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Respiratory Ettinger Flashcards

1
Q

What can occur in humans with severe nasal resistance?

A

Cor pulmonale, cardiomegaly, pulmonary edema

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2
Q

What is a very important factor for protection of the alveoli by the nasal cavity?

A

Conditioning of inspired air by nose

Removal of larger particulate matter

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3
Q

What is the predominant cell type in the nose?

A

Tall ciliated cells

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4
Q

What is the name for the to and fro movement of the cilia to actively move the mucus blanket?

A

Ciliary beat

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5
Q

What are the two layers of the mucus blanket in the nose?

A

The outer layer is more viscid than the deeper, periciliary layer.

Insoluble particles, allergens, and bacteria caught on the outer layer are thus carried to the esophagus. Soluble material reaches the periciliary layer and is absorbed

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6
Q

What is the ultimate cleaning procedure of the nose?

A

Sneeze (reflex)

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7
Q

What is the pathway for transmission of olfactory information?

A

Axons of the olfactory receptor cells from olfactory nerves (under mucosa) pass through cribriform plate directly to olfactory bulb (ipsilateral forebrain)

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8
Q

Name an olfactory test.

A

Activation of brain is recorded by electroencephalographic olfactory analysis

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9
Q

What breed has congenital malformation of the nasal plane?

A

Brachycephalic breeds

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10
Q

What congenital malformation of the nose can result in intermittent nasal discharge?

A

Nasal dermoid cysts
Reported in dogs
Fistula in the midline of the bridge of the nose

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11
Q

What congenital abnormality is reported in cats to result in rhinorrhea?

A

Congenital CSF fistula (reported in one cat) was corrected surgically

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12
Q

What is the consequence of no frontal sinuses?

A

NOTHING

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13
Q

What is congenital ciliary dysfunction or ciliary dyskinesia?

A

Ineffective and uncoordinated ciliary function = rhinitis, bronchitis, and pneumonia
Reported in various dog breeds

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14
Q

What is the name of the syndrome when ciliary dyskinesia is associated with situs inversus?

A

Kartagener’s syndrome

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15
Q

What is the complication of ciliary dyskinesia?

A

Colonization of mucosa by Pasteurella and Bordetella = Hypoplastic conchae by bone resorption

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16
Q

How can you test for ciliary dyskinesia?

A

small drop of 99mTc macroaggregated albumin
Not always normal in normal animals
Can be affects by inflammation (not affected by anesthesia)

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17
Q

What are the hallmark signs of primary ciliary dyskinesia on EM?

A

Lack of outer dynein arms
Abnormal microtubular pattern
Electron-dense core in the basal body

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18
Q

What is the prognosis with primary ciliary dyskinesia?

A 
Guarded = Die of sepsis from recurrent pneumonia 
Tx  = ABX
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19
Q

What type viruses make up 80-90% of infectious upper respiratory infections in cats?

A

Feline herpesvirus 1 (FHV-1)

Feline Calicivirus

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20
Q

What percentage of cats with URI will become chronic carriers?

A

About 80% (even if vaccinated with MLV)

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21
Q

When be calcivirus carriers shed?

A

ALL THE TIME, from the oropharynx

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22
Q

When be herpesvirus carriers shed?

A

ONLY WHEN SHOWING CS (sneezing and nasal dc)

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23
Q

Name the common causes of mycotic rhinitis in dogs.

A

Aspergillus spp, occasional Penicillium spp

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24
Q

Name the common causes of mycotic rhinitis in cats.

A 
Cryptococcus neoformans (MOST common, can occur in dogs too)
Alternaria spp (proliferation of skin on nasal plane = dyspnea)
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25
Q

What is the most common spp of aspergillus in rhintis in dogs?

A

A. fumigatus

A. terreus - related to disseminated dz, that can also occur in the nose but is less common

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26
Q

What are the 3 main methods of dx of Aspergillosis?

A
  1. Rhinoscopy = plaques
  2. Culture (normal dogs can be positive)
  3. Serology (no false positive but can have extensive dz with negative serology)
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27
Q

What percentage of normal dogs can have Aspergillus on nasal cultures?

A

Up to 40% in normal dogs

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28
Q

What are the 2 main treatments for Nasal Aspergillosis?

A

Enilconazole or clotrimazole

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29
Q

In dogs with nasal aspergillosis, what was needed to determine the effectiveness of clotrimazole treatment?

A

Rhinoscopy!

Neither CS nor serology was predictive of disease state

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30
Q

How do you make the diagnosis of Nasal Cryptococcus?

A

from nasal d/c stained with India Ink (thick and encapsulated)
Need to culture it

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31
Q

What is the treatment for Nasal Cryptococcus?

