SA- problem based approach Flashcards
What are the two segments of the URT
Rostral to nasopharynx; pharynx, larynx, cervical trachea
What defines the LRT
Pulmonary airways and parenchyma
Eupnea
normal breathing
hyperpnea
increased depth or force of airflow
hyperventilation
(exchanging more air in a time period) faster and/or deeper
What is the typical cause of bradypnea
Brain issues
Hypopnea
Shallow, decreased
Apnea
Cessation greater than 10 seconds
Hypoventilation
Slower and/or more shallow
Orthopnea
dyspnea while laying down
Apneustic
Deep long inspiration then breath holding and rapid exhalation
Ataxic/agonal
Irregular shifts of hyper and hypoventilation and apnea- DYING!
Cousmal
Air hunger- swallowing air
What is it called when abdomen and thorax are moving in opposition to each other
Paradoxic breathing
What are the usual causes of paradoxic breathing
diaphragmatic hernia or paralysis
Decribe flail chest
Segment of chest wall moves independently from others- usually rib fractrue
Two normally auscultable sounds
Bronchial- normal turbulent air flow in trachea; vesicular- lower area normal sounds that are longer and more intense on inspiration
Audible abnormal sounds
Stertor, stridor, wheeze
Stertor (describe)
Snoring produced by partial obstruction of upper airway
Stridor (describe)
High pitched, harsh, vibratory, from partial obstruction at upper trachea
Stridor (locations)
Larynx, caudal oropharynx, cervical trachea
Stertor (locations)
Only mouth/nasal/nasopharynx
Wheeze
In cats on inspiration
Laryngeal paralysis will cause what audible sound
Stridor (also could be caused by tumor)
What causes crackles
Fluid! Air passing through fluid or forcing open a collapsed airway/alveolar wall
What causes wheezes
Continuous whistling from air turbulence in lower airways from obstruction or narrowed airway
When do crackles occue (I vs E)
Both
When do wheezes occur (I vs E)
Typically expiratory
Where do wheezes originate
Typically below carina but def. below the larynx
What is an end expiratory grunt
Push to get air out by contracting diaphragm
What is the difference between pleural rubs and crackles
Happen at the same time of inspiration every time, less diffuse than crackles, lungs catching due to decreased fluid or fibrin
What is the snare drum sound
Pleural rubs
What is the classic presentation of fluid in the chest
Sounds dorsally but not ventrally
What do sounds ventrally but not dorsally indicate
Air accumulation in lungs
Which region is this associated with - epistaxis
Nose/nasopharynx
Which region is this associated with - sneezing
Nose/nasopharynx
Which region is this associated with - stertor
Nose/nasopharynx
Which region is this associated with - facial asymmetry
Nose/nasopharynx
Which region is this associated with - stridor
URT obstruction
Which region is this associated with - coughing
URT obstruction below larynx or LRT
Which region is this associated with - I >E
URT obstruction
Which region is this associated with - exercise intolerance
URT or LRT
Which region is this associated with - hyperthermia
URT
Which region is this associated with - Tachypnea, dyspnea, distress
URT or LRT
Which region is this associated with - wheezing
LRT bronchi, bronchioles
Which species gets polyps in the nasal/nasoph
Cats
What species is more predisposed to aspergillosis
Dogs
Cause of cat cough
Rare, but if: asthma, HWDz, bronchitis
Lower airway- cat vs dog
feline asthma, canine chronic bronchitis
Pleural space disease cats vs dogs
CHF- cats- pleural space edema dogs- alveolar edema
Tracheal collapse symptoms in large dog is likely
Chronic bronchitis
Signalment for blastomycoses or pyothorax
Hunting dogs
Spontaneous pneumothorax- Signalment
Huskies
Pneumocystis/protozoal pneumonia- signalment
Doxies
Younger or older? Polyps
Younger
Younger or older? viral infection
Younger
Younger or older? Fungal infection
Older
Younger or older? Allergic rhinitis
older
Younger or older? Immune mediated
Older
