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Medicine I > Respiratory - Infectious Lung Disease > Flashcards

Respiratory - Infectious Lung Disease Flashcards

1
Q

What are the differentials for Pulmonary Parenchymal Disease?

A
  • Infectious
    • bacterial, fungal, parasitic, protozoal, viral
  • Non-cardiogenic pulmonary edema
  • pulmonary thromboembolism
  • pulmonary contusions
  • lung lobe torsions
  • pulmonary fibrosis
  • pulmonary hypertension
  • Neoplasia
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2
Q

What are the rule outs for hypercalcemia?

A
  • Granulomatous
  • Osseous
  • Spurious
  • Hyperparathyroid
  • Vitamin D
  • Addisons
  • Renal
  • Neoplasia
  • Idiopathic
  • Toxin
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3
Q

How is a lung aspirate completed?

A
  • Sternal recumbency or standing
  • Clip and clean area (based on radiographs)
  • Needle in, suction back 3x, needle out
  • Do NOT redirect needle inside the chest
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4
Q

What are the possible complications of a lung aspirate

A
  • Pneumothorax
  • lung laceration
  • Introduce infection
  • vagal response
  • hemorrhage
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5
Q

What is Histoplasmosis?

A
  • Caused by Histoplasma spp
  • Infects:
    • Lungs
    • GI
    • Disseminated - Liver, spleen, GI, bone, marrow, skin, eyes
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6
Q

What is Blastomycosis?

A
  • Blastomyces dermatitidis
  • Dimorphic Fungus
    • Mycelia live on decaying organic matter
    • Spores inhaled, become yeast in lungs
  • Organs of Choice:
    • Lungs
    • Nodes
    • Eyes
    • Bone
    • CNS
    • Skin
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7
Q

What is Coccidioidomycosis?

A
  • Coccidioides immitis
  • Southwestern U.S.
  • Inhale conidia (<10 to be infected)
  • In alveoli: conidia become spherules
    • protected from immune system
    • divides, grows, ruptures, releases spores
  • Organs of Choice:
    • Lung
    • Bone
    • Pericardium
    • Skin (especially cats)
    • Can be subclinical
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8
Q

How are fungal pneumonias diagnosed?

A
  • Hypercalcemia
    • macrophages produce calcitriol
      • Calcitriol ⇡ Ca absorption from GI, ⇡ reabsorption from kidneys, and can increase release from bone
    • Some fungal diseases have bone infolvement
  • Hyperglobulinemia
    • Protein electrophoresis shows polyclonal gammopathy
  • Radiographs
    • diffuse nodular or miliary interstitial pattern is most classic
      • some will have bronchial pattern
    • may have hilar lymphadenopathy
    • can see assortment of other radiographic findings
  • Serology (antibody)
    • Blasto/Histo: positive is likely true, high false negative rate
    • Coccidio serology is reliable
  • Antigen test - submit urine/blood
    • Great for blastomycosis and histoplasmosis if cytology/histopathology is not possible
      • can use for diagnosis and monitoring treatment
  • Cytology/Histopathology
    • seeing organism confirms its presence
    • allows for search of differentials at the same time
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9
Q

What is the treatment for fungal pneumonias?

A
  • Systemic Antifungals
    • Fluconazole
    • Itraconazole
    • Amphotericin B
    • Terbinafine
    • Ketoconazole
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10
Q

How is an Endotracheal wash performed?

A
  • Preoxygenate, induce (propofol), sterile intubation
  • Submit Fluid:
    • Red top - aerobic culture and Mycoplasma PCR
    • Purple top - cytology (fluid analysis)
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11
Q

How is a Trans-tracheal Wash performed?

A
  • Sterile Prep, +/- Lidocaine block
  • Pass Catheter, Pull Stylet out
  • Sterile Saline in
  • Coupage/Cough
  • Suction fluid out
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12
Q

What is nebulization?

A
  • Delivers water droplets to the lower airways
  • Increases hydration of mucociliary system
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13
Q

What is Coupage?

A
  • Physical Therapy
  • Firmly patting the chest wall with cupped hands
  • Stimulates the cough reflex
    • Mobilize airway secretions
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14
Q

What causes aspiration pneumonia?

