Respiratory: Clinical Flashcards
What is a normal inspiration:expiration ratio?
1:1 to 1:2
How does opening the mouth help distinguish between respiratory noises?
Opening the mouth should make a nasopharyngeal sound disappear whereas it will make no difference to things lower down for example laryngeal stridor.
Under what conditions do stridor and starter worsen?
Stridor: often with exercise
Stertor: often with rest
Volumes of saline to be used for a BAL
1-2ml/kg in large dogs
2-4ml/kg in small dogs and cats.
What molecular structures are lost in the tracheal rings that cause tracheal collapse?
GAGs e.g. chondroitin sulfate.
What should be performed prior to stunting a tracheal collapse?
Bronchoscopy as if bronchomalacia is present, prognosis with a stent may be worse.
Surgical management options for tracheal collapse
- Options
- Complications
- Prognosis
Options: - Intra-throacic = intraluminal stents - Cervical = extraluminal tracheal rings Complications: - Rings: laryngeal paralysis, tracheal necrosis, - Stents: bacterial tracheitis, stent fracture/migration, stent collapse/deformation, tracheal perforation during placement, and development of obstructive granulation tissue. Prognosis: - Can be very good
Parasites that can form tracheal granulomas
Oslerus osleri
Fileroides osleri
Ceteribri larvae (cats)
Definition of bronchiectasis
Dilation and destruction of bronchial wall
Definition of bronchomalacia
airway collapse during expiration and coughing
Breeds predisposed to eosinophilic bronchopneumopathy
Huskies and malamutes
Breed that has a known genetic component to PCD
Old English sheepdog
Kartagener’s syndrome
Syndrome associated with PCD
- Bronchiectasis
- Left to right transposition of viscera (situs inverts)
- Chronic rhino sinusitis
What diagnostic test is needed to demonstrated PCD?
EM
Outline the likely A-a gradients in the following scenarios:
- Hypoventillation:
- V/Q mismatch:
- Right to left shunt:
- Diffusion impairment:
- Hypoventillation: normal AA gradient
- V/Q mismatch: increased AA gradient that responds to O2 therapy
- Right to left shunt: normal AA gradients that does not respond to O2 therapy
- Diffusion impairment: can lead to increased AA gradient and will respond to O2 supplementation
What is a normal Pa02?
80-105mmHg
Paragnimus kellicotti
- What is it
- Intermediate host
- Life cycle
- Lesions
- Diagnosis
- Treatment
- Trematode of the lung
- Crayfish
- Migrates through diaphragm and adult goes into sub pleural space
- Bullae and cysts
- ova in lavage fluid or sedimentation techniques
- Fenbendazole or praziquantel
Filaroides
- What is it
- Intermediate host/transmission
- Life cycle
- Lesions
- Diagnosis
- Treatment
- Pulmonary nematode
- Direct faecal-oral transmission
- Alveolar space and terminal bronchioles
- Bronchointerstitial or alveolar pattern
- lavage, faecal flotation
- fenbendazole, ivermectin
Aulurostrongylus
- What is it
- Intermediate host
- Life cycle
- Lesions
- Diagnosis
- Treatment
- Feline pulmonary nematode
- Mollusc
- Mature live in bronchioles
- Bronchial pattern?
- airway lavage, sedimentation
- fenbendazole, ivermectin, selamectin
Crenosoma vulpis
- What is it
- Intermediate host
- Life cycle
- Lesions
- Diagnosis
- Treatment
- Pulmonary nematode
- Mollusc
- Adult in airways
- Bronchointerstitial?
- Lavage, sedimentation or flotation
- Fenbendazole, ivermectin, milbemycin
Oslerus osleri
- What is it
- Intermediate host
- Life cycle
- Lesions
- Diagnosis
- Treatment
- Pulmonary nematode
- Direct oral-faecal
- Granulomas in distal trachea and proximal bronchi
- flotation or bronchocopic visualisation of lesions
Eucoleus aerophilus (Capillaria aerophilia)
- What is it
- Intermediate host
- Life cycle
- Lesions
- Diagnosis
- Treatment
- Pulmonary nematode
- None, direct LC
- Tracheal and bronchial mucosal eosinophilic pneumonia
- Flotation > semintation
- fenbendazole, ivermectin
Troglostrongylus
- Feline pulmonary nematode
What types of bacteria generally result in bacterial pneumonia?
Enteric bacteria
What is the ISCAID recommended treatment duration for bacterial lower respiratory tract infection?
1 week beyond resolution of clinical signs.
Treatments to consider in pneumonia patients that are not responding well to antibiotics and oxygen therapy?
Bronchodilators
Mucolytics (e.g. NAC)
Safety pin shaped bipolar gram negative rod
Yersinia pestis
Which bacteria causes a necrotising haemorrhage pneumonia?
Streptococcus equi zooepidemicus
Why can giving albumin therapy be detrimental to patients suffering pulmonary oedema?
Protein may leak into the alveolus if the alveolar wall is damaged which would worsen pulmonary oedema.
Diagnostic cut off for pulmonary hypertension
- PA Systolic pressure
- PA diastolic pressure
- Tricuspid regurgitant jet
- > 25-30mmHg
- > 19mmHg
- > 46mmHg (or velocity >3.4m/s)
What are the pathophysiologic factors (3) that can cause pulmonary vascular remodelling and therefore pulmonary hypertension?
Increased pulmonary blood flow
Increased pulmonary vascular resistance
Increased pulmonary vascular pressure
What are the mechanisms by which nasopharyngeal stenosis can occur in cats?
Congenital - similar to human choanal atresia (rare)
Acquired - secondary to inflammatory disorders
How is nasopharyngeal stenosis treated?
If the membrane is small then surgical removal via incision of the soft palate may be best, if changes are extensive then balloon dilation or expandable metallic stents can be considered
Why is the total protein of chylous effusions potentially higher than would be expected?
Lipids will falsely increase the TP measurement if measured with a refractometer
What are the main Ddx for chylothorax in a cat?
The primary differential diagnosis to consider for chylothorax in the cat is con- gestive heart failure secondary to hypertrophic cardiomyopathy. Additionally, cranial mediastinal neoplasia (e.g., thymoma, lymphoma, or thyroid tumor), pericardial effu- sion, diaphragmatic herniations, or heartworm disease can cause increased venous hydrostatic pressure and subsequent chylous effusion. Chylothorax in the cat has also been reported to occur secondary to thoracic trauma and intrathoracic surgery or can be idiopathic
