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403 Cards in this Set
- Front
- Back
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what comprises the upper airway?
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nasal cavity, nasopharynx, larynx, extrathoracic trachea
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what comprises the lower airway?
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intrathoracic trachea, bronchi, bronchioles
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what comprises the large airways?
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trachea, primary bronchi, secondary bronchi
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what comprises the small airways?
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tertiary bronchi, bronchioles
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what comprises the respiratory parenchyma?
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alveoli, pulmonary vasculature, interstitium
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what are the two functional classifications of respiratory disease and a brief description of each
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1. obstructive respiratory disease: respiration is impaired by obstructed airflow (e.g. inflammation, airway obstruction, mass, or foreign body)
2. restrictive airway disease: respiration is impaired by decreased lung compliance, decreased ability of the lungs to inflate (e.g. pneumonia, pleural disease) |
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what are four cardiovascular indicators of respiratory disease?
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1. pulse quality
2. heart rate 3. rhythm disturbance (uncommon) 4. murmur |
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what are the three components of a breathing pattern?
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1. rate
2. depth 3. effort - increased use of diaphragm and intercostal muscles |
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with restrictive respiratory disease, the following aspects of the breathing pattern:
- rate - depth - effort |
- rate: faster
- depth: shallow - effort: increased |
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with obstructive respiratory disease, the following aspects of the breathing pattern:
- rate - depth - effort |
- rate: slower
- depth: deep - effort: increased |
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what causes a longer inspiratory phase of respiration?
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extrathoracic airway, parenchymal, or pleural disease
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what causes a longer expiratory phase of respiration?
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intrathoracic airway disease, small airway disease
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in a normal animal, which phase of respiration has louder sounds on auscultation?
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inspiration
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what are three things that can cause a normal increase in the volume of bronchovesicular sounds on auscultation?
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1. referred upper airway noise
2. old dog lungs 3. stressed/excited animal |
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what are three things that can cause a normal decrease in the volume of bronchovesicular sounds on auscultation?
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1. obesity
2. shallow breathing 3. auscultation technique |
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what are two things that can cause an abnormal increase in the volume of bronchovesicular sounds on auscultation?
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1. interstitial or alveolar infiltrates
2. increased airway resistance |
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what are three things that can cause an abnormal decrease in the volume of bronchovesicular sounds on auscultation?
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1. intrathoracic mass
2. pleural space disease 3. atelectasis |
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what is stertor and where does the sound originate?
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snoring like noise, localizes to nasal cavity or nasopharyngeal area
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what is stridor and where does the sound originate?
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shrill, harsh inspiratory noise; localizes to oropharynx, larynx, or extrathoracic trachea
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what are wheezes/rhonchi, and where do the sounds originate?
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continuous, musical sound; localizes to lower airway disease; caused by narrowing or obstruction of airways
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what are crackles/rales, and where do the sounds originate?
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discontinuous sounds, “popping”; may be moist or dry; localizes to parenchyma and lower airways
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what are the two types of rales, what type of disease do they indicate, and in what phase of respiration are they heard?
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1. Dry - airway disease, heard on expiration
2. Moist – parenchymal disease, heard on inspiration |
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as a rule of thumb, if RR is slow for the degree of effort involved, what do you think?
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large airway obstruction (intra- or extra-thoracic)
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as a rule of thumb, if RR is fast for the degree of effort involved, what do you think?
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parenchymal or pleural disease
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as a rule of thumb, when you see increased inspiratory effort, what are three locations of disease?
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1. extrathoracic airways
2. parenchyma 3. pleural space |
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as a rule of thumb, when you see increased expiratory effort, what are two locations of disease?
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1. intrathoracic large airways
2. small airways |
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where does a sneeze and nasal discharge generally localize to? What are some exceptions?
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- nasal cavity, sinuses, and nasopharynx
- Exceptions: coughing up of lower airway secretions into oropharynx and nasopharynx; systemic disease that affects lower respiratory system |
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where does a cough localize to?
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larynx and distal
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what are five clinical signs of dyspnea?
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1. orthopnea
2. open-mouth breathing 3. stridor 4. pallor 5. cyanosis |
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what are three general ways to treat dyspnea?
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1. oxygen supplementation
2. anxiolytics 3. limit handling of the animal (i.e. don't increase stress) |
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what are four methods by which to provide oxygen supplementation to a patient with dyspnea?
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1. oxygen cage
2. face mask 3. flow-by 4. nasal insufflation |
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what are three drugs commonly provided to the patient with dyspnea?
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1. acepromazine
2. opioids 3. benzodiazepines |
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young animals are predisposed to what two types of respiratory diseases?
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1. infectious
2. congenital |
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older animals are predisposed to what two types of respiratory diseases?
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1. neoplasia
2. dental disease |
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brachycephalic cats are predisposed to what type of respiratory disease?
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fungal
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brachycephalic dogs are predisposed to what two types of respiratory malformations?
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stenotic nares, elongated soft palate
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dolichocephalic dogs are predisposed to what two types of respiratory diseases?
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1. fungal rhinitis
2. nasal neoplasia |
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outdoor/hunting dogs are predisposed to what two types of respiratory diseases?
