Respiratory Medicine Flashcards
1
Q
How do we localize respiratory signs?
A
Upper vs. Lower
2
Q
Classify the following as upper or lower respiratory: Nasal Discharge.
A
Upper
3
Q
Classify the following as upper or lower respiratory: Sneezing/reverse sneezing.
A
Upper
4
Q
Classify the following as upper or lower respiratory: Increased effort on inspiration
A
Upper
NOTE: INSPIRATION is upper, EXPIRATION is lower
5
Q
Classify the following as upper or lower respiratory: Audible sounds (stertor, stridor, snoring).
A
Upper
6
Q
Classify the following as upper or lower respiratory: Open-mouth breathing.
A
Upper
7
Q
Classify the following as upper or lower respiratory: Pawing at face.
A
Upper
8
Q
What does pawing at the face indicate usually?
A
FB in the airway
9
Q
Classify the following as upper or lower respiratory: Cough.
A
Lower
10
Q
What is the hallmark sign of lower respiratory disease?
A
Coughing
11
Q
What must you also keep in mind when you see coughing?
A
Heart disease
12
Q
Classify the following as upper or lower respiratory: Respiratory distress.
A
Lower
13
Q
Classify the following as upper or lower respiratory: Increased effort on expiration.
A
Lower
14
Q
What is almost always the cause of nasal discharge?
A
Nasal cavity disease.
15
Q
Name 4 types of discharge.
A
Serous
Mucopurulent
Mucoid
Hemorrhagic
16
Q
What often accompanies nasal discharge?
A
Sneezing
17
Q
What are two key aspects of the physical exam?
A
Signalment and history
18
Q
What are two ways we can examine nasal airflow?
A
Glass slide
Wisp of cotton
19
Q
What are two things you should NORMALLY be able to do in a physical exam that you might not in nasal cavity disease?
A
Ocular retropulsion
Depress the soft palate
20
Q
Where does sneezing localize disease to?
A
Nasal cavity
21
Q
Is a reverse sneeze a problem?
A
No
22
Q
What is stertor?
A
Gurgling or snoring
23
Q
What is stridor?
A
High-pitched noise or whine usually on expiraion
24
Q
When can you hear expiratory stridor?
A
Intrathoracic tracheal collapse (laryngeal paralysis)
25
What is the hallmark of trachea/lung disease or cardiac failure?
Cough
26
What are 3 triggers of coughing?
Inflammatory products
Excessive secretions
Airway collapse
27
How are coughs classified?
Dry, non-productive
| Wet, productive
28
What is your next step with a non-cardiogenic cough?
Chest RADs
29
If you take chest RADs for a cough and they're normal, what must you consider?
Tracheal disorders
30
If you take chest RADs for a cough and they're abnormal, what does that tell you?
Lower airway and pulmonary parenchyma disease
31
What is important to remember about the term dyspnea?
It is a human term. In vet med, we should use "respiratory distress".
32
What is tachypnea?
Increased RR
33
Is tachypnea always bad?
No
34
What is panting?
In dog, dispels heat. In cats can mean respiratory distress or stress.
35
What is orthopnea?
Upright position with elbows abducted
THINK PLEURAL DISEASE
36
What is respiratory distress most often associated with?
Lower airway disease
37
When does tachypnea become respiratory distress?
When it is causing distress
38
What is respiratory distress all about?
The O2.
39
What are 5 causes of respiratory distress?
```
Insufficient O2 in inspired air
Insufficient ventilation
Insufficient circulation
Insufficient RBC
Abnormal Hb
```
40
What does cyanosis indicate?
Severe hypoexemia
41
What are 5 things you should do in your physical exam to determine site of respiratory signs?
```
Listen
Observe respiratory pattern
Check for nasal airflow (if upper airway obstruction)
Tracheal palpation
Auscult lungs
```
42
What does increased INSPIRATORY effort indicate?
Upper airway obstruction
43
What does increased EXPIRATORY effort indicate?
Lower airway obstruction
44
Describe normal bronchial sounds.
Loudest over hilus
During expiration
Sounds like wind blowing
45
Describe normal vesicular sounds.
Best on inspiration
At periphery of chest
Sounds like rustling leaves
46
Describe normal bronchovesicular sounds.
Mixture of bronchial and vesicular, but mostly expiratory
| Increase in intensity at central airway
47
What causes "crackles" in the lungs?
Airways snapping open (closed due to fluid in or around them)
48
What causes wheezes?
Airflow through a narrow opening
49
When are wheezes best heard?
Expiration
50
If you hear a loud snap over the hilus at the end of expiration, what should you be thinking?
Collapse of intrathoracic trachea, carina or mainstem bronchi
51
What do "goose honks" indicate?
