SAM II Exam I Material - Respiratory Flashcards
The primary rule out for a patient with a sudden onset of severe expiratory dyspnea and no major changes on thoracic radiographs is:
pulmonary thomboembolism [PTE]
Non-cardiogenic pulmonary edema results from overexpansion of extracellular fluid volume due to 4 general mechanisms. What are those four mechanisms?
- Vascular overload (excessive IV fluid administration)/increased hydrostatic pressure
- Decreased plasma oncotic pressure (low albumin)
- Increased permeability of the alveolar‐capillary membrane
- Lymphatic obstruction
What is the major difference between ALI and ARDS?
degree of hypoxemia
- ALI: pulmonary inflammation & edema resulting in acute respiratory failure
- ARDS: Severe manifestation of ALI
**ALI/ARDS: most commonly a sequela of sepsis, shock, or bacterial pneumonia**
In general, what is the only primary lung tumor that is responsive to chemotherapy?
lymphoma
T/F: In the case of pleural effusion, thoracocentesis is both diagnostic and therapeutic
True
In a very general sense, what is the most common cause of pneumonia in dogs?
bacteria
What are the two most common types of nasal neoplasias in cats?
lymphoma and adenocarcinoma
**lymphoma is the most common in the cat**
T/F: Canine chronic bronchitis is most common is old, small breed dogs
True
Small breed dogs, terriers, and med sized dogs: WHWT and cockers; Mid – old age > 6 years usually; Overweight
T/F: On CT, If you observe destruction of the nasal septum, frontal sinuses or cribriform plate, or extension of disease into the nasopharynx or periorbital region, this animal likely has lymphoplasmacytic rhinitis
False
- Destruction of the nasal septum, frontal sinuses or cribriform plate, or extension of disease into the nasopharynx or periorbital region are not expected with LPR and should prompt investigation into the presence of fungal rhinitis or neoplastic disease*
- Given that it is an idiopathic disease, the lack of specific findings is important. Dogs should have no funduscopic lesions, no lymphadenopathy, no facial or palate deformities, and healthy teeth and gums, etc.*
What are the most common clinical signs associated with nasal mites (Pneumonyssus caninum)?
sneezing, reverse sneezing
What is the hallmark sign associated with feline herpesvirus?
ulcerative keratitis
Clinical signs for FHV: sneezing, inappetence, fever, oculonasal discharges (serous, then mucopurulent due to secondary bacterial infections), ulcerative keratitis (punctate or dendritic ulcers) is hallmark sign!
T/F: Nasal discharge is almost always a sign of local disease within the nasal cavity
True
Exceptions: eosinophilic bronchopneumopathy (EBP), bacterial pneumonia & coagulopathies
What area of the lung is primarily affected with aspiration pneumonia?
right middle lung lobe
although other lungs can be affected
What fluid characteristics would you expect to see associated with a pleural effusion caused by hemorrhage (bleeding masses, coagulopathies, trauma)?
These effusions are red, often contain protein & cell concentrations compatible with peripheral blood
The composition of a hemorrhagic effusion will change with time: As cells are phagocytized & degraded, the number of RBCs will decrease.
In the case of collapsing trachea, corticosteroids as a single dose can be given to decrease tracheal inflammation. What drug is recommended?
dexamethasone
Dexamethasone lasts ~48 hours and is ~7x more potent than prednisone
How long does it take for pulmonary contusions to show up on radiographs?
~2-12 hours after trauma
What fluid characteristics would you expect to see associated with a pleural effusion caused by lymphorrhagia?
predominantly lymphocytic
- These effusions are lymphocyte predominant. As they become chronic or with repeated drainage, inflammation occurs resulting in more neutrophils (non‐degenerate) and macrophages.*
- Chylous effusions contain chylomicrons and are classic “milky” effusions*
__________ is the treatment of choice for most malignant nasal tumors
radiation
- However feline nasal lymphoma responds well to standard lymphoma chemotherapeutic protocols
- Some require surgery and/or chemotherapy or radiation. Surgical debulking before or after radiotherapy may yield best option (mean survival time 12 months) but depends on tumor type.