A

ketoconazole, itraconazole, fluconazole (at least 8 weeks may be long term)

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32
Q

What is the treatment for Alternia spp in cats?

A

Proliferative granulomatous crusts that need to be surgically removed from nasal plane, antifungals are NOT helpful :(

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33
Q

What is neurogenic rhinitis?

A

Unilateral CS: Loss of parasympathetic innervation to nasal glands, associated with ipsilateral KCS, associated with otitis media (resolved with systemic ABX)
Harder if bilateral CS = Needs supportive care only

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34
Q

What are clues for hypoventilation as the cause of hypoxemia?

A 
Increased PaCO2
Normal A-a gradient
Absent radiographic infiltrates
Ex: Drug-induced depression
CNS/PNS disorder
Upper airway obstruction
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35
Q

What are clues for VQ Mismatch as the cause of hypoxemia?

A 
Increased A-a gradient
Mildly increased PaCO2
Improves with O2 supp
Radiographic change common
Examples: Bacterial pneumonia
Pulmonary edema
PTE
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36
Q

What are clues for R→L Shunt

as the cause of hypoxemia?

A

Increased A-a changes
Fails to improve with O2
Heart/pulm changes common

Ex: RL PDA
Pulmonary AV fistula
Atelectatic lung

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37
Q

What are clues for diffusion impairment

as the cause of hypoxemia?

A

Marked interstitial ilfiltrates
Improves with O2

Ex: Asbestosis
Idiopathic pulmonary fibrosis

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38
Q

What are clues for reduced FiO2

as the cause of hypoxemia?

A

Resolves with O2 supplement

Ex: High Altitude
Anesthetic accident
Suffocation

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39
Q

Which intestinal parasites result in migratory through the lungs?

A

Toxocara, Ancylostoma (verminous pneumonia)

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40
Q

Which parasites are considered pulmonary parenchymal parasites?

A

Paragonimus kellicotti

Filaroides hirthi, F. milksi

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41
Q

Which parasites are considered airway parasites?

A

Aelurostongylus abstrusus
Crenosoma vulpis
Oslerus osleri (Filaroides osleri)
Eucoleus aerophilia (Capillaria aerophilia)

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42
Q

For Paragonimus kellicotti:

What is the intermediate host, dx, and tx?

A

o Great Lakes, Midwest, south; Intermediate host – Crayfish
o Intestine -> subpleural tissue -> migrate/tunnel through bronchioles
o Hemoptysis, pneumothorax, pulmonary bullae & cysts w/in parenchyma;
o *Right caudal lung lobe most commonly affected
o Diagnosis: Airway wash, fecal (sedimentation best) - See picture
o Praziquantel (x3 days), fenbendazole

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43
Q

Which lung lobe is most commonly afefcted with Paragonimus kellicotti

A

Right caudal lung lobe

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44
Q

For Filaroides hirthi and F. milksi, what is the transmission, dx, and tx?

A

o Endemic research facilities, oral-fecal transmission (DIRECT)
o Normal vs clinical (young/small breed/immunosuppressed or super infections)

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45
Q

Where is Filaroides hirthi and F. milksi endemic?

A

Research Facilities

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46
Q

For Aelurostrongylus abstrusus, what is the intermediate host, dx, and tx?

A

(Feline lung worm)
o Brochiole worms, mimic bronchopulmonary disease
o Intermediate host – Mollusk
o Airway – larva, Baermann sedimentation larva (& PCR pharyngeal swab)
o Fenbend, ivermectin, selamectin

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47
Q

For Crenosoma vulpis, what is the intermediate host, dx, and tx?

A

Dog only)
o NE USA, East Canada; intermediate host mollusk
o Airway sample, Zn Sulfate, Baermann; Fenben / Iver / Milbemycin oxime

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48
Q

For Oslerus osleri what is the transmission, dx, and tx?

A

o Distal trachea / proximal carina; DIRECT transmission (young dogs; *Greyhounds)
o Bronchoscopy, Zn sulfate sedimentation; Ivermectin may not clear infection completely
o Larva – kinked tail

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49
Q

What breed should you think of with Oslerus osleri?

A

Greyhounds

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50
Q

For Eucoleus aerophilia (Capillaria), how is it dx and tx?

A

o Dog/Cat – imbeds within tracheal & bronchial mucosa
o Flotation preferred to Bearmann
o Double – operculated eggs (*Assymetric & smaller vs Trichuris vulpis)

51
Q

What is the difference in dogs vs cats with heartworms for the host parasite interactions?

