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Companion Animal Med & Surgery > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Factors to pay particular attention to when localizing respiratory disease

A
  • nasal discharge
  • audible sounds other than cough
  • cough
  • auscultation
  • breathing pattern
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2
Q

Stertor helps localize to where

A

upper airways-particularly pharynx

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3
Q

Stridor helps localize to where?

A

upper airways, particularly larynx

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4
Q

Vocal changes suggest localization to where?

A

larynx

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5
Q

Reverse sneezing helps localize disease to where?

A

upper airways-particularly nasopharynx/pharynx

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6
Q

Normal breathing rates at home and in exam room

A

at home: 12-18

in exam room: <30

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7
Q

Relatively slow rate for the degree of effort of breathing indicates:

A

large airway obstruction

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8
Q

Relatively fast rate (>50) indicates what in terms of trying to localize respiratory disease?

A

pulmonary parenchymal or pleural disease

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9
Q

More difficulty on inspiration + slow rate —> ?

A

extrathoracic obstruction

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10
Q

More difficulty on inspiration + fast rate –> ?

A

restrictive disease (loss of compliance, pleural space disease)

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11
Q

More difficulty during expiration –> ?

A
  • intrathroacic obstruction
    • intrathoracic large airway obstruction
    • small airways (obstructive lung disease)
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12
Q

What are factors to evaluate to help determine the severity of respiratory compromise?

A
  • effort (i.e. open mouth breathing in cats = marked compromise)
  • exercise intolerance
  • MM color
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13
Q

Compare and contrast how obstructive and restrictive disease may present

A

Obstructive: rapid rate, increased effort during expiration (listen for wheezes)

Restrictive: rapid rate, relatively increased during inspiration + expiration

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14
Q

What type of presentation is typical of pleural disease?

A
  • decreased sounds on auscultation
  • non-localizing signs
  • exercise intolerance (i.e. tachypnea, relatively increased effort on inspiration)
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15
Q

Describe how a bronchial pattern looks

A
  • Thickened airways look like railroad tracks or doughnuts
  • Bronchiectatic airways are dilated without normal taper
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16
Q

What is an air bronchogram? What pattern does is it seen with?

A
  • stripes without walls
  • occurs with alveolar pattern
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17
Q

What causes an alveolar pattern?

A

overflow of fluid/exudate from the interstitium or airways into the alveoli

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18
Q

Describe a reticular pattern

A
  • ill-defined density
  • loss of detail of normal structures
  • if mild, may be “normal” aging change
  • can be early stage of alveolar or nodular
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19
Q

Types of interstitial patterns

A
  • reticular
  • nodular
  • reticulonodular
  • mass
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20
Q

What does a consolidated lung lobe indicated?

A

advanced interstitial or alveolar disease

  • lung lobe torsion
  • neoplasia
  • severe, localized bacterial pneumonia
  • granuloma
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21
Q

Which lung lobes are “gravity-dependent?”

A

the L and R cranial lobes and the right middle lobe

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22
Q

What is the purpose of thoracic radiographs for assessing respiratory disease?

A
  • support history and PE findings
  • furthur localization within lower respiratory tract
  • assessment of severity of disease
    • not assoc. with pulmonary function
  • assessment of progress
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23
Q

Name four systemic fungal infections that can be detected by serology, and whether antibody or antigen is detected for each

A
  • Blastomycosis: antibody
  • Histoplasmosis: antibody
  • Coccidioidomycosis: antibody
  • crypococcosis: antigen
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24
Q

Besides systemic fungal infections, serolgy is useful to detect what else?

A
  • heartworm
    • need antigen and Ab test in cats
  • toxoplasmosis (Ab)
  • canine influenza (Ab)
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25
Q

Urine tests for fungal antigens are useful for which diseases?

A

Blasto, Histo

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26
Q

A minimum of how many fecal exams is needed for pulmonary parasites?

A

3

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27
Q

Respiratory parasite-eggs sink on sedimenation

A

Paragonimus

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28
Q

Respiratory parasite that can be detected on flotation

A

Capillaria

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29
Q

Larvae of ___________ are detected by a Baermann

A

Aelurostrongylus (cats)

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30
Q

Ddx for bronchial patterns

A
  • canine chronic bronchitis (idiopathic)
  • feline bronchitis (idiopathic)
  • allergic bronchitis
  • canine infectious tracheobronchitis
  • bacterial infection
  • mycoplasma infection
  • pulmonary parasites (Aelurostrongylus, Capillaria, Oslerus)
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31
Q

Differentials for alveolar pattern

A

Pulmonary edema-often peri-hilar or caudo-dorsal distribution

Airway origin pneumonia(often cranioventral dist.)

