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Cardiology and Respiratory SA Med > Respiratory Disease Overview > Flashcards

Respiratory Disease Overview Flashcards

1
Q

Does a heart murmur + cough = heart failure?

A
  • NO NO NO
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2
Q

Does a heart murmur + crackles = heart failure?

A
  • NOPE NOPE NOPE

- Signalment of mitral valve disease is the same as those with chronic bronchitis

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3
Q

Is night cough helpful to differentiate pulmonary disease from heart failure?

A
  • NO
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4
Q

Dyspnea

A
  • Difficult, labored, painful breathing
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5
Q

Tachypnea

A
  • Increased rate
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6
Q

Orthopnea

A
  • Difficulty while recumbent
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7
Q

Bronchial sounds

A
  • Tubular sounds

- Normal

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8
Q

Vesicular sounds

A
  • Soft, breezy sounds

- Normal!

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9
Q

Where are stertor and stridor heard?

A
  • Discontinuous sounds and wheezes heard without a stethoscope
  • Typical for airway disease above the thoracic inlet
  • Larynx, pharynx, trachea, etc.
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10
Q

Where are crackles heard?

A
  • Airways and parenchyma
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11
Q

What are crackles?

A
  • Nonmusical, discontinuous sounds like crumpled paper
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12
Q

What do inspiratory crackles often signify?

A
  • Airway disease
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13
Q

What do end-inspiration/initial expiration crackles often signify?

A
  • Parenchymal disease
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14
Q

What are wheezes?

A
  • Musical, continuous sounds
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15
Q

Where do wheezes often help you localize?

A
  • Almost always airway or bronchial constriction
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16
Q

What should be a part of your general examination for respiratory disease?

A
  • Signalment
  • History
  • observation
  • Physical exam
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17
Q

Parts of signalment

A
  • Age

- Breed/species specific

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18
Q

Important history questions

A
  1. Presenting complaint, onset, duration, progression?
  2. Is the pet coughing? Frequency? Character? Gagging?
  3. Is there fast or heavy breathing or excessive panting?
  4. Episodes of weakness or collapse?
  5. What medications are being administered? When? how much? response?
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19
Q

Things to observe?

A
  • Mentation
  • Respiratory pattern
  • Conformation
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20
Q

What are important things to consider for a respiratory examination?

A
  1. Is the patient ill?
  2. Respiratory rate?
  3. Respiratory effort?
  4. Abnormal sound? What phase of respiration?
  5. Heart rate?
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21
Q

What are some characteristics of patients with parenchymal disease?

A
  • Often sick

- Often tachypneic due to oxygen exchange impairment

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22
Q

Pronounced inspiratory effort - what does that imply?

A
  • Airway disease
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23
Q

If a patient with crackles has a normal heart rate, what should you try to rule out?

A
  • NOT consistent with CHF
  • Sympathetic tone disease with CHF
  • Elevated heart rate is consistent with CHF
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24
Q

Extrathoracic disease PE findings

A
  • Noisy breathing
  • Stertor or stridor
  • Inspiratory
25
Q

Intrathoracic trachea or bronchial PE findings

A
  • Loud/harsh cough
  • Terminal gag**
  • Crackles and wheezes
  • Inspiratory phase
26
Q

Intrathoracic end bronchiole/parenchymal/alveolar disease PE findings

A
  • Tachypnea
  • Soft cough
  • Soft crackles
  • Harsh or quiet sounds
  • End inspiratory
  • +/- expiratory
  • Often not a gag
27
Q

Dfdx for airway disease above the thoracic inlet

A
  • Stenotic nares, brachiocephalic syndrome
  • Laryngeal paralysis
  • Rhinitis
  • Pharyngeal disease or obstruction
  • Tracheal collapse (cervical)
  • Any airway obstruction above thoracic inlet (masses, etc.)
28
Q

Dfdx for airway disease below the thoracic inlet

A
  • 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.)
29
Q

Radiographs of patients with diseases of the lung parenchyma

A
  • Generally have a radiographically apparent disease
30
Q

Dfdx for parenchymal diseae

A
  • 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
31
Q

What are key features of parenchymal disease?

