Respiratory Flashcards
What is not a common complication of repairing a diaphragmatic hernia?
a. lung lobe torsion
b. hemmorhage
c. re-expansion pulmonary congestion
a. lung lobe torsion
What structure is used to measure length of soft palate?
epiglottis- should just overlap by a couple of mm. Or at the border of the tonsillar crypt.
What muscle and nerve is responsible for ABduction of the larynx?
The Recurrent Laryngeal N-> Caudal Laryngeal Nerve innervates the Cricoaritenoideus Dorsalis Muscle, which abducts the larynx. It is the only muscle to do this.
Stertor or Stridor? Which is the sound commonly associated with BAS in which the Larynx is NOT affected? What does it sound like? What causes it?
Stertor!!
Snoring sound- inspiratory dyspnea
Caused by elongated soft palate onto Rima Glottidis
What are the main components of BAS? List the main three:
1: Stenotic Nares
2: Elongated Soft Palate- most common component
3. Shortened, flattened nasal cavity
+/- hypoplastic trachea
Laryngeal Collapse happens in three stages. Describe what happens in these stages and what surgery is used to correct at such stage.
Stage 1: Eversion of laryngeal Saccules-> Excision of everted saccules with scissors (heals by second intention)
Stage 2: Collapse of cuniform cartilage-> Above + vocal cord excision (ventriculocordectomy), partial arytenoidectomy
Stage 3: Collapse of corniculate cartilage-> Permanent Tracheostomy
T/F: Arytenoid Lateralization is a procedure performed bilaterally on dogs to correct Laryngeal Paralysis.
False- it is performed to correct laryngeal paralysis- only in cases of laryngeal paralysis and if adequete cartilage rigidity, AND only done UNIlaterally bc if done bilaterally, it significantly increases the risk of aspiration by opening the Rima Glottis too wide
What CV effect can the secondary effects of BAS lead to?
Right sided Heart Failure
What drugs should you use to induce light anesthesia during an Upper Airway Exam?
Propofol +/- Butorphanol or Buprenorphine
Can use doxapram to stimulate respiratory response
What drugs are respiratory depressants that should specifically be avoided during an exam for BAS?
Ketamine
Medazolam
Diazapam
Pure Mu agonists
What is a common complication with arytenoidesctomy and ventriculocordectomy? How can it be avoided?
“Webbing” or stricture. Can be avoided by not cotting the ventral and dorsal extents of the corniculate processes and vocal folds
(Stertor/ Stridor) is a common symptom of laryngeal disease.
Stridor! Hear Larynx, think Stridor.
What are the three functions of the larynx?
1: Swallowing
2: Abduction- decreases airway resistance during inspiration
3: Voice production
Laryngeal paralysis is diagnosed in an 11 week old Rottweiler puppy. The prognosis is:
a. excellent
b. guarded
c. grave
c. Grave- it is a congenital condition associated with progressive degeneration of nervous system- ataxia, tremors, paresis, etc.
Arytenoids should (abduct/ adduct) on inhalation.
Arytenoids should ABDUCT on inhalation.
Ventriculocordectomy requires what types of approach:
Transoral and ventral approach. Important to leave 1-2 mm of vocal cord intact to decrease risk of webbing
With an Intercostal Thoracotomy, which side and what intercostal spaces are used?
Right side- 3rd and 4th ICS
Tracheal Collapse is seen more in small or large breed dogs? Young, middle aged or old dogs?
Small, middle aged doggies
Obesity is a risk factor
What does the cough sound like in a case of tracheal collapse?
“Goose Honk”
The gold standard diagnostic for diagnosing tracheal collapse?
Tracheoscopy
A trachea that is 75% collapsed is what grade?
Grade 3
1: 25%
2: 50%
3: 75%
4: almost no lumen
External prosthetic tracheal rings can be used only for ______ tracheal rings?
only for Cervical tracheal rings
Prognosis of permanent tracheostomy is guarded to poor in (dogs/ cats)
Cats! Normally good prognosis in dogs
What is the most common surgical approach in thoracic surgery?
a: ventral midline
b. lateral
c. dorsal
Lateral Thoracostomy
Suture technique required for complete lobectomy of lung is a _____ ligation of vessels.
Triple ligation of vessels
Also- for brunchus- pre-placed horizontal mattress sutures and tie prior to transection. Then, oversew transected ends of bronchus
In the thorax, what is the difference between a bleb, bullae and cyst?
Bleb: a small, localized area of air between internal and external pleura
Bullae: non-epithelialized cavities produced by disruction of intra-alveolar septae
Cyst: Closed sacs lined by epithelium and filled with air or fluid. Result of trauma.
Pugs are know for having lung torsion of what part of which lung? Prognosis for pugs with this type of lung torsion is _______?
