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Doctor of Veterinary Medicine (Work in progress) > Veterinary Medicine - Respiratory Tract Diseases > Flashcards

Veterinary Medicine - Respiratory Tract Diseases Flashcards

1
Q

What region: Stertor, Stridor, Reverse sneeze, Cough

A

Stertor - Nasal cavity, Nasopharynx

Stridor - Larynx, Nasopharynx

Cough - Trachea and Distally

Reverse sneeze - Nasopharynx.

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2
Q

Epistaxis - Diagnostic work up

A

Blood pressure (Hypertension)

CBC (Thrombocytopenia, PCV/TS)

Biochemistry (e.g. Hyperviscosity syndre causes - Hyperglobulinemia, Hypertriglyceridemia)

PT/PTT (Hypocoagulation)

BMBT (Thrombocytopathy)

Rule out Oro-nasal fistula (Though usually a more mucopurulent secretion)

Imaging (CT) + Rhinoscopy

Cytology

+/- Histopathology

+/- samples for bacteriology +/- mycology.

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3
Q

Epistaxis - Treatment

A

Lower Blood Pressure: ACP + Benzodiazepines/Opiates

Control Bleeding: Gauze + Adrenaline, Ice Packs

**Ligation of external carotid

**Promote Coagulation: Tranexamic Acid, Yunan Baiyao

**Blood Products

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4
Q

Canine nasal tumor - What tumors are most frequent

A

Two thirds - Carcinomas

One third - Sarcomas

Round cell - The rest

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5
Q

Canine nasal tumors - Diagnostic work up

A

CT > MRI

Histology:
CT - Guided
Rhinoscopy Guided
Nasal Hydropulsion
Blind

Cytology - Less Useful. Only for round cell tumors.

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6
Q

What percent of canine nasal tumor histology turn out positive (as opposed to false negative)

A

70%

Always repeat samples when in doubt

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7
Q

Canine nasal tumors - MST?

A

3 Months

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8
Q

Canine nasal tumors - Describe radiotherapy (Treatment of choice)

A

1) Curative-intent high energy megavoltage radiotherapy: 3-5 Visits a week - but less powerful Best MST - 8-20 Months

2) Hypofrctionated palliative radiotherapy Weekly/Bi-weekly visits - but more powerful. MST - 150-500 Days

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9
Q

Canine nasal tumors - Side effects of Curative Intent Radiotherapy?

A

Acute side-effects: Rhinitis, Keratoconjunctivitis, Oral mucositis, Desquamation of skin

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10
Q

Canine nasal tumors - Side effects of Hypofractionated Palliative RT?

A

Late side effects: KCS, Cataracts, Retinal or optic disc degeneration, Brain necrosis, Osteonecrosis

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11
Q

Feline nasal tumors - Most frequent kind? MST? Best treatment(s)?

A

Lymphoma

MST-1000 Days (Great)

Chemotherapy/RT/ Both - All with good prognosis

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12
Q

Nasal polyps in dogs - Signalment? Epithelium-layer origin? How to diagnose? Difference from tumor? Treatment?

A

Old Dogs

Nasal mucosa

Same as with neoplasia (CT/Biopsy/Rhinoscopy)

Non-invasive

Surgery - Curative
*If there is recurrence - Steroids

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13
Q

Nasal (Not nasopharyngeal) polyps in cats - Signalment? Clinical sign unique to feline nasal polyps as opposed to canine ones? treatment?

A

Young cats - <1 Year

Epistaxis

Rhinoscopy & Removal

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14
Q

Sinonasal aspergillosis in dogs - Infective? Zoonosis?

A

No

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15
Q

Sinonasal aspergillosis in dogs - Acute/Chronic? Invasive/Non-Invasive?

A

Chronic

Non invasive

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16
Q

Sinonasal Aspergillosis in dogs - Signalment, Classic History/Clinical signs

A

Meta/Dolichocephalic > Brachycephalic

Chronic disease - Weeks to years

Mucopurulent discharge - usually unilateral that can progress to bilateral

Epistaxis

Depigmentation of Nasal Planum

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17
Q

Sinonasal Aspergillosis in dogs - Diagnosis

A

CT - Turbinates/Cribriform destruction

Rhinoscopy - Fungal plaques/Turbinate destruction

Cytology - (Highest sensitivity when sample is taken from plaques)

Histology

Culture - Mainly for identifying specific species. Doesn’t matter for treatment.

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18
Q

Sinonasal Aspergillosis in dogs - Treatment (Local or systemic?/What drugs are used? Single or multiple treatments?)

A

Local

Clotrimazole or Enilconazole. Multiple treatments for over 50% of cases are necessary (90-95% success rate). Trephinations (If sinuses are also involved). Extensive debridement can help.

(Systemic treatment - 50%-70% Success Rate).

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19
Q

Aspergillosis in Cats - Signalment? Invasive or Non Invasive? most common lab finding?

A

Brachycephalic breeds

Tends to be more invasive as opposed to dogs

Hyperglobulinemia

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20
Q

Aspergillosis in Cats - what are the 2 syndromes and which is more invasive? Clinical Signs?

A

Sino-nasal Aspergillosis:
Stertor
Sneezing
Reverse sneezing
Mucopurulent discharge
Epistaxis

Sino-orbital Aspergillosis (Invasive):
Exophthalmos
3rd Eyelid prolapse

Severe cases - Destruction of hard palate and nasal bones, Fever, Lymphadenopathy. Can also progress to CNS (e.g. Vestibular signs)

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21
Q

Aspergillosis in cats - Treatment

A

In invasive cases - Systemic treatment in addition to local (e.g. Clotrimazole/Enilconazole + Keto/Flu/Itraconazole)

Surgery with invasive cases also might be indicated

Enucleation

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22
Q

Cryptococcus - Clinical signs/appearance in dogs and cats? Prognosis?