Tracheal collapse
52
What causes a creaking/grating sound?
Pleural friction rubs
53
What is the most important diagnostic test for signs of respiratory system disease?
Imaging
54
What MUST you do before imaging?
Stabilize patient
55
Is a minimum database required for all respiratory cases?
No
56
What 2 things can sometimes be more important than the minimum database?
Fecal
| HWT
57
What has become the standard for evaluating the nasal cavity?
CT/MRI
58
What are 3 indications for a nasal flush?
FB suspected
Cleanse airways prior to rhinoscopy
Obtain samples for cytology
59
What is the difference between a rhinoscopy and a bronchoscopy?
Rhinoscopy is just the nasal cavity
| Bronchoscopy looks at lower respiratory tract
60
What landmark do you NEVER pass when performing a blind core biopsy?
Medial canthus of the eye
61
What must you be careful not to hit when performing a blind core biopsy?
Cribiform plate
62
When is bronchoscopy contraindicated?
In sever respiratory compromise UNLESS therapeutic (removing FB)
63
When is a Bronchoalveolar lavage (BAL) indicated?
Lung dz involving small airway, alveoli or interstitium
64
What can be done to retrieve material from within lungs for sampling?
BAL
65
On what patients can you perform a transtracheal wash and aspirate?
Medium-larger breed dogs
66
On what patients can you perform an endotracheal or transoral wash and aspirate?
Cats and tiny dogs
67
What are 2 indications for a transthoracic lung aspiration?
```
Intrathoracic mass (in contact with thoracic wall)
Diffuse disease
```
68
What is a contraindication to a transthoracic lung aspiration?
An abscess
69
What are 3 possible complications of a transthoracic lung aspiration?
Hemothorax
Pneumothorax
Potentially pyothorax later
70
What are 2 reasons for placing a chest tube?
Treatment of pyothorax
| Management of pneumothorax
71
What is coupage?
Banging on the chest
72
What is the purpose of coupage?
To break up mucous
73
If you see nasal discharge and depigmentation, what should you think of?
Aspergillosis
74
What are the top 5 things on your differential list for nasal discharge?
```
FB
Rhinitis
Dental dz
Neoplasia
Trauma
```
75
What 5 things do we expect to see with a nasal FB?
```
Acute onset
Acute sneezing
Gagging/reverse sneezing
Pawing
Discharge (serous -> mucopurulent after time)
```
76
What is rhinitis?
Inflammation of the nasal cavity
77
What 2 pathogens are responsible for 90% of feline upper resp. cases?
Feline herpesvirus
| Feline calicivirus
78
What 4 pathogens are responsible for 10% of feline upper resp. cases?
Chlamydophyla felis
Mycoplasma
Coronavirus
Bordatella
79
What is a key sign of feline herpesvirus?
Corneal ulcers/ulcerative keratitis
80
What are 2 key signs of feline calicivirus?
```
Oral ulcers (and on nose)
Pneumonia
```
81
What causes limping kitten syndrome?
Feline calicivirus
82
What is a key sign of Chlmydophyla?
Conjunctivitis with chemosis (conjunctival edema)
83
Which virus is shed with stress?
Herpesvirus
84
Which 2 viruses can be shed with or without stress?
Calici
| Chlamdyophyla
85
How is feline herpes transmitted?
Direct contact
| Fomites (US!!)
86
Why do we treat cats with herpesvirus with systemic abx?
Secondary infections
87
What are 3 sequelae to herpesvirus?
```
Chronic rhinitis (turbinate damage = "snuffler")
Chronic conjunctivitis
Fibrosis of lacrimal ducts = epiphora (overflow of tears)
```
88
What does oral lysine do?
Reduces herpes virus replication
89
What are the 2 oral antivirals we use?
Famciclovir
| Acyclovir
90
What are 2 other treatments for herpes cats that fall under "supportive care"?
Abx for secondary infection
| Fluids (keeps animal hydrated and mucus is less sticky)
91
How can the herpes vaccine be administered?
Parenteral
| Intranasal
92
Which herpes vaccine formulation is best in outbreaks?
Intranasal
Intranasal is not blocked by maternal abs like parenteral is
93
Which herpes vaccine formulation may prevent the carrier state?
Intranasal
94
What is important to remember about calicivirus?
Has a high mutation rate and no cross protection from vaccines
95
What 2 ways is calicivirus transmitted?
Via direct contact or fomites
96
T/F: Calicivirus is easily killed with routine disinfectants.
False. It is resistant and has a longer survival time in the environment
97
What are the 2 distinct calicivirus syndromes?
