Respiratory SBAs

Question 1

Scenario: A 10-year-old West Highland White Terrier presents with a history of increasing respiratory distress. On auscultation, you hear diffuse crackles throughout the lung fields. The dog has a prolonged expiratory phase with increased effort.

Lead-in: What is the most likely diagnosis?

Options:

A) Canine Chronic Bronchitis
B) Aspiration Pneumonia
C) Idiopathic Pulmonary Fibrosis
D) Pulmonary Oedema
E) Angiostrongylus Vasorum Infection

Answer 1

Correct Answer: C) Idiopathic Pulmonary Fibrosis

Signalment: West Highland White Terriers are predisposed to IPF.
Clinical Signs:
Crackles indicate fluid in the alveoli, which is consistent with pulmonary oedema (a consequence of IPF).
Prolonged expiratory phase suggests a restrictive lung pattern, typical of IPF where the lungs become stiff and difficult to expand.
Disease Process: IPF involves progressive scarring (fibrosis) of the lungs, making it hard for the dog to breathe.
Let’s look at why the other options are less likely:

A) Canine Chronic Bronchitis: While possible, bronchitis usually presents with a chronic cough, often productive, and may have wheezes on auscultation. The signalment and the rapid progression of respiratory distress make IPF more likely.
B) Aspiration Pneumonia: This typically has a more acute onset and may be associated with fever and signs of systemic illness.
D) Pulmonary Oedema: This is a possible finding secondary to IPF, but IPF itself is the underlying cause.
E) Angiostrongylus Vasorum Infection: Lungworm can cause respiratory signs, but the breed and the specific clinical presentation point more towards IPF.

Question 2

Scenario: A 6-year-old male entire domestic shorthair cat presents with lethargy, inappetence, and increased respiratory rate. On thoracic auscultation, the heart sounds are muffled on the right side.

Lead-in: Which of the following is the most likely cause of this cat’s respiratory signs?

Options:

A) Pneumothorax
B) Chylothorax
C) Pyothorax
D) Hyperthyroidism
E) Diaphragmatic Hernia

Answer 2

Correct Answer: C) Pyothorax

Question 3

Scenario: A 2-year-old Labrador Retriever is brought to your clinic with an acute onset of coughing and gagging. The owner reports that the dog was playing fetch in a field earlier that day.

Lead-in: What is the most important diagnostic step to take first?

Options:

A) Thoracic Radiography
B) Complete Blood Count and Biochemistry Panel
C) Bronchoalveolar Lavage
D) Tracheal Wash
E) Faecal Examination

Answer 3

Correct Answer: A) Thoracic Radiography

Question 4

Scenario: A 4-year-old Golden Retriever presents with a 3-week history of coughing, lethargy, inappetence, and weight loss. The dog is also sleeping on its belly more frequently and panting even on short walks. On clinical exam, you find pale pink mucous membranes, muffled heart sounds, and dull lung fields ventrally.

Lead-in: What is the most likely diagnosis?

Options:

A) Pulmonary Oedema
B) Pericardial Effusion
C) Inhaled Foreign Body
D) Pleural Effusion
E) Aspiration Pneumonia

Answer 4

Correct Answer: D) Pleural Effusion

Question 5

Scenario: A 12-year-old cat presents with severe dyspnoea. You identify that the cat has pleural effusion. Thoracocentesis reveals clear fluid with 3.5 g/dL of protein.

Lead-in: What is the most likely cause of the pleural effusion?

Options:

A) Feline Infectious Peritonitis
B) Right-sided Heart Failure
C) Protein-losing Enteropathy
D) Pyothorax
E) Chylothorax

Answer 5

Correct Answer: B) Right-sided Heart Failure

Question 6

Scenario: A 7-year-old Cavalier King Charles Spaniel presents with a grade 3 heart murmur and moderate dyspnoea.

Lead-in: What is the most appropriate diagnostic test to perform next?

Options:

A) Thoracic radiography
B) Echocardiography
C) Complete blood count and biochemistry panel
D) Bronchoalveolar lavage
E) Computed tomography

Answer 6

Correct Answer: B) Echocardiography

Question 7

Scenario: A 15-year-old cat presents with sudden onset open-mouth breathing and abdominal effort. The owner reports the cat has been shallow breathing at home.