A

Cats: Local disease that also infects paranasal tissues - very swollen nose bridge

Common URT signs (e.g. Sneezing, Reverse sneezing, Stertor)

Skin lesions

Can progress to ocular and CNS disease

Prognosis - Good when only URT disease (75% Response to treatment), Guarded in CNS cases

Dogs: Systemic disease common Can Involve URT, CNS (50-80% of cases) and eyes

Prognosis - Guarded (50% response to treatment)

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23
Q

Cryptococcus - Diagnosis

A

Cytology - Diagnostic in 75-90% of cases

Stains - Giemsa/Gram’s

Latex cryptococcal antigen agglutination test - very specific & sensitive for diagnosis and monitoring! Used on: Serum, Urine & CSF

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24
Q

Cryptococcus - Treatment

A

Treatment - Amphotericin B + Flucytosine / Ampho B + Azoles

Duration - 2 Months after cessation of clinical signs. Alternatively, treatment can be discontinued when antigen titers normalize.

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25
Q

Viral feline rhinitis - what are the viruses?

A

Calicivirus & Herpes

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26
Q

Feline Calicivirus - Clinical signs and physical exam findings

A

Lethargy

Anorexia

Fever

Lymphadenopathy

Rhinitis (Sneezing, Sero/mucopurulent discharge)

Stomatitis

Lingual ulcers (Relatively pathognomonic)

Conjunctivitis

Occasionally GI signs (e.g. vomiting, diarrhea)

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27
Q

Feline Herpesvirus - Clinical signs

A

Lethargy

Anorexia

Fever

Lymphadenopathy

Rhinitis (Sneezing, Sero/mucopurulent discharge)

Stomatitis

Conjunctivitis, Keratitis, Corneal ulcers, Sequestrum

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28
Q

Feline URT Viruses - Treatment

A

Suppurative:
IV fluids
Appetite stimulant
Anti-emetics (if indicated)
Antipyretics
Analgesia
Antibiotics for 2nd Infections (e.g. Azithromycin / Doxycycline / Augmentin)

Specific treatments: Lysine (indicated when Herpes is suspected)

Famciclovir (indicated when Herpes is suspected)

Treatment for corneal ulcers (If indicated in cases of herpes)

Long term for Herpes - Provide a stress free environment to prevent recurrence

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29
Q

Canine viral rhinitis - dog. Most common viral agent?

A

Distemper

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30
Q

Causes for bacterial rhinitis? (Primary & secondary anatomical causes)

A

Primary:
Bordetella
Mycoplasma
Chlamydia

Secondary:
Oro-nasal fistula
Cleft palate
Ciliary dyskinesia

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31
Q

Diagnosis Of Oro-nasal fistula? Common locations?

A

Signalment - Older animals

History & Clinical signs:
Chronic URT disease clinical signs (Sneezing, Stertor, Reverse sneezing)
Mucopurulent discharge, Unilateral

Diagnosis:
Probe & Florecin staining
Dental x-rays

Common locations: Canines, PM1 & PM2

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32
Q

Treatment of osteomyelitis secondary to rhinitis

A

AB treatment for 2-4 weeks (e.g. Augmentin +/- Fluoroquinolone)

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33
Q

Canine Lymphoplasmacytic rhinitis & Feline chronic rhinosinusitis - Classic histological changes

A

-Lymphoplasmocytic infiltrate +/- Eosinophils +/- Neutrophils

-Mucosa - Hyperplastic and squamous metaplastic changes

-Loss of muco-ciliary apparatus

-Hyperplasia of mucus glands

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34
Q

Canine Lymphoplasmacytic rhinitis & Feline chronic rhinosinusitis - Signalment and prevalence

A

Young to middle aged dolico & mesocephalic breeds (Dachshunds & Whippets over represented)

20-40% of chronic rhinitis in dogs and cats.

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35
Q

Canine Lymphoplasmacytic rhinitis & Feline chronic rhinosinusitis - 2 Most common rhinoscopy findings

A

Mucosal hyperemia

Secretions

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36
Q

Canine Lymphoplasmacytic rhinitis & Feline chronic rhinosinusitis - Treatment

A

2 modalities of therapy:

1) Immunomodulatory antibiotics (Azithromycin/Doxycycline) + NSAIDs + Augmenting for 2nd Infections

2) Steroids - If works - switch to MDI. 2nd Immunosuppressant may be add (e.g. Cyclosporine)

Treatment usually prolonged (2-6 months) and start tapering off

Add Vigorous Flushing

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37
Q

Canine Lympho-Plasmocytic Rhinitis & Feline Chronic Rhinosinusitis - Clinical Signs

A

Sneezing

Reverse Sneeze

Muco-Purulent Secretions

Stertor. Rarely epistaxis

Bilateral disease common

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38
Q

Neurogenic rhinitis - fancy name?

A

Xeromycteria

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39
Q

Neurogenic rhinitis - Cause

A

Loss of parasympathetic innervation - Commonly because of otitis media

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40
Q

Neurogenic rhinitis - Common ocular clinical signs / pathologies associated with the disease

A

KCS

Conjunctivitis

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41
Q

Neurogenic rhinitis - Treatment

A

Treat underlying cause (e.g. Otitis media)

Artificial eye drops

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42
Q

Nasopharyngeal polyps in cats - Signalment, Specific location, Treatment

A

Young cats

Eustachian tube => from there extends to the nasopharynx / ear

Surgery + Steroids (To prevent recurrence)

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43
Q

Nasopharyngeal diseases - Common clinical signs

A

Stertor

Stridor (Cats)

Reverse sneezing

Vomiting

Regurgitation (Negative pressure in thorax)