A 
Dogs:
Natural host
Variable burden, usually +++
Mature worms persist 5-7y
Mature infection often has microfilaria
Prevalence varies with geography

Cats: Atypical host
Typically 1-3 worms
Mature worms persist 2-3y
Mature infection rarely has microfilaria
Larva often eliminated by immune response
Prevalence of mature infection about 10% of dog prevalence

52
Q

What is caval syndrome?

A

Syndrome that occurs in dogs with HW dz.
uncommon emergent complication of infection that occurs when the adult worms obstruct the right ventricular inflow tract. Caval syndrome includes tricuspid murmur, intravascular fragmentation hemolysis with hemoglobinuria, right-sided congestive heart failure, and disseminated intravascular coagulation

53
Q

Why s adulticide treatment not recommended in cats?

A

Adulticide treatment in cats is not recommended due to toxicity, lack of efficacy, and fatalities associated with thromboembolism

54
Q

What is the French Heartworm?

A

Angiostrongylus vasorum

55
Q

Where does Angiostrongylus vasorum reside in the host?

A

PA, R heart, and pulmonary arterioles

56
Q

How is Angiostrongylus vasorum diagnosed?

A

Baremann

57
Q

What are common findings on CBC/CHemistry with Angiostrongylus vasorum?

A

Anemia
Low Platelets
Eosinophilia
Hyper Ca!!!

58
Q

Which bacteria can result in acute necrotizing hemorrhagic pneumonia (esp in greyhounds)?

A

Strep equi subspp zooepidemicus and equi

59
Q

What is the concerning spp for Mycoplasma with pneumonia?

A

Mycoplasma cynos

60
Q

If a cat has pneumonia and suppurative lymphadenitis (submand and cervical) which organisms should you consider?

A

Yersinia pestis

61
Q

Which viruses can result in pneumonia in dogs and cats?

A 
Avian influenza (rare)
Canine distemper
Canine herpes virus
Canine infectious hepatitis
Canine influenza
Canine parainfluenza virus
Canine respiratory coronavirus
Feline calicivirus
Feline herpes virus
FIP
62
Q

What is canine influenza virus?

A

H3N8 : RNA virus (from equines)

63
Q

What methods are available for diagnosing CIV?

A

§ Antigen detection, virus isolation, and PCR identification of CIV are all prone to false-negative results. During an outbreak in a kennel, sampling multiple dogs (10% to 30% of those affected) and sampling as early as possible in the course of disease will improve diagnostic accuracy

64
Q

Can cats be infected with influenza virus?

A

YES!!
o Cats are susceptible to avian influenza H5NI (not H3N8)
§ Infected dt contact with poultry and direct cat-cat
§ Pulmonary signs, multi organ hemorhage, neurologic signs (encephalitis), sudden death
§ Asia and Europe
§ This virus can be transmitted from poultry to humans, no reports of cats to humans

65
Q

What is the most common protozoal cause of pneumonia?

A

Toxoplasma gondii in CATS

66
Q

Which fungi are most common to result in pneumonia?

A

o Blastomyces dermatitidis, Histoplasma capsulatum, and Coccidioides immitis

67
Q

Which breeds are overrepresented with Pneumocystis carinii?

A

Min Dachshund (common variable immunodeficeny) & CKCS (Ig G deficiency) overrepresented

68
Q

What is a cancer in the lungs that Rare lymphoproliferative cancer - Atypical lymphoid cells infiltrate around and destroy blood vessels?

A

o Pulmonary Lymphomatoid Granulomatosis (LG)

Rare lymphoproliferative cancer
Bx needed to differentiate from LSA, treatment that same as LSA

69
Q

Which interstitial lung disease is associated with FeLV in cats?

A

Lymphocytic Interstitial Pneumonitis (LIP)
- • FeLV cats (HIV humans)

Lentivirus infected alveolar MPs and T cells become activated

70
Q

Which interstitial lung disease is associated with bronchioles are plugged with connective tissue leading to downstream organizing pneumonia

A

Bronchiolitis Obliterans and Organizing Pneumonia (BOOP)

71
Q

Which interstitial lung disease is associated with dysfunctional alveolar MPs, impaired surfactant clearance, alveolar MP dysfunction

A

Pulmonary Alveolar Proteinosis (PAP)

72
Q

Which interstitial lung disease is associatedImmune mediated connective tissue disorder: xeropthalmia, xerstomia,?

A

Sjogren’s Syndrome

73
Q

Which breeds have a predisposition for eosinophilic bronchopneumopathy?

A

Huskies, Malamute, Rotties

74
Q

Which interstitial lung disease results in globules of lipid in alveolar space and what is the pathophysio?

