Respiratory disease Flashcards by Ben Safrany

What diagnosis is strongly correlated with paradoxical breathing?

Pleural space disease

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What breed is associated with congenital laryngeal malformation?

Norwich Terrier

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Which breeds are associated with feline asthma?

Siamese
Havana

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Ddx cough

Airway narrowing during expiration
Pleural space disease (D>C)
Cardiomegaly
Intrinsic airway narrowing secondary to dynamic small airway disease
Bronchitis
Asthma
Tracheal collapse
Restrictive lung disease

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What are the possible causes of a restrictive breathing pattern?

Bronchopneumonia
Pulmonary fibrosis
Pleural space disease

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What are the CT findings consistent with IPF?

Ground glass opacities, parenchymal bands, honeycombing, peribronchial vascular interstitial thickening, traction bronchiectasis with predominantly sub pleural distribution

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How is lung scintigraphy performed depending on the region of interest?

IV radionucleatides - perfusion
Inhaled radionucleotides - ventilation
Simultaneous - ventilation/perfusion ratio

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What is the most sensitive and specific test for documenting PTE?

Scintigrophy

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Ddx hypoxaemia

Low partial pressure inspired oxygen, alveolar hypoventilation, ventilation-perfusion inequality, R => L shunt, diffusion impairment

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What PaO2 is consistent with hypoxaemia?

<80mmHg

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What upper airway abnormality has been described to develop secondary to IPF in WHWT?

Tracheal collapse

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What other imaging findings are commonly associated with cranial lung lobe herniation?

Collapse of intrathoracic trachea and major bronchi
Redundant dorsal tracheal membrane

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What tracheal tumours are found in a) young dogs and b)older dogs and cats?

a) Osteochondroma
b) MCT, SCC, adenocarcinoma, OSA, extra medullary plasmacytoma, leiomyoma, fibrosarcoma

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What are the causes of parasitic tracheal granuloma in a) dogs and b) cats

a) Oslerus osleri, FIlaroides
b) Cuterebra

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What are the limitations of culture and PCR for diagnosing bordetellosis in dogs?

Bb has been regularly isolated from healthy dogs by culture and PCR of upper airways and lungs
Positive could be incidental, indicate carrier state or infection

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What is the characteristic cytological finding in bordatella infection?

Pleomorphic cocci or coccobacilli adhering to cilia of epithelial cells

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What is the treatment of choice for bordetella infection? What about in unresponsive cases?

Doxycycline
Nebulised gentamicin

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How is chronic bronchitis defined?

Chronic airway inflammation without any identifiable primary cause

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What are the diagnostic criteria of chronic bronchitis?

Chronic cough
Evidence of excessive mucus
Exclusion of other chronic cardiopulmonary disease

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Which breeds are predominantly associated with eosinophilic bronchopneumopathy

Huskies and Malamutes

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What abnormalities can be seen in association with primary ciliary dyskinesia?

Otitis media, infertility in females, asthetoteratospermia in males, hydrocephalus, renal fibrosis or dilation of renal tubules
Situs inversus

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What is bronchiectasis?

Abnormal and permanent dilation and distortion of sub segmental airways, resulting from chronic inflammation damaging the elastic components of the bronchi. Leads to bronchial wall destruction and impaired clearance of secretions

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What causes bronchiectasis?

Usually secondary to acquired disease - aspiration, inhalation injury, chronic infections, bronchopneumonia, eosinophilic bronchpneumopathy, chronic bronchitis, possibly allergic bronchopulmonary aspergillosis
Cats - chronic bronchial inflammation

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What age and breeds are predisposed to bronchiectasis?

American Cocker Spaniel, Poodles, Siberian Husky and English Springer Spaniels
≥7yo

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What are the CT findings of bronchiectasis?

Abnormal bronchial dilation, with lack of tapering and identification of distinct airways within 1cm of pleural surface. Secondary features - bronchial wall thickening, mucus plugging and peripheral air trapping

What is bronchomalacia?

Weakness of walls of principal/small bronchi, leading to collapse

What types of bronchomalacia are described? What are they associated with?

Static - brachycephalics Dynamic - tracheal collapse (tracheobronchomalacia)

What is the difference between feline asthma and chronic bronchitis?

CB - secondary to previous insult causing permanent airway damage Asthma - allergic

What infections can be associated with feline bronchial disease?

Mycoplasma Aerulostorngylus and Trogostorngylus

What has potential as a biomarker of feline asthma?

BALF endothelin-1

What is the most common cause of spontaneous pneumothorax in cats?

Asthma

How does respiratory distress caused by parenchymal disease most often present?

With increase in both inspiratory and expiratory effort

What is the function of BNP?

Promotes natriuresis, increases GFR, causes vasodilation, antagonises RAAS in animals with increased extracellular fluid volume

What causes BNP to increase?

Volume overload, PHT, cardiac dysfunction

What is a non-cardiorespiratory cause of BNP elevation?

Azotaemia

What is Paragonimus kellicotti? How is it spread? How does it present? How is it diagnosed? How is it treated?

Trematode lung fluke Eating crayfish Eosinophilic and neutrophilic inflammation, bullae and cysts Demonstrating ova in airway lavage fluid or in faeces Fenbendazole/praziqunatel

What lungworms are reported in dogs and cats?

Paragonimus kellicotti (trematode lung fluke) - D+C Filaroides - D Aelurostrongylus abstrusus - C Crenosoma tuples - D Oslerus osleri Eucoleus aerophilus (Capillary aerophila) - D+C Trogostrongylus - C Dirofilaria (D+C) Angiostrongylus vasorum - D

Which parasites infect the pulmonary parenchyma?

Paragonimus kellicotti and filaroides

How is filaroides transmitted?