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1. trauma
2. foreign bodies |
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what types of respiratory diseases commonly cause clinical signs that are:
- acute? - chronic? |
- acute: infectious, foreign body
- chronic: neoplasia, fungal |
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what respiratory diseases have a progression that is:
- slow? - fast? |
- slow: neoplasia, fungal
- fast: infectious |
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which respiratory disease tend to be:
- systemic? - local? |
- systemic: viral, fungal
- local: foreign body, neoplasia |
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reverse sneeze:
- what is it? - where does it localize? - what are five etiologies? |
- forceful inspiration against a closed epiglottis
- localizes to the nasopharyngeal area 1. excitement 2. foreign body 3. allergies 4. nasal mite (Pneumonyssus canium) 5. epiglottic entrapment of the soft palate |
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what are six things that can cause unilateral nasal discharge in the small animal?
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1. early fungal infection
2. early neoplastic disease 3. foreign body 4. tooth root abscess 5. oronasal fistula 6. nasopharyngeal polyp |
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what are five things that can cause bilateral nasal discharge in the small animal?
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1. infection
2. allergy 3. advanced fungal disease 4. advanced neoplastic disease 5. systemic disease |
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what are five "types" of nasal discharge?
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1. serous
2. mucoid 3. purulent 4. mucopurulent 5. hemorrhagic |
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what are three etiologies of serous nasal discharge?
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1. acute viral
2. non-infectious disease 3. inflammatory disease |
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what causes mucoid nasal discharge?
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chronic inflammatory disease
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what causes purulent nasal discharge?
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bacterial infection
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what is the most common type of nasal discharge with respiratory disease?
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mucopurulent
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characterize purulent nasal discharge
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opaque and viscous with abundant neutrophilia and bacteria
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what are three basic causes of hemorrhagic nasal discharge?
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1. intranasal disease
2. extra-nasal disease 3. trauma |
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what is the basic pathogenesis of epistaxis with intranasal disease?
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erosion or destruction of turbinates
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what are extra-nasal disease causes of epistaxis?
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hypertension, thrombocytopenia, coagulopathy
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what two basic parameters do you use to characterize nasal discharge?
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1. is it unilateral or bilateral?
2. character (e.g. serous, mucopurulent, etc.) |
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when suspecting a nasal disease, what are six things that you may find in the HX?
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- environment (exposure to animals, outdoor/indoor)
- travel history (fungal, infection) - immunologic status (vaccine history, other illness, immunosuppressive medications) - onset of clinical signs - progression of clinical signs - presence of localized or systemic infections |
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when suspecting a nasal disease, what are 8 things that you may find in the PE?
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- presence of sneezing
- nasal discharge - patency of nares - presence of stertor - ulcerated/crusted nares - oral abnormalities - lymphadenopathy - facial deformity |
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what are nine types of diagnostic tests of the nasal cavity?
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1. nasal swab (cytology, culture)
2. serology (fungal, FeLV/FIV) 3. virus isolation (difficult) 4. molecular testing (PCR) 5. imaging (rads, CT) 6. rhinoscopy 7. pharyngoscopy 8. nasal flush 9. nasal biopsy |
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what is the minimum database for diagnosing disease of the nasal cavity and how do you interpret them?
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- CBC, chemistry, UA
- minimal changes with disease localized to the nasal cavity - systemic changes may show more profound changes |
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comment on nasal swab for:
- cytology - culture |
- cytology: non-specific except for cryptococcus
- culture is difficult to interpret due to normal flora |
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what are four things that you may find using serologic testing with regards to nasal disease?
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1. aspergillosis
2. cryptococcus 3. FeLV 4. FIV |
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what are three methods of nasal biopsy?
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1. direct visualization
2. blind/traumatic 3. rhinotomy |
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what are three tests commonly performed on nasal biopsies?
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1. histopathology
2. cytology 3. culture |
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name four infectious diseases of the nasal of cavity of the dog and cat
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1. Feline upper respiratory infection/complex
2. Canine viral disease 3. Bacterial rhinitis (very rare as a primary disease) 4. Fungal rhinitis |
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name three inflammatory diseases of the nasal of cavity of the dog and cat
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1. allergic
2. feline chronic rhinosinusitis 3. canine chronic/lymphoplasmacytic rhinitis |
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what are the two most common types of nasal masses in the dog and cat?
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1. neoplastic
2. polyps |
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what are six common types of diseases of the nasal cavity of dogs and cats?
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1. infectious
2. inflammatory 3. nasal masses 4. nasal foreign bodies 5. parasites 6. cleft palate |
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what are six agents that cause feline upper respiratory infection and name the two most common?
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1. Feline Herpes Virus-1 (FHV-1) - MOST COMMON
2. Feline Calicivirus (FCV) - MOST COMMON 3. Bordetella bronchiseptica 4. Chlamydophila felis 5. Mycoplasma and other viruses 6. Secondary bacterial infections |
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which virus causes keratotic/dendritic corneal ulcers in the cat?
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FHV-1
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which virus causes oral ulceration in the cat?
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FCV
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what are eight clinical signs of upper respiratory infection in the cat?
