm or sinus tachycardia/arrhythmia

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12
Q

what will the heart rhythm be of a dog coughing due to cardiac disease?

A

sinus arrhythmia

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13
Q

when will a dog cough if the cough is due to cardiac disease?

A

at night or when sleeping/resting

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14
Q

when will a dog cough if the cough is due to respiratory disease?

A

when excited or on exertion

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15
Q

what sort of information would you like to find out in a history about a coughing patient?

A

environment
worming history
travel history
recent events/illness
other clinical signs

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16
Q

regarding the cough itself, what would you like to find out?

A

onset
character - productive??
description - when’s it worst??
length of cough
changes to bark

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17
Q

how will inflamed bronchioles look on radiographs?

A

doughnuts - side on
tramlines - longitudinal

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18
Q

what are the characteristics of the airways in chronic bronchitis?

A

excessive mucus production due to increased goblet cells and submucosal hyperplasia
damage and loss of cilia often with secondary infections

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19
Q

what dogs is chronic bronchitis most commonly seen in?

A

small/toy breed dogs

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20
Q

what is the prognosis of dogs with chronic bronchitis?

A

often guarded because mucosal changes or normally non-reversible
(aim to manage condition)

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21
Q

what is the diagnostic tool of choice for chronic bronchitis cases?

A

bronchoscopy and broncheoalveolar lavage (cytology, bacteriology…)

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22
Q

what should be visible on a successful BAL?

A

froth/foam on top (surfactant)

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23
Q

what is bronchial collapse?

A

regional to diffuse airway collapse of segmental/subsegmental bronchi with associated clinical signs due to airflow limitations

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24
Q

what is bronchial collapse also known as?

A

bronchomalacia

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25
Q

what type of cough is seen with bronchial collapse?

A

wheezy cough

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26
Q

what respiratory parasites can be found in cats/dogs?

A

Oslerus osleri
Crenosoma vulpis
Aelurostrongylus abstrusus (cats)

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27
Q

what is the typical finding on bronchoscopy of an animal with Oslerus osleri?

A

nodules at the bifurcation

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28
Q

what is the typical finding on bronchoscopy of an animal with Crenosoma vulpis?

A

worms readily seen on airway (large worms)

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29
Q

what volume is used for BAL?

A

0.5-1ml/kg

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30
Q

how much fluid should be aspirated on BAL?

A

half of what you put in

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31
Q

how many washes should be carried out in BAL?

A

2-3 sites/washes

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32
Q

what are normal cell to see on BALF cytology?

A

ciliated columnar epithelial cells
goblets cells
macrophages, neutrophils, lymphocytes, eosinophils

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33
Q

how will you know if you BAL sample is contaminated with oral fluids (using cytology)?

A

presence of certain bacteria (Simonsiella)

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34
Q

what will be found on cytology of BALF in chronic bronchitis cases?

A

increased mucus
increased neutrophils and amacrophages
possible bacteria and particulate matter
possible squamous metaplasia of columnar epithelial cells

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35
Q

why should BALF be submitted for bacteriological culture in cases where chronic bronchitis is suspected?

A

to rule out bacteria or mycoplasma being the cause

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36
Q

what should be done in the general management of chronic bronchitis cases?

A

weight control
harness rather than collar/lead
avoid irritant/smoky environment

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37
Q

how can excess mucous be managed in chronic bronchitis cases?

A

avoid dry environment
nebuliser
(put in bathroom when owner shower/bathing)

38
Q

what drugs are used as treatment for chronic bronchitis?

A

bronchodilators
anti-inflammatory (steroids)

39
Q

what effects do the bronchodilators have on managing chronic bronchitis?

A

reduce lower airway spasm
reduce intra-thoracic pressure
reduce large airway collapse
improve diaphragmatic function
improve mucociliary clearance
inhibit mast cell degranulation (reduce bronchoconstriction mediators)
prevent microvascular leakage

40
Q

what are the bronchodilators used for chronic bronchitis?

A

theophyline (dogs)
terbutaline (not licensed)

41
Q

what are the desired effects of glucocorticoids in chronic bronchitis cases?

A

broncho-dilatory
anti-inflammatory
inhibit prostaglandin synthesis
potential beta-2 adrenergic activity
induce lymphopenia
inhibit fibroblast formation
modulate immune system

42
Q

what is a mucolytic that can be used if chronic bronchitis cases?

A

bromhexine

43
Q

what is bronchiectasis?

A

the entire bronchus is very dilated

44
Q

should an antibiotic for respiratory infections be bactericidal or bacteriostatic?

A

bactericidal

45
Q

how long should respiratory tract infections be treated with antibiotics?

A

2 weeks minimum

46
Q

what are some common antibiotics used for respiratory infections?

A

potentiated amoxycillin
cephalexin
TMP sulphonamides
fluroquinolones
doxycycline (myocplasma)

47
Q

what is eosinophilic lung disease?

A

spectrum of disease from chronic bronchitis to pulmonary granulomatous disease (usually with bronchial and interstitial involvement

48
Q

what dogs is eosinophilic lung disease most commonly seen in?