Lead-in: What is the most likely cause of the cat’s respiratory distress?

Options:

A) Asthma
B) Pneumothorax
C) Pleural Effusion
D) Pulmonary thromboembolism
E) Tracheal collapse

Answer 7

Correct Answer: C) Pleural Effusion

Question 8

Scenario: A 2-year-old Labrador Retriever is presented with an acute hacking cough and is tracheal pinch positive.

Lead-in: What is the most likely diagnosis?

Options:

A) Kennel cough
B) Aspiration pneumonia
C) Eosinophilic bronchopneumopathy
D) Canine distemper
E) Tracheal collapse

Answer 8

Correct Answer: A) Kennel cough

Question 9

Scenario: A 10-year-old Chihuahua presents with a chronic, dry, productive cough that has not improved with meloxicam. The cough has lasted for 6 months and often produces yellow mucus. The dog is tracheal pinch positive.

Lead-in: What is the most likely diagnosis?

Options:

A) Chronic bronchitis
B) Aspiration pneumonia
C) Idiopathic pulmonary fibrosis
D) Pulmonary oedema
E) Lungworm infestation

Answer 9

Correct Answer: A) Chronic bronchitis

Question 10

Scenario: A 9-year-old Rottweiler is undergoing a Jamshidi bone biopsy for a suspected osteosarcoma on the left forelimb. Thoracic radiographs taken to rule out lung metastases reveal small, white, nodular lesions in the lungs.

Lead-in: What is the most appropriate next step?

Options:

A) Proceed with the bone biopsy as planned.
B) Recommend computed tomography (CT) of the chest.
C) Perform a bronchoalveolar lavage (BAL).
D) Initiate chemotherapy.
E) Administer broad-spectrum antibiotics.

Answer 10

Correct Answer: B) Recommend computed tomography (CT) of the chest.

Question 11

Question 1

In dogs, the most common cause of pleural effusion is ______________.

Answer 11

Answer: Right-sided heart failure

Question 12

A cat presenting with acute onset open-mouth breathing and abdominal effort is most likely suffering from ______________.

Answer 12

Answer: Pleural effusion

Question 13

Kennel cough is most commonly caused by ______________.

Answer 13

Answer: Bordetella bronchiseptica

Question 14

A 10-year-old Chihuahua presents with a chronic, dry, productive cough that has not improved with meloxicam. The cough has lasted for 6 months and often produces yellow mucus. The dog is also tracheal pinch positive. The most likely diagnosis is ______________.

Answer 14

Answer: Chronic bronchitis

Question 15

A cat presenting with Horner’s syndrome may have ______________ disease.

Answer 15

Answer: Mediastinal

Question 16

In birds, ______________ is a common cause of respiratory distress and can be exacerbated by poor husbandry practices such as low humidity and improper ventilation.

Answer 16

Answer: Airsacculitis

Question 17

In the radiographic evaluation of the heart, the ______________ projection is preferred as it provides a less distorted view of the cardiac silhouette and better visualization of the caudal pulmonary vessels.

Answer 17

Dorsoventral (DV)

Question 18

In the anaesthetic management of animals with cardiopulmonary disease, ______________ and ______________ are essential monitoring parameters to assess oxygenation and ventilation, respectively.

Answer 18

Answer: Pulse oximetry, capnography

Question 19

Scenario: A 5-year-old indoor rabbit is experiencing severe respiratory distress with open-mouth breathing.

Lead-in: Which of the following is the most critical initial intervention?

Options:

A) Administer a bronchodilator such as terbutaline.
B) Perform a deep nasal swab for bacterial culture.
C) Provide oxygen therapy and supportive care.
D) Obtain a radiograph to assess lung pathology.
E) Administer corticosteroids to reduce inflammation.

Answer 19

Correct Answer: C) Provide oxygen therapy and supportive care.

Question 20

Scenario: A tortoise presents with lethargy, anorexia, and nasal discharge. The owner reveals that the humidity levels in the tortoise’s enclosure have been consistently high.

Lead-in: What is the most likely cause of the tortoise’s respiratory signs?