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1. Pyrexia
2. Sneezing 3. Ocular and nasal discharge 4. Conjunctivitis 5. Keratitis/Dendritic corneal ulcers (FHV-1) 6. Oral ulceration (FCV) 7. Cough 8. Hypersalivation |
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what are two important clinical signs of FHV-1?
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sneezing, ocular lesions
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what is an important clinical sign of FCV?
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oral ulceration
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where are Chlamydiophila infections localized in the cat?
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conjunctiva
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what are some clinical signs of Bordatella bronchiseptica infection in the cat?
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- pharyngitis
- laryngitis - may develop into bronchopneumonia |
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which feline upper respiratory infections are diagnosed by culture?
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Bordatella and Chlamydiophila
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what is an important limitation of using PCR to diagnose a viral infection?
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you cannot distinguish active from latent infection
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what are three supportive treatments for feline URI?
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1. hydration
2. smelly foods 3. nebulization |
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what is an oral antiviral medication used in feline URI?
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Famciclovir
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what is a common dietary supplement that helps fight viral infections? What is the proposed mechanism of action?
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- oral lysine
- antagonizes arginine uptake by virus |
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what is a nasal decongestant that can be used in cats
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pediatric neosynephrine (USE SPARINGLY!)
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what two types of feline upper respiratory infections are commonly treated with ocular medications?
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viral and bacterial
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what are two basic type of immunomodulators used in feline URI?
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1. oral interferons
2. ± antibiotics |
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how do you prevent feline Bordatella?
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vaccine for high risk patients
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how do you prevent feline Chlamydiophila?
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vaccine for high risk patients
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how do you prevent feline FHV-1 and FCV
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vaccine; diminishes clinical signs but does not eliminate carrier status
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how do you prevent canine distemper?
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routine vaccination
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what is canine infectious tracheobronchitis?
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Multiple etiologic agents including viral that can cause nasal cavity disease alone or in combination with other clinical signs
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comment on the prevalence of bacterial rhinitis
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- PRIMARY, with rare exception, it does not exist
- SECONDARY infection is very common |
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how do you treat secondary bacterial rhinitis?
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empirical antimicrobial therapy is usually sufficient to treat, but you should look for underlying etiology
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what is the most common causative agent of fungal rhinitis in cats?
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cryptococcus
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what are four clinical signs of cryptococcal fungal rhinitis in cats?
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- sneezing
- mucopurulent nasal discharge (±blood) - nasal granuloma - facial deformity |
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how do you diagnose cryptococcal fungal rhinitis in cats? (3)
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1. identification of organism through cytology or biopsy
2. imaging can be helpful 3. Serology – latex agglutination test is reliable |
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what are three systemic antifungals used to treat cryptococcal fungal rhinitis in cats?
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1. ketoconazole
2. itraconazole 3. fluconazole |
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what is the most common signalment for nasal rhinitis caused by Aspergillus?
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Young to middle aged mesaticephalic and dolichocephalic dogs
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what is the key clinical sign of nasal aspergillosis in the dog?
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profuse mucopurulent discharge, often hemorrhagic
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what are two findings on physical exam of nasal aspergillosis in dogs?
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1. sensitivity to face and nasal palpation
2. depigmentation and ulceration of the nose |
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what are three ways to diagnose canine nasal aspergillosis?
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1. Imaging – radiographs, CT
2. Rhinoscopy – thick plaques 3. Serology – AGID Ab test is supportive but not definitive of diagnosis |
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how is canine nasal aspergillosis treated?
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local antifungal treatment
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what is feline chronic rhinosinusitis (signalment, clinical signs)?
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a sequela to viral infection and/or allergies in young to middle-aged cats, mucoid to mucopurulent nasal discharge, sneezing; no systemic involvement unless active viral disease is present
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how do you treat feline chronic rhinosinusitis? (6)
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- treat secondary bacterial infections
- loosen secretions (nebulization) - lysine (if viral component) - antihistamines - anti-inflammatory doses of glucocorticoids - eliminate environmental allergens/irritants |
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what is canine lymphoplasmacytic rhinitis (signalment, clinical signs)?
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an INFLAMMATORY process (etiology not well characterized) of young to middle-aged dogs, characterized by small to moderate amount of serous, mucoid, to mucopurulent nasal discharge; ± sneezing; and NO systemic signs
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what are two ways to diagnose canine lymphoplasmacytic rhinitis?
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1. rhinoscopy (hyperemic and edematous membranes)
2. biopsy |
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how do you treat canine lymphoplasmacytic rhinitis? (6)
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- treat secondary bacterial infections
- loosen secretions (nebulization) - lysine (if viral component) - antihistamines - immunosuppressive doses of glucocorticoids - eliminate environmental allergens/irritants |
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what type of disease process is allergic rhinitis?
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a Type I hypersensitivity reaction
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what are three ways to treat allergic rhinitis?
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1. remove allergen
2. antihistamines 3. anti-inflammatory doses of glucocorticoids |
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nasopharyngeal polyp:
- signalment - clinical signs - diagnosis - treatment |
- Signalment: young cats, kittens
- Clinical Signs: stertor, ± discharge, open-mouth breathing, ear issues (note, the polyp originates form the bulla) - Diagnosis : Oral examination (behind the soft palate); Aural examination; Nasopharyngoscopy - Treatment: surgical removal, bulla osteotomy |
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what is the most common type of neoplastic nasal mass lesion in the dog and the cat?
