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RUSVM SAM I- Spring '18 > Respiratory Material > Flashcards

Respiratory Material Flashcards

1
Q

What lesions are associated with infective endocarditis that contain platelets, fibrin, microorganisms, inflammatory cells and bacteria?

A

Vegetative lesions

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2
Q

What is the cause of acute regurgitation in infective endocarditis patients?

A

Structural valvular changes

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3
Q

What are the most common valves affected with infective endocarditis?

A

Mitral and aortic

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4
Q

Describe an aortic and mitral murmur.

A

Aortic: left basilar diastolic + bounding pulses
Mitral: left apical systolic

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5
Q

What is required for the development of IE?

A

Bacteremia

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6
Q

What are three clinical syndromes resulting from IE?

A

Immune-mediated disease, CHF/arrhythmias and THromboembolic disease

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7
Q

What are your most common breeds IE is seen in?

A

GSD, goldens, Labs

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8
Q

What is the most common presenting complaint in a dog with IE?

A

Owner complains about lameness- this can be due to the immune-mediated complexes that are deposited in the joints (polyarthritis)

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9
Q

What important protein is lost in the urine and can lead to thromboembolism?

A

Antithrombin III is lost in urine. This protein is needed for clot breakdown- without this protein there will be thrombi formed all over the body without “regulation”

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10
Q

T/F: You always collect blood cultures before antibiotic therapy.

A

TRUE

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11
Q

What is a common finding on thoracic rads with IE?

A

L-sided CHF

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12
Q

What are the five common causative agents of IE?

A

Staph intermedius, staph aureus, strep canis, e coli, bartonella

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13
Q

What is the mainstay of IE therapy?

A

Long-term bactericidal antibiotics

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14
Q

T/F: dogs with IE have grave prognosis and permanent damage to the valves despite infection resolution.

A

TRUE

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15
Q

A patient with this disease should be receiving periprocedural antibiotics to prevent formation of IE.

A

Congenital heart disease patients- especially subaortic stenosis

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16
Q

Myocardial inflammation in the absence of ischemia –> myocyte damage and cardiac dysfunction is also known as?

A

myocarditis

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17
Q

What CS are commonly seen with myocarditis patients?

A

Fever, lethargy, hyporexia, resp signs, syncope, muscle pain and diarrhea

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18
Q

What arrhythmias are commonly seen in patients with myocarditis?

A

VPC

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19
Q

What is often leaked from damaged/necrotic cardiomyocytes into circulation that can be used to diagnose a patient with myocarditis?

A

Cardiac troponin I

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20
Q

What is the most common cause of myocarditis in Texas?

A

Chagas disease

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21
Q

T/F: Systemic hypertension in dogs/cats is a primary disease

A

FALSE- occurs secondary to other conditions

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22
Q

What is the basic pathophysiology of systemic hypertension?

A

Arterial/arteriolar walls diseased and vessel lumen is narrowed –> reduced blood flow to tissues/hemorrhage from vessel fragility

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23
Q

T/F: Cardiac disease can cause hypertension in SA patients

A

FALSE- SH can often lead to cardiac disease

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24
Q

What are the four target organs of damage?

A

Renal, Ophthalmic, neurologic and cardiovascular

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25
Q

What type of renal damage is seen with SH?

A

Glomerular/tubulointerstitial (ischemia, necrosis and atrophy)

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26
Q

What is the drug of choice used to treat hypertension in cats?

A

Amlodipine: inhibits Ca influx across vascular smooth muscle cells

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27
Q

What are some common side effects of ophthalmic damage from SH?

A

Vision loss, retinal detachment, retinal hemorrhage

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28
Q

What are common cardiac damages seen alongside SH in pets?

A

LV concentric hypertrophy, diastolic dysfunction, mitral regurgitation

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29
Q

What is the leading cause of SH in dogs and cats?

A

Renal disease

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30
Q

What is a common drug used in dogs that can cause SH as an adverse affect?

A

PPA

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31
Q

What happens if the BP cuff you’re using is too small/big?

A

Too big= false low; Too small=false high

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32
Q

If there is TOD and BP > 180 what do you do?

A

Start tx of hypertension in addition to TOD tx

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33
Q

What do you do if you patient has >180 mmHg BP?

A

Start hypertension tx

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34
Q

What if you suspect your patient to have SH and upon evaluation they have no TOD and <180 mmHg BP, how do you respond?

A

Reassess within one week

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35
Q

What is the drug of choice in dogs for SH?

A

Angiotensin-converting enzyme inhibitor: indirect vasodilator blocking formation of angiotensin II

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36
Q

How many consecutive readings for BP should you get in hypertensive patients?

