Respiratory Ettinger Flashcards
1
Q
What can occur in humans with severe nasal resistance?
A
Cor pulmonale, cardiomegaly, pulmonary edema
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
3
Q
What is the predominant cell type in the nose?
A
Tall ciliated cells
4
Q
What is the name for the to and fro movement of the cilia to actively move the mucus blanket?
A
Ciliary beat
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
6
Q
What is the ultimate cleaning procedure of the nose?
A
Sneeze (reflex)
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)
8
Q
Name an olfactory test.
A
Activation of brain is recorded by electroencephalographic olfactory analysis
9
Q
What breed has congenital malformation of the nasal plane?
A
Brachycephalic breeds
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
11
Q
What congenital abnormality is reported in cats to result in rhinorrhea?
A
Congenital CSF fistula (reported in one cat) was corrected surgically
12
Q
What is the consequence of no frontal sinuses?
A
NOTHING
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
14
Q
What is the name of the syndrome when ciliary dyskinesia is associated with situs inversus?
A
Kartagener’s syndrome
15
Q
What is the complication of ciliary dyskinesia?
A
Colonization of mucosa by Pasteurella and Bordetella = Hypoplastic conchae by bone resorption
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)
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
18
Q
What is the prognosis with primary ciliary dyskinesia?
A
Guarded = Die of sepsis from recurrent pneumonia Tx = ABX
19
Q
What type viruses make up 80-90% of infectious upper respiratory infections in cats?
A
Feline herpesvirus 1 (FHV-1)
Feline Calicivirus
20
Q
What percentage of cats with URI will become chronic carriers?
A
About 80% (even if vaccinated with MLV)
21
Q
When be calcivirus carriers shed?
A
ALL THE TIME, from the oropharynx
22
Q
When be herpesvirus carriers shed?
A
ONLY WHEN SHOWING CS (sneezing and nasal dc)
23
Q
Name the common causes of mycotic rhinitis in dogs.
A
Aspergillus spp, occasional Penicillium spp
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)
25
What is the most common spp of aspergillus in rhintis in dogs?
A. fumigatus
| A. terreus - related to disseminated dz, that can also occur in the nose but is less common
26
What are the 3 main methods of dx of Aspergillosis?
1. Rhinoscopy = plaques
2. Culture (normal dogs can be positive)
3. Serology (no false positive but can have extensive dz with negative serology)
27
What percentage of normal dogs can have Aspergillus on nasal cultures?
Up to 40% in normal dogs
28
What are the 2 main treatments for Nasal Aspergillosis?
Enilconazole or clotrimazole
29
In dogs with nasal aspergillosis, what was needed to determine the effectiveness of clotrimazole treatment?
Rhinoscopy!
| Neither CS nor serology was predictive of disease state
30
How do you make the diagnosis of Nasal Cryptococcus?
from nasal d/c stained with India Ink (thick and encapsulated)
Need to culture it
31
What is the treatment for Nasal Cryptococcus?
ketoconazole, itraconazole, fluconazole (at least 8 weeks may be long term)
32
What is the treatment for Alternia spp in cats?
Proliferative granulomatous crusts that need to be surgically removed from nasal plane, antifungals are NOT helpful :(
33
What is neurogenic rhinitis?
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
34
What are clues for hypoventilation as the cause of hypoxemia?
```
Increased PaCO2
Normal A-a gradient
Absent radiographic infiltrates
Ex: Drug-induced depression
CNS/PNS disorder
Upper airway obstruction
```
35
What are clues for VQ Mismatch as the cause of hypoxemia?
```
Increased A-a gradient
Mildly increased PaCO2
Improves with O2 supp
Radiographic change common
Examples: Bacterial pneumonia
Pulmonary edema
PTE
```
36
What are clues for R→L Shunt
| as the cause of hypoxemia?
Increased A-a changes
Fails to improve with O2
Heart/pulm changes common
Ex: RL PDA
Pulmonary AV fistula
Atelectatic lung
37
What are clues for diffusion impairment
| as the cause of hypoxemia?
Marked interstitial ilfiltrates
Improves with O2
Ex: Asbestosis
Idiopathic pulmonary fibrosis
38
What are clues for reduced FiO2
| as the cause of hypoxemia?
Resolves with O2 supplement
Ex: High Altitude
Anesthetic accident
Suffocation
39
Which intestinal parasites result in migratory through the lungs?
Toxocara, Ancylostoma (verminous pneumonia)
40
Which parasites are considered pulmonary parenchymal parasites?
Paragonimus kellicotti
| Filaroides hirthi, F. milksi
41
Which parasites are considered airway parasites?
Aelurostongylus abstrusus
Crenosoma vulpis
Oslerus osleri (Filaroides osleri)
Eucoleus aerophilia (Capillaria aerophilia)
42
For Paragonimus kellicotti:
| What is the intermediate host, dx, and tx?