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- dog: carcinomas
- cat: lymphoma |
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what are three clinical signs of nasal neoplastic lesions?
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1. chronic nasal discharge
2. facial deformity 3. lack of pain |
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what are three ways in which neoplastic nasal mass lesions are diagnosed?
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1. imaging
2. rhinoscopy 3. biopsy/histopathology |
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how do you treat nasal
- lymphoma? - carcinoma? |
- lymphoma: chemotherapy
- carcinoma: debulking and radiation |
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what are some clinical signs of a nasal foreign body?
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acute sneezing with acute bleeding that subsides; if in nasopharyngeal area then dysphagia, gagging, dysphonia, outstretched neck
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how do you diagnose a nasal foreign body?
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Oral Exam, Rhinoscopy/Nasopharyngoscopy; occasionally rhinotomy
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how do you treat a nasal foreign body?
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Removal of foreign body; treat secondary bacterial infection.
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what is a common parasite of the canine nasal cavity? Clinical signs? Diagnosis? Treatment?
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- Pneumonyssoides caninum (mites)
- Clinical Signs – sneezing - Diagnosis – rhinoscopy - Treatment – Ivermectin, fenbendazole |
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cleft palate:
- what are the two types? - clinical signs - diagnosis - treatment |
- Two types – primary, secondary
- Clinical signs – milk out of nose; Stunted growth, aspiration pneumonia ' Diagnosis – visualization ' Treatment - surgical |
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what breed types are overrepresented for elongated soft palate, hypoplastic trachea?
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brachycephalic
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what breed types are overrepresented for collapsing trachea?
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small/toy
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what breed types are overrepresented for laryngeal paralysis? In which two specific breeds is laryngeal paralysis congenital?
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- older large breed dogs
- congenital: Bouvier de Flaundres and Samoyeds |
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which "working" dogs are overrepresented for foreign bodies, parasites, and fungal infections?
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hunting
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name the two most common types of disease of the pharynx, larynx. And trachea in
- young animals - old animals |
- young: infectious, congenital
- old: chronic bronchitis, neoplasia |
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when suspecting a nasal disease, what are 8 things that you may find in the HX?
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- environment (kennels, dog parks, outdoors)
- travel history (fungal, parasites) - immunologic status (infectious, immunosuppressed - fungal) - onset of clinical signs - progression of clinical signs - presence of cough - stertor - stridor |
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what disease of the pharynx, larynx, and trachea do animals commonly get from kennels and dog parks?
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infectious tracheobronchitis
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what are the four "qualities" of a cough that you should assess?
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1. onset
2. temporal occurrence 3. rate of progression 4. character |
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what are the two basic onset types of a cough and what are some differentials for disease of the pharynx, larynx, and trachea?
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1. gradual: neoplasia, collapsing trachea, laryngeal paralysis
2. acute: infectious or inflammatory |
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when does cough typically occur with laryngeal paralysis?
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after drinking or eating, exercise, excitement
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a cough with exercise/excitement may indicate which three diseases of the pharynx, larynx, and trachea?
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1. collapsing trachea
2. laryngeal paralysis 3. infectious tracheobronchitis |
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what are the two "characters" of cough and what disease of the pharynx, larynx, and trachea is associated with each?
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1. moist: infectious tracheobronchitis
2. dry: collapsing trachea |
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when a dog has infectious tracheobronchitis, what do owners often mistake for vomiting?
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post-tussive gagging/retching
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in disease of the pharynx, larynx, and trachea to where does
- stridor localize? - stertor localize? |
- stridor: laryngeal disease
- stertor: nasopharyngeal or pharyngeal disease |
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comment on where the following clinical signs of upper airway/tracheal disease localize to:
- Gagging/retching (not associated with cough) - Dysphagia, difficulty swallowing - Voice change - Exercise intolerance - Post-tussive gagging/retching - Reverse sneezing - Coughing after drinking - Stridor with heat/exercise - Coughing with excitement/exercise |
- Gagging/retching (not associated with cough): pharyngeal
- Dysphagia, difficulty swallowing: pharyngeal - Voice change: laryngeal - Exercise intolerance: laryngeal or tracheal - Post-tussive gagging/retching: tracheal - Reverse sneezing: nasopharyngeal - Coughing after drinking: laryngeal - Stridor with heat/exercise: laryngeal - Coughing with excitement/exercise: tracheal |
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comment on where the disease of the pharynx, larynx, or trachea localizes to with:
- increased inspiratory effort - increased expiratory effort - severe disease |
- increased inspiratory effort: pharyngeal, laryngeal, and extrathoracic trachea
- increased expiratory effort: intrathoracic trachea - severe disease: both |
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comment on the cough associated with laryngeal palpation
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If you squeeze the larynx, a normal animal will not cough; an animal with a tracheal irritation will cough
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what are five things to palpate for to detect disease of the pharynx, larynx, and trachea
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1. Tracheal sensitivity – present with tracheal and sometimes bronchial disease
2. Laryngeal sensitivity 3. Size of trachea 4. Masses (e.g. thyroid) 5. Lymph nodes |
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why might a minimum database not be required for a disease of the pharynx, larynx, and trachea?