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44
Q

Nasopharyngeal diseases - Foreign bodies - How do they end up in the nasopharynx

A

Vomiting / Regurgitation

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45
Q

Nasopharyngeal stenosis - Causes

A

Congenital (rare) - Choanal Atresia

Acquired:
Irritation from gastric reflux (e.g. Anesthesia)
Chronic inflammation

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46
Q

Brachycephalic Airway Obstructive Syndrome (BAOS) - Primary changes

A

Stenotic nares

Elongated soft palate

Thickening of soft palate

Macroglossia (Large tongue)

Distorted ethmoidal turbinates

Tracheal hypoplasia (Commonly associated with English bulldog)

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47
Q

Brachycephalic Airway Obstructive Syndrome (BAOS) - Secondary changes

A

Pharyngeal soft tissue thickening & subsequent obstruction

Everted laryngeal saccules

Laryngeal collapse

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48
Q

Brachycephalic Airway Obstructive Syndrome (BAOS) - Common concurrent lower respiratory tract disease

A

Bronchial collapse (Bronchomalacia)

*Tracheal hypoplasia can also be considered

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49
Q

Brachycephalic Airway Obstructive Syndrome (BAOS) - Common “Extra-respiratory” complication/clinical signs. Why does it happen and associated pathologies. How would you treat it?

A

Regurgitation & Vomiting

Increase in intra-thoracic negative pressure

Sliding hiatal hernia, Esophageal / Gastro-esophageal intussusception

1) Correct BAOS if possible (Might resolve GI clinical signs as well)

2) Metoclopramide +/- PPI

3) If clinical signs do not resolve /Gastro-esophageal intussusception is present - corrective surgery.

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50
Q

Brachycephalic Airway Obstructive Syndrome (BAOS) - Common clinical signs

A

Hyperthermia

Tachypnea

Exercise intolerance

Weight gain

Stertor, Stridor, Reverse sneezing

Cyanosis

Coughing (Tracheal +/- Bronchial involvement)

Syncope

Vomiting & Regurgitation

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51
Q

Anti-tussive drugs - 2 Contraindications

A

Bacterial pneumonia / bronchopneumonia

Bronchiectasis

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52
Q

What effects do organic phosphates have on the respiratory system?

A

Bronchoconstriction

Bronchorrhea (Increase in mucus production)

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53
Q

B2 Agonists - Side effects

A

Tachycardia

Muscle tremors/twitching

Hypokalemia (Translocation into the cells)

Hyperglycemia (Inhibits release of insulin)

Decrease Uterine Motility

MDI - Direct irritation and inflammation of airways

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54
Q

B2 Agonists - Effects

A

Potent bronchodilators

Inhibition of mast cell degranulation

Increase muco-ciliary clearance

Improved diaphragm function

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55
Q

Methylxanthines - Effects

A

Bronchodilators

Mast cell stabilization

Increased respiratory muscle strength

Increased muco-ciliary clearance

Decreased microvascular leakage

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56
Q

Methylxanthines - Side Effects

A

GI - Nausea/ Anorexia

Restlessness

Arrhythmias

Vasodilation

Diuresis

CNS signs

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57
Q

Glucocorticoides - Name 3 chronic LRT diseases that are treated with GCs

A

Canine & Feline Chronic Bronchitis

Feline Asthma

Eosinophilic Bronchopneumopathy

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58
Q

Steroids - Side effects (Clinical signs & Common lab-work findings)

A

Pu/Pd

Polyphagia

Panting

Dermal Changes

Muscle atrophy

Pot-belly

Obesity

2nd infections (e.g. Pyoderma, Cystitis)

CBC: Neutrophilia, Lympfhocytopenia, Polycythemia, Thrombocytosis

Biochem: Elevation of liver enzymes (primarily ALP in dogs), Hypertriglyceridemia, Hyperglycemia, Hypernatremia, Hypokalemia

UA: Isosthenuria, Proteinuria.

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59
Q

Steroids - Effects on the respiratory system& Preferred method of use (and name of the drug)

A

Decrease production of cytokines, PG and Leukotrienes

Reduce edema

Decrease granulocyte and lymphocyte migration & activity

Potentiate B2 agonists and mitigate down-regulation of B2 receptors

Metered dose inhaler (MDI) - Fluticasone (Less systemic side effects)

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60
Q

Mucolytics - Name, Mode of administration and why? Name 2 other alternatives to main drug

A

N-Acetylcystein

IV
Oral (Not nebulization - Causes Bronchoconstriction)

1) Maintain proper hydration (makes secretions less viscous)

2) Saline nebulization

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61
Q

Tracheobronchomalacia (Tracheal collapse & Bronchomalacia) - Histological Changes

A

Decreased cellularity of cartilage

Increased water content

Decreased GAG, Glycoprotein, Chondroitin, Calcium

Laxity of dorsal tracheal membrane

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62
Q

Tracheobronchomalacia (Tracheal collapse & Bronchomalacia) - Diagnosis (3 methods)

A

Chest X-Rays (Better for diagnosing TC&raquo_space;» BM. In the case of BM - sensitivity is highest for Mainstem bronchimalacia and decreases further distally)

Fluoroscopy - (Better than X-rays. Better for TC and proximal airway collapse)

Endoscopy - Gold standard for both

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63
Q

Tracheobronchomalacia (Tracheal collapse & Bronchomalacia) - When doing fluoroscopy - what is an additional diagnostic procedure you should always perform?

A

BAL (Broncho-alveolar lavage)

Tracheobronchomalacia has a strong association with bacterial infections.

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64
Q

Tracheobronchomalacia (Tracheal collapse & Bronchomalacia) - What can make the disease suddenly clinical?