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
43
Which lung lobe is most commonly afefcted with Paragonimus kellicotti
Right caudal lung lobe
44
For Filaroides hirthi and F. milksi, what is the transmission, dx, and tx?
o Endemic research facilities, oral-fecal transmission (DIRECT)
o Normal vs clinical (young/small breed/immunosuppressed or super infections)
45
Where is Filaroides hirthi and F. milksi endemic?
Research Facilities
46
For Aelurostrongylus abstrusus, what is the intermediate host, dx, and tx?
(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
47
For Crenosoma vulpis, what is the intermediate host, dx, and tx?
Dog only)
o NE USA, East Canada; intermediate host mollusk
o Airway sample, Zn Sulfate, Baermann; Fenben / Iver / Milbemycin oxime
48
For Oslerus osleri what is the transmission, dx, and tx?
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
49
What breed should you think of with Oslerus osleri?
Greyhounds
50
For Eucoleus aerophilia (Capillaria), how is it dx and tx?
o Dog/Cat – imbeds within tracheal & bronchial mucosa
o Flotation preferred to Bearmann
o Double – operculated eggs (*Assymetric & smaller vs Trichuris vulpis)
51
What is the difference in dogs vs cats with heartworms for the host parasite interactions?
```
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
What is caval syndrome?
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
Why s adulticide treatment not recommended in cats?
Adulticide treatment in cats is not recommended due to toxicity, lack of efficacy, and fatalities associated with thromboembolism
54
What is the French Heartworm?
Angiostrongylus vasorum
55
Where does Angiostrongylus vasorum reside in the host?
PA, R heart, and pulmonary arterioles
56
How is Angiostrongylus vasorum diagnosed?
Baremann
57
What are common findings on CBC/CHemistry with Angiostrongylus vasorum?
Anemia
Low Platelets
Eosinophilia
Hyper Ca!!!
58
Which bacteria can result in acute necrotizing hemorrhagic pneumonia (esp in greyhounds)?
Strep equi subspp zooepidemicus and equi
59
What is the concerning spp for Mycoplasma with pneumonia?
Mycoplasma cynos
60
If a cat has pneumonia and suppurative lymphadenitis (submand and cervical) which organisms should you consider?
Yersinia pestis
61
Which viruses can result in pneumonia in dogs and cats?
```
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
What is canine influenza virus?
H3N8 : RNA virus (from equines)
63
What methods are available for diagnosing CIV?
§ 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
Can cats be infected with influenza virus?
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
What is the most common protozoal cause of pneumonia?
Toxoplasma gondii in CATS
66
Which fungi are most common to result in pneumonia?
o Blastomyces dermatitidis, Histoplasma capsulatum, and Coccidioides immitis
67
Which breeds are overrepresented with Pneumocystis carinii?
Min Dachshund (common variable immunodeficeny) & CKCS (Ig G deficiency) overrepresented
68
What is a cancer in the lungs that Rare lymphoproliferative cancer - Atypical lymphoid cells infiltrate around and destroy blood vessels?
o Pulmonary Lymphomatoid Granulomatosis (LG)
Rare lymphoproliferative cancer
Bx needed to differentiate from LSA, treatment that same as LSA
69
Which interstitial lung disease is associated with FeLV in cats?
Lymphocytic Interstitial Pneumonitis (LIP)
- • FeLV cats (HIV humans)
Lentivirus infected alveolar MPs and T cells become activated
70
Which interstitial lung disease is associated with bronchioles are plugged with connective tissue leading to downstream organizing pneumonia
Bronchiolitis Obliterans and Organizing Pneumonia (BOOP)
71
Which interstitial lung disease is associated with dysfunctional alveolar MPs, impaired surfactant clearance, alveolar MP dysfunction
Pulmonary Alveolar Proteinosis (PAP)
72
Which interstitial lung disease is associatedImmune mediated connective tissue disorder: xeropthalmia, xerstomia,?
Sjogren's Syndrome
73
Which breeds have a predisposition for eosinophilic bronchopneumopathy?
Huskies, Malamute, Rotties
74
Which interstitial lung disease results in globules of lipid in alveolar space and what is the pathophysio?
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
Which breeds are predisposed to idiopathic pulmonary fibrosis?
Westies and Pitties :(
76
What is classic of the histopath in idiopathic pulmonary fibrosis?
Collagen deposition in alevolar space
77
What is the prognosis of idiopathic pulmonary fibrosis?
• Tx – limited to none; Px grave – most die w/in 18 months of initial clinical signs, cats days to weeks (grave)
78
What is a major complication of idiopathic pulmonary fibrosis?
Pulmonary hypertension
79
What is the pathophysio of drowning and poor prognostic indicators?
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
What is a good prognostic sign in smoke inhalation?
Improvement in resp status in first 24 hours
81
What is the difference btwn a bullae and a bleb?
Bleb is accumulation of air bwtn visceral pleural whereas the bulla (3 types) are both layers of pleura involved
82
Has congenital emphysema been reported in dogs or cats?
Young dogs
83
Which breeds are over represented for lung lobe torsions?
Afghan hounds and pugs
84
Which type of effusion is common in lung lobe torisons?