A

3 consecutive readings (toss out the first reading)

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37
Q

Where do adult heartworms typically live?

A

Pulmonary a.

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38
Q

T/F: molting of dirofilaria immitis is dependent on ambient temperature & wolbachia

A

TRUE

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39
Q

Where can S5 HW migrate to besides the pulmonary artery?

A

Main pulmonary artery, right side of heart and vena cavae (heavy infections)

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40
Q

What do the worms cause in the artery?

A

Induce inflammation, endothelial damage, myointimal proliferation, disruption of vascular integrity, fibrosis, and pulmonary hypertension

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41
Q

What do dead worms induce?

A

Thrombosis and more inflammation

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42
Q

What is it called when you have mechanical obstruction (by worms) of blood flow in the R. side of the heart and vena cavae?

A

Caval syndrome

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43
Q

What are some CS seen with HWD dogs?

A

Exercise intolerance, wt loss, lethargy, cough, abdominal distension, syncope, hematuria

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44
Q

Which side of the heart is commonly affected in HWD?

A

R-sided CHF- tricuspid regurgitation (right apical systolic murmur)

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45
Q

What tests are commonly run to assess microfilaria after you have a positive antigen test for HWD?

A

Modified knott or filter test

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46
Q

What will you see on thoracic rads in a dog with HWD?

A

Dilation of any or all pulmonary a. and R-sided enlargement. Infiltrates are commonly seen.

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47
Q

What is the test of choice if there is an arrhythmia in a HWD patient?

A

Electrocardiography

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48
Q

What are the four tx options for HWD dog?

A
  1. Macrocyclic lactone preventative (ivermecitn, milbemycin oxime)
  2. Doxycycline (reduces/eliminates Wolbachia)
  3. Exercise restriction (IMPORTANT)
  4. Adulticide therapy with melarsomine dihydrochloride
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49
Q

Why should milbemycin be avoided in microfilaricide positive dogs?

A

This can cause quick death of baby worms resulting in severe anaphylaxis shock

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50
Q

T/F: Cats are an unnatural host for Dirofilaria immitis which is why they are quite resistant to the infection

A

TRUE

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51
Q

What is the common reason we use HW preventatives in our feline patients since the pevalance of infection is so low?

A

We are trying to prevent our feline friends from getting HARD

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52
Q

Inflammatory & proliferative disease of the pulmonary arteries, bronchioles and pulmonary parenchyma in cats WITHOUT mature infections is known as what?

A

Heartworm-associated respiratory disease (HARD)

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53
Q

What cell type contributes to the profound inflammatory reaction to S5 in cats?

A

Pulmonary intravascular macrophages (PIMs)

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54
Q

What do the symptoms of HARD in feline patients look similar to?

A

Asthma

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55
Q

What are acute respiratory signs in felines a result from in HW infection?

A

Dead worm embolization

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56
Q

Current dx tests detect Ag produced where in the parasite?

A

Reproductive tract of adult female (insensitive for detecting HWI in felines because they typically only have 1 worm and this test usually picks it up with >3 worms present)

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57
Q

When does Ab-positive status occur in HWD patients?

A

Larvae have developed to stage L4

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58
Q

Why is microfilarial testing not typically performed in cats?

A

often amicrofilaremic or low microfilaria numbers

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59
Q

What defines pulmonary hypertension? (systolic, mean and diastolic)

A

Systolic: > 30 mmHg
Mean: > 20 mmHg
Diastolic: >15 mmHg

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60
Q

What are the three mechanisms of PH?

A

Increased CO, increased pulmonary vascular resistance and increased pulmonary venous pressure

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61
Q

What are the five classifications of PH?

A
  1. PH due to pulmonary vascular dz
  2. PH due to L-sided heart dz
  3. PH due to chronic pulmonary dz/hypoxia
  4. PH due to thrombotic/embolic dz
  5. Miscellaneous
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62
Q

What are some PE findings with PE patients?

A

Dyspnea/tachypnea, abnormal lung sounds, cyanosis, murmur from tricuspid regurgitation (might have systemic hypotension)

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63
Q

What is the gold standard test for PH patients?

A

Echocardiography

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64
Q

What are some common findings with PH patientson thoracic radiographs?

A

Pulmonary infiltrates with severe pulmonary hypertension

- dorsal deviation of trachea, sternal contact increased, dilated main pulmonary artery

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65
Q

T/F: If you have concentric hypertrophy of RV and the pulmonic valve is normal- you can infer that there is pulmonary hypertension.