Limping Kitten Syndrome
| Virulent Hemorrhagic Systemic Syndrome
98
What 3 signs do we see with limping kitten syndrome?
Lameness
Ulcers on paws
Sore joints
99
Does the normal calicivirus vaccine strain protect against Virulent Hemorrhagic Systemic Syndrome?
No
100
What is the main treatment for Calicivirus?
Mostly supportive
101
What 4 sequelae can you see from calicivirus?
Chronic rhinitis
Sinusitis
Conjunctivitis
Carrier state
102
What is the hallmark sign of Chlamydophila felis?
Conjunctivitis with chemosis
103
What 2 ways can you dx Chlamydophila felis?
```
Conjuctival smear (see intracytoplasmic inclusions)
PCR: conjunctivia, nares or oropharynx
```
104
How do you treat Chlamydophila felis?
Topical tetracycline or erythromycin
If systemic: oral doxy or azithromycin
NOTE: Remember to give water with doxy to prevent esophageal stricture.
105
Why isn't chlamydophila felis vaccine core?
More reactive than other antigens
106
What are the 6 basics for treating upper respiratory dx in cats?
```
Warm and hydrated
Remove crusts
Humidify
Topical decongestants
Systemic abx
Topical opthalmics
```
107
What topical decongestant is preferred when treating a cat with upper respiratory dz?
Phenylephrine
108
What would you always consider as secondary with nasal discharge?
Bacterial rhinitis
109
What are the 2 big signs of nasal aspergillosis?
Nasal ulceration and depigmentation
110
If you suspect aspergillosis, what is the best sample to collect?
Plaques, though can be done on discharge if owner can't afford rhinoscopy to retrieve plaques
111
How is aspergillosis treated?
Often referred.
Debride, then infuse 1% clotrimazole or 2% enilconazole over 1hr
112
What is a contraindication to treatment for aspergillosis?
Damaged cribiform plate
113
Most common cause of fungal rhinitis in dogs is?
Aspergillosis
114
Mots common cause of fungal rhinitis in cats is?
Cryptococcosis (sometimes dogs too)
115
What dog is most susceptible to fungal rhinitis?
Dolichocephalics
116
What signs do you see with Cryptococcosis in cats?
Chorioretinitis
117
How can you dx Cryptococcosis in cats (2 ways)?
Organisms often in nasal discharge
| Serum titers reliable (Ag test, not Ab)
118
How do you treat Cryptococcosis?
Conazoles systematically
119
What are the 2 key signs of nasal mites?
Sneezing
| Reverse sneezing
120
How do you treat nasal mites?
Ivermectin
121
Do you see nasal mites if the dog is on Heartworm preventative?
Nope
122
What is lymphoplasmacytic rhinitis?
Lymphoplasmacytic infiltration of nasal mucosa
123
What dogs are often affected with lymphoplasmacytic rhinitis?
Dolichocephalics
124
Is it likely lymphoplasmacytic rhinitis if you see destruction of nasal septum, frontal sinus or cribiform plate?
No
125
What would lymphoplasmacytic rhinitis look like on rhinoscopy?
Red, edematous mucosa that bleeds easily and turbinate atrophy
126
How do you treat lymphoplasmacytic rhinitis?
Nothing effective, avoid all smoke
Maroptiant used off label as an antiinflammatory
127
What are two major signs you see with nasal neoplasia?
Loss of airflow (d/t mass effect)
| Facial deformity
128
What else can look like nasal neoplasia?
Fungal rhinitis
129
What 3 ways can you diagnose nasal cancer?
Nasal discharge cytology (sometimes you get lucky)
FNA of ipsilateral l.n. (sometimes you get lucky)
Rhinoscopy (not always available)
130
What is the last resort for diagnosing nasal cancer?
Rhinotomy
131
What is the treatment of choice for nasal cancer?
Radiation (survival to 12-16mos with debulking)
132
What is the cause of death with nasal cancer?
Airway obstruction
133
Why is chemotherapy not commonly used for nasal cancer?
Only effective on LSA
134
What 2 nasal cancers have the better prognosis?
Adenocarcinomas
Sarcomas
NOTE: after radiation
135
What 2 nasal cancers have the worse prognosis?
Undifferentiated carcinomas
| Squamous cell carcinomas
136
T/F: Cats live longer than dogs with radiation.
True... Of course they do.
137
What is the typical signalment of a dog with nasal neoplasia?
Older (>8yrs), long nosed breeds predisposed
138
T/F: Most nasal neoplasias are malignant.
True
139
What are the 2 most common types of nasal neoplasia in dogs?
Adenocarcinoma
| Squamous Cell Carcinoma
140
What are the 2 most common types of nasal neoplasia in cats?
