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SAM > Respiratory - Pulmonary Parenchymal Diseases > Flashcards

Respiratory - Pulmonary Parenchymal Diseases Flashcards

1
Q 
Which is not included as pulmonary parenchyma?
A) interstitium
B) alveoli
C) Microvasculature
D) pleura
A

D - pleura

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2
Q

Primary function of the parenchyma is

A

gas exchange

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3
Q 
The exchange or transfer of gas across the blood-gas barrier occurs by
A) active transport
B) osmosis
C) diffusion
D) no body knows
A

C - diffusion

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4
Q

Fick’s Law

A

the rate of transfer of a gas through a sheet of tissue is proportional to the tissue area and the difference in the partial pressure of gas on the two sides of the tissue and inversely proportional to tissue thickness

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5
Q

Bacterial pneumonia

A

bacterial infection within the pulmonary parenchyma

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6
Q

potential routes of infection causing bacterial pneumonia

A

inhaled, aspirated, extension from nearby tissues, hematogenous

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7
Q

T/F virulent primary pathogens are more common causes of bacterial pneumonia

A

false, opportunistic pathogens are more common so it is important to investigate for predisposing factors (immunosuppression, pre-existing respiratory disease, aspiration)

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8
Q

Common opportunistic pathogens of bacterial pneumonia in dogs

A

E. coli, pasteurella, klebsiella, staphylococcus, streptococcus, bordetella, mycoplasma

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9
Q

Common opportunistic pathogens of bacterial pneumonia in cats

A

mycoplasma, pasteurella, bordetella, streptococcus, E. coli

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10
Q

Virulent (primary) pathogens that can cause bacterial pneumonia

A

strep. equi subspecies zooepidemicus, extra intestinal E. coi
hemorrhagic or necrotizing pneumonia, parachute to acute, high mortality rate

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11
Q

Community Acquired Pneumonia (CAP)

A

develops in a patient that has not recently been hospitalized (and aspiration of gastric and oropharyngeal contents is not suspected

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12
Q

Hospital acquired pneumonia (HAP)

A

occurs >48h after hospital admission and was not incubating at the time of admission

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13
Q

Aspiration pneumonia

A

result of inhalation of gastric/oropharyngeal contents that are contaminated by pathogenic bacteria

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14
Q

T/F: treatment strategies for CAP, HAP and aspiration pneumonia are all similar

A

False, CAP and aspiration pneumonia similar but HAP differs

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15
Q

Signalment of bacterial pneumonia

A

dogs > cats, young or old but any age can be affected

no breed disposition

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16
Q

Common clinical signs of bacterial pneumonia

A

cough, exercise intolerance, nasal discharge, increased RR and effort, lethargy, hyporexia, pyrexia

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17
Q

Potential findings in a PE of an animal with bacterial pneumonia

A

abnormal lung sounds, tachypnea, dyspnea, nasal discharge, pyrexia, cyanosis, sinus arrhythmia (due to increased vagal tone)

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18
Q

Thoracic radiographs of a dog with bacterial pneumonia

A

classic pattern is alveolar, predominantly ventral
interstitial and/or bronchial markings may be present
diffuse distribution more common with hematogenous pneumonia
pneumonia associated with aspiration, foreign body or a tumor may only involve 1 lobe

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19
Q

Definitive diagnosis of bacterial pneumonia requires

A

identification of sepsis (neutrophilic inflammation and intracellular bacteria) from lower airway samples (obtained via transtracheal wash or bronchoalveolar lavage) followed by culture and sensitivity
mycoplasma ID requires special media or PCR

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20
Q

Common CBC findings in bacterial pneumonia

A

neutrophilic

21
Q

When reading a pulse oximeter, a low (<95%) SpO2 suggests patient is _____

A

hypodermic and supplemental O2 should be given

22
Q

What are arterial blood gas and pulse oximetry used for?

A

detecting hypoxia, measuring oxygenation

23
Q

Which is FALSE regarding treatment of bacterial pneumonia?
A) antibiotics are mainstay of treatment and last usually 10-14d
B) Lower airway samples should be obtained prior to starting antibiotic therapy
C) One most always obtain a lower airway sample
D) Multidrug resistant pathogens are common in hospitals so patients with HAP are at increased risk of getting a MDR infection

A

C - don’t need to if patient has a CAP, no prior history of pneumonia and no recent history of having antibiotic therapy

24
Q

Treatment of bacterial pneumonia in patients with late onset (>4d) HAP or otherwise at risk for having a MDR infection

A

1) 1st generation cephalosporin + 2nd or 3rd gen cephalosporin
2) carbapenem (B-lactam) or amikacin + amoxicillin/sublactam or ticarcillin/clavulanate