Rule outs for cough
regurg/vomiting, reverse sneeze, HWDz
Chronic or acute? fungal
Chronic
Chronic or acute? viral/bacterial
Acute
Chronic or acute? CHF
Acute
Ocular retropulsion tests for
Nasal/nasoph
Observing abdominal movements and postural changes - for:
Airway or pulmonary disease
Increased time/effort of inspiration- tx
Bypass upper airway, tap chest
Increased time/effort of expiration- tx
bronchodilators, steroids
Characterize cough
Productive, dry, moist, harsh, soft; spasmodic, paroxysmal; induced/spontaneous
Characterize wheezes
Sonorous- low pitch; sibilant- high pitch
Causes of respiratory distress
Lack of oxygen delivery from obstruction, cardiac, hematologic
True airway distress localizes issue to :
Larynx or lower
Head/neck extension posture, inspiratory component localized:
Laryngeal/ upper airway
Tachycardia, murmur, pulse abnormalities significant enough to cause distress- primary ddx
Cardiac disease
Iatrogenic pathology of decreased O2
Environmental O2
Squeeze cat cranial thorax- cant compress =
Mass
Where are cough receptors found
URT and large airways primarily
Why can cough occur when URT not primary affected
movement of secretions, compression,
Two causes of cardiac cough
Chamber enlargement compressing airway (should have murmur);
True respiratory distress only occurs if lesion is
At or below larynx
Muffled lung sounds indicate
pleural space disease
Expiratory effort- localized
Intrathoracic lesions
Inspiratory effort- localized
Extrathoracic lesions
First test performed for chronic respiratory distress
HWT! Ab in dogs, Ab/Ag in cats
How are FELV and FIV linked to respiratory issues
Cause cancers or immumosuppressive opportunistic infections - no primary respiratory component
What parasite tests should be done?
Baermann with float, +/- direct smear
Most common infectious disease test
PCR
What will blood gas test tell
Severity of disease - pulmonary dz vs hypoventilation (disease must be severe to be appreciated)
What does pulse ox measure
% Hg molecules saturated with O2- not total content
What is a limitation of pulse ox
Anemia or toxicity (usually CO2) poisoning will look like 100% - but actual carrying ability decreased
FiO2: PaO2 ideal
> 400 nomral
3-4 mild-moderate
below 3 - severe
Pulse ox reading 90 - corresponding PaO2
65 - tissue damage (FiO2 of 300)
Normal room air PaO2
97-99
Danger level for PaO2 and corresponding pulse ox
60 or below; pulse ox - 88
Fatal level of PaO2 and corresponding pulse ox
50 or below (pulse ox 80)- need intervention! O2 to assisted ventilation
Intervention point of PaO2 and pulse ox
50 / 80
Primary reason for angiography
PTE or lung perfusion
Primary reason for fluoroscopy
dynamic collapse
Primary reason for CT
Bone
Primary reason for MR
Soft tissue
When would an oropharyngeal exam be indicated
CS localized to URT - teeth, palate, masses, etc. REQUIRE ANESTHESIA
3 types of nasal cytology
FNA/impression smear, FNA of local lymph nodes, nasal flush sample - not a great test (bacteria normal
When is nasal cytology most useful
Fungal rhinitis or neoplasia
What are the only things that can be diagnosed via rhinoscopy
Foreign body or nasal mites
Best nasal test for specific diagnosis
Nasal biopsy
What is bronchoscopy
Direct visualization of airways that facilitates sample collection from LRT
What is obtained in tracheal wash
Cells and fluid from large airways that bypasses normal oral flora
What diseases should use a tracheal wash for dx
Large airway and severe diffuse alveolar
What is the only tracheal wash that doesnt require anesthesia
TTW
What are the two main techniques for bronchoalveolar lavage
Bronchoscopy guided and endotracheal lavage
What cells should predominate in normal respiratory secretions
mononuclear cells
What do neutrophils in a TW indicate
inflammation or infection
What do eosinophils in a TW indicate
allergic or parasitic infection
Normal or abnormal: organisms within phagocytes
Abnormal especially if one species predominates