A

Obesity

Airway Inflammation/Infection

Intubation

Laryngeal Paralysis/Paresis

Airway Irritants

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65
Q

Tracheobronchomalacia (Tracheal collapse & Bronchomalacia) - Treatment

A

1) Conservative / Medical approach (usually the preferred approach):
Switch from leash to harness
Promote weight loss
No extraneous exercise

Anti-tussives
Bronchodilators
GC (Short course to reduce inflammation)
*AB (if indicated for 2nd infection)

2) Surgical approach (in case medical approach fails, relevant only for TC):
-External prostheses (cervical trachea)
-Stents (cervical + thoracic trachea + proximal bronchi)
*Short course of GC + AB

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66
Q

Tracheobronchomalacia (Tracheal collapse & Bronchomalacia) - Treatment of an acute episode (Rare)

A

ACP + Benzodiazepine

Anti-tussive (e.g. Butorphanol)

Bronchodilators

Oxygen - might help

Short term GC

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67
Q

Tracheobronchomalacia (Tracheal collapse & Bronchomalacia) - Signalment & Clinical Signs

A

Middle age to older dogs

BM - Generally large breeds and brachycephalic dogs (present in 88% of BAOS cases)

TM (AKA Tracheal collapse) - small breed dogs (Pomeranian over-represented)

Chronic disease
Hyperthermia
Tachypnea
Cyanosis
Exercise Intolerance
Weight gain
Cough
Crackles & Wheezes
Goose Honk (TM)
Syncope

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68
Q

Canine Infectious Tracheobronchitis (Kennel Cough) - Causative agents

A

Bordetella Bronchiseptica»»
Mycoplasma
Canine adenovirus
Parainfluenza
Calicivirus (Cat).

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69
Q

Canine Infectious Tracheobronchitis (Kennel Cough) - What are the 2 methods of vaccination? Onset of efficacy? Protection period

A

Bordetella Bronchiseptica:
1) Parenteral: 2 Injections 3-4 weeks apart, Effective 2 weeks after second shot
2) Intranasal - Starts working after 3 days. Single dose. Duration of immunity - 1 Year

*CAV, PI, Calicivirus - Core vaccinations

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70
Q

Canine Infectious Tracheobronchitis (Kennel Cough) - Treatment

A

A self limiting disease

If choosing to treat: Doxycycline (Drug of choice) / Azithromycin / Augmentin

Anti-Tussives

Fluids

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71
Q

Canine Infectious Tracheobronchitis (Kennel Cough) - Clinical signs

A

1) Nasal discharge without cough

2) Episodes of retching & coughing

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72
Q

Canine Infectious Tracheobronchitis (Kennel Cough) - Duration of Clinical signs without treatment & Duration of shedding

A

2 Weeks for clinical signs

2-3 Months of shedding

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73
Q

Tracheal Hypoplasia - Signalment & CS

A

Congenital disease - Median 5 Months (2 Days - 12 years). Strong association with BAOS (English bulldog over-represented). Hyperthermia, Tachypnea, Weight gain, Exercise Intolerance, Cough, Inspiratory & Expiratory Difficulty, Syncope

74
Q

Tracheal Hypoplasia - Diagnosis

A

X-Ray (Irregular Trachea to T1 Ratio - < 0.16)

75
Q

Tracheal Hypoplasia - Treatment

A

Lifestyle changes:
Switch to harness
Promote weight loss
Avoid strenuous exercise

Treat concurrent diseases (e.g. 2nd infection, BAOS)

Symptomatic treatment:
Anti-tussives
Bronchodilators

**Tracheal diameter may increase with age

76
Q

Segmental Tracheal Stenosis - Causes

A

Intubation (Over inflation of the tube)

Trauma

Surgery

Neoplasia

Infection

77
Q

Primary ciliary dyskinesia - Name 3 Body systems that are associated with the disease, the pathologies and one rare associated condition

A

Respiratory tract - Recurrent Bronchopneumonia and Rhinosinusitis

Eustachian tube - Deafness

Reproductive tract - Infertility

Situs Inversus - Kartagener’s syndrome

78
Q

Primary Ciliary Dyskinesis - Classical Presentation

A

Very young dog (Days to Months) with recurrent episodes of rhinitis / pneumonia that resolves after antibiotics

79
Q

Primary Ciliary Dyskinesis - Diagnosis

A

Signalment, History, Clinical signs

X-Rays:
evidence of pneumonia
Bronchiectasis
Situs Inversus

Radioactive droplet (Mucociliary Scintigraphy) - droplet doesn’t leave the carina for 30 minutes (not specific)

Electron microscope - abnormal arrangement of the microtubules

80
Q

Primary Ciliary Dyskinesis - Treatment

A

Antibiotics

Mucolytics

81
Q

Canine Chronic Bronchitis - Signalment & Clinical signs & Physical exam findings

A

Middle aged-older dogs

Chronic cough (> 2 Months)

Retching +/- White phlegm spitting out

Exercise intolerance

Obesity

Crackles & Wheezes

Cough on tracheal palpation (Extremely not specific)

82
Q

Canine Chronic Bronchitis - Secondary complications

A

2nd Bacterial bronchopneumonia

Bronchiectasis

Pulmonary hypertension

83
Q

Canine Chronic Bronchitis - Diagnosis

A

Hx, Sig, CS

X-Rays:
Bronchial pattern +/- alveolar patches (Normal chest radiographs do not rule out)

Tracheobronchoscopy findings - Hyperemia, Increased granularity, Nodules, Increased vascularity and secretions

BAL - Mature neutrophils predominate +/- Eosinophils

84
Q

Canine Chronic Bronchitis - Treatment

A

Glucocorticoids (Anti-inflammatory dosage) and gradually taper off. Start P.O and can later switch to MDI

