Test 3: 47 cases Flashcards
Ellie, a 1.5-year-old spayed female DSH cat, is presented for an acute onset of worsening respiratory distress over the preceding few hours. For the past several days Ellie has had a decreased appetite and today was completely uninterested in food. She has not had any vomiting, diarrhea, polyuria or polydipsia. She does sneeze occasionally. She is kept strictly indoors and her vaccines are current. She tested negative for Feline Leukemia Virus and FIV as a kitten.
On exam, Ellie is bright and alert. Her heart rate is 200/minute and her respiratory rate is 60-70/minute. She has moderate respiratory effort and her respiratory pattern is rapid and shallow. No upper airway noises (stridor or stertor) are noted. Thoracic auscultation reveals normal cardiac sounds and dull lung sounds bilaterally. Her abdominal palpation is unremarkable. Pulse quality is normal. Mucous membranes are pink with a CRT of 1-2 seconds. Skin turgor is normal.
- Based on the history and physical exam findings, can you localize Ellie’s respiratory distress to a specific anatomic region of the respiratory tract?
- Create a list of differential diagnoses for Ellie’s respiratory distress
pleural space
pneumothorax
pleural effusion
diaphragmatic hernia
mass
asthma
ruptured bula
Ellie, a 1.5-year-old spayed female DSH cat, is presented for an acute onset of
worsening respiratory distress over the preceding few hours. For the past several days Ellie has had a decreased appetite and today was completely uninterested in food. She has not had any vomiting, diarrhea, polyuria or polydipsia. She does
sneeze occasionally. She is kept strictly indoors and her vaccines are current. She tested negative for Feline Leukemia Virus and FIV as a kitten.
On exam, Ellie is bright and alert. Her heart rate is 200/minute and her respiratory rate is 60-70/minute. She has moderate respiratory effort and her respiratory pattern is rapid and shallow. No upper airway noises (stridor or stertor) are noted. Thoracic auscultation reveals normal cardiac sounds and dull lung sounds bilaterally. Her abdominal palpation is unremarkable. Pulse quality is normal. Mucous membranes are pink with a CRT of 1-2 seconds. Skin turgor is normal
What is your initial diagnostic and therapeutic plan for Ellie?
Evaluate and interpret the images for Case 1.
What are some potential underlying causes for the problem identified by thoracic imaging?
- O2 supplementation- flow by then cage
- T fast- B-lines- effusion
- mild sedation- to decrease effort
- chest tap
xrays- pneumothorax- heart lifted, collapsed lung lobe
should tap then xray
trauma, spontaneous- pulmonary bulla rupture, severe lower pulmonary disease (cats with asthma)
Ellie, a 1.5-year-old spayed female DSH cat, is presented for an acute onset of
worsening respiratory distress over the preceding few hours. For the past several days Ellie has had a decreased appetite and today was completely uninterested in food. She has not had any vomiting, diarrhea, polyuria or polydipsia. She does
sneeze occasionally. She is kept strictly indoors and her vaccines are current. She tested negative for Feline Leukemia Virus and FIV as a kitten.
On exam, Ellie is bright and alert. Her heart rate is 200/minute and her respiratory rate is 60-70/minute. She has moderate respiratory effort and her respiratory pattern is rapid and shallow. No upper airway noises (stridor or stertor) are noted. Thoracic auscultation reveals normal cardiac sounds and dull lung sounds bilaterally. Her abdominal palpation is unremarkable. Pulse quality is normal. Mucous membranes are pink with a CRT of 1-2 seconds. Skin turgor is normal
- Given the findings on thoracic imaging(pneumo) , what therapeutic procedure do you recommend? What equipment is required and what are the steps for this procedure?
- Ellie stabilizes following the procedure discussed in Question 6; however, 30 minutes later she has recurrence of significant respiratory distress. What do you recommend to further manage her condition?