  • bacterial pneumonia
  • aspiration pneumonia

Hemorrhage

  • pulmonary contusion
  • pulmonary thromboembolism
  • neoplasia
  • fungal pneumonia
  • systemic coagulopathy

Differentials for interstitial patterns if also sever inflammation, edema, or hemorrhage

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32
Q

Name some differentials that often cause a nodular interstitial pattern

A
  • blastomycosis
  • histoplasmosis
  • coccidioidomycosis
  • paragonimus
  • aelurostrongylus
  • neoplasia
  • eosinophilic lung dz (reticular, nodular, or both)
  • abscess
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33
Q

Name some possible differentials for a reticular interstitial pattern

A
  • mild pulmonary edema
  • infectious
    • viral pneumonia-canine distemper
    • bacterial pneumonia
    • protozoal pneumonia
    • heartworm dz
  • eosinophilic lung disease (can be reticular, nodular, or both)
  • idiopathic interstitial pneumonia
  • mild hemorrhage
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34
Q

Differentials for a vascular pattern

A
  • Enlarged arteries
    • heartworm
    • PTE
    • pulmonary hypertension
  • Enlarged veins
    • left-sided HF
  • Enlarged arteries and veins
    • left to right shunts
  • small arteries and veins
    • cardiovascular shock
    • hypovolemia
    • severe dehydration
    • blood loss
    • hypoadrenocorticism
  • pulmonic valve stenosis
  • hyperinflation of lungs
    • feline bronchitis
    • allergic bronchitis
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35
Q

Name forms of specialized radiography that might be indicated for diagnosing respiratory disease and why they are helpful

A
  • Inspiratory neck/expiratory thorax films-for trachea and large airway collapse
  • ultrasonography for masses against the body wall
  • CT for increased detail and sensitivity
  • Angiography, contrast CT, or nuclear imaging for PTE
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36
Q

Considerations for pulmoary specimen collection

A
  • client capabilities/priorities
  • top differential diagnoses
  • localization within the lung
  • risk of procedure balanced with condition of patient
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37
Q

What are the indications for a tracheal wash?

A
  • bronchial and alveolar disease
    • bacterial and aspiration pneumonia; chronic cough/bronchitis
  • may consider for any lung disease because of safety and availability
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38
Q

Advantages of a trach wash

A
  • simple
  • minimal expense
  • no special equipment
  • complications are rare
  • volume is adequate for cytology and culture
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39
Q

Disadvantages of trach wash

A

representative cells must be present in the large airways

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40
Q

Indications for a transthoracic lung aspiration

A
  • solid masses adjacent to body wall
  • diffuse interstitial lung disease
    • best for diffuse nodular disease
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41
Q

Advantages of transthoracic lung aspiration

A
  • simple
  • minimal expense
  • no special equipment needed; though US increases yield and decreases risk
  • solid masses adjacet to chest wall: gives an excellent representation with minimal risk
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42
Q

Potential complications with transthoracic lung aspiration

A
  • pneumothorax
  • hemothorax
  • pulmonary hemorrhage
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43
Q

Disadvantages of transthoracic lung aspiration

A
  • complications
  • relatively small area of lung sampled
  • specimen only adequate for cytology
  • specimen blood contaminated
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44
Q

Bronchoalveolar lavage is indicated for what type of disease?

A

interstitial

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45
Q

Advantages of NB-BAL

A
  • minimal expertise and expense
  • no special equipemtn
  • hypoxemia is transiet and responsive to O2 in stable patients
  • large volume of lung is sampled
  • high quality cytologic specimen
  • large volume for analysis
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46
Q

Disadvantages of NB-BAL

A
  • not recommended for animals with increased respiratory effort or other signs of poor oxygenation
  • general anesthesia required
  • need access to oxygen/ventilation
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47
Q

What is the site of collection for thoracotomy + lung biopsy?

