Respiratory Disease Flashcards
1
Q
Effect of lower airway disease on breathing pattern
A
Inspiratory phase is shorter than expiratory (normally this is reversed)
2
Q
Effect of upper respiratory tract on breathing pattern
A
Slow respiratory rate and exaggerated inspiratory effort (longer phase)
3
Q
Effect of pleural disease on breathing pattern
A
Inspiratory and expiratory effort increased
4
Q
Effect of lower respiratory restrictive disease (e.g. IPF, pleural effusion) on breathing pattern
A
Fast shallow breaths
5
Q
Tachypnoea
A
Increased respiratory effort
6
Q
Hyperpnoea
A
Increased respiratory rate
7
Q
Orthopnoea
A
Dyspnoea in any position other than standing or erect sitting (usually due to bilateral pulmonary oedema)
8
Q
Trepopnoea
A
Dyspnoea in one lateral recumbency but not the other (unilateral lung or pleural disease, or unilateral airway obstruction e.g. unilateral pleural effusion)
9
Q
Abnormal sounds that occur due to narrowing of airways
A
Wheeze (high pitched) and rhonchi (low pitched)
Most commonly on expiration, can be on inspiration
10
Q
Cell type in bronchiole epithelium
A
Clara cells
11
Q
What does the respiratory portion of lungs consist of?
A
Respiratory bronchioles
Alveoli
Simple squamous epithelium and scant loose connective tissue
12
Q
Main clinical sign with airway disease
A
Cough
13
Q
Disease of which lung structures cause breathlessness?
A
Interstitial tissue
Alveoli
14
Q
The 4 causes of respiratory distress
A
URT
Pleural space
Lung
Non-CRS
15
Q
Characteristics of URT disease
A
Inspiratory difficulty
Audible noise
(May be cyanosis/cough)
16
Q
Characteristics of pleural space disease
A
Characteristic respiratory pattern
Muffled heart and lung sounds?
(May be cyanosis/cough)
17
Q
Management of URT disease
A
Mostly surgical
Emergency tracheostomy
18
Q
Management of pleural space disease
A
Ultrasound thorax
Remove fluid
19
Q
Characteristics of lung disease
A
Alveolar (blood/pus/parasites) or interstitial
(May be cyanosis/cough)
20
Q
Characteristics of non-CRS conditions causing respiratory disease
A
Often open-mouth, panting, rapid, shallow breathing
Rarely severe difficulty
21
Q
Differentials for non-CRS breathing difficulty
A
Hyperthermia/heat stroke/fever
Obesity
Excitement/stress/pain/fear
Parturition/false pregnancy/eclampsia
Anaemia/abnormal haemaglobin
Acidosis
CNS disease
Endocrine disease (HAC, steroid treatment, Hyperthyroidism
Neuromuscular disease
Pulmonary thromboembolism
22
Q
Clinical presentation of pulmonary thromboembolism
A
Acute onset dyspnoea
Few radiographic signs
Hypercoagulable state
Pulmonary hypertension
23
Q
Pathophysiology of cyanosis
A
Severe hypoxaemia (<80% saturation of arterial blood), colour comes from desaturated haemoglobin
24
Q
Actions to take when cyanosis is present
A
Auscultate lung, trachea and heart with stethoscope to identify upper/lower respiratory tract disease
Cool animal and reduce stress/movement to reduce oxygen demand
Oxygen supplementation
25
Long term management of cyanosis brought on by moderate heat
Weight loss
BOAS surgery
26
What is paradoxical respiration and what is its significance?
Movement not synchronous
Means there is respiratory disease, not just exertion/stress
27
How do you manage a dog that presents with respiratory distress?
Signalment/clinical history
Observe patient (emergency or clinically stable?)
Breathing pattern (inspiratory and expiratory phases)
Respiratory pattern (rate/effort)
Thoracic examination (palpation, auscultation, percussion)
Investigations (clinical exam, haem/biochem, imaging, tracheal wash/bronchoscopy/BAL, lung FNA/biopsy)
28
Management of a cat with dyspnoea showing abdominal breathing
(Abdominal breathing indicates pleural effusion)
Auscultate lungs and heart
Lung percussion
Radiograph (conscious DV)
Thoracocentesis
29
Is bacterial pneumonia more common in dogs or cats?
Dogs
30
What is always an emergency in cats?
Mouth breathing
31
How should a cat in respiratory stress be managed?
Hands off assessment
Oxygenation in oxygen cage
32
Signs of upper airway disease in the cat
Laboured inspiration (stridor, increased effort, slow inspiratory phase)
Change in purr/vocalisation
Dysphagia +/- salivation
Coughing/gagging
'Head shaking'
33
Signs of lower airway disease in the cat
Laboured expiration (prolonged expiratory phase, audible expiratory push/wheeze)
Increased airway resistance (bronchospasm, mucus, bronchial wall thickening)
Occasional paroxysmal cough
34
What is feline asthma?
Airway hyperreactivity (bronchoconstriction) to inhaled allergen
Reversible
35
Clinical signs of feline asthma
Episodic respiratory distress/dyspnoea
Coughing
36
Cell type involved in airway inflammation in feline asthma
Eosinophils
37
What is chronic bronchitis?