Direct fecal-oral transmission

What contributes to the pathogenicity of bordetella?

Secretion of exotoxins which disrupt the mucociliary escalator

What illness is causes by strep equi subspecies zooepidemicus? Which species are affected?

Haemorrhagic pneumonia. Dogs and cats

What is a ddx for feline pneumonia in midwestern and far western USA?

Yersinim pestis (plague)

What are the natural hosts of yersinia pestis?

Rodents spread by ingestion or transmitted by fleas

How does yersinia pestis present?

Suppurative lymphadenitis Can develop into septicaemia or secondary pneumonic form

How is yersinia pestis treated?

Aminoglycosides, fluoroquinolone, chloramphenicol and tetracyclines have all been used

What two influenza strains have been implicated in outbreaks in dogs?

H3N8 H3N2

Which breeds are associated with pneumocystis carinii infection?

Miniature dachshunds and CKCS

What immunodeficiency is associated with pneumocytosis?

CKCS - IgG Miniature Dachsunds and Pomeranians - common variable

Which lung lobe is most effected by aspiration pneumonia?

Right middle, right cranial and caudal portion of left cranial

What is the pathogenesis of non-cardiogenic pulmonary oedema?

Increased vascular permeability following lung injury Damaged epithelial cells are unable to pump NaCl across the epithelial cell to resolve oedema

How do cardiogenic and non-cardiogenic oedema fluid differ?

NCO fluid higher protein

Why is hypoalbuminaemia not a common cause of pulmonary oedema?

Pulmonary lymphatics are very efficient

What are the possible causes of non-cardiogenic pulmonary oedema?

Neurogenic (seizures, electrocution, head trauma) Postobstructive Systemic disease (sepsis, shock, pancreatitis, babesiosis, paraquat poisoning, envenomation, gastric/splenic/mesenteric torsion, parvovirus, uraemia) Pulmonary injury (aspiration pneumonia, bacterial pneumonia, lung lobe torsion, smoke inhalation) Miscellaneous (near drowning, altitude, pheochromocytoma)

What is pulmonary lymphomatous granulomatosis? How is it diagnosed?

Lymphoproliferative cancer Atypical cells infiltrate around and destroy blood vessels Biopsy needed to diagnose

What is the prognosis for pulmonary lymphomatous granulomatosis?

Durable remission possible Recurrence of pulmonary involvement or development of lymphoma can occur months to years after treatment

Which lung lobe is most commonly affected by malignant histiocytosis?

Right middle

Do dogs or cats get primary lung neoplasia most often?

Dogs

What is the most common primary lung tumour?

Adenocarcinoma

Which lung lobes are most often affected by solitary nodular tumours (other than histocytic)?

Caudal lung lobes

What gender and breeds are predisposed to eosinophilic pneumonia?

Females Siberian Husky, Alaskan Malamute, Rottweiler

What respiratory disease in dogs is associated with loud inspiratory crackles?

Idiopathic pulmonary fibrosis

What radiographic finding is a negative prognostic indicator following drowning?

Sand bronchograms

What PaO2:FiO2 ratio is associated with severe respiratory compromise?

<300

What are: a) Bullae b) Blebs c) Pulmonary cysts

a) Air pocket resulting from destruction of alveolar walls and confluence of adjacent alveoli. Not lined with epithelium b) Accumulations of air escaped from the lung trapped within the visceral pleura. Always found on rung surface c) Lined with pulmonary epithelium

What are the causes of bullae?

Idiopathic, parasitic, neoplastic, infectious, congenital (bronchopulmonary dysplasia)

What breeds are overrepresented for lung lobe torsion?

Pugs and Afghan Hounds

What are the CXR findings in lung lobe torsion?

Pleural effusion +/- abnormal bronchus position Narrowed proximal bronchus Vesicular gas pattern

Which lung lobe is most commonly affected by torsion?

Left cranial and right middle

What are the inducers of pulmonary vasoconstriction?

Hypoxia Endothelin-1 Serotonin

What is the stimulus for endothelin-1 release? What are its effects?

Changes in blood flow, vascular stretch, increased thrombin Smooth muscle growth, collagen synthesis, vascular remodelling

What conditions are associated with increased endothelin-1 concentrations?

Heartworm Left heart disease

What effects do prostacyclin and thromboxane A2 have on pulmonary artery cells?

Prostacyclin - vasodilator, platelet inhibitor, anti proliferative effects Thromboxane A2 - vasoconstrictor, platelet activator

How does nitrous oxide cause vasodilation?

Activates cGMP - vasodilation

What test can be useful in ruling out a PTE?

D-dimers

What clinical findings are considered highly suggestive of PHT?

Syncope Respiratory distress at rest Activity/exercise terminating in respiratory distress R-CHF

How is pulmonary artery pressure estimated?

Modified Bernoulli equation PG = 4xTRV-squared Estimated RA pressure + PG = PAP

What factors alter TRV?

PAP PVR RV function Pericardial restraint

What is the primary metric used to estimate PAP in dogs?

TRV

How can PHT secondary to left heart disease be diagnosed?

Evidence of PHT + documentation of LHD + LA enlargement

What condition could potentially cause PHT secondary to LHD, with an elevated PAWP without LA enlargement?

Acute onset LHD (eg chord tendineae rupture)

Describe the classification system for PHT?

Consensus pg 6

Ddx chylothorax

Idiopathic (>50%) Cardiac disease Cranial vena caval thrombus or mass Heartworm disease Neoplasia

In dogs, which lung lobes are most commonly affected by bullous lesions?

Left cranial, right cranial

What clinical signs are associated with mediastinitis?

Tachypnoea, dyspnoea, cough, head/neck oedema, regurgitation