A

TRUE

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66
Q

What is seen on Echo due to the increased RV pressure preventing LV to fill up normally

A

Diastolic flattening of ventricular septum

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67
Q

What is the drug of choice for tx pulmonary arterial hypertension?

A

Slidenafil: phosphodiesterase V inhibitor

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68
Q

T/F: Supplemental O2 can be used to dilate pulmonary arteries

A

TRUE

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69
Q

If PH patient hasn’t improved on slidenafil on its own, what drug can you use?

A

Pimobendan

70
Q

___ is the obstruction of a pulmonary artery by a thrombus that originated in systemic venous circulation.

A

PTE

71
Q

What are the three componenets to a thrombus formation? (Vrichow’s triad)

A
  1. Hypercoaguability
  2. Endothelial injury
  3. Blood stasis
72
Q

What are two mechanisms of gas-exchange impairment seen with PTE patients?

A

Ventiation-perfusion mismatch and diffusion impairment

73
Q

T/F: Onset of signs with PTE patients is acute.

A

TRUE

74
Q

What product of clot breakdown can be used as a dx test for PTE?

A

D-dimers

75
Q

T/F: Thoracic radiographs with a PTE patient may appear completely normal.

A

TRUE

76
Q

What radiographic finding would be fairly specific for a PTE patient?

A

Hypovascular area/lobe

77
Q

What arterial blood gas finding may be abnormal with a PTE patient?

A

Hypoxic, hypocapnic and increased alveolar-arterial gradient

78
Q

T/F: normal D-dimers in a patient with acute respiratory signs rules PTE in?

A

FALSE- rules out

79
Q

What is an initial/acute tx for PTE patients?

A

Anticoagulant therapy with unfractionated heparin (less chance of bleeding complication) or low molecular weight heparin (more targeted in coag cascade, $$)

80
Q

What are two categories of drugs used for PTE patients?

A

Anticoagulant and antiplatelet

81
Q

What is the most common pleural space disease that you will see?

A

Pleural effusion- abnormal accumulation of fluid in pleural space

82
Q

What kind of breathing pattern is seen in patients with pleural effusion?

A

Restrictive breathing pattern (shallow and rapid)- increased inspiratory effort and rate

83
Q

What are the three effusion categories?

A

Transudate, modified transudate and exudate

84
Q

Which type of effusion would a patient with protein-losing enteropathy have?

A

Transudate- low protein and low cells

This patient will have a colloid oncotic pressure problem

85
Q

What is the most common exudate found in patients with pleural effusion and what is an example of a disease in this category?

A

Modified transudate

CHF

86
Q

What category of pleural effusion would pyothorax fall under?

A

Exudate- high protein and high cells (SEPTIC patients)

87
Q

What would you hear when auscultating the lungs of a patient with pleural effusion?

A

Muffled or absent lung sounds- this is because there is a layer of water between the lungs and your stethoscope, so you will not be able to hear the sound waves as readily as a normal patient where it is just a tissue/muscle interface between

88
Q

What dx method is commonly used to quickly confirm the dx of pleural effusion?

A

Thoracic FAST- this is important because it causes minimal stress to the patient

89
Q

When would you consider placing a pleural port in a patient with pleural effusion.

A

When they have an underlying disease that cannot be resolved

90
Q

What is one of the few curable respiratory diseases that was discussed?

A

Pyothorax- must be caught early

91
Q

Why is it so important to stop the chronic fluid build up in a patient with pleural effusion?

A

Chronic fluid –> Chronic inflammation –> Fibrosis

92
Q

What are the three types of pneumothorax and which is most commonly seen?

A

Traumatic, spontaneous, iatrogenic

Traumatic is most commonly seen

93
Q

T/F: The skin wound in a patient with pneumothorax can be centimeters away from the site of penetration into the lungs.

A

TRUE

94
Q

T/F: Spontaneous pneumothorax patients are often times congenital

A

TRUE

95
Q

T/F: You as the doctor can cause pneumothorax while performing thoracocentesis.

A

TRUE (also seen during IPPV mishaps)

96
Q

Pneumomediastinum is most commonly caused by what?

A

Damage from the trachea

97
Q

What are some CS of a pneumomediastinum patient?

A

Tachypnea, dyspnea, SubQ emphysema (crunchy skin) and vomiting (CATS)

98
Q

What is a common routine procedure that can cause pneumomediastinum?

A

Dental cleanings- flipping the patient constantly and the ETT can damage the trachea and potentially rupture it

99
Q

What three components are considered to make up the pulmonary parenchyma?

A

Alveoli, microvasculature and interstitium

100
Q

What is the primary function of the parenchyma?

A

Gas exchange

101
Q

T/F: The rate of transfer of gas through tissue is proportional to the tissue area and the difference in partial pressure of gas and inversely proportional to tissue thickness.