A
  • Impaired Airway
    • Recent anesthesia/recumbency
    • Seizures, coma, head trauma
    • Laryngeal dysfunction
  • Recent vomiting
  • Too much food/Impaired GI motility
    • Megaesophagus
    • Overfeeding though enteral tubes
    • Delayed gastric emptying
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15
Q

What diseases are common with Bacterial pneumonia?

A
  • Respiratory Disease
    • Bordetella
    • tracheal collapse
    • foreign body inhalation
    • bronchitis
    • etc,
  • Systemic Disease
    • Infections
    • Immunosuppressive conditions
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16
Q

What bacteria commonly cause bacterial pneumonia?

A
  • Mostly opportunistic, often from the GI or upper respiratory tract
    • E. coli
    • Staphylococcus
    • Streptococcus
      • Strep equi sub zooepidemicus
    • Pasteurella multocida
    • Pseudomonas
    • Klebsiella pneumoniae
    • Mycoplasma
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17
Q

What happens during bacterial pneumonia caused by Streptococcus zooepidemicus?

A
  • Causes a severe, acute hemorrhagic pneumonia in dogs
    • Highly contagious between dogs
    • May look like kennel cough initially
    • Can be fatal within 24 hours
    • Fortunately sporadic and rare outbreaks
    • Tracheal wash culture when possible
      • In shelter, outbreak situation, use necropsy to guide therapy for remaining patients
    • Empirical treatment targeting this species: IV ampicillin
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18
Q

How is Bacterial Pneumonia diagnosed?

A
  • CBC: inflammatory leukogram
  • Radiographs: air bronchograms, alveolar pattern
    • right middle/cranial or left cranial lung lobes
  • Tracheal wash for cytology, culture/susceptibility
19
Q

How is Bacterial pneumonia treated?

A
  • Empirically until culture results are back
    • Recheck after 2 weeks
    • Optimal duration of treatment unknown
    • Supportive care as needed
      • O2, nebulize, coupage, nutrition, IV fluids
20
Q

How can aspiration pneumonia be prevented?

A
  • Extra care during anesthesia
    • NPO to keep stomach empty
    • Keep cuff inflated when intubated
    • Suction any fluid prior to extubating
  • Feed megaesophagus patients upright and keep upright for 20-30 minutes after meals
    • ID and address underlying cause
21
Q

What is Mycoplasma spp.?

A
  • Prokaryotic microbes w/out a cell wall
  • Normal flora of upper airway
  • Almost 50% of dogs with lower airway disease were positive for Mycoplasma spp
    • more often occur w/ another bacteria
  • Species ID and sensitivity not routinely available
    • Need antibiotic that does NOT target the cell wall
      • Azithromycin, doxycycline, fluoroquinolones, chloramphenicol, TMS
22
Q

What pulmonary parasites affect dogs/cats?

A
  • Paragonimus kellicotti (lung flukes)
  • Nematodes
    • Aelurostongylus abstrusus
    • capillaia aerophila
    • Filaroides
  • Toxoplasmoais (protozoal)
23
Q

What are Paragonimus kellicotti?

A
  • Lung flukes of dogs and cats
  • Midwest and South US
24
Q

Describe the life cycle of Paragonimus kellicotii

A
  • Dog/cats eats crayfish
  • Metacercariae migrate from GI through diaphragm
  • Adult flukes live paired in cysts in lungs
  • Eggs coughed, swallowed, in feces
  • Egg hatches, miracidia enter snail
  • Mature cercariae penetrate crayfish
25
Q

How are Paragonimus kellicotti diagnosed?

A
  • Radiographs show cystic lesions in lungs (like bullae)
    • Mostly right caudal lung lobe
    • Interstitial and bronchial patterns possible
  • Tracheal wash - eosinophils and eggs
  • Fecal sedimentation or zinc sulfate for eggs
26
Q

How is a Paragonimus kellicotti infection treated?

A
  • Praziquantel
  • Fenbendazole
27
Q

Who is commonly affected by Aelurostongylus abstrusus?

A

stray or hunting cats

28
Q

Who is commonly affected by Capillaria aerophila?

A

Dogs and cats

29
Q

Who is affected by filaroides?

A

young puppies

30
Q

What is heartworm disease? (symptoms, complications?)