A

o Exogenous (ie aspiration) vs Endogenous (associated with neoplasia – pnemocyte injury leads to cellular degeneration w/ release of cholesterol & chol rich surfactant), lipids phagocytzed by MPs = Foamy MPs

75
Q

Which breeds are predisposed to idiopathic pulmonary fibrosis?

A

Westies and Pitties :(

76
Q

What is classic of the histopath in idiopathic pulmonary fibrosis?

A

Collagen deposition in alevolar space

77
Q

What is the prognosis of idiopathic pulmonary fibrosis?

A

• Tx – limited to none; Px grave – most die w/in 18 months of initial clinical signs, cats days to weeks (grave)

78
Q

What is a major complication of idiopathic pulmonary fibrosis?

A

Pulmonary hypertension

79
Q

What is the pathophysio of drowning and poor prognostic indicators?

A

Diluted/dysfunctional surfactant causes alveolar collapse
○ Poor Px indicators:
o CXR: Radiographic appearance of “sand bronchograms” at presentation
o Need for CPR or mech ventilation
o pH < 7

80
Q

What is a good prognostic sign in smoke inhalation?

A

Improvement in resp status in first 24 hours

81
Q

What is the difference btwn a bullae and a bleb?

A

Bleb is accumulation of air bwtn visceral pleural whereas the bulla (3 types) are both layers of pleura involved

82
Q

Has congenital emphysema been reported in dogs or cats?

A

Young dogs

83
Q

Which breeds are over represented for lung lobe torsions?

A

Afghan hounds and pugs

84
Q

Which type of effusion is common in lung lobe torisons?

A

Chylous effusion

85
Q

Which lung lobe is the most commonly affected in lung lobe torsions?

A

Left cranial lobe

86
Q

What can occur with pneumomediastinum?

A

§ Can communicate with retroperitoneum and fascial planes of the neck
□ SQ emphysema and penumoretroperitoneum

Pneumomediastinum can cause pneumothorax, but not the other way around

87
Q

What is the most common cause of penumomediastinum in cats?

A

69% Secondary; 31% Spontaneous - Most common 38% intubation and PPV

88
Q

Which organisms can be seen with mediastinitis?

A

□ Chronic granulomatous infections
® Histoplasma/Cryptococcus
® Actinomyces/Nocardia
□ Spirocercosis

89
Q

In dogs what is normally associated with mediastinal lymphoma?

A

HyperCa (poor prognostic indicator)

90
Q

What is thymic hemorrhage?

A

Spontaneous thymic hemorrhage
Noted in 1 cat and a few dogs
HIGH mortality rate

91
Q

What is classic for cytology of thymoma?

A

Variable # lymphocytes (hard to tell from LSA) - mast cells are also seen

92
Q

What paraneoplatic syndrome is seen with thymomas?

A

Myasthenia gravis

93
Q

What are congenital causes of diaphragmatic hernias?

A

pleuroperitoneal, PPDH, and hiatal hernia

94
Q

What is the most common organ to herniate?

A

LIVER

95
Q

What is a PPDH?

A

Peritoneopericardial Diaphragmatic Hernia -CONGENITAL - no attachment between pericardium and diaphragm in adults

96
Q

Which breeds are over represented with Peritoneopericardial Diaphragmatic Hernia?

A

Weimeraners, DLH, Persian, Himalayan cats

97
Q

What is the survival with Peritoneopericardial Diaphragmatic Hernia?

A

· Survival – 86% of cats, 83% of dogs; controversy over early versus late surgical intervention – only 9% of cases managed conservatively progressed to necessitate intervention

98
Q

What is a common form of thoracic wall trauma in cats?

A

RIB fractures (87% cats)

99
Q

What is Pectus Excavatum?

A

Deformity of the costochondral cartilages and sternum causing dorsoventral narrowing of the thoracic cavity
Swimmer puppies - Pectoral limbs abducted
Repair is controversial; external splint for animals with compliant thoracic sternal walls, internal splint or partial sternectomy otherwise

100
Q

How do patients with bile peritonitis develop bilious pleural effusion?

A

inflammation and increased permeability of pleural and diaphragmatic lymphatics transporting bile from the abdomen

101
Q

What can be used to discriminate cats with pleueral effusion that are in CHF and those that are not?