Reaction to infection or inhaled irritants cause airway damage and excess mucus
38
Clinical signs of chronic bronchitis (cats)
Coughing
39
Cell type involved in airway inflammation in chronic bronchitis (cats)
Neutrophils
40
Pathogenesis leading to dyspnoea in chronic bronchitis
Type I hypersensitivity of bronchial smooth muscle (autonomic and mucociliary imbalance)
Acute bronchoconstriction (response to trigger factor)
Inflammation of bronchial mucosal lining (histamine and leukotrine release)
Airway obstruction (bronchoconstriction, inflammation and mucus plugs in narrowed bronchioles)
Air trapping = destruction of alveoli
Chronic damage (irreversible)
41
Differentials for a coughing cat
URT disease
Inflammatory lower airway disease
Infectious (bacterial, parasitic, viral)
Foreign body
Neoplasia
(Heart disease rarely causes coughing in cats)
42
Differentials for hyperpnoea/tachypnoea in cats (long list)
Stress/pain/fear
CNS disease
Anaemia/hypovolaemia
Heatstroke
Cardiac disease (causing pleural effusion/pulmonary oedema)
Respiratory disease (airways/lung parenchyma)
Pleural space disease
Mediastinal disease
Ruptured diaphragm
Peritoneal pericardial diaphragmatic hernia
43
Feline lungworm parasite
Aelurostrongylus abstrusus
44
Prepatent period of Aelurostrongylus abstrusus
1-2 months
45
How do cats become infected with Aulurostrongylus abstrusus?
Eat paratenic host (rodent/bird)
46
Clinical presentation of feline lungworm
Most infected cats are asymptomatic
Usually young cats
Mild coughing, sometimes dyspnoea
47
Diagnosis of feline lungworm
Identify L1 larvae (faecal flotation/Baermanns, airway wash analysis, false negatives can occur)
48
Treatment when there is suspected/diagnosed feline lungworm
Fenbendazole
49
Causative agents of mycobacterial pneumonia in cats
M. bovis
M. microti
50
At what stage of mycobacterial infection does pneumonia occur? (Cat)
Late (due to systemic spread)
51
Early signs of mycobacterial infection (cat)
Cutaneous (bite from infected vole/rodent)
GI (ingestion of contaminated milk)
52
Diagnosis of mycobacteria infection in cat
Histopathology
PCR
53
Important consideration with mycobacterial pneumonia
Zoonotic
54
Treatment of mycobacterial pneumonia
Rifampicin, pradofloxacin, azithromycin
~6m course as pulmonary involvement, might be controversial (compliance)
55
Differentials for eosinophilic inflammation in BAL/blind tracheal wash of the cat
Feline inflammatory airway disease (asthma/bronochitis)
Viral pneumonia
Parasitic
HES
56
Risks of bronchoscopy in the cat
Aggravating irritable airways
Moving plugs of mucus
Bronchospasm
57
What is this cat suffering from?
Congestive heart failure
Perl's stain is positive for iron (haemosiderin) in macrophages, also know as 'heart failure cells'
Feature of chronic congestion
SHOULD NOT HAVE HAD A BAL
58
Treatment of a cat in a respiratory crisis (LRT)
Oxygenate
Manage inflammation: dexamethasone IV
Manage bronchospasm: terbutaline and inhaled salbutamol
59
Terbutaline class and action
Selective B2 receptor agonist
Smooth muscle relaxant and bronchodilator
60
Why might you pre-treat with terbutaline before a cat receives a BAL?
Hyper reactive airways prone to bronchospasm
61
What should you rule out before treatment with terbutaline?
Heart disease
62
What drug class is inhaled salbutamol?
Selective B2 receptor agonist
63
Long term treatment of feline asthma/chronic bronchitis
Reduce allergens
Prednisolone (2-3w)
Inhaled fluticasone if improvement on prednisolone
Review case if no response to prednisolone (test for Mycoplasma/treatment trial, lungworm, ciclosporin)
64
What disease would you be suspicious of in this dog with nasal planum depigmentation?
Aspergillosis
65
What disease causes nasal planum depigmentation in cats (rare in dogs)?
Squamous cell carcinoma
66
Which type of cats commonly suffer from squamous cell carcinoma?
White cats with solar exposure
67
Management of nasal squamous cell carcinoma in cats
Photodynamic therapy
Planectomy (good prognosis with nose off, biopsy may cure)
Immunomodulators (imiquimod)
68
Does squamous cell carcinoma commonly metastasise?
No (metastasis rare, locally invasive)
69
Investigating a nasal neoplasia
MRI/CT
Rhinoscopy
Biopsy
70
Is aspergillosis more common in dogs or cats?
Dogs
(Rare in cats)
71
Is neoplasia or aspergillosis a more common cause of nasal disease?
Neoplasia
72
Pathogen that causes aspergillosis
A. fumigatus
73
Signalment in Aspergillosis
Medium to long nosed breeds
74
Clinical signs of Aspergillosis
Nasal discharge (mucopurulent, unilateral then bilateral, intermittent epistaxis)
Ulceration/depigmentation of nasal planum
Pain on palpation
Sneezing
Facial deformity?
Neurological signs?
75
How can Aspergillosis cause facial deformity?
Destructive to turbinates
Erode frontal bones and cribiform plate
76
How is (allergic?) rhinitis diagnosed?
Diagnosis of exclusion
Biopsy of nose may indicate allergic response
77
What disease causes laboured/noisy breathing, nasal discharge, headshaking, sneezing and difficulty swallowing in cats?
Nasopharyngeal polyps
78
The only significant larynx disease in cats
Laryngeal lymphoma
79
Canine laryngeal/tracheal diseases
Oncocytoma/rhabdomyosarcoma
Tracheal cartilaginous tumours
OSA
Fibrosarcoma
SCC
80
Management of tracheal masses
Usually benign so can be resected
81
What type of endoscope is best for rhinoscopy?