Anti-tussives

Bronchodilators

AB for secondary infections

Nebulization / Mucolytics for secretions

85
Q

Feline Asthma - Possible X-Ray Findings

A

Bronchial pattern

Lung hyperinflation

Caudal displacement of diaphragm

Mediastinal right shift (Atelectasis of right middle lung lobe)

Alveolar infiltrates

Bronchial mineralization (Chronic change)

86
Q

What are the considerations when preforming BAL in cats

A

Cats tend to undergo bronchoconstriction when lungs are irritated (unlike dogs)

Complications are mild but very common (40%)

Prior to BAL - Give bronchodilators

87
Q

Feline Asthma - Treatment

A

Acute Episode - GC & Bronchodilators (IV/Inhalation)

Chronic - GC (PO/Inhaled/ Depomedrol for tough cases) & Bronchodilators for Acute Episodes

Removal of Irritants (New Furniture, Dust, Cigarettes)

Weight loss

88
Q

Feline Asthma - Signalment & Clinical signs

A

Young cats (Mean age 4 years)

Episodes of coughing (classic) but can also be chronic daily coughing.

89
Q

Feline Asthma/Chronic Bronchitis - Predominant cell in BAL

A

Feline Asthma - Eosinophils

Chronic Bronchitis - Neutrophils (Predominant) +/- Eosinophils.

90
Q

Feline Asthma - Other major DD For episodes/chronic coughing in young cats and eosinophils in BAL

A

Lung worms - Aelurostrongylus Abstrusus

91
Q

Feline Asthma - What is a common CBC finding? In what frequency of asthmatic cats?

A

Eosinophilia (20-40%)

92
Q

Respiratory abdominal effort in cats - Suggestive of…?

A

Pleural effusion

93
Q

Bacterial Pneumonia - Predisposing Factors

A

Immunocompromised (Young&raquo_space; Old)

Immunosuppression (e.g. Cushing’s disease, Steroids, FeLV)

Congenital Diseases / Anatomical Defects (e.g. Tracheal hypoplasia, PCD, IgA deficiency)

Aspiration pneumonia (e.g. Regurgitations > Vomiting, Larynx pathologies, Anesthesia)

Debilitating Disease (Prolonged Recumbency)

Pulmonary diseases (e.g. Bronchiectasis, Neoplasia)

94
Q

Bacterial Pneumonia - Treatment

A

Treat underlying cause. AB: 1st Line: Augmentin / Beta-Lactam + Fluoroquinolone / Azithromycin + Fluoroquinolone / TMS / Clindamycin + Fluoroquinolones 2nd Line (G- Aerobes) : Aminoglycosides / Chloramphenicol / TMS / 3rd & 4th Gen Cephalosporins 3rd Line: Carbapenem . Oxygen (When PaO2 < 80 mmHg / SpO2 < 94 % ) *When PaO2 < 60 / pCO2 > 50mmHg / PaO2 : FIO < 2 - 3 ==> Positive pressure inhalation. Fluids, Bronchodilators, Mucolytics / Saline Nebulization, Coupage and periodic walks (Physical therapy) - clearance of secretions

95
Q

Bacterial Pneumonia - What is a good blood test to rule in / differentiate BP From other pulmonary diseases?

A

C-Reactive protein (High in BP)

96
Q

Bacterial Pneumonia - How long to treat? (2 Options)

A

1-2 Weeks after X-rays normalize. The moment C-reactive protein normalizes

97
Q

Bacterial Pneumonia - Most common infectious agents

A

Common Bacteria : E.Coli, Strep, Staph, Pasteurella, Pseudomonas. Bacteria with Tropism & are Contagious: Bordetella, Strep equi sub zooepidemicus, Yersinia Pestis. Unique: Mycobacteria, Actinomyces, Rhodococcus, Nocardia.

98
Q

Bacterial Pneumonia - Treatment failed. Possible causes?

A

Wrong AB / Not-susceptible bacteria. Abscessation, Foreign Body, Neoplasia. Underlying cause not resolved: (e.g. Anatomical defects, causes for aspiration pneumonia, Immunosuppression). ARDS. Lipid pneumonia

99
Q

Viral Pneumonitis - Viral agents (Specific to LRT & Non-specific)

A

Specific: Canine Influenza (H3N8), Feline Influenza (H5N1), PI, Canine Adenovirus. Non Specific: Distemper, FIP, Virulent Calicivirus, Herpes (Mostly Lethal in puppies), Cowpox in Cats (zoonotic)

100
Q

Viral Pneumonitis - What are the 3 main target systems for Distemper?

A

GI, Respiratory (e.g. Rhinitis, Pneumonia), CNS

101
Q

Viral Pneumonitis - Treatment

A

General supportive (e.g. fluids, anti-pyretics, appetite stimulant), Mucolytics, Nebulization, Coupage, O2 (If indicated), AB for secondary Infections

102
Q

Mycotic Bronchopneumonia - Classic X-ray findings

A

Nodular interstitial pattern, Lymphadenopathy

103
Q

Toxoplasmosis (Protozoal Bronchopneumonia) - After Infection when does the cat start to excrete the parasite? How long after does it become infective?

A

7-14 Days after infection. 1-5 Days after being excreted. Remains infective for months to years

104
Q

Toxoplasmosis (Protozoal Bronchopneumonia) - What is the Stage that does the damage?

A

Tachyzoites (Bradyzoites remain quiet within the tissues).

105
Q

Toxoplasmosis (Protozoal Bronchopneumonia) - Mode of Infection

A

Ingestion (All life stages), Transplacental, Lactation

106
Q

Toxoplasmosis (Protozoal Bronchopneumonia) - What are the causes for respiratory disease/parasite reactivation?