A

TRUE

102
Q

What is the MOST COMMON pulmonary parenchymal disease?

A

Pneumonia (bacterial)

103
Q

What is the second most common pulmonary parenchymal disease?

A

Idiopathic pulmonary fibrosis

104
Q

T/F: Primary pathogens more commonly result in bacterial pneumonia as opposed to opportunistic pneumonia?

A

FALSE- opposite

105
Q

What are your common opportunistic pathogens in dogs and cats?

A

Dogs: E. coli, pasteurella, klebsiella, staph, strep, bordetella (mycoplasma can-uncommon though)
Cats: mycoplasma, pasteurella, bordetella and e. coli

106
Q

What are the two classifications of bacterial pneumonia?

A

Community-acquired and hospital acquired pneumonia

107
Q

What is important to know about hospital-acquired pneumonia agents?

A

These bugs typically are drug resistant

108
Q

T/F: Patients with bacterial pneumonia typically have a non-productive cough as the main presenting complaint

A

FALSE: productive cough

109
Q

What is the classic rad pattern in a pneumonia patient?

A

Ventral alveolar pattern

110
Q

What is the def dx. of bacterial pneumonia?

A

identification of sepsis from lower airway samples

111
Q

What is the typical tx for pneumonia patients?

A

Ab for at least 2 weeks and continue for 1 week post CS resolution

112
Q

Tx of choice for a dog with HAP pneumonia would be what?

A

1st generation cephalosporin (B-lactam) + 2nd/3rd generation cephalosporin

113
Q

T/F: Often times patients with pneumonia are in a lot of discomfort from the productive cough- it is important that you supplement the dog with a cough suppressant.

A

FALSE- never give a patient with pneumonia a cough suppressant- this is their body’s way of trying to clear the foreign substance

114
Q

Along with lower respiratory signs, what else is noticed upon evaluation of a patient with mycotic pneumonia?

A

Lymphadenopathy and weight loss are of concern

115
Q

What is the most common cause of protozoal pneumonia?

A

Toxoplasma gondii

116
Q

What are the two breeds most commonly predisposed to idiopathic pulmonary fibrosis?

A

West highland terrier and stafforshire bull terrier

117
Q

What lung sound is often associated with patients who have idiopathic pulmonary fibrosis?

A

Crackles

118
Q

What radiographic abnormalities are seen in patients with idiopathic pulmonary fibrosis?

A

Bronchointerstitial pattern is most common in dogs

119
Q

T/F: Non-cardiogenic pulmonary edema is typically protein-rich

A

TRUE

Cardiogenic pulmonary edema is low in protein

120
Q

What is the most common bronchial disease?

A

Chronic bronchitis

121
Q

What is the pathophysiology of chronic bronchitis?

A

BREAK THE CYCLE- airway collapse occurs secondary to chronic inflammation and coughing –> collapse causes more inflammation and mucous production –> more coughing. Intervene the cycle to MAKE IT STOP

122
Q

T/F: Patients with chronic bronchitis have a productive cough with a terminal retch

A

FALSE- non-productive (white foam seen occasionally)

123
Q

What sounds do you hear on pulmonary auscultation in patients with chronic bronchitis?

A

Crackles, wheezes and snapping

124
Q

T/F: Expiratory dyspnea is specific to lower airway problems

A

TRUE

125
Q

What lesions will you see on thoracic radiographs in a patient with chronic bronchitis?

A

Bronchial pattern (donut lesions)

126
Q

What is the curative tx of chronic bronchitis?

A

TRICK. NO CURATIVE TX.

127
Q

This disease is commonly seen in young adult siberian huskies and will have coughing, retching, dyspnea and nasal discharge with an eosinophilia.

A

Eosinophilic bronchopneumopathy

128
Q

What is the difference of chronic bronchitis and feline asthma?

A

Chronic bronchitis: inflammation, mucus and wall thickening

Asthma: inflammation, mucus, wall thickening AND bronchospasm

129
Q

What are the primary effector cells in allergic asthma in felines?

A

Eosinophils- release hyper-reactive proteins

130
Q

What are the most common breeds of cats that have chronic bronchitis?

A

Siamese cats

131
Q

T/F: Cats with bronchitis have intermittent coughing and owner may not see the patient coughing everyday

A

FALSE- daily coughing

Asthma patients have intermittent/episodic signs

132
Q

What is an important ddx for cats with chronic bronchitis?

A

HARD (HW associated resp dz)

133
Q

What defines tracheal collapse?