Flexible (best for flexing above palate)
82
Appearance of aspergillosis on rhinoscopy
White plaques
83
What diagnostic methods are gold standard when investigating nasal disease?
CT and rhinoscopy
84
What differentials for nasal disease may be diagnosed on CT?
Foreign body
Neoplasia
85
What differentials for nasal disease may be diagnosed on rhinoscopy?
Aspergillosis
Foreign body
86
Use of nasal radiography in nasal disease
Limited
May rule out destructive disease
87
What nasal disease can be diagnosed by serology?
Aspergillosis
88
Main causes of chronic rhinitis in cats
Tumours
Polyps
Rhinitis
Foreign bodies
89
Chronic rhinitis
Inflammation and swelling of conchae with increased mucous production and usually secondary infection, mucopurulent secretion may contain blood
(Cats)
90
What can occur in severe chronic rhinitis in cats?
Loss of conchae
91
What disease could play a role in chronic nasal inflammation in cats, resulting in destructive rhinitis?
Feline herpesvirus 1
92
Treatment of aspergillosis
(Challenging)
Oral antifungal agents ('azoles, prolonged treatment, not recommended due to side effects)
Topical therapy (enilconazole/clotrimazole, preferred option)
93
Delivery methods of topical therapy in aspergillosis
Catheter placement in frontal sinuses via surgery, repeated in 7-14 days
Infusion of nasal cavities under GA (minimally invasive method, more success if repeated)
94
Clinical signs of infectious respiratory disease in dogs
Nasal disease
Change in bark/meow
Conjunctiva inflammation
95
Do ocular and nasal discharge indicate URT or LRT?
URT
96
If there is a cough where can respiratory disease be localised to?
Bronchioles (site of cough receptors)
97
Systemic signs of infectious respiratory disease
Pyrexia
Depression
Lethargy
Inappetence
98
What life threatening complication can develop after infectious URT disease?
Pneumonia
99
What is 'kennel cough' referring to?
Canine Infectious Respiratory Disease complex/CIRDc
100
Specific type of cough in CIRDc
Tracheitis
101
Clinical presentation of kennel cough
Hacking cough +/- productive (may cough so much they vomit)
Submandibular lymphadenopathy
Ocular/nasal discharge
+/- Lethargy
+/- Pyrexia
102
Viruses in kennel cough
Canine parainfluenza virus/CPiV
Canine respiratory coronavirus/CRCoV
Canine adenovirus-2/CAV-2
103
How does kennel cough progress?
Initially low pathogenicity virus (CPiV, CRCoV, CAV-2)
Disrupt mucociliary escalator
Allows invasion of 'bystander'/secondary bacteria
104
What type of virus is canine parainfluenza virus?
Enveloped RNA virus
105
What type of virus is canine adenovirus-2?
Non-enveloped DNA virus
106
What type of virus is canine respiratory virus?
Enveloped RNA virus
107
Bacteria usually involved in kennel cough
Bordatella bronchiseptica
108
Significance of Bordatella bronchiseptica in a culture
Often positive and not significant, but can be significant in unwell animal and therefore is justification for antibiotics
109
Why can't a kennel cough vaccine be given to a dog who's owner is immunocompromised/pregnant?
Bordatella bronchiseptica is zoonotic
110
How long is Bordatella bronchiseptica shed following an infection?
12 weeks
111
Unusual cause of respiratory disease in dogs
Canine distemper virus (common abroad, possibly been imported)
112
What type of virus is canine distemper virus?
Enveloped RNA virus
113
How is canine distemper transmitted?
Shed in all bodily fluids
114
Clinical signs of canine distemper virus
Bronchopneumonia
Purulent ocular and nasal discharge
Haemorrhagic vomiting and diarrhoea
Neurological signs
Hyperkeratosis
Weight loss (as very unwell)
115
Does 'serological evidence = disease' in canine influenza?
No, many dogs serologically positive
116
Novel respiratory pathogens in the UK
Canine influenza
Strep equi
117
Clinical signs of canine influenza
Cough
Purulent nasal discharge
Pyrexia/pneumonia in 20% of cases
118
Strep equi clinical signs
Pyrexia
Bloody nasal discharge
Haematemesis
119
Main transmission routes for CIRD
Aerosol
120
Symptomatic treatment of respiratory disease
Avoid choke chains/pulling on collar
Clean eyes/nose
NSAIDs/steroids? (NSAIDs good for pyrexia but affects prostaglandins which are protective in lung)
Medication to stop cough and prevent further irritation (butorphanol/codeine)
Antibiotics? (Doxycycline for gram negative cover: Bordatella, Pseudomonas, Klebsiella)
121
Prevention of respiratory disease
Environmental hygiene
Dog-to-dog contact
Fomite transmission
Ventilation
Vaccination
122
Distemper vaccine
Live, subcutaneous
123
Parainfluenza vaccine
Live, subcutaneous or intranasal (combined with Bordatella)
124
How can intranasal vaccination be made easier for the dog
Cover eyes
Keep diluent out of fridge
Warm gently in palm
Trickle, don't squirt
125
What is the importance of cats using smell and taste to enjoy food?
Not hungry without sense of smell
126
How is feline herpesvirus spread?
Fomites
127
What are the long term effects of damage to nasal bones in feline herpes?
Cat flu kittens become chronic 'snufflers'
128
Clinical signs of feline herpesvirus
'Flu' signs
Ocular ulcers
Hepatic dermatitis
129
What type of virus is feline herpesvirus?