In pugs, the Left cranial lung lobe is the most commonly affected.
Good, as opposed to most other breeds, which normally will have the right middle lobe or the left cranial lobe.
T/F: In cases of flail chest (multiple, segmental rib fractures and hypoxemia), cases should be treated with conservative management unless fractures are severely displaced.
True.
T/F: Fibrosing pleuritis may be a long term consequence of chylothorax?
True
T/F: Treatment of the most common type of cylothorax, idiopathic chylothorax, is through conservative medical treatment unless patient is very unstable?
False, surgery is indicated for idiopathic chylothorax consisting of:
Thoracic Duct Ligation (dogs- right 10th ICS and cats- left 10th ICS)
Cysterna Chyli Ablation
Subtotal Pericardectomy
T/F: Complications of surgery for idiopathic chylothorax consist of lung lobe torsion.
True
T/F: Re-expansion pulmonary is a complication of diaphramatic heriaorrhaphy, but can be corrected.
False, it IS a complication, but is untreatable. Keeping close control of PPV during surgery helps to prevent (<15 cm ppv)
PPHD should be performed as soon as detected, often 8-16 weeks assuming patient is stable.
True!
What is the most common congenital heart defect in dogs?
Patent Ductus Arteriosus. Seen more in F»> M and in purebred»_space;» mixed breed dogs.
T/F: PDA can result in Left sided heart failure due to shunting of blood from Left to right side.
True- due to volume overload in left side.
T/F: Surgical treatment is indicated in all types of PDA.
False- only in the most common type L->R shunting. Corrected with minimally invasive procedures such as coil embolization or Amplatzer ductal occluder or with surgical ligation.
What is the most common cardiac neoplasia in dogs?
Hemangiosarcoma of right auricle. Treated with excision of mass and chemo.
T/F: Pericardial disease is most commonly seen in young, small breed dogs.
False: Pericardial dz is most commonly seen in older, large breed dogs. Diagnosed with pericardiocentesis- which is both diagnostic and theraputic.
There are several types of PRAA- Persistant Right Aortic Arch, which abnormal vessels constrain/ compress the trachea and esophagus. What type is the most common?
PRAA with left ligamentum arteriosum is most common.
Which breed of dog is PRAA most commonly disgnosed in?
German Shepherd puppies!
T/F: When removing the nasal planum due to trauma or neoplasia in dogs and cats, it is reasonable to just use purse string sutures to make the opening smaller and to allow second intention healing to take place.
False- only works in cats! In dogs, the nasal passage will often become stenotic.
If a dog comes in with some type of nasal disease process going on, what is the first think you do?
Imaging! So you don’t make it worse by poking around in there! Rads, Commuted Tomography or MRI.
Which type of cuff on the ETT would be best for a bulldog undergoing surgery for BAS?
a. High Volume/ Low Pressure
b. Low Volume/ High Pressure
c. High Volume/ High Pressure
d. Low Volume/ Low Pressure
a. High Volume/ Low pressure- less chance of damaging the tracheal lumen bc you can regulate the pressure.
The low volume/ high pressure ones are cheaper and more widely available, but don’t use them!
And I just made up options C or D - they prob aren’t even real options for ETTs
You are checking on a dog that you performed a tracheostomy on to correct a laryngeal collapse. The dog is hyperthermic. What do you think is happening?
Aspiration pneumonia- the dog has a fever, and it may be the only sign.
Dogs who have laryngeal paralysis will often show signs of paresis/ paralysis in what other muscle?
Cranial Tibial Muscle
What signalment is common for acquired, idiopathic laryngeal paralysis cases?
Old, overweight, large breed dogs. Typically old retreivers. May also have hypothyroidism.
In interpreting rads for tracheal collapse. Which area, thoracic or cervical will collapse on inspiration/ expiration?
Inspiration- cervical
Expiration- thoracic
T/F: In cases of tracheal collapse, surgery should be avoided if possible.
True
The top two types of primary lung neoplasia are:
Adenocarcinoma and SCC
In diagnosing Chylothorax, the cytologic evaluation of the pleural effusion will show that the _________ of the fluid are higher than in serum.
Triglycerides will be higher in fluid than in serum. This is the one consistent diagnostic way to diagnose Chylothorax.
Almost all diaphramatic hernias occur in the ______ and ______ portion.
ventral portion of the muscular
Peri-operative mortality for repairing diaphramatic hernias is increased in all of the these cases except:
a. chronic hernias
b. young, small breed dog
c. female cats
d. patients with concurrent injuries
B. perioperative mortality with repairing diaphramatic hernias is not increased in young, small breed dogs
T/F: Reverse PDA is associated with severe pulmonary hypertension.
True!
What are some common clinical signs of a L->R PDA?
Waterhammer/ hyperkinetic pulse, continuous murmur, and stunted growth