A

small airways, alveoli, interstitium

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48
Q

What are the advantages of thoracotomy + lung biopsy

A
  • highest quality specimen plus potential for therapeutic benefit with focal disease
  • ideal specimen
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49
Q

Indications for thoracotomy and lung biopsy

A
  • localized process where exicsion may be therapeutic as well as diagnostic
  • any progressive disease not diagnosed by less invasive means
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50
Q

Thoracotomy + lung biopsy disadvantages

A
  • relatively expensive
  • requires expertise
  • requires general anesthesia
  • major surgical procedure
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51
Q

Summarize approach to patient with lower respiratory tract disease

A
  • localize to lower respiratory tract with history and PE
  • critically evaluate thoracic radiographs and CBC for further localization and to prioritize differentials
  • perform non-invasive tests as indicated by the list of differential diagnoses (fecal exams, blood tests, specialized radiographic techniques)
  • collect pulmonary specimens
  • continue to work through options until:
    • obtain specific and complete diagnosis OR
    • elect to refer OR
    • determine that trial treatment is better than more diagnostics
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52
Q

Gold standard pulmonary function test

A

arterial blood gas

53
Q

Why is arterial blood gas done?

A
  • confirm pulmonary compromise (vs. dz)
  • monitor progression of disease/response to therapy
  • assess risk of procedures
  • assess the need for oxygen supplementation
  • assess the need for ventilatory support
54
Q

Categories of pleural cavity disease

A
  • pleural effusion
  • pneumothorax
  • mediastinal masses
  • pneumomediastinum
55
Q

What are some possible signs seen with pleural cavity disease?

A
  • abnormal breathing, tachypnea
  • fever
  • anorexia
  • palpable cranial thoracic mass (cats)
  • cough! - cats with chylothorax
56
Q

Chorioretinitis is associated with ______ in cats

A

FIP

57
Q

What is the imporatnce of evaluating the thoracic radiographs after air/fluid removed?

A
  • need full inspiration on thoracic rads to accurately evaluate; otherwise may look like pneumonia, masses, etc. that are really not there but it looks like that because the lung is not fully expanded
58
Q

Name two situations where there might be a pleural effusion but you may not want to remove all the fluid/remove only as much as needed to stabilize patient

A
  • if ultrasound is possible
  • or if the fluid is blood; they can autotransfuse it
59
Q

The major differential for a pure transudate is hypoalbuminemia. What are the major underlying causes to look for?

A

PLE, PLN, liver disease

60
Q

If you see a nonseptic exudate in a cat, what is one concern?

A

FIP

61
Q

If you have a nonseptic exudate, what are the next steps to evaluate for neoplasia?

A
  • thoracic rads
  • US
  • CT
  • thoracoscopy
  • throacotomy
62
Q

Diagnostic approach for septic exudate

A
  • Gram stain
  • aerobic culture (+/- anaerobic culture)
  • Serial thoracic rads
63
Q

Correct treatment of pyothorax

A
  1. Immediate stabilization
    • thoracocentesis
    • IV fluids (often needed if septic)
  2. treatment of the infection
    • antibiotics (IV while in hospital, send home on long term oral)
    • chest tube
  3. follow-through
    • long term antibiotics
    • radiographic monitoring
64
Q

What factors give the best prognosis for pyothorax?

A
  • survive the first day or two
  • timely, aggressive treatment
65
Q

How to prove chylothorax

A

TG measurements

TG fluid > TG serum/plasma

66
Q

Chylous effusion differentials

A
  • idiopathic
  • traumatic
    • will usu. resolve spontaneously
  • anterior mediastinal mass
  • neoplasia
  • heart disease
  • dirofilariasis
  • pericardial disease
67
Q

Management of chylothorax

A
  • treat underlying disease
  • intermittent thoracocentesis
  • rutin (nutraceutical)
  • fat restricted diet
  • surgical exploration and palliation (NOT CURATIVE)
    • thoracic duct ligation
    • drains (fluid from thorax into abdomen or vessels)
    • pericardectomy
68
Q

Chylothorax prognosis

A

guarded

69
Q

Differentials for a hemorrhagic effusion? What additional diagnstics are warranted for each?

A
  • trauma–>hx, PE
  • bleeding disorder–>PE, platelet count, coagualtion tests (ACT, PT, PTT)
  • neoplasia –>thoracic radiographs, US, CT, thoracoscopy, thoracotomy
  • lung lobe torsion–>thoracic rads, US, bronchoscopy, thoracotomy
70
Q

Most common cause of acute nasal signs in cats

A

viral rhinitis (herpesvirus, calicivirus)

71
Q

What are the two big concerns with acute nasal signs in dogs?