A

Dorsoventral flattening of the tracheal rings

134
Q

Collapse of ___ occurs during inspiration and collapse of ___ occurs during expiration.

A

Cervical trachea and thoracic trachea

135
Q

What is a common sound that is heard in dogs with a tracheal collapse?

A

“Honking”

136
Q

What is the pathophysiology of tracheal collapse?

A

Mechanical trauma to tracheal mucosa –> inflammation is a result –> coughing is stimulated –> increased intrathoracic pressure –> tracheal collapse is exacerbated –>inflammation increases –> more coughing SO ON SO FORTH

137
Q

What area in the body is the area of severe tracheal collapse?

A

Thoracic inlet

138
Q

What is the common signalment for a patient with tracheal collapse?

A

Small breed, chronic honking cough with terminal retch and owner may complain about these episodes when they are picking their dog up

139
Q

T/F: A cough elicited with tracheal palpation is specific for tracheal collapse

A

FALSE- suggests tracheal sensitivity

140
Q

T/F: Normal radiographs rule out tracheal collapse

A

FALSE- this is a dynamic condition, so you may not have caught it at the right time

141
Q

What are the three functions of the larynx?

A

Regulate airflow
Protect trachea from aspiration during swallowing
Control phonation

142
Q

Which nerve innervates all but 1 of the intrinsic laryngeal muscles?

A

Caudal laryngeal n.

143
Q

What is the most common cause of acquired laryngeal paralysis?

A

Polyneuropathy

144
Q

What breeds do you commonly see polyneuropathy in?

A

Rottweilers, dalmatians, and white-coated GSD

145
Q

What is the most common cause of laryngeal paralysis in labs?

A

Geriatric-onset

146
Q

What will exacerbate clinical signs of laryngeal paralysis?

A

heat, humidity and exercise

147
Q

What is the name for loud inspiration seen during panting that localizes the problem to the larynx or extrathoracic trachea?

A

Stridor

148
Q

What is a fast acting laryngeal swelling drug?

A

Dexamethasone

149
Q

What is the most common cause of laryngeal paralysis in cats?

A

Neoplastic infiltration

150
Q

What are two other common laryngeal diseases?

A

Laryngeal collapse and laryngeal masses

151
Q

What are the two primary defects of brachycephalic airway obstruction?

A

Stenotic nares and elongated soft palate

152
Q

What nasal parasite is seen in cats and causes mild chronic inflammation with minimal CS?

A

Mammomonogamus

153
Q

What is the dx and tx of Mammomonogamus?

A

Dx: fecalfloat, rhinoscopic cytology
Tx: fenbendazole

154
Q

What is the name of the nasal mite that causes sneezing, rhinitis, nasal discharge and facial pruritis in dogs?

A

Pneumonyssoides

155
Q

What is the tx for Pneumonyssoides?

A

Selamectin or milbemycin oxime

156
Q

What is a problem in the nasopharynx commonly seen in young cats due to chronic inflammation?

A

Nasal polyps

157
Q

What CS in dogs is related to nasopharyngeal polyps?

A

Reverse sneezing

158
Q

What is a common cause of nasopharyngeal stenosis?

A

Regurgitation associated with anesthesia

159
Q

What is the most common cause of fungal rhinitis in cats?

A

Cryptococcus

160
Q

What are the CS associated with Cryptococcus?

A

Sneezing and nasal discharge

161
Q

What is the most common source of fungal rhinosinusitis in dogs?

A

Aspergillus fumigatus

162
Q

What are the CS of a dog with aspergillosis?

A

Nasal discharge and sneezing

163
Q

What can be used in tx aspergillosis?

A

Topical infusion of clotrimazole or enilconazole

164
Q

What are the most common causes of canine infectious respiratory disease?

A

Canine parainfluenza virus with bordetella bronchiseptica

165
Q

T/F: Canine infectious respiratory disease is highly contagious and is transmitted via oronasal exposure from direct contact with secretions or inhalation of aerosolized respiratory droplets

A

TRUE

166
Q

What is the incubation period for CIRD?

A

3-10 days

167
Q

How long does virus shedding associated with CIRD last?

A

10 days

168
Q

T/F: Bordetella can be transmitted through human contact if the human has been exposed to another patient with CIRD

A

TRUE- fomite and ourselves can transfer this virus- GOOD HYGIENE is important

169
Q

What are the two main viral causes of feline upper resp tract infec?

A

Feline herpesvirus and feline calicivirus

170
Q

T/F: Shedding of herpesvirus in cats increases dramatically in stressful situations

A

TRUE

171
Q

What is the definitive dx test for PTE?

A

CT or angiography

RUSVM SAM I- Spring '18 (2 decks)

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