- tap chest- butterfly, 3 way stopper, syringe, clippers, scrub
- need to tap again or place chest tube
cat had bulla causing pneumothorax
Rosie, a ten-week-old female Chow Chow puppy, is presented for an acute onset of
respiratory distress. Rosie was fine until earlier this evening when she was left
unsupervised in the basement for approximately 15 minutes. When she was found, she had urinated on the floor and was mildly ataxic. She was coughing and occasionally produced a small amount of blood-tinged saliva. Over the past thirty minutes, she has continued to cough and her breathing has become slightly labored. Prior to this evening Rosie has been healthy. She received her first vaccination four weeks ago and her first dose of heartworm preventative was given at the same time.
On exam, Rosie is bright and alert. She appears well hydrated. Her respiratory rate is slightly elevated at 40/minute and she has a moderately increased respiratory effort. She is coughing intermittently. On thoracic auscultation her lung sounds are increased and crackles are noted in the dorsal lung fields. Cardiac auscultation is
normal. Mucous membranes are pink and moist although she is salivating quite a bit. Otherwise, her exam is unremarkable.
- Based on the history and physical exam findings, can you localize Rosie’s respiratory distress to a specific anatomic region of the respiratory tract?
- What is your initial diagnostic and therapeutic plan for Rosie?
- pulmonary parenchyma- crackles
- give O2, IV, US (Tfast), Xray, pulse ox, arterial blood gas
Rosie, a ten-week-old female Chow Chow puppy, is presented for an acute onset of
respiratory distress. Rosie was fine until earlier this evening when she was left
unsupervised in the basement for approximately 15 minutes. When she was found, she had urinated on the floor and was mildly ataxic. She was coughing and occasionally produced a small amount of blood-tinged saliva. Over the past thirty minutes, she has continued to cough and her breathing has become slightly labored. Prior to this evening Rosie has been healthy. She received her first vaccination four weeks ago and her first dose of heartworm preventative was given at the same time.
On exam, Rosie is bright and alert. She appears well hydrated. Her respiratory rate is slightly elevated at 40/minute and she has a moderately increased respiratory effort. She is coughing intermittently. On thoracic auscultation her lung sounds are increased and crackles are noted in the dorsal lung fields. Cardiac auscultation is
normal. Mucous membranes are pink and moist although she is salivating quite a bit. Otherwise, her exam is unremarkable.
- Evaluate and interpret the images for Case 2. Given the imaging findings,
what is the most likely diagnosis?
- caudodorsal alveolar pattern- air bronchograms
- non cardiogenic pulmonary edema
Rosie, a ten-week-old female Chow Chow puppy, is presented for an acute onset of respiratory distress. left unsupervised for 15 minutes. When she was found, she had urinated on the floor and was mildly ataxic. She was coughing and occasionally produced a small amount of blood-tinged saliva. Over the past thirty minutes, she has continued to cough and her breathing has become slightly labored. Prior to this evening Rosie has been healthy. She received her first vaccination four weeks ago and her first dose of heartworm preventative was given at the same time.
On exam, Rosie is bright and alert. She appears well hydrated. Her respiratory rate is slightly elevated at 40/minute and she has a moderately increased respiratory effort. She is coughing intermittently. On thoracic auscultation her lung sounds are increased and crackles are noted in the dorsal lung fields. Cardiac auscultation is
normal. Mucous membranes are pink and moist although she is salivating quite a bit. Otherwise, her exam is unremarkable.
- What are some potential underlying causes for the problem identified by thoracic imaging (caudodorsal alveolar pattern)?
- What is your therapeutic plan for Rosie? What is the prognosis?
non cardiogenic pulmonary edema- chocking, electrocution, seizure, drowning, hemorrhage (rat poison)
- O2 support, supportive care, time resolve in 24-48 hrs
Luna, an approximately two-year-old female pit bull mix, was brought to VHUP from the Philadelphia Animal Welfare Society for ovariohysterectomy as part of the Junior Surgery program. Prior to arrival at our hospital she was vaccinated and a heartworm test was negative. No ova were seen on fecal flotation. Luna’s preoperative physical exam was unremarkable and her anesthesia and surgical procedure were uneventful. She was a bit quiet on the first preoperative day but otherwise seemed to be recovering well.