Lymphoma
| Adenocarcinoma
141
What is ciliary dyskinesia?
Immotile ciliary
142
How does a dog get ciliary dyskinesia?
Autosomal recessive gene
143
What is affected by ciliary dyskinesia?
Nasal cavity, trachea and lower airways
144
Describe the classic presentation of ciliary dyskinesis.
Young
Purebreed
Recurrent respiratory tract infection/signs**
145
What is Kartagner's Syndrome?
Bronchiectasis, situs inversus and chronic rhinosinusitis
Bronchiectasis = abnormal widening of the bronchi or their branches, causing a risk of infection
Situs inversus = inverted position of chest and abdominal organ
146
How do you diagnose ciliary dyskinesis?
Biopsy and TEM
147
What do you do to treat ciliary dyskinesis?
Nothing
148
What is the most common sign of tracheal and bronchial disease?
Cough
149
What are the top 4 signs you see with tracheal and bronchial disease?
Cough (#1)
Wheezing
Inspiratory sounds
Retch/gag
150
What is kennel cough?
A complex caused by both bacteria and viruses.
Can be one or multiple organisms
151
What 4 organisms most commonly cause kennel cough?
Parainfluenza
Canine adenovirus 2
Mycoplasma
Bordatella
152
What severity of signs do you see with kennel cough caused by Parainfluenza?
Mild
153
What severity of signs do you see with kennel cough caused by Canine adenovirus 2?
Mild
154
What severity of signs do you see with kennel cough caused by Mycoplasma?
Mild to severe
155
What severity of signs do you see with kennel cough caused by Bordatella?
Mild to severe
156
How is kennel cough spread?
Respiratory secretions and fomites
VERY CONTAGIOUS!!
157
Describe "uncomplicated kennel cough".
Happy dog with dry cough on tracheal palpation, serous oculonasal discharge, gagging/retching.
Upper resp. only.
158
Describe "complicated kennel cough".
Sick dog with moist cough, mucopurulent oculonasal discharge, can progress to bronchopneumonia.
Upper and lower resp.
159
When do clinical signs of kennel cough develop?
4-10 days post exposure
160
If you have the complicated form of kennel cough, what else might you want to look at besides history and clinical signs?
Hemogram
Thoracic RADs
TTW cytology and culture
161
How do you treat uncomplicated kennel cough?
Restrict exercise
Doxycycline (if Bordatella suspected)
Cough suppressants
162
How quickly does uncomplicated kennel cough usually resolve?
Within 2 weeks
163
How do you treat complicated kennel cough?
Restrict exercise
Systemic Abx (2weeks)
Nebulization with Gentamycin to decrease cough (patient will be hospitalized)
Cough supressants (UNLESS BACTERIAL PNEUMONIA PRESENT)
Brochodilators (Theophylline
NOTE: Penicillin not a good choice d/t poor levels in respiratory secretions
NOTES: Avoid or decrease bronchodilator dose by 30% if using quinolone Abx
164
What is a general rule about the use of cough supressants?
DO NOT USE in a productive cough
165
What is the prognosis of kennel cough?
Good to excellent
166
What are 4 ways to prevent kennel cough?
Parenteral vaccine (CAV and Parainfluenza)
Intranasal and oral vaccine (Parainfluenza and Bordatella)
Sanitation (Bleach diluted 1:32)
Ventilation in kennels
167
What is canine influenza related to?
Equine flu
168
How is canine influenza transmitted?
Direct contact with respiratory secretions/fomites
169
What percentage of dogs with influenza have signs?
80%
170
What is your window to get samples for a PCR to confirm canine influenza?
Within 72 hours of onset
171
Describe mild/uncomplicated canine influenza.
Looks like mild/uncomplicated kennel cough.
172
Describe severe/complicated canine influenza.
High fever
Hemorrhagic pneumonia (coughing up blood)
Rapid onset, can be fatal in hours
173
What is the mortality rate of severe/complicated canine influenza?
5-8%
174
How do you treat canine influenza?
Supportive care
| Systemic Abx if severe
175
How do you prevent canine influenza?
Vaccine available, but not core!
Isolate sick and exposed dogs.
Change clothes and wash hands between patients
176
What age of dog do you typically see Oslerus osleri in?
Younger dogs
177
What 3 signs do Oslerus osleri commonly cause?
Cough
Wheezing
Dyspnea
178
How can you diagnose Oslerus osleri?
Tracheal mass on xray
Mass seen with broncoscopy
Brushings/biopsy of mass
Fecal exam
179
What 2 drugs can you use to treat Oslerus osleri?
Ivermectin
| Fenbendazole
180
What is the typical signalment for collapsing tracheas?
Middle age to older, small or toy breed dogs, often obese
181
What is tracheal collapse?