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Many diseases localized to pharynx, larynx, and trachea will not cause disturbances in CBC, Chem, UA
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what is an important, often overlooked procedure to diagnose diseases of the upper airway, such as laryngeal paralysis, foreign bodies, etc.?
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oral exam under sedation
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what are six diagnostics used for a suspected disease of the pharynx, larynx, or trachea?
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1. oral exam under sedation
2. pharyngoscopy/laryngoscopy 3. tracheoscopy 4. radiographs 5. fluoroscopy 6. endotracheal or transtracheal wash |
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why is tracheoscopy useful in diagnosis of disease of the pharynx, larynx, and trachea?
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- visualize collapsing trachea and tracheal masses
- aids in obtaining samples for cytology, culture, biopsy |
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what can be seen radiographically in diagnosing of disease of the pharynx, larynx, and trachea?
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- Radio-opaque foreign bodies, masses
- collapsing trachea: need both inspiratory and expiratory films - Hypoplastic trachea |
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why is fluoroscopy useful in diagnosis of disease of the pharynx, larynx, and trachea?
|
- Allows for dynamic visualization of airways
- Useful for diagnosis of collapsing trachea/bronchi |
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why is endotracheal or transtracheal wash useful in diagnosis of disease of the pharynx, larynx, and trachea?
|
- Collection of material for cytology and culture
- Identify inflammatory cells, bacteria, parasites, neoplastic cells |
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what is the functional classification of brachycephalic airway syndrome? What are four clinical signs? What can happen if left untreated?
|
- Obstructive respiratory disease
- Stenotic nares - Elongated soft palate - Everted laryngeal saccules - Tracheal hypoplasia - Chronicity may lead to laryngeal collapse |
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what are three PE findings of brachycephalic syndrome?
|
1. Stertor
2. Visibly narrowed nares 3. Reduced airflow through nares |
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what will you find on a sedated oral exam in a dog that has brachycephalic syndrome?
|
- Soft palate extends beyond tip of epiglottis
- Laryngeal saccules may be everted and readily apparent (normally difficult to visualize) |
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how is brachycephalic syndrome treated?
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- Surgical correction of elongated palate, stenotic nares
If laryngeal collapse present, poor prognosis |
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what is the pathophysiology of the development and anatomical presentation of laryngeal paralysis?
|
- Recurrent laryngeal nerve innervates arytenoids
- Dysfunction of nerve causes failure of arytenoid abduction - Unilateral or Bilateral disease - Paradoxical movement common with bilateral involvement (Close on inspiration instead of opening) |
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what is the most common signalment (breed and age) for idiopathic laryngeal paralysis?
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- middle to older age dogs
- Labradors |
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in which two dog breeds is laryngeal paralysis a heritable trait?
|
1. Bouvier de Flaundres
2. Samoyeds |
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what are four etiologies of laryngeal paralysis in the dog?
|
1. Idiopathic - most common (Labradors; Middle to older age dogs)
2. Hypothyroidism 3. Immune-mediated (polyneuropathy: will develop other signs, e.g. paralysis of back legs) 4. Congenital: Bouvier des Flaundres, Samoyeds |
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what are five HX signs of laryngeal paralysis?
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1. Stridor, particularly upon exertion
2. Change in voice 3. Increased panting 4. Coughing after eating/drinking 5. Exercise Intolerance |
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what are four clinical sings on PE of laryngeal paralysis?
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1. Characteristic “stridor” during exam
2. Mild to moderate increase in respiratory rate 3. Greater inspiratory than expiratory effort 4. May present in dyspneic crisis |
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what are four diagnostic procedures to rule in/out laryngeal paralysis in the dog?
|
1. Laryngeal exam under sedation
2. Ultrasound may be useful in detecting laryngeal movement 3. Rule out hypothyroidism, polyneuropathy 4. Thoracic rads – may demonstrate atelectasis or mixed pattern due to dyspnea; beware of interpreting these films |
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what are five treatments for a dog in acute dyspneic crisis due to laryngeal paralysis?
|
1. OXYGEN
2. SEDATION (acepromazine/butorphanol) 3. Anesthetize and intubate; wake up slowly 4. Tracheostomy 5. ± Corticosteroids (laryngeal edema is often present) |
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what are complications of laryngeal "tie-back"?
|
aspiration pneumonia, arytenoid fracture
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what are some medical ways to manage laryngeal paralysis without surgery?
|
- sedatives
- avoid heat, exercise, excitement |
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pharyngitis/laryngitis: what are the two basic etiologies?
|
1. inflammatory
2. infectious |
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what are four infectious causes of pharyngitis/laryngitis in the dog and cat?
|
1. parainfluenza virus
2. Bordetella 3. feline herpes 4. caliciviruses |
|
|
what are four inflammatory causes of pharyngitis/laryngitis in the dog and cat?
|
1. caustic agents
2. allergens 3. immune-mediated disease (lymphocytic/plasmacytic) 4. foreign bodies |
|
|
what are six clinical signs of pharyngitis/laryngitis in the cat and dog?