DNA virus, enveloped, stress related recrudescence
130
What feline virus does chronic rhinitis ('snuffles') follow?
'Cat flu'/feline herpesvirus
Rule out non-viral causes e.g. polyp
131
Treatment of chronic rhinitis in cats
Antibiotics? (prolonged)
Aerosol therapy
Decongestants (can't be prolonged)
Anti-virals? (specific, must know virus)
132
What type of virus is feline calicivirus?
RNA, fast evolving
133
Clinical signs of feline calicivirus
'Flu' signs
Tongue ulcers
Floppy kittens (synovitis)
Associated with Feline Chronic Gingivitis Stomatitis
134
Causative agent of Chlamydophila in cats
Chlamydia felis (intracellular bacterium like organism)
135
Transmission of Chlamydia felis
Close contact
Poor hygiene
136
Clinical signs of Chlamydophila
Can initially appear unilateral
Chemosis (swelling of conjunctiva)
137
Treatment of Chlamydophila
Doxycycline (4w), treat all in contacts
138
Predominant causative agents of 'cat flu'
FHV
Chlamydia
139
Supportive treatment for cat flu
High calorie diet (nasogastric/oesophageal tube)
Fluids
Supplement potassium (drops when not eating)
140
Possible meaning of a low head in a cat with cat flu?
Low potassium (no nuchal ligament)
141
Symptomatic treatment in cat flu
NSAIDs (hydrate to prevent kidney damage)
Nebulise with sterile water
Mirtazapine tablets
Eye drops
142
Specific anti-virals for cat flu
Famciclovir (Herpes, effective but expensive)
L-lysine?
Fusidic acid?
143
Core vaccinations for cats in the UK
Feline panleukopaenia virus
Feline herpes virus
Feline calicivirus
144
Non-core vaccines available for cats in the UK
Chlamydia felis
Bordatella bronchiseptica
Feline leukaemia virus (recommended in kittens)
Rabies virus
145
Core vaccines for cats in the UK
Feline panleukopaenia virus
Feline herpes virus
Feline calicivirus
146
Prevention of cat flu
Hygiene (disinfectants, FHV labile, FCV more resistant)
Barriers (prevent cat-cat transmission)
Ventilation
Reduce stress
Vaccinations
147
Which cat flu causative agent is resistant to quaternary ammonium compounds (disinfectant)
FCV
148
Pleural effusion presentation
Coughing
Lethargy
Inappetence
Weight loss
Sleeping on belly not side
Dyspnoea (pant at reduced exercise levels)
Increased RR
Shallow breathing
Lung sounds muffled ventrally
Sinus arrythmia and muffled heart sounds on both sides
149
Pleural effusion with protein under 25g/l, low cellularity and clear colour
Pure transudate
150
Pleural effusion with protein 25-40g/l, moderate cellularity and hazy in colour
Modified transudate
151
Pleural effusion with protein >30g/l, moderate to high cell count and opaque in colour
Exudate
152
Pleural effusion with protein >35g/l, high cell count, smelly and amber/red/yellow in colour
Pyothorax (inflammatory fluid/pus)
153
Pleural effusion that have variable protein, high cell count and is creamy/pale pink in colour
Chylothorax
154
Diagnosis of a pleural effusion
Radiography (contrast study)
Ultrasound
Thoracocentesis
155
Uses of radiography in pleural effusion
Identify fluid level for future monitoring
Establish if effusion is unilateral/bilateral before thoracocentesis
156
What does the yellow box on this DV radiograph highlight?
Retracted lung lobe (pulled back from thoracic wall when there is fluid/air in the pleural space)
Can also be seen at top of this lateral radiograph
157
What is being highlighted by the yellow boxes at the bottom of this radiograph?
Obscured cardiac silhouette and diaphragm, obscured by pleural effusion in the ventral pleural space
158
What is highlighted by this contrast study?
Thoracic duct under vertebrae is intact but some smaller duct branches more cranially are indistinct
159
How can you diagnose pleural effusion by ultrasound?
Fluid ventrally around lungs
160
Thoracocentesis equipment
Butterfly catheter in small cats/dogs (19-23G), fenestrated plastic catheter in large/obese dogs (18-22G 1/5-2.5in catheter)
Attached to three way stopcock and syringe (10-20ml)
161
Technique for thoracocentesis
Animal placed in sternal recumbency/standing
Not usually sedated
Local anaesthesia may be used (Lidocaine 2%)
Site clipped and scrubbed
Tap 7th/8th ICS, needle inserted cranial to rib to avoid intercostal vessels and nerves
162
Which tube should be used for analysis of pleural fluid cytology/cell count/TP?
EDTA
163
Medical management of chylothorax
Chest drain
Low fat diet and rutin (after discharge)
164
Surgical management of chylothorax (if medical management not successful)
Thoracotomy and thoracic duct ligation
165
Important considerations when placing a chest drain in chylothorax management
Drain enough fluid to stabilise for GA
Place chest drain on each side (technically only need one as fenestrated mediastinum but may become clogged)
Antibiotics for secondary infection
NSAIDs (chest drain painful)
166
Clinical signs of pulmonary parenchymal disease
Increased inspiratory and expiratory effort
+/- Cough (alveolar disease may not reach bronchi)
Less frequent: hemoptysis, collapse/syncope, cyanosis
167
Findings in physical exam when there is alveolar disease
Cyanosis
Crackles
Increased/decreased bronchovesicular sounds
Auscultation can be unremarkable
Signs of systemic disease: pyrexia, lymphadenopathy, lameness
168
Differentials for alveolar disease
Aspiration pneumonia
Pulmonary oedema (cardiogenic/non-cardiogenic?)