Options:

A) Bacterial pneumonia
B) Viral infection
C) Fungal infection
D) Parasitic infestation
E) Foreign body aspiration

Answer 20

Correct Answer: A) Bacterial pneumonia

Question 21

Scenario: A bird is showing signs of respiratory distress, including tail bobbing and an increased respiratory rate.

Lead-in: Which of the following diagnostic tools would be most useful in identifying the location and extent of the respiratory problem?

Options:

A) Bloodwork
B) Radiography
C) Endoscopy
D) Faecal analysis
E) PCR testing

Answer 21

Correct Answer: B) Radiography

Question 22

Scenario: A rabbit presents with sneezing, ocular discharge, and a head tilt.

Lead-in: Which of the following conditions is most likely to cause these signs?

Options:

A) Bordetella bronchiseptica infection
B) Chlamydophila caviae infection
C) Adenovirus infection
D) Pasteurella multocida infection
E) Mycoplasma pulmonis infection

Answer 22

Correct Answer: D) Pasteurella multocida infection

Question 23

Scenario: A 7-year-old West Highland White Terrier presents with a 1-month history of progressive exercise intolerance and increased respiratory effort. The dog has a dry, hacking cough and you notice mild cyanosis after exertion. Auscultation reveals diffuse crackles throughout the lung fields.

Lead-in: Rank the following differential diagnoses in order of most to least likely:

Options:

A) Pulmonary oedema
B) Idiopathic pulmonary fibrosis
C) Chronic bronchitis
D) Aspiration pneumonia
E) Angiostrongylus vasorum infection

Answer 23

Correct Answer: B, C, A, E, D

Question 24

Scenario: A 3-year-old male neutered domestic shorthair cat presents with acute onset open-mouth breathing. The cat is tachypnoeic with increased respiratory effort. You notice dull lung sounds ventrally on both sides. The cat’s mucous membranes are slightly cyanotic.

Lead-in: Rank the following differential diagnoses in order of most to least likely:

Options:

A) Pneumothorax
B) Asthma
C) Pleural effusion
D) Pulmonary thromboembolism
E) Diaphragmatic hernia

Answer 24

Correct Answer: C, A, E, B, D

Question 25

Scenario: A 12-year-old Labrador Retriever presents with a 3-month history of a dry, honking cough. The cough is worse at night and after exercise. The dog is otherwise bright and alert with a good appetite. Auscultation reveals harsh lung sounds and a tracheal pinch elicits a coughing episode.

Lead-in: Rank the following differential diagnoses in order of most to least likely:

Options:

A) Tracheal collapse
B) Chronic bronchitis
C) Laryngeal paralysis
D) Pulmonary neoplasia
E) Heartworm disease

Answer 25

Correct Answer: A, B, C, D, E

Question 26

Scenario: A 6-month-old puppy presents with a 2-week history of a moist, productive cough. The puppy is also sneezing and has mild ocular discharge. The puppy is otherwise bright and alert with a good appetite. Auscultation reveals harsh lung sounds and crackles.

Lead-in: Rank the following differential diagnoses in order of most to least likely:

Options:

Answer 26

A) Kennel cough
B) Aspiration pneumonia
C) Canine distemper
D) Eosinophilic bronchopneumopathy
E) Tracheal collapse

Question 27

Scenario: A 4-year-old Golden Retriever presents with a 2-day history of acute onset respiratory distress. The dog is tachypnoeic and has muffled heart sounds. The dog’s mucous membranes are pale. You perform a thoracocentesis and obtain a milky pink fluid.

Lead-in: Rank the following causes for the pleural effusion in order of most to least likely:

Options:

A) Chylothorax
B) Pyothorax
C) Hemothorax
D) Right-sided heart failure
E) Neoplasia

Answer 27

Correct Answer: A, C, B, E, D

Question 28

You image a coughing dog, identify the lung pattern shown:

A) Bronchial
B) Interstitial - diffuse
C) Interstitial - nodular
D) Alveolar
E) Vascular

Answer 28

A) Bronchial

Question 29

You image a coughing dog, identify the lung pattern shown:

A) Bronchial
B) Interstitial - diffuse
C) Interstitial - nodular
D) Alveolar
E) Vascular

Answer 29

B) Interstitial - diffuse

Question 30

Signalment: 10-year-old, male neutered, Jack Russell Terrier

Presenting Complaint: Chronic cough and exercise intolerance

History: The owner reports a 6-month history of a non-productive cough, which is worse at night and during exercise. The dog has also shown decreased stamina on walks and has been less playful recently. The owner denies any history of trauma or foreign body ingestion. The dog is up to date on vaccinations and parasite prevention.