Reduction in chondrocytes allows cartilage to weaken so tracheal rings collapse -> causes irritation, edema and inflammation -> rings loose firmness and collapse
182
What is the typical sign of collapsing trachea?
Goose honk cough
183
What types of things might exacerbate a collapsing trachea?
Excitement, exercise, eating
184
What else do dogs with a collapsing trachea seem to have commonly?
Hepatomegaly
Theory: O2 deprivation results in liver disease. Liver function improves with the placement of a stent.
185
What 3 ways can you dx a collapsing trachea?
Thoracic/cervical RADs
Fluoroscopy
Bronchoscopy
186
What is the BEST dx tool for a collapsing trachea?
Bronchoscopy
187
What 5 steps should you take in the case of an acute severe collapsing trachea?
```
Clam patient/owner
Cough suppressant
Corticosteroid
O2
Be prepared to intubate
```
188
What are 4 things the owner can do to help their chronic collapsing trachea dog?
Weight loss
Avoid neck collars
Avoid excitement
Avoid smoke, dust, pollen, carpet cleaner
189
What 3 things can we use to treat the chronic collapsing trachea dog?
Cough suppressants
Short course, low dose corticosteroids
Abx for secondary infection
190
What is another name for chronic canine bronchitis?
Chronic obstructive pulmonary disease
191
What is the result of chronic canine bronchitis?
a daily cough >2mos duration
192
What is chronic canine bronchitis?
Inflammation of bronchial walls -> thickened walls -> increased mucus blocking small air ways
193
What are 3 long term sequelae of chronic canine bronchitis?
Emphysema
Bronchiectasis
Pneumonia
194
T/F: Chronic canine bronchitis is similar to asthma in people or cats.
FALSE!!!!
195
What is the signalment of a chronic canine bronchitis dog?
Same as for collapsing trachea.
Small breed, middle to old age, obese small breed.
196
What might you also find on physical exam of a dog with chronic canine bronchitis (2 things)?
Concurrent tacheal collapse
| Mitral insufficiency
197
How do you diagnose chronic canine bronchitis (3 ways)?
Chest RADs
Bronchoscopy
Bronchial cytology and culture
198
Why does it help to keep a dog with chronic canine bronchitis hydrated?
Aids mucociliary clearance
199
What can you give a dog with chronic canine bronchitis to reduce inflammation?
Prednisolone
200
What is the signalment for a cat with idiopathic feline bronchitis.
Any age, but commonly young to middle age
SIAMESE predisposed
201
What are the 2 major signs of idiopathic feline bronchitis?
Chronic or intermittent cough
| Acute respiratory distress (911!!!!)
202
What is another name for idiopathic feline bronchitis?
Feline asthma
203
What 3 things might you note with feline asthma on auscultation?
Wheezes
Crackles
Increased inspiratory effort
204
Compare the sounds heard on auscultation of an asthma cat and a cat with pleural effusion.
Asthma will hear more bronchovesicular sounds.
| Pleural effusion will result in muffled sounds.
205
What is the temprament of a cat with asthma.
Usually an otherwise happy cat.
Contrast: Pleural effusion cats are sick kitties
206
What is the first step in working up a cough/wheeze in a cat (3 things)?
RADs if cat is stable
CBC
Fecal exam
207
What 2 things are in the second step of a work up for a cat that has a cough/wheeze?
TTW/Bronchoscopy
| Cytology/culture
208
What percentage of cats with asthma have normal RADs?
23%
209
What is the most common radiographic sign you will see in an asthmatic cat?
Bronchial pattern
210
What are 4 other things you might see on RADs of an asthmatic cat (besides bronchial pattern)?
Interstitial and patchy alveolar opacities
Hyperinflation of lungs (REALLY black lungs)
10% have collapse of right middle lung lobe
Flattening of diaphragm
211
What will you see on cytology of an asthma case?
Increased eos or neuts and mized inflammation
212
What will you see on cytology of a coughing/wheezing cat with an infection etiology?
Degenerate neuts +/- intracellular bacteria
213
If culture is positive in a coughing/wheezing cat, is it likely asthma?
No, but should consider secondary infection
214
What 4 things do you do to manage the acute bronchoconstricted or severe respiratory distress cat?
No stress
O2
Terbutaline (might make cat "spacey") or Albuterol via MDI
Dex
215
What 4 things do you do to manage the chronic intermittent coughing or wheezing cat?
Prednisolone
No more smoke in the house, avoid other irritants
Metered dose inhaler once signs are under control with oral steroids
216
What are 3 advantages of an MDI?
Less systemic corticosteroid effects
Easier to treat
Possibly higher drug concentration to the lungs
217
What are 3 disadvantages of an MDI?