- Surgery alone: No significant increase in survival time: 3‐6 months
protein-poor transudate in the pleural cavity is most frequenty caused by:
hypoalbuminemia
The local humane society has contacted you about an outbreak of upper respiratory signs in dogs. One dog died overnight. You did necropsy and found blood in trachea and hemorrhagic mottled lungs. Which disease would you be most concerned about?
- Bordetella
- Canine herpes virus
- Kennel cough
- Influenza Type A H3N8
- Canine distemper
Influenza Type A H3N8
Because this is a rather newly emerging disease, almost all dogs, regardless of breed or age, are susceptible to infection and have no immunity. Virtually all dogs that are exposed to the virus become infected and nearly 80% show clinical signs of disease. Fortunately, most affected dogs have the mild form
An overflow of tears onto the face is termed:
epiphora
- This is a possible sequela of feline herpesvirus due to fibrosis of lacrimal ducts.*
- This condition may also occur while studying for SAM II*
These normal lung sounds sound like the “rustling of leaves” and are heard over peripheral airways:
vesicular sounds
Inspiration is slightly loud & longer than expiration. They indicate normal air‐filled lungs
Non-cardiogenic pulmonary edema results from overexpansion of extracellular fluid volume due to 4 general mechanisms. Which of the four mechanisms is considered the most serious cause?
Increased permeability of the alveolar‐capillary membrane
-
The most serious cause, permeability of membrane, causes protein‐rich fluid to flood the alveoli. It can result from:
-
Pulmonary insults, including
- Aspiration of gastric contents
- Severe upper airway obstruction
- Inhalant injury
- Extrapulmonary disorders, such as sepsis, electric shock, central nervous system disease, pancreatitis, disseminated intravascular coagulation
-
Pulmonary insults, including
Upper respiratory or lower respiratory sign?
nasal discharge
upper respiratory
T/F: Canine Chronic Bronchitis is usually self-limiting and dogs recover within a year after initial signs
False
canine chronic bronchitis is irreversible and progressive; incurable.
What is the typical signalment associated with ciliary dyskinesia?
young purebred dog with recurrent respiratory tract infections/signs
What is the mortality rate associated with cases of ALI/ARDS?
~100%
**There have been 2 reported cases that have survived**
What diagnostic modality provides us with a definitive diagnosis in the case of progressive interstitial fibrosis?
lung biopsy
Lung aspirate is sometimes helpful & less invasive than lung biopsy
protein-rich transudate in the pleural cavity is most frequenty caused by:
heart failure
The lungs contain lymph that is higher in protein and thus fluid escaping from the capillary beds here has higher protein content.
T/F: When performing thoracic radiographs to help diagnose pulmonary neoplasia, sixteen-thousand views should be taken
False
Three views should suffice
-
Thoracic radiography: Take right & left laterals & VD: 3 view “met check”
-
Primary neoplasia:
- Usually focal single‐ or multiple‐mass lesions o lobar consolidation
- Diffuse pulmonary infiltrate can also be found
- Dog: Right caudal lobe more commonly affected
- Cat: Left caudal lobe more often involved
-
Metastatic neoplasia
- Multiple, discrete, interstitial nodules of variable sizes or
- Diffuse interstitial pattern
- May find lymphadenopathy, pleural effusion
- Cat: Ill defined nodules or diffuse, patchy, mixed alveolar patterns
-
Primary neoplasia:
T/F: In animals with pyothorax, antibiotics should be administered for 5-7 days and if the response to therapy is poor a chest drain should be inserted
False
antibiotics should be given long-term (months)
You would expect to hear crackles with which of the following diseases?