Physical Examination:

General: The dog is bright, alert, and responsive but exhibits increased respiratory effort at rest.
Respiratory: Harsh lung sounds are audible on auscultation, with occasional crackles evident bilaterally. No wheezes or stridor are noted. A tracheal pinch elicits a coughing episode.
Cardiovascular: No murmurs or arrhythmias are auscultated. Femoral pulses are strong and synchronous.
Other: No other significant findings are noted on physical examination.

Lead-in: What is the most likely diagnosis based on the radiographic findings?

Options:

A) Chronic bronchitis
B) Idiopathic pulmonary fibrosis
C) Pulmonary oedema
D) Aspiration pneumonia
E) Pulmonary neoplasia

Answer 30

Correct Answer: B) Idiopathic pulmonary fibrosis

Question 31

I’m ready to test your knowledge with some challenging SBAs on respiratory disease treatment. Here are 4 questions featuring specific drug names, doses, and routes of administration:

Question 1

Scenario: A 6-year-old ferret presents with a history of sneezing, lethargy, and mucopurulent nasal discharge. You suspect a bacterial upper respiratory tract infection.

Lead-in: Which of the following is the most appropriate initial treatment?

Options:

A) Enrofloxacin 10 mg/kg orally once daily
B) Doxycycline 5 mg/kg orally twice daily
C) Trimethoprim-sulfadimethoxine 30 mg/kg orally twice daily
D) Azithromycin 10 mg/kg orally once daily
E) Metronidazole 20 mg/kg orally twice daily

Answer 31

C) Trimethoprim-sulfadimethoxine 30 mg/kg orally twice daily

Question 32

Scenario: A 12-year-old cat with a history of heart disease presents with acute onset respiratory distress. Thoracic radiographs reveal pulmonary oedema.

Lead-in: Which of the following is the most appropriate immediate treatment?

Options:

A) Furosemide 2 mg/kg intravenously
B) Prednisolone 1 mg/kg orally
C) Terbutaline 0.6 mg/kg subcutaneously
D) Butorphanol 0.2 mg/kg intramuscularly
E) Oxygen therapy via face mask

Answer 32

Correct Answer: A) Furosemide 2 mg/kg intravenously

Question 33

Scenario: A 4-year-old rabbit presents with severe respiratory distress and open-mouth breathing. You suspect an acute asthma attack.

Lead-in: Which of the following is the most appropriate treatment?

Options:

A) Dexamethasone 0.5 mg/kg intramuscularly
B) Terbutaline 0.6 mg/kg nebulised
C) Bromhexine 2 mg/kg orally
D) Meloxicam 0.2 mg/kg subcutaneously
E) Enrofloxacin 10 mg/kg subcutaneously

Answer 33

B) Terbutaline 0.6 mg/kg nebulised

Question 34

Question 4

Scenario: A 2-year-old dog presents with a chronic cough and exercise intolerance. Thoracic radiographs reveal a diffuse bronchointerstitial pattern. You suspect idiopathic pulmonary fibrosis.

Lead-in: Which of the following is the most appropriate treatment?

Options:

A) Prednisolone 1 mg/kg orally once daily
B) Theophylline 10 mg/kg orally twice daily
C) Colchicine 0.03 mg/kg orally once daily
D) Sildenafil 1 mg/kg orally three times daily
E) Azathioprine 2 mg/kg orally once daily

Answer 34

Correct Answer: A) Prednisolone 1 mg/kg orally once daily

Question 35

Scenario: A 5-year-old Border Collie presents with a 4-week history of a persistent, dry, hacking cough. The cough is worse during exertion and at night. The dog is otherwise bright, alert, and has a good appetite. Auscultation reveals harsh lung sounds with no crackles or wheezes. Thoracic radiographs show a diffuse bronchial pattern.

Lead-in: Which of the following is the most appropriate treatment?