Pulmonary haemorrhage
Eosinophilic lung disease
(Pulmonary parasites)
(Pulmonary neoplasia, primary/metastatic)
(Infectious pneumonias)
169
Definitive diagnosis of lower airway disease in the dog
History (e.g. swimming, vomiting)
Other clinical signs (e.g. pyrexia = inflammatory)
BAL/trans-tracheal wash
Biopsy?
170
Aspiration pneumonia
Inhalation of material into lower airway
171
Serious aspiration events
Chemical aspiration (pneumonitis)
Large volume (drowning event)
Iatrogenic (e.g. PEG fluids in bowel prep pull interstitial fluid into lungs)
172
Is infection in aspiration pneumonia more commonly primary or secondary?
Secondary (due to damage)
173
Signs of aspiration pneumonia
Cough
Harsh/reduced lung sounds
Tachypnoea
Pyrexia
174
Alveolar pattern
Border obliteration (can't see cardiac silhouette/blood vessels)
Air bronchograms still present (airways spared)
175
Radiographic findings in aspiration pneumonia
Most commonly right middle, right cranial or left cranial lobe
Alveolar pattern
176
Is a BAL a high or low risk procedure?
Low
(20ml saline in but quickly reabsorbed so 1ml out)
177
BAL microscopy findings in aspiration pneumonia
Bacteria inside toxic neutrophils
178
Treatment of aspiration pneumonia
Supportive (oxygen, broad spectrum antibiotics, care with oxidative damage to fragile lung)
Treat underlying cause
Anti-acid medication if frequent occurrence
Metaclopramide (improve motility and increase LOS tone)
179
Lung biopsy findings in aspiration pneumonia
Airways and alveoli are full of neutrophils rather than air, airways spared
180
Conditions that can cause pulmonary oedema
Increased hydrostatic pressure
Reduced oncotic pressure
Increased vascular permeability
Impaired lymphatic drainage
181
Where is fluid accumulation in pulmonary oedema?
Interstitium and subsequently alveoli
182
What is the consequence of pulmonary oedema?
Ventilation perfusion mismatch and hypoxaemia
183
What are the types of fluid in pulmonary oedema, and which is most common?
Cardiogenic (most common)
Non-cardiogenic
184
Cardiogenic fluid protein content in pulmonary oedema
Low protein due to increased hydrostatic pressure (heart failure) without increased vascular permeability
185
What are the arrows pointing to?
Air bronchograms
(Left heart failure and border obliteration over left atrium which is elevating trachea)
186
What causes non-cardiogenic pulmonary oedema?
Lung damage increases vascular permeability so protein leaks out (high protein fluid in alveoli)
Removal of lung fluid is an active process (active transport of sodium and chloride) so damaged epithelium causes fluid build up
187
Main cause of non-cardiogenic pulmonary oedema
Pulmonary epithelial injury (choking, near-drowning, electric shock, head trauma, smoke inhalation, SIRS)
188
When should radiograph be taken after phsical lung injury to assess damage and why?
Not immediately, lag phase between injury and fluid build up
189
Most common cause of eosinophilic airway disease in dogs
Eosinophilic bronchopneumopathy
190
Most common cause of eosinophilic airway disease in cats
Reactive eosinophilic airway disease
191
Typical presentation of eosinophilic bronchopneumopathy
Coughing
Young adults
Weight loss
192
Radiographic findings in eosinophilic bronchopneumopathy
Bronchointerstitial pattern (bronchial markings: donuts/lines with clear centres, interstitial markings: aren't seen on radiograph as thin, just greying out)
Can see alveolar pattern
193
Blood finding in eosinophilic bronchopneumonia
Circulating eosinophilia (~50% of dogs, some will have hypereosinophilic syndrome)
194
Diagnosis of eosinophilic bronchopneumonpathy
Radiograph
BAL to confirm
195
Treatment of eosinophilic bronchopneumopathy
Prednisolone
196
Prognosis of eosinophilic bronchopneumopathy
Outcome good
(Guarded if other organs involved)
197
Diagnosing lower respiratory tract disease
Localise problem to lungs
Clinical exam
Thoracic ultrasound
If lung disease present on ultrasound then radiograph
198
Antibiotic selection in lower respiratory tract disease
Based on C&S but takes too long to come back
High concentration required in lung/airways
Treatment for 4-6 weeks for severe/chronic infection
Lipophilic (penetrate blood-bronchus barrier)
Bacteriocidal
199
Antibiotic choice for lower airway disease
Fluroquinolones (good penetration, good for gram -ve/moderate for gram +ve)
Amoxicillin clavulanate (penicillin with best distribution into bronchial tissue, good for gram +ve/moderate for gram -ve)
Combination of the two is best if cause unknown
200
What is Bromohexine used for?
Mucolytic: reduces mucus accumulation in chronic bronchitis and other conditions with compromised muco-ciliary clearance (increases lysosyme activity and IgA concentration)
201
What is the pleura?
Inner wall of body cavities lined by single layer of mesothelial cells
202
What do you call the pleura covering the surface of the lung?
Visceral (pulmonary) pleura
203
What is the parietal pleura made up of?
Mediastinal, diaphragmatic and costal pleura
204
How is the pleural space drained?