|
1. Voice change
2. Difficulty swallowing 3. Dysphagia 4. Gagging/Retching 5. Ptyalism 6. ± Fever |
|
|
what are four ways in which pharyngitis/laryngitis is diagnosed?
|
1. Empirical
2. Oral exam 3. ± Biopsy 4. Culture seldom useful unless Bordetella |
|
|
what are three things to do to treat pharyngitis/laryngitis?
|
1. PAIN MEDICATIONS
2. maintain hydration 3. ± antibiotics |
|
|
what is the medical name for Kennel Cough?
|
Canine Infectious Tracheobronchitis
|
|
|
what are three types of organisms that cause canine infectious tracheobronchitis?
|
1. bacteria
2. viruses 3. Mycoplasma |
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|
what are six clinical signs of canine infectious tracheobronchitis?
|
1. Loud, goose-honk cough
2. Cough often productive with clear or foamy sputum 3. Post-tussive gagging is common 4. +/- mucopurulent ocular and nasal discharge 5. sneezing 6. Vomiting may occur as a result of severe muscle contraction |
|
|
what are physical exam findings in dogs with uncomplicated canine infectious tracheobronchitis? (2)
|
- Tracheal sensitivity
- normal lung sounds |
|
|
what are physical exam findings in dogs with complicated canine infectious tracheobronchitis? (4)
|
1. fever
2. crackles 3. wheezes 4. anorexia |
|
|
how is uncomplicated canine infectious tracheobronchitis diagnosed?
|
empirically
|
|
|
what are three ways that complicated canine infectious tracheobronchitis is diagnosed?
|
1. CBC
2. Chest radiographs 3. ± Tracheal wash with cytology and culture |
|
|
how is uncomplicated canine infectious tracheobronchitis treated? (4)
|
- Self limiting, usually resolves in 10-14 days without tx
- Anti-tussives (butorphanol, hydrocodone) - ± anti-inflammatory doses glucocorticoids - ± antibiotics – empiric choices (doxycycline, clavamox, trimethoprim sulfa) |
|
|
what are three antibiotics commonly used to empirically treat uncomplicated canine infectious tracheobronchitis
|
1. doxycycline
2. clavamox 3. trimethoprim sulfa |
|
|
how is complicated canine infectious tracheobronchitis treated?
|
1. Antibiotics – culture of tracheal wash fluid best
2. Nebulization of antibiotics (gentamicin) most efficacious 3. Supportive care, including maintaining hydration, ± bronchodilators, ± anti-inflammatory doses of glucocorticoids, coupage (percussion of thorax to remove secretions) and nebulization |
|
|
what is the antibiotic of choice to topically treat canine infectious tracheobronchitis?
|
gentamicin
|
|
|
what are three vaccinations given to prevent canine infectious tracheobronchitis and by what route are they given?
|
1. parainfluenza: intranasal
2. Bordatella: intranasal or parenteral 3. parenteral: CAV-2 |
|
|
what is a fancy synonym for collapsing trachea?
|
tracheobronchomalacia
|
|
|
pathophysiology of collapsing trachea:
'- in which anatomical plane does it collapse? - in which respiratory phase does it collapse - which anatomical airway structures are involved? - how does the disease get worse? |
- dorsoventral collapse
- collapses during inspiration - intra-, extra-thoracic trachea and/or mainstem bronchi - the disease self-perpetuates (i.e. it makes itself worse over time) |
|
|
what is the typical signalment for collapsing trachea?
|
middle-aged to older toy and small breed dogs
|
|
|
what are six clinical signs of collapsing trachea?
|
1. Dry, nonproductive cough
2. Cough worse with excitement /exercise 3. Occasionally associated with post-tussive gagging/retching 4. Increased inspiratory effort with extrathoracic collapse 5. Increased expiratory effort with intrathoracic collapse 6. May present in dyspneic crisis |
|
|
what is a common clinical finding on physical exam of collapsing trachea?
|
tracheal sensitivity upon palpation
|
|
|
what are four diagnostic techniques used to rule-in or rule-out collapsing trachea?
|
1. Radiographs – inspiratory and expiratory films
2. Fluoroscopy 3. Tracheoscopy 4. Tracheal wash may be helpful in ruling out other underlying disease |
|
|
name two bronchodilators used to treat collapsing trachea
|
1. aminophylline
2. terbutaline |
|
|
name two antitussives used to treat collapsing trachea
|
1. butorphanol
2. hydrocodone |
|
|
what are five ways to treat a stable patient with collapsing trachea?
|
1. Bronchodilators (aminophylline, terbutaline)
2. Anti-inflammatory doses of glucocorticoids 3. Anti-tussives (butorphanol, hydrocodone) 4. Antibiotics if infection involved 5. Weight loss if obese |
|
|
what are four ways to manage a dyspneic patient with a collapsing trachea?
|
1. oxygen
2. anxiolytics 3. nebulization 4. glucocorticoids |
|
|
what is a surgical means for treating a collapsing trachea?
|
placement of stents
|
|
|
what is the dog lungworm?
|
Oslerus osleri
|
|
|
what are two conditions involving trauma to the pharynx, larynx, and/or trachea that may be palpated or seen as a radiolucent lesion on radiography?