Increased risk of dental dz (immune compromise in the mouth)
Re-emergence of latent herpes virus
Local dermatitis (irritating to lips)
218
What are 2 other possible long-term treatments?
Oral bronchodilators
| Antibiotics
219
What 2 oral bronchodilators would you use?
Oral theophylline
| Terbutaline
220
What are the 3 major indications for a bronchodilator in a cat?
When large quantities of glucocorticoid needed
Adverse to glucocorticoid
Owner can't use MDI
221
What is the prognosis for long term medically treated feline asthma?
Good
222
What is the prognosis for untreated feline asthma?
Permanent changes
- Bronchitis with fibrosis
- Emphysema
223
What is the typical signalment for chronic bronchitis in cats?
Typically older cats
224
What are 2 major characteristics of chronic bronchitis?
Neutrophili inflammation
| Excessive mucus production
225
What do the clinical signs of chronic bronchitis look like?
Feline asthma
226
What is the focus of management in chronic bronchitis?
Control of inflammation with glucocorticoids
227
What are 5 major signs of lung disease?
```
Difficulty on expiration
Cough
Exercise intolerance
Abnormal lung sounds
Abnormal posture
```
228
What posture would you see in lung disease?
Orthopnea
229
What is pneumonia?
Inflammatory disorder of lung parenchyma
230
What are 5 causes of pneumonia?
```
Bacterial
Aspiration
Viral
Fungal
Parasitic
```
231
What is the most common cause of pneumonia in dogs?
Bacteria
232
Describe the cough in a pneumonia case.
Soft and ineffectual
233
What 3 systemic signs you expect with a pneumonia case?
Fever
Lethargy
Poor appetite
234
What age group typically gets PRIMARY bacterial pneumonia?
Yonger dogs
235
What age group typically gets SECONDARY bacterial pneumonia?
Older dogs
236
What are the 2 main causes for primary bacterial pneumonia?
Bordatella
| Pasturella
237
What are the top 5 causes for secondary pneumonia?
```
Aspiration
FB
Neoplasia
Viral or fungal infection
Bronchitis
```
238
What is an important thing to remember if a dog was recently sedated or anesthetized and has pneumonia?
Likely more resistant because of "hospital bugs"
239
What are 2 good ways to dx bacterial pneumonia?
Thoracic RADs
| Hemogram
240
What 2 things do you expect to see on thoracic RADs of a bacterial pneumonia suspect?
Interstitial pattern
| Alveolar pattern
241
What 2 things do you expect to find on a hemogram of a bacterial pneumonia suspect?
Neutrophilic leukocytosis with left shift
| Monocytosis IF chronic
242
What can bacterial pneumonia result in?
Sepsis -> ALI (acute lung injury) -> ARDS (acute respiratory distress syndrome) (death)
243
What 3 general things can you do to treat bacterial pneumonia?
Abx
Nebulization
Supportive care
244
What sort of Abx would you look to to treat bacterial pneumonia?
Broad-specturum (4 quadrant = G+, G-, aerobe, anaerobe)
245
How long should you treat a bacterial pneumonia case with Abx?
4-8 WEEKS
246
What dose nebulization help do?
Mobilizes airway secretions
247
What is often added to saline in a nebulizer to treat G-?
Gentamicin
248
What 4 things would you considder as supportive care for a bacterial pneumonia case?
Fluids
O2
Coupage
+/- Bronchodilators
249
What respiratory signs will you see with a mycotic pneumonia?
Similar to bacterial pneumonia (cough, exercise intolerance)
250
What 3 things can you use to diagnose mycotic pneumonia?
Cytology/Histology
Urine
Serum antigens
251
What do you see in serum of bacterial pneumonia vs. mycotic pneumonia?
Bacterial: Degenerate neuts with bacteria
Mycotic: eos, monos, plasma cells, happy neuts
252
What 3 things might you use to treat mycotic pneumonia?
Itraconazole
Amphotericin B
Ketoconazole
253
How might geographic location help with determining fungal organism.
Certain fungi are common to certain areas
254
What else might you see in the case of a mycotic pneumonia caused by histoplasmosis?
GI signs
255
What cytology will help you determine causative agent in mycotic pneumonia?
```
L.N.
Draining lesions
TTW/BAL
Endotracheal wash
Lung aspirate
```
256
What fungi is detected by serum ANTIGEN titer?
Cryptococcus
257
What 3 fungi are detected by urine ANTIGEN?
Blasto
Histo
Valley fever
258
How long do you treat mycotic pneumonia?
4-12+ MONTHS
259
Which conazole is good to use in mycotic pneumonia cases with CNS signs?