A
  • possible foreign body
  • possible exposure to “kennel cough”/influenza type organisms
72
Q

If you suspect nasal foreign body, what should you do next?

A

immediate rhinoscopy, including retrograde exam of nasopharynx

73
Q

What are the next appropriate steps if you suspect “kennel cough”?

A
  • isolation
  • rest, time
  • +/- antibiotics
  • monitor progress
74
Q

What are the more common differentials for nasal bumps

A
  • carnassial tooth root abscesses
  • neoplasia-usually malignant
  • cryptococcosis (cats)
75
Q

Approach to nasal bumps

A
  • fine needle aspiration
  • cryptococcal titers (cats)
  • work up as for chronic nasal discharge or external biopsy the mass
76
Q

Do cats or dogs often have idiopathic chronic rhinosinusitis?

A

CATS

77
Q

Most nasal diseases have what distribution?

A

focal or multifocal

78
Q

Most bacterial infections of the nasal cavity are ________ (primary/secondary)?

A

SECONDARY

79
Q

Lymphadenopathy might be indicated if you suspect what?

A

cryptococcus or neoplasia (carcinoma, lymphoma)

80
Q

What is an agent that is associated with facial pain (fairly unique)

A

Aspergillus

81
Q

How to diagnose cryptococcosis

A

nasal swab cytology

cryptococcal antigen test

82
Q

What should be done in dogs and cats with nasal hemorrhage?

A
  • CBC + platelet count
  • coagulation times
  • BMBT
  • Rickettsial titers (dogs)
  • arterial blood pressure
  • Von Willebrand’s factor assay (dogs)
83
Q

What to do for feline idiopathic chronic rhinosinusitis

A
  • facilitate drainage
    • vaporizer treatments, topical saline solution, nasal cavity flushes under anesthesia, topical decongestants(for acute flare ups)
  • decrease environmental irritants
  • control secondary bacteria
    • Clavamox, doxy, azithromycin
      • if improment noted in 1 wk, continue 4-6 weeks
      • if signs recur after stopping, re-initiate SAME antibiotic, continue for months
  • treat possible herpesvirus
    • lysine diet supplementation
    • famciclovir
  • reduce inflammation
    • second generation antihistamine (cetirizine)
    • oral prednsolone
    • omega 3 supplementation
    • N-acetylcysteine orally
  • surgical intervention
    • turbinectomy
    • frontal sinus ablation
84
Q

What to do for canine idiopathic chronic/lymphoplasmacytic rhinitis

A
  • facilitate drainage
    • vaporizer treatments
    • topical saline solution
  • decrease irritants in env
  • control secondary bacterial infection
    • long term antibiotics
  • reduce inflammation
    • oral prednisone
    • omega 3 supp.
    • oral N-aceylcysteine
  • antihistamines
  • surgical intervetion
85
Q

Bronchodilators-use in emergency

A
  • albuterol by MDI
  • terbutaline injectable
  • oral aminophylline or theophylline
86
Q

What is a maintenance corticosteroid that can be given by MDI?

A

Fluticasone

87
Q

Bronchodilator that can be administered once daily to cats?

A

Theophylline

88
Q

Patients with obstructive disease have more difficulty with which phase of respiration?

A

expiration

89
Q

A 6 year old, male castrated, domestic short hair cat is presented for respiratory distress. His respiratory rate is 65/min. He is breathing too quickly to discern which phase is most affected. On auscultation, expiratory wheezes are heard. He most likely has …

A

obstructive (small airway disease)

90
Q

An 8 year old, spayed female, DSH cat is presented for respiratory distress. Her respiratory rate is 65/min. Neither phase of respiratory is obviously more effortful than the other. She has decreased lung sounds bilaterally. The only other remarkable finding is a body temperature of 104 F (40.0C). The most likely differential diagnosis is

A

Pyothorax

91
Q

A 10 year old, male castrated, Labrador retriever is presented for respiratory distress. His respiratory rate is 35/min. Stridor is audible during inspiration. He most likely has…

A

Extrathoracic large airway obstruction

92
Q

A 5 year old, male castrated Great Dane is presented for respiratory distress and stertor. He is cyanotic. His respiratory rate is 30/min. Inspiration is prolonged relative to expiration. He most likely has …

A

extrathoracic large airway obstruction

93
Q

A Baermann can be used to identify _______ larvae in dogs, but this parasite has so far only been seen in the northeastern part of the country

A

Crenosoma

94
Q

Lung specimen collection techniques that do not require general anesthesia

A
  • trans-tracheal wash
  • lung aspiration
95
Q

Treatment for lung lobe torsion

A

Lobectomy

96
Q

Treatment for cryptococcus

A

fluconazole

97
Q

Sildenafil is indicated for _________

A

pulmonary hypertension

98
Q

What is the appropriate treatment for ARDS?