A

Immunosuppression (e.g. FIV, FeLV, Steroids, Cyclosporine)

107
Q

Toxoplasmosis (Protozoal Bronchopneumonia) - Diagnosis (2 main methods)

A

Detection of Bradyzoite cyst or Tachyzoites in fluids - BAL, CSF, Pleural effusion). Serology - High IgM / Seroconversion of IgG (4x increase in 2 Weeks)

108
Q

Toxoplasmosis (Protozoal Bronchopneumonia) - Treatment and prognosis for pulmonary Toxoplasmosis

A

Clindamycin or TMS (Not in Cats). Grave

109
Q

Neosporosis (Protozoal Bronchopneumonia) - Most common signalment and affected systems

A

Puppies. Muscles (Polymyositis), CNS, Lungs

110
Q

Neosporosis (Protozoal Bronchopneumonia) - Diagnosis & Treatment

A

In fluids (CSF, BAL, Cysts in Muscles) Serology (IgM, IgG Seroconversion). Clindamycin / TMS

111
Q

Pneumocystis Carinii - Signalment (2 Over-represents breeds & and one Situational/Non-specific)

A

Miniature Dachshund, Cavalier King Charles (Young). Immunosuppressed animals

112
Q

Pneumocystis Carinii - Clinical Signs

A

Exercise Intolerance, Weight loss (different than other respiratory disease), Hair-Coat Changes., Cough, Cyanosis, Tachypnea, Dyspnea

113
Q

Pneumocystis Carinii - Diagnosis

A

X-Ray: Symmetric milliary interstitial to alveolar infiltrate Emphysema. Signs of pulmonary hypertension. Direct demonstration of P.Carinii cysts in respiratory fluids. PCR on BAL fluids

114
Q

Pneumocystis Carinii - Treatment and for duration

A

TMS . Several Months

115
Q

Pneumocystis Carinii - Zoonosis?

A

Risk mainly for Immune-comprised

116
Q

Aleurostrongylus Abstrusus - Clinical signs and arterial blood gas findings

A

Cough (Chronic), Dyspnea, Tachypnea. Hypoventilation due to obstruction

117
Q

Aleurostrongylus Abstrusus - Modes of infection

A

Ingestion of molluscans or paratenic hosts (Rodents/Birds)

118
Q

Aleurostrongylus Abstrusus - Diagnosis

A

X-rays, L1 in Fecal Floatation (Berman) , See the worms BAL cytology

119
Q

Aleurostrongylus Abstrusus - Treatment

A

Fenbendazole for 2 - 3 Weeks (Broadline, Advocate also fine). GC (to reduce inflammation). Bronchodilators

120
Q

Interstitial Lung Diseases - Clinical signs

A

Shallow Breathing, Tachypnea, Cyanosis , Signs of R-CHF (e.g. Syncope, Ascites), Exercise Intolerance, Cough

121
Q

Interstitial Lung Diseases - Name the 2 main methods in which a general diagnosis of ILD can be achieved

A

Imaging (CT), Histology

122
Q

Interstitial Lung Diseases - 2 Main Histological Findings

A

Inflammation , Fibrosis

123
Q

Interstitial Lung Diseases - Common CT Findings (But not Specific)

A

Ground-glass opacity, Traction bronchiectasis, Honeycomb, Subpleural fibrosis

124
Q

Interstitial Lung Diseases - Clinical signs are due to 3 elements:

A

Hypoxemia, Inflammation, Pulmonary hypertension

125
Q

Eosinophilic Bronchopneumopathy - Signalment (and common breeds) and main clinical sign

A

Young adult females (Husky, Malamute, Rottweiler over-represented). Cough (Chronic)

126
Q

Eosinophilic Bronchopneumopathy - Diagnosis

A

X-rays: Various patterns can be seen such as broncointerstitial, Nodules, alveolar infiltrates and more. Bronchiectasis in severe cases. BAL - Predominantly Eosinophils

127
Q

Eosinophilic Bronchopneumopathy - Treatment & Prognosis

A

GCs and slowly taper off (MDI if possible), Anti-tussives, Bronchodilators. Prognosis for cure is good. Relapses are common

128
Q

Eosinophilic Bronchopneumopathy - How frequently are radiographic changes seen in times of clinical signs? As opposed to what other diseases that are accompanied with chronic cough?

A

EBP - Radiographic changes can be seen the majority of cases. As opposed to Chronic Bronchitis, Feline asthma (Lack of changes do not rule out the diseases)

129
Q

Eosinophilic Bronchopneumopathy - Common bloodwork finding, and in what frequency does it appear?

A

Eosinophilia (~50%)

130
Q

Idiopathic Pulmonary Fibrosis - Signalment, Clinical signs and main PE findings

A

Middle age to old dogs. Terriers, Particularly West Highland White Terrier, Pekingese (A more severe disease) Tachypnea, Dyspnea, Severe exercise intolerance, Syncope (Pulmonary Hypertension 40% of Cases), Cough, Cyanosis , Crackles, Velcro sounds

131
Q

Idiopathic Pulmonary Fibrosis - Diagnosis

A

CT (Ground glass opacity, Traction bronchiectasis, Subpleural bands, Honeycomb) *Suggestive but not specific. Histology (Gold standard): Severe fibrosis with no significant inflammation

132
Q

Idiopathic Pulmonary Fibrosis - Treatment & Prognosis

A

O2, PDE-5 inhibitors (e.g. Sildenafil) - for Pulmonary hypertension. AB for 2ndary Infections, Guarded, but can live for a few more years

133
Q

Idiopathic Pulmonary Fibrosis - MST for Pekingese IPF

A

60 Days

134
Q

Lipid Pneumonia - Exogenous common cause and why does it occur to begin with?

A

Mineral Oil / Vegetable / animal-based. It doesn’t irritate the mucosa going down - suspicion only rises after clinical signs begin

135
Q

Lipid Pneumonia - Endogenous causes

A

PTE, Neoplasia, Bacterial Pneumonia, Idiopathic

136
Q

Lipid Pneumonia - What is the source of the lipids in Endogenous lipid pneumonia?