Fluconazole
260
What do you need to monitor when treating with Amphotericin B and why?
Monitor BUN and Creatinine because nephrotoxic
261
What do you expect in the first week of treating mycotic pneumonia?
Increase chance of worsening of respiratory signs
262
How effective is treatment on Blasto and Crypto?
80%
263
What is the prognosis of localized Histo vs. disseminated Histo?
```
Disseminated = guarded
Localized = better
```
264
What is the recovery rate of Coccidio?
60%
BUT meds often needed for 6-12 months+ (sometimes lifetime)
265
What are the 2 causes of parasitic pneumonia?
```
Aleurostrongylus abstrusus (cat)
Paragonimus kellicoti (dog/cat)
```
266
What would you see on chest RADs in a cat with Aleurostrongylus abstrusus?
Diffuse, nodular densities usually in caudal lobes
267
How do you diagnose Aleurostrongylus abstrusus?
Larvae in fecal exam
268
How do you treat Aleurostrongylus abstrusus (2 meds)?
Fenbendazole
| Ivermectin
269
What is a possible complication of Paragonimus kellicoti?
Cysts rupture = Pneumothorax
270
What might you see on chest RADs with Paragonimus kellicoti?
May see air-filled sacs
271
What is idiopathic pulmonary fibrosis?
Chronic fibrosis of lung interstitium
272
How is idiopathic pulmonary fibrosis characterized (2 things)?
Infiltration of fibroblasts
| Collagen deposition
273
What is the typical signalment for idiopathic pulmonary fibrosis?
Terriers
Middle age to older
Some cats
274
What is the history of idiopathic pulmonary fibrosis?
Slow onset exercise intolerance
275
What is the most noticeable clinical sign of idiopathic pulmonary fibrosis?
Respiratory distress and tachypnea
276
What is the hallmark finding on a dog with idiopathic pulmonary fibrosis?
Inspiratory crackles
277
What woudl you find on a blood gas of a dog with idiopathic pulmonary fibrosis?
Hypoexemia if severe
278
What can you use to help eliminate other Ddx when you suspect idiopathic pulmonary fibrosis?
TTW/BAL
Will find non-degenerate neuts, lymphocytes
Epithelial dysplasia
279
What is the definitive dx for idiopathic pulmonary fibrosis?
Lung biopsy
280
How can you treat idiopathic pulmonary fibrosis?
Corticosteroids + bronchodilators
281
What is the prognosis for a dog with idiopathic pulmonary fibrosis?
Guarded d/t progressive respiratory failure
282
What are the 2 types of primary pulmonary neoplasia?
Adenocarcinoma
| Squamous Cell Carcinoma
283
What are the 4 types of metastatic pulmonary neoplasia?
Adenocarcinoma
Osterosarcoma/Chondrosarcoma
Hamangiosarcoma; oral/digital melanoma
SCC
284
What type of cancer is most common in the lungs?
Metastatic
285
What are 3 types of multicentric pulmonary neoplasia you might see?
Lymphoma
Malignant histiocytosis
Mastocytoma
286
Why are mets so common to find in the lung?
The lung acts as a filter for these cells
287
What is the signalment for pulmonary neoplasia?
Usually older animal
288
What respiratory signs do you see with pulmonary neoplasia?
Cough
Laboured breathing
Increased RR
Hemoptysis (coughing up blood)
289
What would you expect to hear in the lungs if you suspect pulmonary neoplasia?
Crackles
Wheezes
Muffled
290
What non-respiratory signs might you expect to see (5 things)?
```
Weight loss
Inappetence
Lameness (Hypertrophic osteopathy)
Dysphagia/regurg
Head/neck edema
```
291
Why might you see lameness in a case of pulmonary neoplasia?
HOP (hypertrophic osteopathy)
292
How do you gain a tentative diagnosis of pulmonary neoplasia?
Thoracic RADs
THREE VIEWS!!!!!
293
Where do you gain a histological or cytological sample?
Bronchoscopy (and BAL)
FNA
NOTE: BAL may not show anything because don't often exfoliate cells
294
What is the treatment for a primary pulmonary neoplasia?
Surgery if it's a single nodule
295
What is the treatment for mets in the lungs?
Treat primary mass
| Can use chemotherapy in lymphoma
296
What is the prognosis for pulmonary neoplasia?
Guarded to poor
297
T/F: Malignant pulmonary neoplasia better than benign?
False
298
T/F: Primary pulmonary neoplasia better than mets?
True
299
T/F: SCC better than adenocarcinoma in the lungs?
False
300
T/F: Small pulmonary neoplasia better than large?
True
301
T/F: Tumors in one lung better than entire lung?