Rich lymphatic system
205
Pleural cavity/space
Narrow 'space' between the parietal and visceral pleura, contains serous fluid
206
Function of pleural space
Establishes adhesion
Smooth movement of lungs when breathing
Sub-atmospheric (negative) pressure allows expansion of lungs in respiration
207
Mediastinum
Space between left and right pleural sac, in midline of thorax
Continuous in most species
Contains blood vessels, nerves, oesophagus, heart and trachea
208
Why does pleural space disease cause difficulty breathing?
Accumulation of fluid, air or soft tissue causes loss of thoracic cavity and possible collapse of of lungs due to loss of negative pressure
209
Cause of pneumothorax
Rupture of major airways/lung parenchyma
Thoracic trauma (broken rib lacerates pleura/penetrating wound)
Perforation of oesophagus
Bullous ('blister' = spontaneous pneumothorax, necrotising/neoplastic lung disease)
Iatrogenic (prolonged ventilation under GA/bronchoscopy)
Gas producing bacterial infection in pleural space
210
What disease would you expect when lung percussion sounds like a 'drum', there are dull lung sounds dorsally and increased lung sounds ventrally and slow rapid breaths?
Pneumothorax
211
What is 'tension pneumothorax'?
Lesion in lung parenchyma acts as 'one way valve'
Pleural pressure rises causing severe lung compression
Pressure can exceed central venous pressure, reducing venous return and cardiac output
Rapidly life threatening
212
Why might the apex beat of the heart be displaced?
Mass in mediastinum
213
Diagnosis of pneumothorax
Physical examination
Assessment of respiratory status
Thoracic radiographs if stable enough (increased distance between heart and sternum, black around heart, collapsed lung lobes)
Thoracic ultrasound (glide sign lost)
(Routine haematology/biochemistry)
Blood gas and pulse oximetry to assess severity
214
Treatment of traumatic pneumothorax
Oxygen
Drain as necessary (avoid overdrainage)
Strict cage rest
+/- chest drain (Heimlich valve attached to thoracostomy tube)
Surgical correction if no improvement (saline in thorax, see where air leaks in)
215
Most common cause of spontaneous pneumothorax
Ruptured pulmonary bulla or sub-pleural bleb
Can occur with chronic asthma in cats
216
Management of spontaneous pneumothorax
Medical management to stabilise
Lobectomy as necessary
217
Tracheal placement and meaning
Displaced dorsally = must be mass present (hidden behind pleural effusion)
218
Mediastinal masses/lesions
Benign or malignant tumours
Cystic lesions
Enlarged mediastinal LNs
Haematomas
219
Most useful diagnostic imaging for surgical mediastinal masses
CT
220
Is diagnosis important for mediastinal disease?
Yes, it is difficult but determines treatment options (e.g. lymphoma vs. sarcoma)
221
Signalment for mediastinal lymphoma
Young cats, Siamese (50% + for FeLV)
Dogs with stage 3-5 lymphoma (negative prognostic indicator)
222
How can you identify a mediastinal mass by palpation in cats?
Squeeze cranial thorax, should be springy but if solid mediastinal mass present
223
Main differential for a medistinal lymphoma?
Thymoma
224
Diagnosis of mediastinal lymphoma
Cytology
225
Treatment of mediastinal lymphoma
Chemo +/- radiotherapy
(Remission, not cure)
226
What presents with respiratory disease +/- cranial caval syndrome +/- myasthenia gravis?
Thymoma (rare, old dogs)
(Subcutaneous oedema as no venous return from head via vena cava)
227
Do thymomas typically metastasise?
No (benign or malignant but mets rare from both)
228
Management of suspect thymoma
Thoracic radiographs to confirm presence of mass
Cytology +/- tru-cut +/- flow cytometry (diagnosis important as lymphoma is a differential and not surgical, may consider CT)
Surgical resection is treatment of choice
Excellent prognosis if fully resectable, poor in old dog with megaoesophagus (invasive)
229
How can thyroid in thorax be confirmed? (Heavy ectopic masses can sink into thorax, cats present as unresponsive hyperthyroid)
Scintigraphy (active?)
230
Pleural tumour from epithelial lining cells
Mesothelioma (rare)
231
What can be diagnosed with this pleural fluid cytology?
Mesothelioma (accumulation of neoplastic cells)
232
Rib tumours
Osteosarcomas/chondrosarcomas/overlying soft tissue tumours
Treatment via rib resection
Prognosis worse for osteosarcoma (aggressive in this location), may also require chemotherapy
233
Coughing reflex
Irritation of airways
Glottis closes
Intrathoracic pressure against closed glottis
Expel airway contents
234
How can you accurately determine from an owners history whether a dog is coughing, sneezing, retching, has dysphagia etc.?
Video
235
Diagnostic plan for a coughing dog
Imaging (radiograph/CT, bronchial pattern/LHF/FB?)
Endoscopy (FB?)
Trans-tracheal wash
Bronchoalveolar lavage
Haematology
Faecal exam (parasites)
236
Differentials for an acute cough (dog)
Tracheobronchitis ('kennel cough')
Irritation by smoke/dust/chemicals/medicines
Airway FB
Pulmonary haemorrhage
Acute pneumonia
Acute oedema
Airway trauma (choke chains/bites)
237
Differentials for a chronic cough (dog)
Chronic bronchitis/bronchiectasis
LHF
Oslerus/Aelurostrongylus/Angiostrongylus infection
Tracheal collapse
Airway FB
Bronchopneumonia
Pulmonary neoplasia (primary/secondary)
Extra-luminal mass (thyroid/abscess/lymphoma)
Eosinophilic disease
(Pulmonary fibrosis)
238
Anti-tussives
Butorphanol
Codeine
239
Canine chronic bronchitis
Daily coughing >2m
Thickening of bronchial tissue
Overproduction of airway mucus
Narrowing of airways
240
Clinical signs of chronic bronchitis
Wheezing
Productive coughing
Worse on excitement
Externally well
Exaggerated sinus arrhythmia (high parasympathetic tone)
241
Radiographic findings with chronic bronchitis
Bronchial lung pattern (tram lines and donuts)
242
What disease would you suspect in a BAL with increased mucus, non-degenerate neutrophils/eosinophils/macrophages and Cushmann's spirals (airway mucus cast)?