- Diaphragmatic hernia
- Pulmonary edema
- Pneumothorax
- Nasopharyngeal polyp
- Chylothorax
Pulmonary edema
Animals with pulmonary edema are seen because of cough,tachypnea, respiratory distress, or signs of the inciting disease. Crackles are heard on auscultation, except in animals with mild or early disease. Blood-tinged froth may appear in the trachea, pharynx, or nares immediately preceding death from pulmonary edema.
Which treatment(s) would most likely increase the lifespan for a 10 year old collie diagnosed with nasal adenocarcinoma?
- Rhinoscopy with curretage and chemo
- Chemo
- Surgical debulking with chemo
- Surgical debulking with radiation
- Chemo and radiation
Surgical debulking with radiation
T/F: Expiratory wheezes are a hallmark finding in dogs with idiopathic pulmonary fibrosis (progressive interstitial fibrosis)
False
_INSPIRATORY CRACKLES_ are a hallmark finding in dogs with idiopathic pulmonary fibrosis (progressive interstitial fibrosis)
T/F: Canine nasal aspergillosis is most common in brachycephalic breeds
False
Canine nasal aspergillosis is most common in _dolichocephalic_ breeds
__________ is the most common causative agent of chronic rhinitis in dogs
Aspergillus fumigatus
Which of the following is the mainstay of treatment in chronic bronchitis?
- Antibiotics
- Prednisolone
- Furosemide
- Bronchodilator
- Cough suppressant
Prednisolone
-
Prednisolone to suppress airway inflammation ‐‐taper the dose
- 1 mg/kg po BID for 5 days; then 0.5 mg/kg BID for 5 days; then 0.5 mg/kg eod
- Taper dose over 1‐2 months if possible or get to the lowest dose that will maintain
- Some dogs can get by on 0.25 mg/kg po BID every 2‐3 days
What is the best diagnostic tool for collapsing trachea?
bronchoscopy
can assess dynamic changes; grade and extent of collapse; confirm location; assess for concurrent disease (bronchitis); allow for BAL & culture
__________ indicates only an increase in respiratory rate, not always associated with hyperventilation
tachypnea
do not confuse with panting
T/F: Stridor is a whine or high-pitched expiratory wheeze
False
- Stridor is a whine or high-pitched inspiratory wheeze*
- Often associated with laryngeal paralysis or mass obstructing the upper airway. Indicates airway narrowing/stricture. Often more obvious during exertion or excitement*
- Ex: laryngeal paralysis, nasopharyngeal stenosis*
What are the most common respiratory abnormalities associated with feline asthma?
cough, wheeze and/or respiratory distress
This is a chronic inflammatory rhinitis characterized by lymphocytic-plasmacytic infiltration of nasal mucosa in the absence of an obvious underlying etiology:
lymphoplasmacytic rhinitis
A dog presents to your clinic with a peracute onset of severe unrelenting dyspnea. You take radiographs and find no radiographic evidence of severe lung disease.
Shit. What’s he got, docta?
Pulmonary Thromboembolism
- Associated with heartworm disease, immune mediated hemolytic anemia (common), nephrotic syndrome , hyperadrenocorticism (common), pancreatitis, DIC (common), infective (bacterial) endocarditis, hypothyroidism *
- Prognosis is poor to grave*
A “goose-honk” cough is characteristic for:
collapsing trachea
- “Goose‐honk” cough: easily elicited by tracheal palpation
- Normal respiratory pattern in most cases. If see marked respiratory effort, think about bronchial collapse
- Auscultation of trachea: musical wheezing sounds.
- Hepatomegaly is a significant feature: 92%. Theory: oxygen deprived hepatocytes (function improves after stent placed)
- Some have concurrent bronchitis or lower airway disease – evident on auscultation
- Heart murmur: > 20% have mitral valve insufficiency
What lung sounds are commonly heard associated with chronic canine bronchitis?