A

Cholesterol from Pneumocytes type II that spill out upon destruction

137
Q

Lipid Pneumonia - Common arterial blood gas results

A

Hypercapnia, Hypoxemia

138
Q

Lipid Pneumonia - Diagnosis

A

BAL cytology - Oil laden macrophages

139
Q

Lipid Pneumonia - Exogenous - Treatment

A

Supportive treatment for pneumonia. If treatment fails - short course of GC to reduce inflammation. Oxygen if needed. AB for secondary pneumonia

140
Q

Lipid Pneumonia - Endogenous - Treatment

A

Treat primary disease, GC to reduce Inflammation, Removal of affected lobes if severe

141
Q

Lung neoplasia - what is the most common primary malignant neoplasia

A

Adenocarcinoma >> Carcinoma (70%)

142
Q

Lung neoplasia - what is more common - primary or metastasis?

A

Metastasis

143
Q

Lung neoplasia - What are 2 common clues to a thoracic mass (commonly associated with neoplasm)? Name one in a dog and one in cat

A

Dogs - Hypertrophic Osteopathy. Cats - Lung-digit syndrome

144
Q

Lung neoplasia - Most efficient diagnostic tools

A

FNA (~80% Diagnostic). Biopsy

145
Q

Lung Neoplasia - Negative prognostic indicators

A

Presentation with clinical signs, Centrally located (Closer to lung hilus), Lymph node involvement, Multiple lesions, Pleural lesions, Undifferentiated carcinomas, Adenocarcinoma>SCC (More metastasis)

146
Q

Aspiration Pneumonia - Predisposing Factors

A

Force feeding. Regurgitation (e.g. Megaesophagus, Myasthenia Gravis, Esophagitis, Sliding hiatal hernia). Vomiting (less of a risk factor than regurgitation). Impaired laryngeal function (e.g. Laryngeal paralysis, Masses adjacent to larynx). Impaired consciousness: (e.g. Anesthesia, Coma, Syncope, Seizures)

147
Q

Aspiration Pneumonia - Treatment

A

Remove underlying problem, AB for 2nd infection, Oxygen

148
Q

Aspiration Pneumonia - Diagnosis

A

CBC: neutrophilia. High CRP. X-rays: Interstitial-Alveolar Pattern - Cranio-ventral distribution (classically but not limited to right cranial, right middle (most commonly affected) lung lobes

149
Q

Aspiration Pneumonia - Prevention (Think about the general causes and how to prevent each one)

A

Regurgitations: Treat underlying issue if possible, Baileys chair / feed from above, High frequency + low volume meals, Pro-motiles. Anesthesia related AP: Proper fasting before procedure, Use endotracheal tube and inflate appropriately, Pro-motiles (e.g. Metoclopramide), PPIs

150
Q

Aspiration Pneumonia - What are the characteristics of the worst kind of ingest to inhale (3)

A

Big particles , High tonicity, Acidic

151
Q

Pneumothorax - 3 Main categories of causes and name common causes for each

A

Traumatic: HBC, Bite wound. Iatrogenic: Rapid re-expansion of lungs, Open pop-off valve, High pressure ventilation, Thoracocentesis. Spontaneous: 1) Primary- Bullae, Blebs. 2) Secondary: Abscess, Neoplasia, Granuloma, Inflammatory diseases (e.g. Asthma, Chronic bronchitis), Ruptured esophagus, Tracheal rupture

152
Q

Pneumothorax - Classic signalment for primary pneumothorax

A

Middle age to old, large breed, deep chested dogs

153
Q

Pneumothorax - What are the common types of spontaneous pneumothorax (Primary vs. secondary) - Cats vs dogs?

A

Dogs - Primary. Cats - Secondary

154
Q

Pneumothorax - Diagnosis

A

TFAST - Absence of “glide sign” and / or B-lines (Can help rule out if present) and presence of lung point.. Diagnostic thoracocentesis. Chest X-rays: Cardiac silhouette elevations, Evidence of bullas (not sensitive). CT (For bullae - still sensitivity only 40-60%)

155
Q

Pneumothorax - Clinical signs, PE findings and arterial blood gas

A

Tachypnea, Dyspnea, Cyanosis, Auscultation - decreased respiratory sounds dorsally. Hypercapnia, Hypoxemia

156
Q

Pneumothorax - Treatment (Traumatic / Primary / Secondary)

A

Traumatic : Monitoring=>Thoracocentesis=> Chest tubes. Oxygen (Lesions heal 3-5 days). Secondary (e.g. Foreign body, Abscess, Neoplasia): Treat underlying problem (Surgery) and occasionally requires thoracocentesis but most heal conservatively after surgery. Primary (Bulla, Blebs): Pleurodesis treatment of choice = Blood Pleurodesis

157
Q

Pulmonary thromboembolism (PTE) - Causes

A

IMHA Pancreatitis PLN/PLE, Inflammation, Cushing’s/Steroids, Sepsis, S.Lupi, Cardiomyopathy, Neoplasia

158
Q

Pulmonary thromboembolism (PTE) - Diagnosis

A

High D-Dimer - Mostly for acute cases (after 24h sensitivity drops). Not specifiec. Useful for ruling out PTE. Angio-CT/ MRI (Gold standard). *Echocardiography - useful for detecting pulmonary hypertension 2nd to PTE. *Arterial blood-gas - Hypoxemia

159
Q

Pulmonary thromboembolism (PTE) - Treatment

A

Treat underlying cause. Anti l-coagulants/anti-thrombotics (e.g. Clopidogrel/LMWH/Rivaroxaban). *Thrombolysis is not recommended. Oxygen