A
  • Tachypnea

- Illness

32
Q

What broad category of disease is implied with restrictive lung disease?

A
  • Pleural space disease
33
Q

Dfdx for restrictive airway disease

A
  • Pneumothorax
  • Pleural effusion
  • Pericardial effusion
  • Intrathoracic mass
  • Extrathoracic compression (e.g. severe ascites)
34
Q

Restrictive breathing pattern

A
  • Inspiratory and expiratory effort

- Tachypnea

35
Q

What are other miscellaneous causes of tachypnea associated with normal lung sounds and normal radiographs?

A
  • Anemia
  • Methemoglobinemia
  • Acidosis
  • Pain
  • Neurologic disease
36
Q

What history suggests heart failure? (Asterisks are specific to heart failure)

A
  • Cough with exercise or excitement
  • Soft cough with tachypnea**
  • Decrease in activity or lethargy*
  • Weight loss/inappetence
37
Q

What PE suggests heart failure? (Asterisks are specific to heart failure)

A
  • Tachypnea/dyspnea**
  • Increased effort AND crackles (end-inspiratory and expiratory)**
  • Murmur, usually mitral
  • Heart rate is elevated due to sympathetic tone**
38
Q

ECG suggesting heart failure

A
  • Sinus tachycardia due to sympathetic tone
  • Rapid arrhythmias
  • +/- p mitrale, other QRS complex
39
Q

Thoracic radiograph findings of heart failure

A
  • Cardiac enlargement (LA especially)
  • Interstitial edema, adjacent to large vessels and hilar region
  • Venous distension
40
Q

Bronchial wash suggesting CHF

A
  • Normal cytology
41
Q

Medical therapy suggesting CHF

A
  • Diuretic responsive
42
Q

History suggesting airway disease (asterisks specific to airway disease)

A
  • Cough with exercise or excitement
  • Loud or honking +/- terminal gag***
  • No activity change
  • No weight loss
43
Q

PE suggesting airway disease (asterisks specific to airway disease)

A
  • 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***
44
Q

ECG with airway disease

A
  • Pronounced respiratory arrhythmia (vagal tone)
  • Normal to slow HR
  • +/- P pulmonale
45
Q

Thoracic radiographs with airway disease

A
  • +/- cardiac enlargement
  • Bronchial infiltrate, doughnuts or tram lines
  • Airway collapse
  • Normal
46
Q

Bronchial wash with airway disease

A
  • Inflammatory or other infiltrate
47
Q

Medical therapy with airway disease

A
  • Incomplete or non-responsive to diuretics
48
Q

If there is cross-over of multiple diseases, how can you help differentiate the initial disorder?

A
  • Often characteristics of the initial disorder predominate
49
Q

Examples of diseases with multiple locations impacted

A
  1. Chronic bronchitis with 2° interstitial pneumonia
  2. Emphysematous airway disease with interstitial fibrosis
  3. Interstitial pulmonary edema may eventually flood large airways
50
Q

General principles to localize disease

A
  • SEE CHART in notes

- SUPER HELPFUL

51
Q

Initial diagnostics for respiratory disease

A
  • 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
52
Q

What can limit the efficacy of thoracic radiographs?

A
  • Taking radiographs of the affected area
53
Q

What blood and urine tests should be considered for respiratory disease?

A
  • CBC/Chem/Urinalysis
54
Q

Cytologic assessment of respiratory disease

A
  • Tracheal wash
  • BAL
  • Bronchoscopy
  • Transthoracic aspiration
55
Q

Pulmonary function testing

A
  • Arterial blood gas
  • Pulse ox
  • Nuclear imaging
56
Q

Serologic tests to consider for respiratory disease

A
  • HW antigen/antibody testing
  • Fungal titers
  • Toxoplasmosis
57
Q

Fecal tests to consider for respiratory disease

A
  • Flotation
  • Baermann
  • Sedimentation
58
Q

Other tests to consider for respiratory disease

A
  • Ultrasonography
  • Echocardiogram
  • Endoscopy
  • Surgical biopsy

Cardiology and Respiratory SA Med (15 decks)

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