A

positive pressure ventilation

99
Q

Aspergillosis is treated with ____________

A

Topical Clotrimazole

100
Q

Nasal mites-name

A

Pneumonyssoides caninum

101
Q

An effusion with 1 g/dl protein and 300 cells/ul, most of which are mesothelial cells and neutrophils.

A

Transudate

102
Q

An effusion with a total protein of 4.3 g/dl and 20,000 cells/ul, most of which are non-degenerative neutrophils.

A

exudate

103
Q

An effusion with a total protein of 4.0 g/dl and 70,000 cells/ul, most of which are degenerative neutrophils, and intracellular bacteria

A

exudate

104
Q

One cytologic characteristic used to identify a hemorrhagic effusion is the presence of

A

RBCs within macrophages

105
Q

A 10 year old, spayed female, Siamese cat is presented for lethargy and tachypnea. Radiographs confirm pleural effusion. Cytology of the effusion: 5.0 g/dl protein; 15,000 cells/ul; primarily non-degenerative neutrophils and macrophages. On physical examination you notice chorioretinitis. Of the following choices, which is the most likely differential diagnosis.

A

FIP

106
Q

Name four possible underlying causes of pulmonary edema

A
  • overhydration
  • LHF
  • smoke inhalation
  • electrocution
107
Q

Name two possible underlying causes of PTE

A
  • Hyperadrenocorticism
  • IMHA
108
Q

Treatment for nasal aspergillosis

A

Topical clotrimazole

109
Q

Nasopharyngeal polyps can result in chronic nasal discharge, signs of upper airway obstruction, otitis externa, and ____________

A

Head tilt

110
Q

Tx for uncomplicated acute tracheobronchitis

A

rest, time important

  • abx prescribed sometimes (mycoplasma and bordetella involvement)
    • Doxycycline (follow with liquid to avoid stricture)
  • could do cough suppressant
111
Q

Are asthma attacks common with canine chronic bronchitis?

A

NO

112
Q

Normal protective mechanisms of the lung

A
  • Physical protection of larynx, pharynx
  • Mucociliary apparatus
  • Cough
  • Macrophages
  • Inflammatory response
113
Q

Components of the bellows mechanism

A

chest wall

diaphragm

pleural space

114
Q

Open glottis injury

A

Diaphragmatic hernia

115
Q

A tear in the lung parenchyma or tracheo-bronchial tree results in what type pf pneumothorax

A

closed

116
Q

Clinical signs of pneumothorax

A
  • resp distress
  • chest wall expansion
  • hollow percussion of thorax
  • shock
  • cyanosis
117
Q

You can test for what antigens in urine?

A

Blasto, Histo

118
Q

Antibiotics indicated if you suspect “kennel cough”

A

doxycycline or amoxicillin-clavulanate

119
Q

Pure transudate

A

Low protein <2.5-3 g/dl

Low cells <500-1000/ul

120
Q

What characteristic confirms septic exudate?

A

intracellular bacteria

121
Q

Blastomycosis treatment

A

Fluconazole (Itraconazole) +/- Amphotericin B(reserved for worst cases)

  • Fluconazole has better ocular penetration
122
Q

Ddx for transudates

A
  • RHF
  • Pericardial dz
  • neoplasia
  • diaphragmatic hernia
  • hypoalbuminemia (pure transudate)
123
Q

Ddx for non-septic exudates

A
  • FIP
  • Lung lobe torsion
  • Neoplasia
  • Diaphragmantic hernia
124
Q

Ddx for septic exudate

A
  • pyothorax
  • foreign body
  • idiopathic
125
Q

Ddx for chylous effusion

A
  • idiopathic
  • traumatic
  • anterior mediastinal mass
  • neoplasia
  • heart dz
  • heartworm
  • pericardial disease
126
Q

Most common complications of transthoracic lung aspiration

A
  • pneumothorax
  • hemothorax
  • pulmonary hemorrhage
127
Q

What type of sampling techniques are appropriate for diffuse interstitial disease?

A

lung aspirate or NB-BAL

128
Q
A

Companion Animal Med & Surgery (12 decks)

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