Chylous effusion
85
Which lung lobe is the most commonly affected in lung lobe torsions?
Left cranial lobe
86
What can occur with pneumomediastinum?
§ 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
What is the most common cause of penumomediastinum in cats?
69% Secondary; 31% Spontaneous - Most common 38% intubation and PPV
88
Which organisms can be seen with mediastinitis?
□ Chronic granulomatous infections
® Histoplasma/Cryptococcus
® Actinomyces/Nocardia
□ Spirocercosis
89
In dogs what is normally associated with mediastinal lymphoma?
HyperCa (poor prognostic indicator)
90
What is thymic hemorrhage?
Spontaneous thymic hemorrhage
Noted in 1 cat and a few dogs
HIGH mortality rate
91
What is classic for cytology of thymoma?
Variable # lymphocytes (hard to tell from LSA) - mast cells are also seen
92
What paraneoplatic syndrome is seen with thymomas?
Myasthenia gravis
93
What are congenital causes of diaphragmatic hernias?
pleuroperitoneal, PPDH, and hiatal hernia
94
What is the most common organ to herniate?
LIVER
95
What is a PPDH?
Peritoneopericardial Diaphragmatic Hernia -CONGENITAL - no attachment between pericardium and diaphragm in adults
96
Which breeds are over represented with Peritoneopericardial Diaphragmatic Hernia?
Weimeraners, DLH, Persian, Himalayan cats
97
What is the survival with Peritoneopericardial Diaphragmatic Hernia?
· 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
What is a common form of thoracic wall trauma in cats?
RIB fractures (87% cats)
99
What is Pectus Excavatum?
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
How do patients with bile peritonitis develop bilious pleural effusion?
inflammation and increased permeability of pleural and diaphragmatic lymphatics transporting bile from the abdomen
101
What can be used to discriminate cats with pleueral effusion that are in CHF and those that are not?
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
For a transudate:
Causes
Protein Content (g/dL)
TNCC (cells/uL)
Color
Transparency
Biochemical parameters
Predominant cell types
low albumin or increased hydrostatic pressure
<1500
Clear
Colorless
None
Mesothelial cells, macrophages
103
For a modified transudate:
Causes
Protein Content (g/dL)
TNCC (cells/uL)
Color
Transparency
Biochemical parameters
Predominant cell types
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
For a exudate:
Causes
Protein Content (g/dL)
TNCC (cells/uL)
Color
Transparency
Biochemical parameters
Predominant cell types
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
For a pyothorax:
Protein Content (g/dL)
TNCC (cells/uL)
Color
Transparency
Biochemical parameters
Predominant cell types
>3.5
>7000
Amber to red or white
Turbid or opaque
Glucose <10 mg/dL
Degenerative neutrophils
106
For a chylothorax:
Protein Content (g/dL)
TNCC (cells/uL)
Color
Transparency
Biochemical parameters
Predominant cell types
Variable
serum triglyceride
Lymphocytes or neutrophils
107
```
For a FIP:
Protein Content (g/dL)
```
TNCC (cells/uL)
Color
Transparency
Biochemical parameters
Predominant cell types
>5
<10000
Straw to gold colored
Hazy
Non-degenerative neutrophils
108
What has been shown to be helpful in differentiating malignant effusions from non-neoplastic?
Fibrinectin levels - high FN in effusion was 100% sens., 57% spec. for malignant effusions
109
What are the most common causes of pyothorax in dogs?
obligate anaerobes, Actinomyces (most common in dogs), Nocardia
110
What are the most common causes of pyothorax in cats?
· Cats – obligate anaerobes, Pasteurella (most common in cats)
111
What are predisposed breeds for chylothorax?
Predisposed breeds – Afghan Hound (middle aged), Shiba Inu (less than 1 year of age), oriental cat breeds (Siamese, Himalayan)
112
What are cuases of chylothorax?
Cardiac disease, thoracic wall, lymphatic, or mediastinal neoplasia, fungal granuloma, cranial caval thrombosis, PPDH, lung lobe torsion, and congenital abnormalities of the TD
113
How do you diagnose chylothorax?
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
What has changed with the nutritional recommendations for chylothorax?
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
What is rutin used for?
Chylothorax - potentially increases number/function of macrophages to remove protein from lymph and increase reabsorption
116
How does octerotide used in chylothorax?
believed to aid in healing of the TD by decreasing TD flow
117
What is the prognosis for surgical interventions with chylothorax?
· 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
Why does blood from a hemorrhagic effusion not clot?
Rapid defibrination in pleural space
119
What is the most common type of pneumothorax?
traumatic
120
What is a tension penumothorax?
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
Which breed is predisposed to spontaneous pneumothroax?
Siberian Huskies!
122
Which breeds are over represented with pyothorax?
Labs and Springer Spaniels
123
Antibiotics for Actinomyces spp. ?
Ampicillin, amoxicillin plus clavulanic acid, penicillin,
124
Antibiotics for Nocardia spp. ?
TMS, amiakcin