|
1. subcutaneous emphysema
2. pneumomediastinum |
|
|
what are three lower airway diseases that would present with an acute onset and progression of clinical signs?
|
1. bacterial pneumonia
2. pulmonary contusions 3. asthmatic crisis |
|
|
what are two general lower airway diseases that would present with an insidious onset and progression of clinical signs?
|
1. neoplasia
2. fungal infection |
|
|
what are three general clinical signs on PE of lower airway disease?
|
1. cough
2. increased expiratory effort 3. wheezes or crackles, particularly upon expiration |
|
|
what are five general clinical signs on PE of parenchymal disease?
|
1. systemic signs such as fever, weight loss, anorexia
2. cough 3. tachypnea 4. increased bronchovesicular sounds or crackles upon inspiration 5. mixed increase in inspiratory/expiratory effort |
|
|
with what other spaces does the mediastinum communicate?
|
- fascial planes of the neck cranially
- retroperitoneal space (via the aortic hiatus) caudally |
|
|
what are three sets of lymph nodes contained within the mediastinum?
|
1. sternal
2. cranial mediastinal 3. tracheobronchial |
|
|
what are four mediastinal structures normally seen in the thoracic radiograph?
|
1. heart
2. descending aorta 3. caudal vena cava 4. trachea |
|
|
what four structures comprise the homogenous soft-tissue density, ventral to the trachea, that is referred to as the cranial mediastinum?
|
1. cranial vena cava
2. major arteries branching off the ascending aorta 3. lymph nodes 4. thymus (in young animals) |
|
|
where is the mediastinum located in a VD view and how wide should it be?
|
- located midline
- should be no wider than 2x the width of the spine |
|
|
what are two common non-pathologic reasons that the mediastinum may be widened on a VD view (i.e. > 2x the width of the spine)?
|
1. obesity
2. brachycephalic breed |
|
|
what could be confused for a mass in the cranial mediastinum in young animals?
|
thymus, and also mediastinal fat in cats
|
|
|
where is the thymus located in a VD view?
|
just left of the midline
|
|
|
what are two locations of mediastinal reflections on the VD/DV view?
|
1. cranioventral mediastinum to the left running from the first rib to the sternum
2. a reflection accommodating the accessory lung lobe to the left of midline |
|
|
how do you differentiate increased lung opacity due to atelectasis from infiltrative disease on a radiograph?
|
presence of a mediastinal shift indicates atelectasis
|
|
|
what causes a mediastinal shift?
|
loss of lung volume
|
|
|
what is the easiest way to recognize a mediastinal shift?
|
the heart has shifted in position
|
|
|
what severe condition can occur from marked pneumomediastinum?
|
pneumothorax
|
|
|
what may be seen in a lateral radiograph, of a mass in the cranioventral mediastinum? (5)
|
1. loss of the radiolucent space cranial to the heart
2. elevation of the trachea 3. tracheal compression 4. caudal displacement of the heart and carina (beyond the 6th intercostal space) 5. silhouette sign with the heart |
|
|
what may be seen in a DV/VD radiograph, of a mass in the cranial mediastinum? (3)
|
1. widening of the cranial mediastinum
2. rightward displacement of the trachea 3. caudal displacement of the cranial lung lobes |
|
|
if a mediastinal mass is silhouetting the heart, how do you distinguish this condition from cardiomegaly in a lateral radiograph?
|
the location of the trachea and mainstem bronchi
|
|
|
what are five causes of cranial mediastinal masses as seen on radiography?
|
1. Thymomas
2. ectopic thyroid tumors 3. enlarged sternal lymph nodes 4. enlarged cranial mediastinal lymph nodes 5. heart base tumors |
|
|
on the lateral radiograph, what may cause a ventral displacement of the mainstem bronchi, elevation of the carina, and a mass effect at the heart base (other than heart enlargement)?
|
enlarged tracheobronchial lymph nodes
|
|
|
what is seen in a lateral radiograph of a mass lesion of the esophagus?
|
ventral displacement of the trachea
|
|
|
what are four radiographic signs of pleural effusion?
|
1. widening and increased radiopacity of the pleural space
2. the presence of visible fissure lines (the pleural space extends between lung lobes, and individual lobes become visible when surrounded by radiopaque fluid) 3. silhouette sign with the heart and diaphragm 4. partial/complete collapse of the lung lobes with retraction of the lobar borders from the chest wall |
|
|
what should you suspect if you can visualize individual lung lobes on a thoracic radiograph?
|
pleural effusion
|
|
|
what radiographic view is the best to take to see early signs of pleural effusion?
|
VD
|
|
|
what will happen to the trachea, as seen radiographically in lateral position, with severe pleural effusion?
|
ventral displacement of the trachea
|
|
|
what are two things can cause unilateral pleural effusion (as seen radiographically)?
|
1. pyothorax
2. fibrinous pleuritis |
|
|
what are three radiographic changes seen with a collapsed lung due to pneumothorax?
|
1. a widened, radiolucent pleural space
2. atelectasis of lung lobes 3. absence of vascular and interstitial markings outside the collapsed lung |
|
|
what is the best position to radiograph pneumothorax? Which phase of respiration?
|
DV on expiration
|
|
|
what is a good way to diagnose pneumothorax with a collapsed lung lobe on a lateral radiograph? What is an important exception?
