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
Upper respiratory or lower respiratory sign?
increased efforts on inspiration
upper respiratory
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*
__________ is the inability to breathe unless in an upright position
orthopnea
Animal assumes a sitting position with elbows held wide apart in attempt to enlarge the chest cavity and allow for better lung expansion. Typically found with large pleural filling defects/pleural space diseases (hernia, effusion).
Feline chronic bronchitis is an inflammatory airway disease, typically seen more in older cats, that is characterized by:
neutrophilic inflammation, mucosal edema, mucous gland hypertrophy, excessive mucous production
Clinical signs are indistinguishable from signs of asthma in cats
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
Is respiratory distress associated more often with upper airway diseases or lower airway diseases?
lower airway diseases
However, remember that dogs with bilateral laryngeal paralysis (an upper airway disease) are in respiratory distress!
This potential sequela of feline herpesvirus is the result of nasal turbinate damage:
feline chronic rhinosinusitis
turbinate damage predisposes to secondary bacterial infections of nasal cavity = ‘snuffler’
What lung sounds are commonly heard associated with chronic canine bronchitis?
Often inspiratory crackles and expiratory wheezes
What are the two most common types of nasal neoplasias in dogs?
adenocarcinoma and squamous cell carcinoma (SCC)
**adenocarcinoma is the most common**
What is the treatment of choice for aspergillosis rhinitis?
1% Clotrimazole solution
- 1% Clotrimazole solution infused into each nasal cavity (30‐60 ml per side for average retriever) over 1 hr under general anesthesia*
- Contraindicated if cribiform plate is damaged - can cause fatal meningoencephalitis! *
- 2% Enilconazole may be used as an alternative to clotrimazole but would require 2‐3 treatments*
- **contraindicated if cribriform plate is damaged***
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
Describe the nasal discharge associated with nasal foreign bodies:
unilateral; serous to mucopurulent or serosanguineous
This is a chronic fibrosis of lung interstitium characterized by infiltration of fibroblasts; collagen deposits in alveolar septa:
idiopathic pulmonary fibrosis (IPF)
- Clinical Signs: Most common signs: cough, tachypnea, exercise intolerance or overt respiratory distress (dyspnea)
- Inspiratory** **crackles are a hallmark finding!
What breed is predisposed to developing eosinophilic bronchopneumonopathy (EBP)?
Siberian Husky
What drugs are indicated for treatment of Oslerus osleri?
Ivermectin and Fenbendazole
**Note: The inflammatory response is greatest to dead and dying worms; thus, signs may initially worsen after treatment**
With nasal cavity disease, would you expect to see respiratory difficulty on inspiration or expiration?
inspiration
ALI and ARDS are most commonly a sequela of:
sepsis, shock, or bacterial pneumonia
- ALI: pulmonary inflammation & edema resulting in acute respiratory failure
- ARDS: Severe manifestation of ALI. Degree of hypoxemia is major difference between the 2.
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!*
Chronic bronchitis in dogs is best diagnosed by:
clinical signs
must rule out all other causes of chronic cough in dogs
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*
This highly contagious illness often develops in dogs that are boarded or housed in crowded, unsanitary conditions:
canine infectious tracheobronchitis
Infectious agents include viruses (canine adenovirus 2 and canine parainfluenza) and bacteria (e.g. Bordetella, Mycoplasma)
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
A 3-year-old mixed breed dog is presented because it started to paw at the right side of its face last evening. It also sneezes and has a slight amount of blood in the right nostril. Previous history was unremarkable as was the rest of the physical examination. Your first rule out or most likely possibility is:
nasal foreign body
What are the two distinct syndromes associated with feline calicivirus?
- Limping kitten syndrome (lameness, ulcers on paw, sore joints)
- Virulent hemorrhagic systemic syndrome (mutation of virus)
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
~90% of cases of feline upper respiratory disease are caused by:
feline herpesvirus and feline calicivirus
-
90% of cases
- Feline herpesvirus I (feline viral rhinotracheitis or FVR)
- Feline calicivirus (FCV)
-
10% of cases:
- Chlamydophila felis (Chlamydia psittaci) = chlamydiosis, pneumonitis
- Others: Mycoplasma spp, coronavirus, Bordetella
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
A 3-year-old cat is examined because it can’t breathe and has been coughing for about 6 hours. This happened 2 months ago too, at which time the hemogram showed 4500 eosinophils (n=300-1200). Which of the following is the least likely possibility?
- Toxoplasmosis
- Feline asthma
- Feline idiopathic bronchitis
- Bacterial pneumonia
- Heartworm disease
Bacterial pneumonia
Upper respiratory or lower respiratory sign?
increased efforts on expiration
lower respiratory
What is the treatment of choice for mycotic pneumonia?
Itraconazole or Fluconazole
Side effects: increases hepatic enzymes esp. ALT; may cause vasculitis manifested by ulcerative skin lesions or limb edema
What are the 2 forms of canine influenza? Which is the most common?
Mild/Uncomplicated (more common) and Severe/complicated
-
Mild form is the most common one seen!
- Can be asymptomatic
- Soft moist cough persisting for 10‐30 days
- May have secondary bacterial infection: nasal discharge
- Looks just like mild case of “kennel cough”
-
Severe form
- High fevers (104˚‐106˚ F)
- Hemorrhagic pneumonia: hemoptysis (coughing up blood), dyspnea, tachypnea
- Rapid onset; some cases die within hours of presentation: mortality of 5‐8%.
__________ is a term used in human medicine to refer to a sensation of difficult or labored breathing
dyspnea
In dogs and cats, it is probably better to use the term “respiratory distress” to refer to difficult or labored breathing
What fluid characteristics would you expect to see associated with a pleural effusion caused by inflammation?
high cell content & high protein content
Fluid leaks across damaged endothelial cells. Damaged endothelium can be due to bacterial toxins or deposition of antibody/antigen complexes.
What is the hallmark sign of Chlamydophila felis in the cat?
conjunctivitis with chemosis
How do you confirm diagnosis of lymphoplasmacytic rhinitis (LPR)?
biopsy and histopathology
Diagnosis is based on histological findings of both nasal passages and by excluding other causes of rhinitis
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
A kitten presents lame on one limb with edema to the joints; and another kitten in the litter presented with ulcers on the mouth.
What is the most likely cause?
calicivirus
Conjunctival swelling/edema is termed:
chemosis
What are the treatment options for nasal mites (Pneumonyssus caninum)?
Ivermectin, Milbemycin, Selamectin
Death associated with nasal neoplasia is usually due to:
airway obstruction
death is usually due to local invasion resulting in airway obstruction
T/F: It is common for nasal neoplasia to metastasize to the lymph nodes and lungs
False
Metastasis to local lymph nodes is relatively common.
Metastasis to lungs is RARE
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.*
___________ is a disease syndrome defined as cough that occurs on most days of 2 or more consecutive months in the past year in the absence of other active disease
canine chronic bronchitis
Histologic changes in the airways are those of long-term inflammation and include fibrosis, epithelial hyperplasia, glandular hypertrophy, and inflammatory infiltrates. Some of these changes are irreversible. Excessive mucus is present within the airways, and small airway obstruction occurs
T/F: Bronchial pattern is typically seen on thoracic radiographs in the case of feline asthma
True
In fourteen hundred ninety-two, ________ sailed the ocean blue
Columbus