A
  • Symptoms:
    • Cough, exercise intolerance, inappetence, weight loss
    • Vomiting in cats
  • Complications:
    • Congestive heart failure
    • Caval syndrome
    • Allergic pneumonitis
      • Diffuse interstitial disease
      • Treat with steroids prior to adulticide
31
Q

What is Caval syndrome

A
  • Caused by a mass of heartworms in the right atrium, ventricle, or vena cava
    • interferes with closure of the tricuspid valve and impedes normal flow of blood through the right heart, leading to cardiovascular collapse
      • significant tricuspid regurg
      • compromised right ventricular filling
      • circulatory collapse
  • Requires surgical intervention
32
Q

How is Heartworm disease treated in dogs/cats?

A
  • Dogs:
    • melarsomine - adulticide
    • Heartgard for very slow treatment
  • Cats:
    • Glucocorticoids and Heartgard
    • NO melarsomine
33
Q

What is Toxoplasmosis?

A
  • pneumonia is rare unless immunosuppressed
    • Prednisone or chemotherapy
    • Retroviral infections
    • Distemper Infections
  • typically acutely ill
    • Other other organs too
34
Q

How is Toxoplasmosis diagnosed?

A
  • Radiographs - diffuse interstitial to alveolar pattern, can have mild effusion
  • Serology:
    • high IgM suggests active infection
    • 4-fold rise in IgG suggests active infection
  • Aspirate/Biopsy to find tachyzoites in macrophages or neutrophils
35
Q

How is toxoplasmosis treated?

A
  • Clindamycin and supportive care
36
Q

What causes viral pneumonia in dogs?

A
  • Distemper - Most serious
    • Often 2° bacterial and Mycoplasma infections
    • May be complicated with GI and neurologic disease
  • Canine influenza - can be severe
  • Parainfluenza - mild and self-limiting
    • can be complicated by Bordetella of other bacterial infections
    • No real need to confirm presence of these viruses
  • Canine adenovirus-2 - mild and self-limiting
    • can be complicated by Bordetella of other bacterial infections
    • No real need to confirm presence of these viruses
37
Q

What causes viral pneumonia in cats

A
  • Calicivirus - rarely cause pneumonia
  • Herpesvirus - rarely cause pneumonia
38
Q

What is the pathophysiology of viral pneumonia?

A
  • Virus gains access and tries to replicate
    • Enter bronchial and alveolar cells
    • Targets Type I pneumocytes
  • Host immune Defenses
    • Mucociliary clearance sweeps the viruses out
    • IgG, IgA, IgM block attachment, neutralize
    • Cytokines destroy virus
    • Lymphocytes kill infected cells
    • Alveolar macrophages clean up debris
39
Q

What type of interstitial pattern does viral pneumonia cause?

A
  • Usually a diffuse or caudodorsal pattern
  • Not cranioventral like bacterial pneumonia
40
Q

What is the common signalment of patients with Viral Pneumonia?

A
  • Young animals
  • incomplete vaccine series
  • ⇡ risk if crowded, stresses, poor ventilation
41
Q

What are the clinical signs of viral pneumonia?

A
  • Lethargic
  • febrile
  • URI
  • kennel cough
  • dyspneic
42
Q

How is viral pneumonia treated?

A
  • Supportive Care
    • IV fluids and nutritional support
    • Oxygen if needed
    • Humidification/Nebulization (coupage if exudate)
    • Isolate to minimize spread
43
Q

what are the options for administrating oxygen to dogs/cats? (Pros/Cons)

A
  • Face Mask or Flow-by
    • Pros: Fast, access to pet 30-70% O2
    • Cons: Stressful, only temporary fix
  • Oxygen Cage
    • Pros: easy, not stressful
    • Cons: patient inaccessible, 40% O2, expensive, technical challenges, many clinics don’t have
  • Nasal Oxygen
    • Pros: Excellent accessibility, cheaper than cage
    • Cons: can be stressful to place but most tolerate very well
    • Achieve 40% O2 with 1 cannula, 50-60% with 2
44
Q

How is nasal oxygen placed?

A
  • Awake or sedated dog
  • Topical Anesthetic (xylocaine jelly)
  • Red-rubber or flexible green catheter
  • Insert to medial canthus of eye
  • Suture: Chinese finger trap
  • need E-Collar

Medicine I (43 decks)

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