A

NT-proBNP · Optimal cut off: 258pmol/l - Discriminated effectively btwn cats with and without CHF

	· NT-proBNP was significantly higher in CFH group (982pmol/l) compared to non CHF group (69pmol/l)
102
Q

For a transudate:
Causes
Protein Content (g/dL)

TNCC (cells/uL)

Color

Transparency

Biochemical parameters

Predominant cell types

A

low albumin or increased hydrostatic pressure
<1500

Clear

Colorless

None

Mesothelial cells, macrophages

103
Q

For a modified transudate:
Causes
Protein Content (g/dL)

TNCC (cells/uL)

Color

Transparency

Biochemical parameters

Predominant cell types

A

right-sided heart failure, pericardial disease, DH, idiopathic chylothorax, neoplasia
2.5 - 4

1000-7000

Yellow, whitish-pink, red

Hazy to turbid

None

Mesothelial cells, macrophages, eosinophils, lymphocytes
plasia

104
Q

For a exudate:
Causes
Protein Content (g/dL)

TNCC (cells/uL)

Color

Transparency

Biochemical parameters

Predominant cell types

A

neoplasia, chronic DH, FIP, lung lobe torsion, lymphatic obstruction or leakage, infectious processes

> 3

> 7000

White, amber, red

Usually opaque

LDH >200

Neutrophils, lymphocytes, macrophages, mesothelial cells, neoplastic cells

105
Q

For a pyothorax:

Protein Content (g/dL)

TNCC (cells/uL)

Color

Transparency

Biochemical parameters

Predominant cell types

A

> 3.5

> 7000

Amber to red or white

Turbid or opaque

Glucose <10 mg/dL

Degenerative neutrophils

106
Q

For a chylothorax:

Protein Content (g/dL)

TNCC (cells/uL)

Color

Transparency

Biochemical parameters

Predominant cell types

A

Variable

serum triglyceride

Lymphocytes or neutrophils

107
Q 
For a FIP: 
Protein Content (g/dL)

TNCC (cells/uL)

Color

Transparency

Biochemical parameters

Predominant cell types

A

> 5

<10000

Straw to gold colored

Hazy

Non-degenerative neutrophils

108
Q

What has been shown to be helpful in differentiating malignant effusions from non-neoplastic?

A

Fibrinectin levels - high FN in effusion was 100% sens., 57% spec. for malignant effusions

109
Q

What are the most common causes of pyothorax in dogs?

A

obligate anaerobes, Actinomyces (most common in dogs), Nocardia

110
Q

What are the most common causes of pyothorax in cats?

A

· Cats – obligate anaerobes, Pasteurella (most common in cats)

111
Q

What are predisposed breeds for chylothorax?

A

Predisposed breeds – Afghan Hound (middle aged), Shiba Inu (less than 1 year of age), oriental cat breeds (Siamese, Himalayan)

112
Q

What are cuases of chylothorax?

A

Cardiac disease, thoracic wall, lymphatic, or mediastinal neoplasia, fungal granuloma, cranial caval thrombosis, PPDH, lung lobe torsion, and congenital abnormalities of the TD

113
Q

How do you diagnose chylothorax?

A

TG in serum compared to fluid

cholesterol-triglyceride ratio <1, chylomicrons seen on wet mount, fluid that clears with addition of ether, presence of lipid droplets with Sudan III stain

114
Q

What has changed with the nutritional recommendations for chylothorax?

A

Previously recommended to feed MCT (medium chain triglyceride) oil, theorized to bypass the TD and be absorbed directly into the portal vein, no longer recommended because MCT’s detected in TD lymph and the oil is not palatable

FEED LOW FAT DIET - to decrease lipid content

115
Q

What is rutin used for?

A

Chylothorax - potentially increases number/function of macrophages to remove protein from lymph and increase reabsorption

116
Q

How does octerotide used in chylothorax?

A

believed to aid in healing of the TD by decreasing TD flow

117
Q

What is the prognosis for surgical interventions with chylothorax?

A

· TD ligation alone - <60% successful in dogs, 21-53% in cats
· Combo w/cisterna chyli ablation up to 88% to alleviate lymphatic hypertension, promote lymphaticovenous anastomoses

Combo w/pericardectomy to decrease right-sided venous pressures – 100% dogs, 80% cats

118
Q

Why does blood from a hemorrhagic effusion not clot?

A

Rapid defibrination in pleural space

119
Q

What is the most common type of pneumothorax?

A

traumatic

120
Q

What is a tension penumothorax?

A

fistula between pleura and external environment or lung acts as a one-way valve; allows air to enter on inspiration, but not exit on expiration

121
Q

Which breed is predisposed to spontaneous pneumothroax?

A

Siberian Huskies!

122
Q

Which breeds are over represented with pyothorax?

A

Labs and Springer Spaniels

123
Q

Antibiotics for Actinomyces spp. ?

A

Ampicillin, amoxicillin plus clavulanic acid, penicillin,

124
Q

Antibiotics for Nocardia spp. ?

A

TMS, amiakcin

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