Respiratory Flashcards
A West Highland White Terrier is brought to your clinic because he has been getting more and more intolerant to exercise. He also seems to have trouble breathing sometimes. Upon auscultation you note inspiratory crackles. What is your primary differential and how can you obtain a definitive diagnosis?
Idiopathic pulmonary fibrosis/Progressive intersitial fibrosis
Lung biopsy
What idiopathic disease with variable clinical signs such as a cough or acute respiratory distress do Siamese cats appear predisposed to?
Idiopathic feline bronchitis/ asthma
What radiographic pattern predominates in feline asthma?
Bronchial
Some cats (10%) with feline asthma have a collapsed right ____ lung lobe. The lungs are often ___-inflated.
Middle
Hyper-inflated
What is typically found in a cytology of a transtracheal wash or BAL in an asthma patient?
Increased eosinophils or neutrophils
Mixed Inflammation
T/F Canine chronic bronchitis is similar to asthma in people or cats.
False
What bronchodilators are used in the management of acute life-threatening cases of feline asthma? What is administered via MDI for long term management of this disease.
Acute: Albuterol (MDI or PO) or Tertbutaline (SQ or MDI)
Chronic: Fluticasone proprionate (Flovent) or Beclomethasone (Qvar)
What type of disease can be caused by the use of a MDI?
Dental disease
T/F Steroids are counter-indicated in the treatment of feline asthma as well as feline chronic bronchitis.
False, dexamethasone is indicated in acute life-threatening cases of asthma and glucocorticoids are used for long-term management of both asthma and chronic bronchitis.
What characterizes Feline chronic bronchitis?
Chronic airway inflammation Neutrophilic inflammation Mucosal edema Mucus gland hypertrophy Excessive mucus production
Bawldy Hawn, an 8 year old Chinese Crested, that has been struggling with her weight (a lot) is brought to your clinic because she has been coughing every day for more than 2 months. She is bright and seems happy otherwise. As she struts into the exam room, you can hear her wheezing. She has a history of mitral valve insufficiency. What disease do you suspect? How will you treat it? What medications will you avoid?
Canine chronic bronchitis
Council her owner to minimize triggers such as smoke and excitement, keep her hydrated, and reduce her weight.
Prescribe prednisolone and consider a metered dose inhaler once she is stable.
Avoid cough suppressants.
Your doggie patient is a pure bred 1 year old Xoloitzcuintli who has has recurrent respiratory infections all his life and his response to supportive therapy has been getting progressively weaker over time. He is also infertile. Which immotile ciliary syndrome do you suspect?
Primary ciliary dyskinesia (PCD) - autosomal recessive trait
Which vessel, the pulmonary artery or pulmonary vein carries oxygenated blood?
Vein
Dalai Clawma presents to your clinic with nasal discharge, sneezing, increased inspiratory effor, and open-mouth breathing. Where is the location of the problem (which airways)?
Upper airways
____ is the hallmark of a tracheal or pulmonary disease, or cardiac failure.
Coughing
Anderson Pooper presents to your clinic with difficulty breathing. When he lies down he has a hard time catching his breath, so he sits in sternal recumbency with his elbows abducted, neck extended and is open-mouth breathing. What term best describes this?
Orthopnea
T/F Most noises are heard on expiration.
False, inspiration.
Jude Paw is brought to your clinic coughing. He has increased effort in expiration and on auscultation you hear crackles and wheezing. Where is the location of the problem (which airways)?
Lower airways.
You are auscultating a dog and hear a low pitched sound on inspiration, it sounds like gurgling or snorting. What is this sound called? What is it caused by?
Stertor
Produced by air passing over a soft tissue obstruction.
Captain Galacticat has a paroxysmal cough. What does this mean?
The cough occurs in sudden bursts
Where are bronchiovesicular sounds the loudest?
Over the hilus
What is the high pitched inspiratory noise called, caused by rapid airflow over a rigid obstruction or a paralyzed/collapsed larynx?
Stidor
T/F: Neoplasia is an important cause of nasal discharge in dogs. Rhinitis is an important cause of nasal discharge in cats.
True
Steve the dog presents with sudden onset clinical signs, including acute sneezing, gagging, reverse sneezing, pawing at the nose and serous nasal discharge.
What is your top differential and what are your options for diagnosis?
Nasal foreign body
CT/MRI
Rhinoscopy
Nasal flush
What is the chronic inflammatory rhinitis characterized by a lymphocytic and plasmacytic infiltration into the nasal mucosa in the abense of any obvious underlying etiology?
How is it diagnosed?
Lymphoplasmacytic Rhinitis (LPR)
CT/MRI - if you see destruction of nasal septum, frontal sinus or cribiform plate, it is UNLIKELY to be LPR
Rhinoscopy- hyrperaemic, fragile, edematous mucosa, turbinates atrophied/destroyed, looks similar to neoplasia or fungus sometimes
BIOPSY/HISTO PATH NEEDED
What is the best diagnostic for detecting nasal neoplasia?
CT/MRI
What is the most common nasal tumor in dogs? What is the treatment of choice?
Adenocarcinoma (also SCCs)
Radiation +/- surgical debulking
(If lymphoma, use chemo)
What disorder is characterized by a goose honking cough which is exacerbated by excitement and elicited with tracheal palpation? It causes cyanosis, collapse and syncope, and many dogs have concurrent hepatomegaly and a cardiac murmur.
Tracheal collapse
What is the best diagnostic tool for tracheal collapse?
Bronchoscopy
Allows you to asses the dynamic change, grade the extent and look for concurrent disease
T/F: Cough suppressants such as torb and hydrocodone are indicated for tracheal collapse.
True, as long as no underlying pneumonia.
What surgical options exist for tracheal collapse? What is each indicated for?
Extraluminal stents - extrathoracic or cervical collapse
Endoluminal stents (Nitinol) - intrathoracic or entire tracheal collapse
This occurs secondary to chronic conditions because of damage to the bronchial structure resulting in a thickened wall and dilation so mucus cannot be cleared. It is irreversible. What is it?
Bronchiectasis
What are the 4 main mechanisms for non-cardiogenic pulmonary edema?
- Vascular overload/ increased hydrostatic pressure (IVF overload)
- Decreased plasma oncotic pressure (Low albumin)
- Increased alveolar-capillary membrane permeability (Insult, injury)
- Lymphatic obstruction
What is hears on thoracic auscultation when you have pulmonary edema? What is seen on rads?
Crackles
Bilateral alveolar patterns, especially in caudo-dorsal lung fields
T/F: Pulmonary edema is commonly seen post-seizures,
True
Acute lung injury(ALI) and Acute Respiratory Distress Syndrome (ARDS) are most common secondary to sepsis, systemic inflammatory distress syndrome, shock or bacterial pneumonia.
What is the PaO2/FiO2 for ALI? For ARDS?
<300 for ALI
<200 for ARDS
(>470 is normal)
What will you hear on thoracic auscultation with pulmonary contusions?
Crackles
Siberian huskies are predisposed to this disease which presents with a harsh cough, progressive respiratory diffuculty, exercise intolerance, and sometimes nasal discharge and anorexia/lethargy. What is this disease? How is it treated?
Eosinophilic bronchopneumopathy
NO ANTIBIOTICS - doesn’t respond
Give CORTICISTEROIDS (inhalation maybe?) and fenbendazole (Even if no evidence of lungworms)
Any disease that causes increased systemic venous pressure can potentially cause ___-thorax
Chylo
When the fluid from a thoracocentesis shows higher triglycerides than the [triglycerides] in serum, this indicates what pathology?
Cylothorax