A

young large breeds

49
Q

what is the presumed cause of eosinophilic lung disease?

A

hypersensitivity to inhaled allergens

50
Q

how will eosinophilic lung disease generally present on bronchoscopy?

A

copious amounts of green mucus and inflammation

51
Q

how is eosinophilic lung disease treated?

A

immunosuppressive doses of prednisolone (2 mg/kg/day)

52
Q

what is the most common cause of coughing cats?

A

inflammatory airway disease

53
Q

does feline asthma usually cause an inspiratory or expiratory dyspnoea?

A

expiratory

54
Q

what is used to treat feline asthma for dyspneic cats?

A

humidified oxygen
minimise stress
IV dexamethasone (steroid)
bronchodilator (terbutaline)

55
Q

what drugs can be used in inhalers for feline asthma?

A

salbutamol
fluticasone (long term inflammation control)

56
Q

what are the clinical signs of bronchial foreign body?

A

sudden onset cough
halitosis (if its been there a while)
history of field/woodland walking

57
Q

what mismatch in ratio do pulmonary parenchymal diseases result in?

A

ventilation:perfusion mismatch

58
Q

what partial pressure of oxygen will make a patient clearly cyanotic?

A

<60mmHg

59
Q

is audible breathing noise associated with upper or lower airway disease?

A

upper

60
Q

what is the main cause of inspiratory dyspnoea?

A

upper airway obstruction (laryngeal paralysis, mass/compression…)

61
Q

what is the main cause of expiratory dyspnoea?

A

dynamic airway collapse of bronchial narrowing

62
Q

what can cause both inspiratory and expiratory dyspnoea?

A

oedema or idiopathic fibrosis

63
Q

what is the main sign of obstructive dyspnoea?

A

increased breathing effort

64
Q

what is the main sign of restrictive dyspnoea?

A

fast shallow respirations

65
Q

what can cause inspiratory obstructive dyspnoea?

A

upper airway obstruction

66
Q

what causes expiratory obstructive dyspnoea?

A

bronchospasm (feline asthma…)

67
Q

is restrictive dyspnoea usually inspiratory or expiratory?

A

usually both (pleural effusions…)

68
Q

what percentage oxygen should be given to patients with dyspnoea?

A

<50% (avoid 100% as can cause toxicity)

69
Q

what does a poor response to supplementing a cyanotic dyspnoeic animal with oxygen suggest?

A

animal may have congenital heart disease with a right to left shunt

70
Q

what is inspiratory stirtur usually caused by?

A

upper airway obstruction

71
Q

what breathing pattern is usually seen with pleural effusions?

A

restrictive (increased effort)

72
Q

how does a radiograph of a pneumothorax look?

A

lungs partially collapsed
heart elevated from sternum

73
Q

what are the physiological mechanisms that cause pleural effusion?

A

increased hydrostatic pressure
decreased plasma oncotic pressure
increased vascular/pleural permeability
increased fluid production

74
Q

why are standing lateral radiographs discouraged?

A

dangerous - unless lead lined walls

75
Q

why would a standing lateral radiograph be useful in pleural effusion cases? (discouraged)

A

will get a clear line of fluid and gas

76
Q

what is used instead of a standing lateral radiograph to visualise pleural effusions?

A

ultrasound

77
Q

how is thoracocentesis done?

A

clips and clean area
use 21G 1 inch butterfly catheter with and three way tap and syringe and insert into 7th/8th intercostal space at the costochondral junction

78
Q

how does a pure transudate appear?

A

clear colourless fluid

79
Q

how does a modified transudate appear?

A

slightly red/straw coloured

80
Q

how much protein and cells do transudates have?

A

very low protein and cells (pretty much done)

81
Q

how much protein and cells do modified transudates have?

A

high proteins but low cells

82
Q

how much protein and cells do exudates have?

A

high proteins and cells

83
Q

what are some examples of exudates?

A

haemothorax
pyothorax
chylothorax

84
Q

what is the most common cause of pleural effusion in cats?

A

congestive heart failure

85
Q

what should be done if you diagnose after thoracocentesis that the pleural effusion is due to a pericardial effusion

A

rapidly carry out pericardiocentesis

86
Q

what should be done if purulent exudate is drained by thoracocentesis?

A

submit for aerobic/anaerobic culture and sensitivity
insert drain to lavage daily

87
Q

what are some possible broad spectrum antibiotics that can be used while awaiting culture/sensitivity of prothorax fluid?

A

potentiated amoxycillin
metronidazole
fluroquinolone combination

88
Q

what are some possible causes of chylothorax?

A

trauma/lesions disrupting thoracic duct or cranial vena cava
pericardial disease
congestive heart failure (especially cats)
lung lobe torsion
idiopathic

89
Q

how can chylothorax be treated following thoracocentesis?

A

treat underlying disease
feed low fat diet
rutin (reduce chyle production)
most cases require surgery

90
Q

what needs to be done in all pleural effusion cases after thoracocentesis?

A

radiograph to check for neoplasia (will get a clear view now there is no fluid)

small animal (fourth year) (26 decks)

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