160
Q

Pulmonary Hypertension - Causes (From most to least common)

A

L-CHF - 50%, Pulmonary diseases with hypoxia (Bronchitis/TBM/Fibrosis) - 25%, PTE/Emboli - 10%, R-L Shunts (PDA/VSD) - 10%, Idiopathic (Rare)

161
Q

Pulmonary Hypertension - Definition & Diagnosis (Optimal imaging technique and possible findings)

A

Pulmonary arterial pressure > 25 mmHg. Echocardiography: Bernoulli’s equation (4v^2)- right ventricle/atrium pressure increases. Flattening of interventricular septum. Pulmonary artery/aorta diameter > 1. Right ventricular hypertrophy

162
Q

Pulmonary Hypertension - Clinical signs and PE findings

A

Syncope, Ascites, Exercise Intolerance. Basal, Left Sided, Decrescendo Murmur, Split S2, Right apical systolic murmur, Jugular distension and or pulsation

163
Q

Pulmonary Hypertension - Treatment

A

Treat underlying cause, Avoid strenuous exercise, PDE-5 Inhibitors (Sildenafil, Tadalafil), Oxygen

164
Q

Cardiogenic/Non-cardiogenic pulmonary edema - General categories of causes of fluid extravasation

A

Increase in hydrostatic pressure, Decrease in oncotic pressure, Increase in vascular permeability, Decrease in lymphatic drainage

165
Q

Cardiogenic/Non-cardiogenic pulmonary edema - of the general causes for fluid extravasation - Which 2 categories are more likely to cause pulmonary edema? What pathologies do the other 2 generally lead to?

A

Causes pulmonary edema: 1) Increase in hydrostatic pressure (e.g. L-CHF) 2) Increase in permeability (e.g. SIRS). Don’t generally cause pulmonary edema: 1) Decrease in osmotic pressure: (Hypoalbuminemia) - Pleural effusion. Also - Ascites, Peripheral edema. 2) Decrease in lymphatic drainage - Chylothorax.

166
Q

Cardiogenic/Non-cardiogenic pulmonary edema - for each main category of fluid extravasation which can lead to pulmonary edema - What is the fluid type and does it respond to diuretics?

A

1) Increase in hydrostatic pressure (e.g. L-CHF) - Transudate (Protein poor) - Responds well to diuretics. 2) Increase in permeability - Protein Rich - Doesn’t respond well to diuretics

167
Q

Non-cardiogenic pulmonary edema - Common causes for increase in permeability

A

Post-obstructive lung edema: Rapid lung Re-expansion, Strangulation. ALI/ARDS: Pancreatitis, IMHA, Vasculitis, Uremia, Heat stroke, TRALI, Oxygen toxicity, Sepsis, Snake bite. Direct lung damage: Aspiration pneumonia, Paraquat, PTE. Neurogenic lung edema: Seizures, Electrocution, Head trauma

168
Q

Cardiogenic/Non-cardiogenic pulmonary edema - A useful lab parameter which can help distinguish between cardiogenic and non-cardiogenic pulmonary edema

A

NT-proBNP

169
Q

Cardiogenic/Non-Cardiogenic Pulmonary Edema - Common arterial blood gas results

A

Hypoxemia, High A-a Gradient, low PaO2:FIO2 , Normo to hypocapnia (Hypoxemia which leads to tachypnea and hyper-ventilation)

170
Q

Non-cardiogenic pulmonary edema - Treatment

A

Treat underlying cause, Oxygen Support while the lungs heal, Positive pressure when SpO2 <90%, PaO2 < 60 mmHg

171
Q

Lung lobe torsion - Signalment & Clinical signs

A

Deep-chested dogs (Afghan hounds, Pugs over-represented. Non-Specific - Malaise, Fever, Anorexia, Shock, Collapse, Tachypnea, Cough, Hemoptysis

172
Q

Lung lobe torsion - Commonly affected lung lobes

A

Left-cranial, Right middle

173
Q

Lung lobe torsion - Diagnosis & Treatment

A

CT > X-Ray (Lung consolidation). Thoracocentesis of pleural effusion if present (Modified transudate / Hemorrhagic / Chyle). Removal of affected lung lobe

174
Q

What drug inhibits the metabolism of Theophylline in the liver - risking overdose?

A

Enrofloxacin

175
Q

What 2 respiratory diseases are in strong association with BAOS?

A

Bronchomalacia, Tracheal hypoplasia (Mainly English Bulldogs)

176
Q

Feline Calicivirus - in addition to common Calicivirus clinical signs and physical exam - name the pathologies commonly associated with virulent stains

A

Pneumonia, Polyarthritis, Jaundice, Vasculitis, Edema, and ulceration (Face, limbs, foot pads)

177
Q

Neurogenic rhinitis - Common clinical signs

A

Mainly unilateral disease, Hyperkeratosis and dryness of nasal planum, Nasal discharge, Sneezing

178
Q

Coughing Patient - Important Hx Questions

A

How long has it been coughing? Productive cough or not? Exposed to irritants? Any other clinical signs? Worse in the morning (Respiratory) or at night (Cardiogenic)

179
Q

Cough is Respiratory or Cardiogenic: Elevation of sleeping respiratory rate

A

Cardiogenic

180
Q

Pulmonary hypertension - Common causes

A

R-L Shunt (e.g. PDA, VSD) , Cardiac diseases (e.g. Mitral regurgitation) Respiratory diseases (Mainly lower tract disease), PTE, Heart worms, Idiopathic

181
Q

Pulmonary hypertension - treatment

A

Treat underlying cause, Oxygen supplementation, PDE-5 Inhibitors (Sildenafil / Tadalafil), Less exercise

Doctor of Veterinary Medicine (Work in progress) (17 decks)

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