Chronic bronchitis
243
If there is bacteria on a chronic bronchitis BAL is this a normal finding?
No, this likely means that a bactrial infection is the cause. Immediate therapy needed as compromised resistance mechanisms
244
Management of chronic bronchitis
Weight control, harness, avoid irritants (e.g. smoking), moist environment
Glucocorticoids (inhaled/oral)
Bronchodilator therapy?
Coupage
Antimicrobials if evidence of need
245
Compare the two inhaled bronchodilators
Salbutamol: fast onset of action, cleared renally
Salmeterol: longer lasting
246
Most common inhaled glucocorticoid
Fluticasone (propionate)
247
Options for delivery of inhaled medication
Mask
Spacing device/chamber (don't have to coordinate breathing)
248
Benefits of inhaled medications in chronic airway disease
Minimal absorption into circulation so less systemic side effects
Faster onset of action
Lower dose required
249
Actions of glucocorticoids in airway
Bronchodilatory (beta 2 adrenergic)
Anti-inflammatory (inhibit prostaglandin and leukotriene synthesis)
Reduced leukocyte accumulation
Reverse increased vascular permeability
Alter macrophage function
Inhibit fibroblast growth
Modulate immune system
250
What drug class are bronchodilators?
Beta 2 agonist
251
Benefits of bronchodilators
Reduce spasm of lower airways
Decrease intrathoracic pressures
Decrease tendency of larger airways to collapse
Improve diaphragmatic function
Improve mucociliary clearance
Inhibit mast cell degranulation (reduce release of mediators of bronchoconstriction)
252
Disadvantages of inhaled medications
Expensive
Time consuming
Owner compliance
Patient compliance
253
Oral bronchodilators
Terbutaline
Theophylline
254
Pathogens involved in bacterial bronchopneumonia
(Mixed)
E. coli, Klebsiella, Pasteurella, Staphs, Streps, mycoplasma, B. bronchiseptica , Strep. equi zooepidemicus
255
Factors predisposing to bronchopneumonia
Debilitation
Prolonged recumbency
Systemic immunosuppression
Immunodeficiency
Damaged respiratory epithelium
Defective respiratory defenses
Aspiration
Airway obstruction
Systemic sepsis
Bronchiectasis
256
Top differential in a working dog with sudden onset coughing and gagging with progressive halitosis
Bronchial foreign body
257
Primary lung tumours (rare, dogs>cats)
Oral melanoma, thyroid carcinoma, osteosarcoma, haemangiosarcoma, mammary carcinoma
258
Where in the lung does metastatic neoplasia occur?
Interstitial disease
259
Complications of transthoracic FNA (ultrasound guidance)
Pneumothorax/pyothorax
Empyema
Bleeding
Seeding of neoplasia into body wall along track of needle
260
Primary cardiorespiratory parasite in metastrongyloidea family that affects young dogs (6-12m)
Oslerus osleri
261
Diagnosis of O. osleri
BAL (characteristic nodules 1-1.5cm seen via bronchoscopy at tracheal bifurcation, 2m after infection)
L1 in faeces/BAL fluid
262
Treatment of O. osleri
Fenbendazole (daily for 10d, repeat 4w later)
263
Asymptomatic parasite with same lifecycle as O. osleri
Filaroides hirthi
264
Parasite of wolves and foxes that occasionally causes chronic bronchopulmonary disease and productive cough in dogs
Crenosoma vulpis
265
Intermediate host of C. vulpis
Slugs/snails
266
What noise is heard with brachycephalic obstructive airway disease?
Stertor (reverberation of nasopharynx)
267
Primary pathophysiology factors causing brachycephalic obstructing airway disease
Stenotic external nares
Relative overlength of soft palate
Relative oversize of tongue
Tracheal hypoplasia/stenosis
Sliding hiatal hernia
268
What can be seen on this radiograph?
Tracheal hypoplasia
269
What is a secondary consequence of the negative pressure associated with upper respiratory tract disease?
Laryngeal collapse
Stage 1: laryngeal saccule eversion
Stage 2: medial deviation of cuneiform cartilage and aryepiglottic fold/collapse
Stage 3: medial deviation of corniculate process of the arytenoid cartilage or corniculate collapse
270
Describe the appearance of these nares
External nasal aperture stenosis
271
Surgical option for brachycephalic airway syndrome
Rhinoplasty (wedge-resection)
Alar fold resection (preferred)
Surgery of soft palate (partial staphylectomy)
Folded flap palatoplasty (make palate shorter and thinner)
Tonsillectomy (often included in soft palate surgery)
272
Clinical signs of idiopathic acquired laryngeal paralysis
Stridor
Cough
Dyspnoea
Change in phonation (bark)
Exercise intolerance
Collapse
(Worse when hot/excited/exercising)
273
Diagnosis of laryngeal paralysis
Clinical signs/auscultation
Laryngoscopy (light GA)
274
Emergency medical management of laryngeal paralysis
Rest/cooling
Supplemental oxygen
Sedation (low dose medetomidine)
IV access
IV corticosteroids
Tracheostomy tube placement/surgical management?