True
302
T/F: No l.n. involvement better than l.n. involvement?
True
303
What is pulmonary edema?
Accumulation of fluid in alveoli or pulmonary interstitium
304
What do you need to determine in pulmonary edema?
Cardiogenic or non-cardiogenic
305
If you have pulmonary edema, where will you hear crackles?
Perihilar area
306
What are 4 general mechanisms of non-cardiogenic pulmonary edema?
Vascular overload/increased hydrostatic pressure
Decreased oncotic pressure (PLE and PLN)
Increased alveolar-capillary membrane permeability***
Lymphatic obstruction
307
What are 3 pulmonary causes for increased alveolar-capillary membrane permeability?
Aspiration
Upper airway obstruction
Smoke
308
What are 5 non-pulmonary causes for increased alveolar-capillary membrane permeability?
```
Sepsis
Electric shock
CNS dz
Pancreatitis
DIC
```
309
What 2 things can pulmonary edema progress to?
Acute Lung Injury (ALI)
| Acute Respiratory Distress Syndrome (ARDS) -> Respiratory failure
310
What would you hear on thoracic auscultation with non-cardiogenic pulmonary edema?
Crackles
311
What would you see on thoracic RADs with non-cardiogenic pulmonary edema?
```
Perihilar infiltrate
Alveolar pattern (bilateral)
Caudodorsal lung fields are affected
```
312
How do you treat non-cardiogenic pulmonary edema (3 things)
Aggressive control of primary dz
Cage rest with O2
Supportive care (sedation to relax, cautious fluid therapy, Positive Pressure ventilation in severe cases)
313
What is the prognosis for non-cardiogenic pulmonary edema?
Guarded if d/t permeability edema
| Better if d.t fluid overload and if renal fxn is intact
314
What is the cause of ALI?
Pulmonary inflammation and edema
NOTE: NOT a dx, but a clinical description
315
What is ARDS?
Severe form of ALI
316
What is the difference between ALI and ARDS?
Degree of hypoxemia
317
What are ARDS/ALI most commonly a sequela of (3 things)?
Sepsis
Shock
Bacterial pneumonia
318
How soon after the inciting incident might you see clinical signs of ARDS/ALI?
1-4days
319
What are the clinical signs of ARDS/ALI?
Progressive hypoxemia
Respiratory distress
Cyanosis
320
Is ALI/ARDS primary?
No, will be secondary to something else.
321
How do you treat ALI/ARDS?
Aggressive supportive therapy
24-7 care
Positive pressure ventilation
322
What is the prognosis for ALI/ARDS?
Mortality close to 100%... so not good.
323
What 2 clues might you see to tip you off to pulmonary contusions?
Bloody nose
| Bloody mouth
324
What are clinical signs of pulmonary contusions?
Various degrees of respiratory distress
325
What might you see pulmonary contusions concurrent with?
Blunt force trauma (eg. HBC)
326
What is important to remember with pulmonary contusions?
Changes may take 2-12 hours to show up.
MUST MONITOR for 24-48hrs
327
What is eosinophilic bronchopneumopathy?
Inflammation of lungs caused by hypersensitivity to unknown antigen.
328
What breed is predisposed to eosinophilic bronchopneumopathy?
Siberian huskies
329
What age do we typically see eosinophilic bronchopneumopathy in?
Young to middle age dogs
330
What do we typically see clinically with eosinophilic bronchopneumopathy?
Harsh cough
| Lack of response to Abx also common
331
When it comes to treatment of eosinophilic bronchopneumopathy, what do we need to consider if planning on giving steroids?
If patient has bacterial or fungal infection, will make infection WORSE
332
What might you see on the hemogram in a patient with eosinophilic bronchopneumopathy?
1/2 the cases have increased WBCs (neuts or eos)
333
What 2 other tests should be done if you see eosinophilic bronchopneumopathy?
Heartworm
| Fecal
334
If you perform a TTW, BAL or endotracheal wash on a patient with eosinophilic bronchopneumopathy, what cell type will predominate?
Eosinophils (20-25%)
335
How do you treat eosinophilic bronchopneumopathy?
Find and treat the underlying cause
Can give corticosteroids BUT...
BE CAREFUL TO LOOK FOR PROTOZOAL, BACTERIAL OR FUNGAL INFECTIONS FIRST
336
How long is treatment for eosinophilic bronchopneumopathy?
Often need long term because of replases
337
What is the treatment for pulmonary thromboembolism (6 things)?
```
O2
Keep calm
Tx underlying dzz
Bronchodilators
Pred if IMHA or HW
Low dose heparin if DIC or hypercoagulable
```
338
What is the prognosis for pulmonary thromboembolism?
Poor to grave
