Respiratory Disease

Question 1

Most common causes of coughing

Answer 1

Acute or Chronic Bronchitis
Asthma (especially cats)
Tracheal/airway collapse or compression
Airway obstruction
Left sided congestive heart failure
Parenchymal lung disease (neoplasia, pneumonia, infectious)

Question 2

True or False:

Heart murmur + cough = heart failure

Answer 2

FALSE

Question 3

True or False:

Heart murmur + crackles does NOT = heart failure

Answer 3

TRUE

Question 4

Stertor and Stridor

Answer 4

Discontinuous sounds and wheezes heard WITHOUT a stethoscope

Localizes airway disease above thoracic inlet

Normal sound in brachiocephalic dogs

Question 5

Crackles

Answer 5

Nonmusical, discontinuous sounds (crumpled paper)

Inspiratory crackles = airway disease
End-inspiration/initial expiration = parenchymal disease

Question 6

Wheezes

Answer 6

Musical, continuous sounds

Airway or bronchial constriction/narrowing

Only diagnosed with stethoscope

Question 7

Respiratory Exam

Answer 7

Most patients with parenchymal disease are often sick (systemic, pneumonia, CHF, neoplasia)

Pateitns with parenchymal disease are often tachypenic (decreased O2 exchange)

Pronounced inspiratory effort with airway diseases

Crackles throughout inspiration; airway/bronchial disease

Normal heart rate than NOT CHF (usually have sinus tachycardia)

Respiratory effort = airway disease

Question 8

Extrathoracic PE findings

Answer 8

Noisy breathing
Stertor/Stridor
Do NOT need stethoscope to hear respiratory sounds

Question 9

Intrathoracic (end bronchiole, parenchyma/alveoli)

PE findings

Answer 9

Tachypnea (could see open mouth breathing)
Soft cough
Soft crackles
Harsh/quite sounds (stuff in the parenchyma)
End-Inspiratory
+/- expiratory

Need stethoscope to hear the abnormalities

Question 10

Intrathoracic (Trachea/bronchi)

PE Findings

Answer 10

Loud/harsh cough
Terminal gag 
Crackles/wheezes
Inspiratory phase
Can palpate trachea and elicit a cough
Productive cough

Need stethoscope to hear abnormalities

Question 11

Thoracic Inlet Disease DfDx

Answer 11

Stenotic nares 
Brachiocephalic syndrome
Laryngeal paralysis
Rhinitis
Pharyngeal disease or obstruction
Tracheal collapse (cervical)
Airway obstruction above TI (masses, toy, stick)

Question 12

Intrathoracic Disease DfDx

Answer 12

Canine chronic bronchitis/COPD types a, b
Tracheal collapse below TI
Feline bronchitis (asthma)
Allergic bronchitis
Infectious tracheobronchitis
Airway compression or inflammation (masses)

Question 13

Parenchyma disease

Radiographic Findings

Answer 13

Diffuse interstitial pattern

Question 14

Parenchymal Disease

DfDx

Answer 14

Pneumonia (bacterial, mycotic, viral)
Pulmonary neoplasia
Pulmonary Edema 
Non-cardiogenic edema (ARDS)
Asthma, end-bronchiolar constriction
Eosinophilic lung disease
Toxoplasmosis
Lung contusion
Pulmonary parasites 

Note: often tachypneic and ill

Question 15

Pleural Space Disease

What is it?

Answer 15

Restrictive airway disease (lungs cannot fully expand)

Between chest wall and lung

Both inspiratory and expiratory effort

Tachypnea

Question 16

Pleural Space Disease

DfDx

Answer 16

Restrictive airway disease

Pneumothorax
Pleural effusion (see fluid line, quite lung sounds)
Pericardial effusion (compression of lungs)
Intrathoracic mass
Extrathoracic compression (ascites)

Question 17

Tachypnea

DfDx

Answer 17

Respiratory disease
Anemia
Methemoglobinemia (toxins)
Acidosis
Pain
Neurologic disease

Question 18

Cough; Heart? Lung?

History

Answer 18

Heart Failure:
Cough with exercise or excitement
Soft cough with tachypnea
Decrease in activity/lethargy 
Weight loss/inappetence 

Airway Disease:
Cough with exercise/excitement
Loud or honking +/- terminal gag
No activity change
No weight loss

Question 19

Cough; Heart? Lung?

PE/auscultation

Answer 19

Heart Failure:
Tachypnea/dyspnea
Increased effort and crackles (end-inspiratory and expiratory) 
Murmur, usually mitral
Heart rate; elevated (sympathetic tone) 

Airway disease:
No tachypnea 
Increased inspiratory effort
\+/- crackles (inspiratory) or normal lung sounds
\+/- murmur
Heart rate; normal to slow (vagal tone)

Question 20

Cough; Heart? Lung?

ECG

Answer 20

Heat failure:
Sinus tachycardia (sympathetic tone), rapid arrhythmias
+/- p mitrale (wide P wave)

Airway Disease:
Pronounced respiratory arrhythmia (vagal tone)
Normal to slow HR
+/- P pulmonale

Question 21

Cough; Heart? Lung?

Thoracic Radiographs

Answer 21

Heart Failure:
Cardiac enlargement (LA)
Interstitial edema (adjacent to large vessels and hilar region)
Venous distension

Airway Disease:
\+/- cardiac enlargement 
Bronchial infiltrate, doughnuts
Airway collapse
Normal radiographs

Question 22

Cough; Heart? Lung?

Bronchial wash

Answer 22

Heart Failure:
Normal cytology

Airway Disease:
Inflammatory or other infiltrate

Question 23

Cough; Heart? Lung?

Medical therapy

Answer 23

Heart Failure:
Diuretic responsive

Airway Disease:
Incomplete or non-responsive to diruetics

Question 24

Airway Disease
Above TI and Below TI
Clinical Signs

Answer 24

Above TI:
Noisy breathing
Inspiratory effort much greater then expiratory
Sterdor/Stridor

Below TI:
Harsh cough, gag, +/- wheeze
Inspiratory greater than expiratory effort
Crackles/Wheezes

Question 25

Parenchyma and End-terminus bronchiole

Clinical Signs

Answer 25

Cough, soft
Tachypnea
Potentially ill

Increase effort both phases or expiration greater than inspriation

Crackles (end of inspiration)
Harsh, quieter lung sounds

Question 26

Restrictive Airway Disease

Clinical signs

Answer 26

Tachypnea
Ill
Inspiratory and Expiratory effort

Potentially normal lung sounds or muffled lung sounds