Respiratory Disease Overview Flashcards
Does a heart murmur + cough = heart failure?
- NO NO NO
Does a heart murmur + crackles = heart failure?
- NOPE NOPE NOPE
- Signalment of mitral valve disease is the same as those with chronic bronchitis
Is night cough helpful to differentiate pulmonary disease from heart failure?
- NO
Dyspnea
- Difficult, labored, painful breathing
Tachypnea
- Increased rate
Orthopnea
- Difficulty while recumbent
Bronchial sounds
- Tubular sounds
- Normal
Vesicular sounds
- Soft, breezy sounds
- Normal!
Where are stertor and stridor heard?
- Discontinuous sounds and wheezes heard without a stethoscope
- Typical for airway disease above the thoracic inlet
- Larynx, pharynx, trachea, etc.
Where are crackles heard?
- Airways and parenchyma
What are crackles?
- Nonmusical, discontinuous sounds like crumpled paper
What do inspiratory crackles often signify?
- Airway disease
What do end-inspiration/initial expiration crackles often signify?
- Parenchymal disease
What are wheezes?
- Musical, continuous sounds
Where do wheezes often help you localize?
- Almost always airway or bronchial constriction
What should be a part of your general examination for respiratory disease?
- Signalment
- History
- observation
- Physical exam
Parts of signalment
- Age
- Breed/species specific
Important history questions
- Presenting complaint, onset, duration, progression?
- Is the pet coughing? Frequency? Character? Gagging?
- Is there fast or heavy breathing or excessive panting?
- Episodes of weakness or collapse?
- What medications are being administered? When? how much? response?
Things to observe?
- Mentation
- Respiratory pattern
- Conformation
What are important things to consider for a respiratory examination?
- Is the patient ill?
- Respiratory rate?
- Respiratory effort?
- Abnormal sound? What phase of respiration?
- Heart rate?
What are some characteristics of patients with parenchymal disease?
- Often sick
- Often tachypneic due to oxygen exchange impairment
Pronounced inspiratory effort - what does that imply?
- Airway disease
If a patient with crackles has a normal heart rate, what should you try to rule out?
- NOT consistent with CHF
- Sympathetic tone disease with CHF
- Elevated heart rate is consistent with CHF
Extrathoracic disease PE findings
- Noisy breathing
- Stertor or stridor
- Inspiratory
Intrathoracic trachea or bronchial PE findings
- Loud/harsh cough
- Terminal gag**
- Crackles and wheezes
- Inspiratory phase
Intrathoracic end bronchiole/parenchymal/alveolar disease PE findings
- Tachypnea
- Soft cough
- Soft crackles
- Harsh or quiet sounds
- End inspiratory
- +/- expiratory
- Often not a gag
Dfdx for airway disease above the thoracic inlet
- Stenotic nares, brachiocephalic syndrome
- Laryngeal paralysis
- Rhinitis
- Pharyngeal disease or obstruction
- Tracheal collapse (cervical)
- Any airway obstruction above thoracic inlet (masses, etc.)
Dfdx for airway disease below the thoracic inlet
- Canine chronic bronchitis or COPD types A and B
- Tracheal collapse below the thoracic inlet
- Feline bronchitis (asthma)
- Allergic bronchitis
- Infectious tracheobronchitis
- Airway compression or inflammation (masses, etc.)
Radiographs of patients with diseases of the lung parenchyma
- Generally have a radiographically apparent disease
Dfdx for parenchymal diseae
- Pneumonia (mycotic, viral, bacterial, parasitic, aspiration)
- Pulmonary neoplasia
- Pulmonary edema
- Non-cardiogenic edema (ARDS, electrocution, etc.)
- True asthma; end-bronchiolar constriction
- Eosinophilic lung disease
- Toxoplasmosis
- Lung contusion
- Pulmonary parasites
What are key features of parenchymal disease?
- Tachypnea
- Illness
What broad category of disease is implied with restrictive lung disease?
- Pleural space disease
Dfdx for restrictive airway disease
- Pneumothorax
- Pleural effusion
- Pericardial effusion
- Intrathoracic mass
- Extrathoracic compression (e.g. severe ascites)
Restrictive breathing pattern
- Inspiratory and expiratory effort
- Tachypnea
What are other miscellaneous causes of tachypnea associated with normal lung sounds and normal radiographs?
- Anemia
- Methemoglobinemia
- Acidosis
- Pain
- Neurologic disease
What history suggests heart failure? (Asterisks are specific to heart failure)
- Cough with exercise or excitement
- Soft cough with tachypnea**
- Decrease in activity or lethargy*
- Weight loss/inappetence
What PE suggests heart failure? (Asterisks are specific to heart failure)
- Tachypnea/dyspnea**
- Increased effort AND crackles (end-inspiratory and expiratory)**
- Murmur, usually mitral
- Heart rate is elevated due to sympathetic tone**
ECG suggesting heart failure
- Sinus tachycardia due to sympathetic tone
- Rapid arrhythmias
- +/- p mitrale, other QRS complex
Thoracic radiograph findings of heart failure
- Cardiac enlargement (LA especially)
- Interstitial edema, adjacent to large vessels and hilar region
- Venous distension
Bronchial wash suggesting CHF
- Normal cytology
Medical therapy suggesting CHF
- Diuretic responsive
History suggesting airway disease (asterisks specific to airway disease)
- Cough with exercise or excitement
- Loud or honking +/- terminal gag***
- No activity change
- No weight loss
PE suggesting airway disease (asterisks specific to airway disease)
- No tachypnea** (unless disease complicated)
- Increased inspiratory effort**
- +/- crackles* (inspiratory) or normal lung sounds
- +/- murmur
- Heart rate is normal to slow due to vagal tone***
ECG with airway disease
- Pronounced respiratory arrhythmia (vagal tone)
- Normal to slow HR
- +/- P pulmonale
Thoracic radiographs with airway disease
- +/- cardiac enlargement
- Bronchial infiltrate, doughnuts or tram lines
- Airway collapse
- Normal
Bronchial wash with airway disease
- Inflammatory or other infiltrate
Medical therapy with airway disease
- Incomplete or non-responsive to diuretics
If there is cross-over of multiple diseases, how can you help differentiate the initial disorder?
- Often characteristics of the initial disorder predominate
Examples of diseases with multiple locations impacted
- Chronic bronchitis with 2° interstitial pneumonia
- Emphysematous airway disease with interstitial fibrosis
- Interstitial pulmonary edema may eventually flood large airways
General principles to localize disease
- SEE CHART in notes
- SUPER HELPFUL
Initial diagnostics for respiratory disease
- Thoracic +/- cervical radiographs
- Localize to an organ system, e.g. cardiac, pulmonary, airway, pleural, mediastinal disease
- Narrow list of dfdx
- Formulate a specific diagnostic plan
What can limit the efficacy of thoracic radiographs?
- Taking radiographs of the affected area
What blood and urine tests should be considered for respiratory disease?
- CBC/Chem/Urinalysis
Cytologic assessment of respiratory disease
- Tracheal wash
- BAL
- Bronchoscopy
- Transthoracic aspiration
Pulmonary function testing
- Arterial blood gas
- Pulse ox
- Nuclear imaging
Serologic tests to consider for respiratory disease
- HW antigen/antibody testing
- Fungal titers
- Toxoplasmosis
Fecal tests to consider for respiratory disease
- Flotation
- Baermann
- Sedimentation
Other tests to consider for respiratory disease
- Ultrasonography
- Echocardiogram
- Endoscopy
- Surgical biopsy