Options:

A) Amoxicillin-clavulanate 20 mg/kg orally twice daily
B) Prednisolone 0.5 mg/kg orally once daily
C) Fenbendazole 50 mg/kg orally once daily
D) Butorphanol 0.2 mg/kg intramuscularly as needed
E) Nebulised terbutaline 0.6 mg/kg every 8 hours

Answer 35

Correct Answer: B) Prednisolone 0.5 mg/kg orally once daily

Why B is correct: Chronic bronchitis is an inflammatory airway disease. Prednisolone is a corticosteroid with potent anti-inflammatory effects, making it the most appropriate first-line treatment to reduce airway inflammation and control the cough.
Why other options are incorrect:
A) Amoxicillin-clavulanate: While bacterial infections can exacerbate bronchitis, they are not the primary cause. Antibiotics are not routinely indicated.
C) Fenbendazole: This is an antiparasitic drug and not relevant in this case.
D) Butorphanol: This is a cough suppressant. While it can provide symptomatic relief, it does not address the underlying inflammation.
E) Nebulised terbutaline: This is a bronchodilator. While it can be helpful in some cases of bronchitis, corticosteroids are generally more effective as first-line therapy.

Question 36

Scenario: A 2-year-old Labrador Retriever presents with an acute onset of severe respiratory distress. The dog is open-mouth breathing with cyanotic mucous membranes. Thoracic radiographs reveal a diffuse alveolar pattern with air bronchograms. You suspect bacterial pneumonia.

Lead-in: Which of the following is the most appropriate initial treatment?

Options:

A) Marbofloxacin 1 mg/kg intravenously once daily
B) Doxycycline 10 mg/kg orally twice daily
C) Cefovecin 8 mg/kg subcutaneously once
D) Trimethoprim-sulfadimethoxine 30 mg/kg orally twice daily
E) Metronidazole 15 mg/kg intravenously twice daily

Answer 36

Marbofloxacin 1 mg/kg intravenously once daily

Why A is correct: Marbofloxacin is a broad-spectrum fluoroquinolone antibiotic with excellent penetration into the respiratory tract. Intravenous administration ensures rapid therapeutic levels in this critical patient.
Why other options are incorrect:
B) Doxycycline: While effective against some respiratory pathogens, it may not be the best choice for severe pneumonia.
C) Cefovecin: This is a long-acting antibiotic, but its efficacy against the most common pneumonia-causing bacteria may be limited.
D) Trimethoprim-sulfadimethoxine: This is a good oral antibiotic for less severe infections, but intravenous therapy is preferred in this critical case.
E) Metronidazole: This primarily targets anaerobic bacteria and protozoa and is not the most appropriate choice for pneumonia.

Question 37

Scenario: A 7-year-old Cocker Spaniel presents with a 2-month history of a productive cough, weight loss, and exercise intolerance. The dog has been treated with multiple courses of antibiotics with no improvement. You suspect lungworm infection.

Lead-in: Which of the following is the most appropriate treatment?

Options:

A) Fenbendazole 50 mg/kg orally once daily for 10 days
B) Ivermectin 6 µg/kg subcutaneously once
C) Milbemycin oxime 0.5 mg/kg orally once
D) Moxidectin 2.5 mg/kg topically once
E) Levamisole 7 mg/kg orally once

Answer 37

A or C

Why A is correct: Fenbendazole at this dose and duration is the recommended treatment for lungworm. It effectively eliminates adult worms and larvae.
Why other options are incorrect:
B) Ivermectin: While effective against some parasites, it has limited activity against lungworm.
C) Milbemycin oxime: This is a preventative for lungworm but may not be sufficient for treating an established infection.
D) Moxidectin: While effective, it is usually administered as a monthly preventative rather than a treatment for an active infection.
E) Levamisole: This is not effective against lungworm.

Question 38

Scenario: A 10-year-old West Highland White Terrier presents with a 1-year history of progressive exercise intolerance and a dry, hacking cough. Thoracic radiographs reveal a diffuse interstitial pattern. You suspect idiopathic pulmonary fibrosis.

Lead-in: Which of the following is the most appropriate treatment for potential concurrent pulmonary hypertension?