Often inspiratory crackles and expiratory wheezes
Describe the treatment for life-threatening bronchoconstriction (Status Asthmaticus) in a cat:
- Avoid stress (rads can kill the cat)
- O2: chamber or mask
- Fast-acting corticosteroid: dexamethasone
- Bronchodilator: terbutaline
What breed is predisposed to developing eosinophilic bronchopneumonopathy (EBP)?
Siberian Husky
How do you diagnose cryptococcosis in cats?
LCAT
- Latex cryptococcal antigen test (LCAT) detects capsular antigens in serum, CSF, or urine*
- Cryptococcosis is the most common cause of fungal rhinitis in cats!*
T/F: When dragonflies mate, their tails form the shape of a heart
True
T/F: Cats require stress in order to shed calicivirus
False
- Cats do NOT require stress to shed calicivirus!*
- Carrier state is common following recovery & provides virus with opportunity to replicate and mutate within each infected cat: new strains emerging constantly with no cross protection from either vaccine or other strains. In some experimental studies, approximately 50% of cats were still shedding 75 days after infection*
These abnormal lung sounds sound like the distant popping of bubble‐wrap or the sound of Rice Krispies cereal and can be described as fine, medium or coarse
Crackles
Crackles are caused by the snapping open of airways that have closed due to fluid either in or around them. They can be heard with bronchitis, pneumonia, or fibrosis, and occasionally with severe pulmonary edema
T/F: Squamous cell carcinomas (SCC) on the noses of cats are best treated with chemotherapy
False
T/F: Nasal neoplasia can result in exophthalmia, facial distortion, and sneezing
True
Name the breed that is over-represented with regard to idiopathic pulmonary fibrosis (IPF)
West Highland White Terriers
What type of dog is most commonly affected by aspergillosis?
dolichocephalic breeds
- dolichocephalic = long skull (greyhounds, for example)
- Usually young adults
- increased incidence in golden retrievers and collies too
What do you expect to see on bronchoscopy in a dog infected with Oslerus osleri?
cream-colored nodules in the trachea
May also see larvae at edge of nodule
The most common cause of pneumothorax in dogs is:
trauma
What is the most common bacterial species that contributes to bacterial pneumonia in the dog?
Bordetella bronchiseptica
Others: Staphylococcus spp, Escherichia coli, Klebsiella pneumonia, Enterobacter spp, Acinetobacter and Pasteurella spp.
What is the most common nasal fungal disease in cats?
Cryptococcosis
What is the hallmark sign of Chlamydophila felis in the cat?
conjunctivitis with chemosis
T/F: Nasal aspergillus does not respond to systemic antifungal therapy
False
-
Systemic antibiotics are indicated if infection outside nasal cavity or if cribiform plate has been breached
- Itraconazole 5 mg/kg BID x minimum 2‐3 months results in 60‐70 % cure rate
- Fluconazole 2.5‐5.0 mg/kg/day x minimum 2‐3 months
What is the most common sign associated with tracheobronchial disease?
cough
may or may not be productive
T/F: Bacterial rhinitis is very commonly a primary disease process in dogs
False
It’s just not. Consider it always secondary.
This virus establishes lifelong latency in the trigeminal ganglia:
feline herpesvirus
A dog presents with unilateral nasal discharge along with depigmentation and ulceration.
What is the most likely diagnosis?
Aspergillosis
Conjunctival swelling/edema is termed:
chemosis
T/F: In general, you want to avoid cough suppressants if a dog has a moist, productive cough
Yep.
- Cough suppressants are used cautiously because cough is an important mechanism for clearing airway secretions.*
- In some dogs, however, the cough is incessant and exhausting, or ineffective, because of marked tracheobronchomalacia and airway collapse. Cough suppressants can provide significant relief for such animals and may even facilitate ventilation and decrease anxiety.*
In fourteen hundred ninety-two, ________ sailed the ocean blue
Columbus
