Respiratory 2

Question 1

tracheal collapse is caused by

Answer 1

dorsoventral flattening of the tracheal rings and the dorsal tracheal membrane prolpasing into the lumen

why this happens if not exactly clear, could be defective cartilage development or degeneration of hyaline cartilage

Question 2

what factors make tracheal collapse worse?

Answer 2

obesity, chronic coughing from cardiac disease, lower airway disease, BOAS

Question 3

the cervical trachea tends to collapse during______ compared to the thoracic trachea which tends to collapse during _____

Answer 3

inspiration

expiration

Question 4

which breeds are prone to tracheal collapse?

Answer 4

chihuahuas, poms, toy poodles, yorkies

Question 5

a 6 yo yorkie named Sadie comes to you because she has a goose honk cough that worsens with exercise. top differential? what diagnostics would you like to do?

Answer 5

tracheal collapse

rads (both inspiratory and expiratory), tracheosbronchoscopy, fluoroscopy

remember, it may not show up on rads as this is a dynamic disease

Question 6

for diagnosing tracheal collapse on tracheobronchoscopy, what is the grading?

Answer 6

grade 1: 25% collapsed, rings still circular
grade 2: 50% collapsed, dorsal membrane stretched
grade 3: 75% collapsed, dorsal membrane pendulous
grade 4: 95% collapsed

Question 7

how will you treat Sadie with tracheal collapse?

Answer 7

Medical: environmental, pharmacologic, manage concurrent conditions

surgical: only used if medical fails

Question 8

what are some environmental changes you can make to help medically manage tracheal collapse for Sadie?

Answer 8

weight loss, use a harness instead of a collar, avoid excitement or stress, treat any concurrent disease

Question 9

what medications can you use for tracheal collapse?

Answer 9

cough suppressants: hydrocodan, butorphanol, loperamide
possibly bronchodilators
anti inflammatory steroids, not as much due to side effects

Question 10

what are the surgical treatment options for tracheal collapse?

Answer 10

intraluminal stents, supportive rings

Question 11

Sadie the yorkie with tracheal collapse is NOT responding to medical management and the owner wants to try surgery. what are important things you need the owner to know about before doing so?

Answer 11

surgery is only used for severe cases that are not managed by medical treatment alone! surgical treatment does NOT stop coughing and Sadie will still need medications! a stent is a FB and can cause inflammation as well! and if the problem extends into the bronchi, you can’t stent that!

Question 12

what is hypoplastic treachea, who is it common in, and how is it treated?

Answer 12

congenital disease in bulldogs and bostons, essentialy their trachea is too small

treat BOAS! these cannot be stented

Question 13

classically, CIRDC is referring to:

Answer 13

parainfluenza, adenovirus-2, bordetella

can also involve: distemper, influenza, pasturella, strep zoo

Question 14

a dog named Barney that recently went to doggy daycare presents to you with a hacking cough and some sneezing. top differential?

Answer 14

canine infectious respiratory disease complex

Question 15

does vaccination prevent CIRDC?

Answer 15

no (except for distemper)

Question 16

how do you diagnose CIRDC?

Answer 16

usually based on history and exam findings

sampling often not necessary, but you could IF: disease is complicated, if there is an outbreak in kennels or shelters, or in cases with unusual/severe clinical signs

Question 17

how will you treat CIRDC in Barney?

Answer 17

supportive care

could use abs if: complicated infection (fever, lethargy, inappetence + mucupurulent discharge), doxycycline good first choice

Question 18

when does a dog with CIRDC need a diagnostic workup?

Answer 18

if there’s no improvement in 7 days, signs of penumonia (crackles, wheezes, productive coughing, hypoxemia, dysnpea, etc), or if there’s other concerns

Question 19

Barney’s owner asks how they can prevent CIRDC “kennel cough”, and you say…

Answer 19

vaccination=less shedding and less severe clinical signs
decrease exposure: isolate infected animals and avoiding places like kennels, shelters, dog parks

Question 20

tracheal rupture is most commonly seen…….and results in…

Answer 20

after ET intubation in cats

pneumomediastinum, sub Q emphysema

Question 21

how is tracheal rupture treated?

Answer 21

most heal without doing anything, just monitor the patient. on rads might see sub Q gas

Question 22

tracheal parasites are caused by _____ and treated with _____

Answer 22

oslerus osleri

fenbendazole or ivermectin

Question 23

a 6 yo chihuahua named Nacho comes to you for a 3 month history or harsh coughing and exercise intolerance and increased resp effort. when listening to lungs you hear crackles and wheezes. differential?

Answer 23

chronic bronchitis

Question 24

how do you diagnose chronic bronchitis?

Answer 24

exclude other causes of cough: heartworm testing, fecal testing for parasites, bloodwork

rads: may be normal

BAL: more cells, lots of non degenerate neutrophils

Question 25

how will you treat Nacho with chronic bronchitis?

Answer 25

glucocorticoids: oral prednisone 1mg/kg/day and then taper to lowest effective dose

inhaled steroids: fluticasone

could consider bronchodilators like theophylline or albuterol

maintain ideal BCS and avoid environmental stressors, get a humidifier

Question 26

what is the pred rule for dosaging?

Answer 26

0.1 mg/kg/day is replacement
0.5-1 is anti inflammatory
1-2 is immune supressive

Question 27

chronic bronchitis cannot be cured, only controlled, so why bother treat at all?

Answer 27

it will get worse and predispose to penumonia, bronchiectasis, bronchomalacia due to the ongoing inflammation

Question 28

what are the 2 big feline bronchial diseases?

Answer 28

asthma and chronic bronchitis

Question 29

with feline asthma, clinical signs are a result of

Answer 29

airway narrowing: smooth muscle conrtaction, airway edema, mucus, cellular infiltrates and inflammation

Question 30

feline asthma starts with airway inflammation and progresses to…

Answer 30

excessive mucus–>bronchial wall edema and remodelling–>bronchoconstriction

Question 31

a 4 yo siamese named Nelly presents with coughing, wheezing, expiratory dyspnea and tachypnea. top differential? what diagnostics do you wanna do?

Answer 31

asthma

use history and C/S and exclude other diseases like chronic bronchitis and heartworm, cardiac disease and pleural effusion,

rads–>bronchial pattern, collapse of R middle lobe if severe, hyperinflation, hyperlucent lungs

cytology/airway sampling: eosinophils

Question 32

what do hyperlucent lungs look like on rads, as with feline asthma?

Answer 32

diaphragm is flattened, lungs poke out past ribs, and you can’t see the vessels as much as usual

Question 33

eosinohpils are most consistent with____ and neutrophils are most consistent with ____

Answer 33

asthma
bronchitis

Question 34

how will you treat Nelly with asthma?

Answer 34

steroids: injectable, oral, inhaled
bronchodilators (doesn’t help inflammation)
dont use albuterol chronically, only during a crisis!!

Question 35

emergency treatment of feline asthma (acute crisis) includes:

Answer 35

oxygen and sedation (butorphanol)
bronchodilator (albuterol or terbutaline)
steroid injection (dex IV)
possibly abs if secodnary infections

Question 36

chronic treatment of feline asthma includes:

Answer 36

oral pred 1-2mg/kg/day and taper
inhaled fluticasone (not immediately effective)
bronchodilators for acute flareups only
environmental modifications