25
Q

Adjunct treatment of bacterial pneumonia

A 
supplemental O2 in hypoxic patients
fluid therapy to maintain perfusion
nebulization to enhance mucus fluidity
coupage to encourage coughing of mucus
bronchodilator and/or mucolytic not routine but may be helpful
treatment of any predisposing causes
26
Q

Mycotic pneumonia

A

blastomyces dermatitis, histoplasmosis capsulate, coccidioides immitis
lower resp signs + lymphadenopathy and weight loss
rads are nodular or military interstitial and perihilar lymphadenopathy
Diagnosis - sample skin or nodes cytologically, urine fungal antigen test
Tx - long term anti fungal therapy and supportive care
Blasto + history - itraconazole, Cocci - fluconazole or itraconazole

27
Q 
How would you diagnose a mycotic pneumonia?
A) pulse oximetry and blood gas analysis
B) transtracheal wash
C) bronchoalveolar lavage
D) cytology of skin and lymph nodes
A

D - cytology of skin and lymph nodes

28
Q

Pneumocystitis carinii

A

associated with severe morbidity and high mortality in immunocompromised
common in mini daschunds and CKC spaniel
fever usually absent despite severe pneumonia
mycotic
Tx - potentiated sulfonamides and supportive care

29
Q 
Which type of pneumonia appears as a "snowstorm" on rads?
A) bacterial
B) Mycotic
C) Viral
D) protozoal
A

B - mycotic

30
Q

Viral Pneumonia

A

primary pathogens and contagious
canine - parainfluenza, influenza, distemper, coronavirus, infectious hepatitis, herpesvirus
Cats - coronavirus, calicivirus, herpesvirus
D - PCR
Tx - supportive, antibiotic therapy if secondary bacterial infection suspected

31
Q

Protozoal pneumonia

A

toxoplasma gondii most common, cats are reservoir
Dx - serology, tachyzoites may be in airway sample
Tx - potentiated sulphonamides or clindamycine

32
Q

what is idiopathic pulmonary fibrosis (IPF)

A

an interstitial lung disease characterized by the presence of fibrosis - cause of fibrosis unknown

33
Q

which breeds are predisposed to IPF?

A

wastes, strafforshire bull terrier, usually middle aged to older
cats - no breed disposition, any age affected

34
Q

common clinical signs of IPF

A

cough, exercise intolerance, tachypnea, lethargy, syncope

PE reveals loud crackles in all fields

35
Q

What do you expect to see on the Rads of an animal with IPF?

A

diffuse bronco interstitial pattern in dogs
in cats, bronchial, interstitial and alveolar patterns possible
if severe PH present, R sided cardiomegaly + PA enlargment

36
Q

When is an echo indicated for IPF patients?

A

if PH suspected and to evaluate for concurrent primary cardiac disease

37
Q

Definitive diagnosis of IPF requires

A

lung biopsy and histopathology

not normally done bc of risk

38
Q

Which is FALSE regarding therapy of IPF?
A) cough suppressant therapy can help
B) Corticosteroids are contraindicated in treatment
C) No specific therapy available
D) Bronchodilators can improve clinical signs

A

B - corticosteroids can help improve clinical signs in some patients

39
Q

What is non-cardiogenic pulmonary edema (NCPE)?

A

increased vascular permeability secondary to lung injury, is usually protein rich (in contrast to cariogenic pulmonary edema which is low in protein)

40
Q

Hypoxemia during NCPE usually results from

A

alveolar fluid, decreased lung compliance, airway compression

41
Q

Mechanisms of pulmonary edema

A

increased hydrostatic pressure, decreased oncotic pressure, increased vascular permeability, and/or impaired lymph drainage

42
Q

2 categories of pulmonary edema

A

cardiogenic or non-cardiogenic

43
Q

Causes of NCPE

A 
acute respiratory distress syndrome secondary to primary pulmonary disease or secondary
airway obstruction
seizure
electrocution
vasculitis
severe hypoalbuminemia
44
Q

Clinical signs of NCPE

A

parachute or acute onset
tachypnea, exercise intolerance, dyspnea, cough, cyanosis, hemoptysis
depends on degree of pulmonary injury and amount of NCPE
increased BV sounds and/or crackles common auscultatory abnormalities
decreased lung sounds if edema severe

45
Q

Treatment of NCPE

A 
supplemental O2 in hypoxic patients
minimize stres
may require mechanical ventilation
low-dose furosemide may help
specific therapy if underlying cause
46
Q

What is ARDS?

A

acute respiratory distress syndrome

pulmonary inflammatory disorder characterized by NCPE, neutrophilic inflammation, hypoxemia

47
Q

What is SIRS?

A

systemic inflammatory response syndrome

caused by systemic inflammation of infectious or non-infectious origin

48
Q

Diagnosis of SIRS in dogs and cats

A 
2 of the 4:
tachycardia
tachypnea
hypo or hyperthermia
leukocytosis, leukopenia, or >5% bands

SAM (48 decks)

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