275
Sugrical management of laryngeal paralysis
Arytenoid lateralisation (tiebacl)
Needed in all cases for quality of life
276
Top differential for 'goose-honk' cough
Tracheal collapse
277
What does this radiograph show?
Trachea flattened at thoracic inlet
278
Diagnosis of collapsed trachea
Radiograph
Endoscopy (grading)
279
Medical management of tracheal collapse (usual approach)
Anti-tussives
Bronchodilators
Antibiotics/BAL to check for infection
NSAIDs
Corticosteroids (inhaled)
Bronchodilators (inhaled)
280
Surgical approaches to collapsed trachea
Open ring prosthesis (externally placed around trachea)
Stent (self-extending metal alloy, supports lumen internally)
281
Diagnosis with sneezing and these endoscopic findings
Aspergillosis
282
Nematode (family: metastrongyloidea) that is a vascular worm referred to as the 'French Heartworm'
Angiostrongylus vasorum
283
Lifecycle of A. vasorum and relevance in diagnosis
Indirect (dog definitive host and slug/snail intermediate host)
Stomach to mesenteric LNs to lymphatics to HP vein/liver to vena cava to right ventricle to pulmonary arteries (adults)
L1 coughed up and swallowed, diagnosis of L1 in faeces/BAL
284
Clinical signs of A. vasorum infection
Chronic cough
Breathlessness/exercise intolerance
Pulmonary hypertension
Coagulopathy/immune mediated thrombocytopaenia
285
Diagnosis of A. vasorum
L1 in faeces/BAL
SNAP test
Radiography (interstitial pattern)
PCR on BAL/pharynx swab
286
Products for treatment of A. vasorum
Imadocloprid and moxidectin (licenced, spot on), used for prevention
Milbemycin oxime and praziquantel (licenced, oral)
Fenbendazole (unlicenced, effective but start at low dose to reduce complications from massive worm death)
High risk: may add bronchodilators, corticosteroids, phosphodiesterase inhibitors (reduce pulmonary arterial pressure), cage rest and oxygen therapy
287
Presentation of interstitial pulmonary fibrosis
WHWT ('Westie lung')/staffies
Middle aged/older dogs, rarely cats
Insidious onset chronic breathlessness which is progressive, may be coughing/cyanosis/syncope
288
What is the 'most crackly' thing you'll hear in the lungs?
Interstitial pulmonary fibrosis
289
What lung pattern is this?
Interstitial
290
Diagnosis of interstitial pulmonary fibrosis
Interstitial lung pattern on radiograph (+/- R cardiomegaly +/- pulmonary hypertension)
CT
Definitive: lung biopsy
291
Treatment and prognosis of interstitial pulmonary fibrosis
Treatment not very effective, prognosis guarded
Symptomatic (avoid collars/smoke)
Inhaled and oral bronchodilator/corticosteroids
Additional immunosuppressives?
Manage pulmonary hypertension (phosphodiesterase inhibitors, sidenafil/Viagra, tadalafil, pimobendan)
292
What disease (associated with Herpesvirus, this is puppy) causes this severe subacute multifocal to coalescing pattern which spares the airways/alveoli?
Interstitial pneumonia
293
Most common interstitial neoplasias
Metastatic (osteosarcoma, haemangiosarcoma, thyroid carcinoma, melanoma of mucucutaneous junction)
294
What can be seen in this radiograph?
Nodular masses within interstitial tissue
(May be more diffuse interstitial pattern as in picture)
295
Treatment of metastatic interstitial neoplasia
Solitary metastatic mass removal becoming more common (CT needed)
Locally delivered chemotherapy (delivery and penetration problems)
296
Most useful diagnostic test in respiratory disease (overall)
CT/radiography
297
Indications for tracheal wash
Suspicion of large airway disease
298
Compare tracheal wash to BAL
Less sensitive
Easier
Can be carried out in conscious patient
299
Technique for tracheal wash
Clip and prep proximal trachea
Inject local between tracheal rings
Large bore catheter between rings into tracheal lumen
Long soft catheter through bore catheter into trachea, inject saline and immediately aspirate
300
Indications for bronchoscopy
Investigate unexplained clinical signs
Obtain diagnostic samples
Evaluate radiographic lung lesions
Assessment of airways
Treatment of airway disease
301
Contraindications for bronchoscopy
Hyper-responsive airways (cats with allergic bronchial disease/dogs with wheezing suggesting airway spasm)
Unstable cardiac failure/arrythmias
Tracheal obstruction
Increased haemorrhage risk
302
BAL technique
Sterilise scope
Sternal recumbency, nose parallel to table
GA (no ET tube if small, pre-oxygenate
Assess larynx/pharynx/trachea
Gently direct through airways (tracheal rings, carina, right bronchus: cranial then middle then accessory, left bronchus: cranial 2 branches then caudal)
303
Methods to collect samples on bronchoscopy
Bronchoalveolar lavage (20ml saline then immediate suction)
Surface brushing (cytology brush)
Biopsies
304
What disease can be diagnosed from this bronchoscopy finding?
Oslerus osleri
305
6y MN Siamese with 4w history of lethargy, inappetence and dyspnoea. Pleural fluid on radiograph, this is a smear from the colletced material on thoracocentesis. What is the most likely diagnosis?
Lymphoma
306
Elderly, MN, BCS 2/9
Acute breathlessness and sudden death on admission to a cat shelter. This fluid is collected from the pleural cavity. What is the likely diagnosis?
Hypertrophic cardiomyopathy