Today, two days postoperatively, she is lethargic and coughing frequently. Her temperature is elevated at 103.5F. Her heart rate is 100/minute and her respiratory rate is 45/minute with increased respiratory effort. Thoracic auscultation reveals diffuse inspiratory crackles, loudest in the cranioventral lung fields. Cardiac auscultation is normal. Her abdomen is comfortable on gentle palpation and her surgical incision is clean, dry, and intact with no erythema or discharge noted.
- Based on the history and physical exam findings, can you localize Luna’s respiratory distress to a specific anatomic region of the respiratory tract?
- Evaluate and interpret the images for Case 3. Given the history, physical
exam findings and thoracic imaging, create a list of differential diagnoses
- parenchymal disease- fine end inspiratory crackles
- lobar signs, cranial ventral alveolar pattern →aspiration, infection(viral or bacterial) pneumonia
Luna, an approximately two-year-old female pit bull mix, was brought to VHUP from the Philadelphia Animal Welfare Society for ovariohysterectomy as part of the Junior Surgery program. Prior to arrival at our hospital she was vaccinated and a heartworm test was negative. No ova were seen on fecal flotation. Luna’s preoperative physical exam was unremarkable and her anesthesia and surgical procedure were uneventful. She was a bit quiet on the first preoperative day but otherwise seemed to be recovering well.
Today, two days postoperatively, she is lethargic and coughing frequently. Her temperature is elevated at 103.5F. Her heart rate is 100/minute and her respiratory rate is 45/minute with increased respiratory effort. Thoracic auscultation reveals diffuse inspiratory crackles, loudest in the cranioventral lung fields. Cardiac auscultation is normal. Her abdomen is comfortable on gentle palpation and her surgical incision is clean, dry, and intact with no erythema or discharge noted.
- What additional diagnostic testing is warranted at this point to rule in/rule
out differential diagnoses aspiration vs infectious pneumonia? - What is your therapeutic plan for Luna?
- endotracheal wash- culture and PCR
- IV fluids, broad spectrum antibiotics, nebulization, coupage, bronchodilators, O2 therapy, supportive care
Max, a 4.5-year-old male castrated DSH cat, is presented for lethargy and poor appetite. Max is an indoor/outdoor cat who typically roams the neighborhood but generally returns within 12-24 hours. He went out yesterday and did not return until this morning. Since that time he has been quite lethargic and unwilling to eat.
On exam, Max is depressed but responsive. His temperature is elevated at 103.2F. His heart rate is 180/minute and his respiratory rate is 40/minute with mildly increased respiratory effort. His mucous membranes are pink and dry and his skin turgor is increased. Thoracic auscultation reveals very quiet lung sounds in the ventral lung fields and normal lung sounds in the dorsal lung fields. Cardiac auscultation is normal. Abdominal palpation is unremarkable and pulse quality is normal.
- Based on the history and physical exam findings, can you localize Max’s respiratory distress to a specific anatomic region of the respiratory tract?
- Evaluate and interpret the images for Case 4 and create a list of differential
diagnoses for the findings. What diagnostic procedure would you perform to rule in/rule out the differential diagnoses you are considering?
pleural space disease-dull dorsal lung fields →fluid
pleural effusion- tap and xray
Max, a 4.5-year-old male castrated DSH cat, is presented for lethargy and poor appetite. Max is an indoor/outdoor cat who typically roams the neighborhood but generally returns within 12-24 hours. He went out yesterday and did not return until this morning. Since that time he has been quite lethargic and unwilling to eat.
On exam, Max is depressed but responsive. His temperature is elevated at 103.2F. His heart rate is 180/minute and his respiratory rate is 40/minute with mildly increased respiratory effort. His mucous membranes are pink and dry and his skin turgor is increased. Thoracic auscultation reveals very quiet lung sounds in the ventral lung fields and normal lung sounds in the dorsal lung fields. Cardiac auscultation is normal. Abdominal palpation is unremarkable and pulse quality is normal.
- Fluid recovered via chest tap is foul smelling and slightly blood tinged. Cytology reveals numerous intracellular rod and cocci bacteria. Based on this information, what is the diagnosis?
- What additional diagnostic tests are indicated?
- What is your therapeutic plan for Max?
- pyothorax
- culture- anaeorbic and aerobic
- atibiotics, chest tube or surgical debride (foreign body, abscess)