Options:

A) Pimobendan 0.25 mg/kg orally twice daily
B) Sildenafil 1 mg/kg orally three times daily
C) Theophylline 10 mg/kg orally twice daily
D) Furosemide 2 mg/kg intravenously twice daily
E) Hydrochlorothiazide 2 mg/kg orally twice daily

Answer 38

Correct Answer: B) Sildenafil 1 mg/kg orally three times daily

Why B is correct: Sildenafil is a phosphodiesterase-5 inhibitor that acts as a vasodilator, specifically targeting the pulmonary arteries. It can help reduce pulmonary hypertension and improve exercise tolerance.
Why other options are incorrect:
A) Pimobendan: While it can be used in heart failure, it does not directly address pulmonary hypertension.
C) Theophylline: This is a bronchodilator and not effective for pulmonary hypertension.
D) Furosemide: This is a diuretic used for fluid overload and is not the primary treatment for pulmonary hypertension.
E) Hydrochlorothiazide: This is another diuretic with less potency than furosemide.

Question 39

Scenario: A 6-year-old cat presents with acute onset respiratory distress. The cat is open-mouth breathing with marked abdominal effort. Thoracic radiographs reveal pleural effusion. You perform a thoracocentesis and remove 50 ml of purulent fluid. Cytology of the fluid shows degenerate neutrophils and intracellular bacteria.

Lead-in: Which of the following is the most appropriate next step?

Options:

A) Repeat thoracocentesis in 24 hours
B) Place a chest drain
C) Administer furosemide 2 mg/kg intravenously
D) Prescribe amoxicillin-clavulanate 12.5 mg/kg orally twice daily
E) Refer for a CT scan

Answer 39

Correct Answer: B) Place a chest drain

Question 40

Scenario:

A 4-year-old, male neutered, indoor-outdoor cat presents with a 1-week history of increasing respiratory distress. Initially, the cat had mild sneezing and ocular discharge, but now you observe open-mouth breathing with pronounced abdominal effort. On auscultation, there are decreased lung sounds bilaterally, especially in the ventral lung fields. The cat is febrile (103.8°F, 39.9°C) and slightly tachypneic. You perform thoracic radiographs, which reveal pleural effusion with a mild alveolar pattern in the ventral lung fields. Thoracocentesis yields 40 ml of cloudy, yellowish fluid.

Lead-in:

Based on the most likely diagnosis, which of the following is the most appropriate treatment plan?

Options:

A) Amoxicillin-clavulanate 12.5 mg/kg orally twice daily for 3 weeks
B) Cefpodoxime proxetil 10 mg/kg orally twice daily for 4 weeks
C) Marbofloxacin 2 mg/kg subcutaneously once daily for 2 weeks
D) Doxycycline 10 mg/kg orally once daily for 4 weeks, with a chest drain placed under sedation
E) Prednisolone 1 mg/kg orally once daily for 2 weeks, with thoracocentesis repeated in 48 hours

Answer 40

Correct Answer: D) Doxycycline 10 mg/kg orally once daily for 4 weeks, with a chest drain placed under sedation

Why Doxycycline is the Best Choice Here:

This cat likely has pyothorax, a serious condition requiring aggressive treatment. Here’s why doxycycline with a chest drain is the most appropriate option:

Doxycycline’s Properties:

Excellent penetration into pleural fluid.
Effective against many common bacteria causing pyothorax.
Anti-inflammatory properties in addition to its antibacterial action.
Chest Drain: Essential for managing pyothorax to:

Remove the infected pleural fluid.
Allow lavage of the pleural space.
Facilitate ongoing drainage.
Why Other Options Are Less Suitable:

A) Amoxicillin-clavulanate: Good for upper respiratory infections, but less effective for pyothorax due to limited penetration into the pleural space.
B) Cefpodoxime proxetil: Not licensed for use in cats in the UK.
C) Marbofloxacin: Limited efficacy against anaerobic bacteria, which are often involved in pyothorax.
E) Prednisolone: Corticosteroids are contraindicated in pyothorax as they can suppress the immune system and worsen the infection. Thoracocentesis alone is insufficient to manage pyothorax effectively.
Important Note: This case highlights the need for multimodal therapy in pyothorax. In addition to doxycycline and a chest drain, supportive care (oxygen therapy, fluid therapy, nutritional support) is crucial. The choice of antibiotic may be adjusted based on culture and sensitivity results.