|
- "separation" of the heart from the sternum
- exception: deep-chested dogs, this is a normal appearance |
|
|
what improper technique could simulate a mediastinal shift?
|
oblique VD view
|
|
|
what are four causes of pneumomediastinum?
|
1. Tracheal rupture
2. Esophageal rupture 3. Cervical soft tissue injury 4. Lung trauma |
|
|
what is the normal intercostal space location of the carina?
|
5th or 6th
|
|
|
what is the location of the sternal lymph nodes?
|
Ventral mediastinum, 2nd intercostal space
|
|
|
what is the location of the cranial mediastinal lymph nodes?
|
Lie along cranial vena cava, ventral to trachea
|
|
|
what is the location of the tracheobronchial (hilar) lymph nodes?
|
Middle mediastinum, surround stem bronchi and carina
|
|
|
what normal radiographic sign that is commonly found in older cats, located cranial to the heart base, could be confused as a mass?
|
aortic knob
|
|
|
where is the thymus seen on a lateral and VD view?
|
- lateral: immediately cranial to the heart
- VD: a triangular shape on the left, cranial to the heart |
|
|
what are the two most common mediastinal masses?
|
1. LSA
2. thymoma |
|
|
what are seven types of mediastinal masses?
|
1. Lymphosarcoma
2. Thymoma 3. Ectopic thyroid mass 4. Heart base tumor 5. Mediastinal cyst 6. Paraspinal tumor 7. Megaesophagus |
|
|
what does pleural effusion look like on a DV view?
|
lungs visible, but heart is silhouetted with the fluid and thus not visible
|
|
|
what does pleural effusion look like on a VD view?
|
heart is visible and lung fissure lines can be seen
|
|
|
what can appear as radiolucent, cyst-like lesions in the pleural space?
|
a pulmonary bulla (smaller) or bleb (larger)
|
|
|
what four structures make up the parenchymal component ("lung unit") in thoracic radiography?
|
1. Alveoli
2. Bronchial walls 3. Interstitial tissue 4. Pulmonary vessels |
|
|
what makes up the majority of the normal background opacity of the lungs?
|
blood vessels
|
|
|
what comprises an alveolar lung pattern?
|
- Homogeneous, uniform fluid opacity
- Lobar sign - Silhouette effect - Air bronchogram - Not all signs seen on every radiograph |
|
|
what is a lobar sign in a thoracic radiograph?
|
occurs when infiltrate (opacity) extends to periphery of lung lobe, and stops abruptly, leaving a dramatic transition between opacified lobe border and adjacent normal radiolucent lobe
|
|
|
what is an air bronchogram?
|
the classic sign of an alveolar lung pattern. Formed by air-filled bronchus extending through fluid opacity lung lobe. Bronchial walls are NOT seen; only bronchial lumen.
|
|
|
what does it mean when you have a silhouette effect in a thoracic radiograph with an alveolar pattern?
|
“border effacement”, or loss of border visualization between heart and opacified lung lobe, or diaphragm and lung lobe. Occurs when the two fluid opacity structures are in close anatomic contact.
|
|
|
where do bronchopneumonia and aspiration pneumonia localize on a chest radiograph?
|
- cranioventral distribution
- periphery to central |
|
|
which three lung lobes are most commonly affected with bronchopneumonia or aspiration pneumonia?
|
right cranial, right middle, and left cranial lung lobes
|
|
|
where does hematogenous pneumonia localize on a chest radiograph?
|
diffuse distribution
|
|
|
where does cardiogenic edema localize on a chest radiograph?
|
dorsal and hilar distribution
|
|
|
how does hematogenous pneumonia appear on a chest radiograph (pattern, key radiographic signs, and distribution)
|
a diffuse, alveolar pattern, characterized by air bronchograms
|
|
|
what are six common etiologies of non-cardiogenic, non-infectious pulmonary edema in small animal patients (stuff that can happen at home)?
|
1. Electrocution
2. Smoke inhalation 3. Acute hypoxia 4. Head trauma 5. Submersion injury 6. ARDS (acute respiratory distress syndrome) |
|
|
what commonly causes cardiac pulmonary edema?
|
left-sided congestive heart failure
|
|
|
in acute, decompensated cardiac pulmonary edema, what side will show signs first?
|
right
|
|
|
comment on the distribution of cardiogenic edema in cats
|
there is no typical distribution
|
|
|
pulmonary contusions:
- lung pattern - timing - what are three associated radiographic changes? |
- alveolar pattern
- may take 12-24 hours to appear and may worsen over 24-48 hours - associated changes: rib fractures, pneumothorax, pleural effusion |
|
|
what are seven causes of an alveolar pattern on a chest radiograph?
|
1. pneumonia
2. hemorrhage 3. pulmonary edema 4. lung lobe torsion 5. pulmonary thromboembolism 6. neoplasia 7. bronchial foreign body |
|
|
atelectasis:
- lung pattern - two radiographic signs |
- alveolar pattern
1. loss of volume 2. mediastinal shift |
|
|
describe a linear interstitial pattern (5)
|
- Overall increase in pulmonary opacity
- Does not coalesce - Vessels appear smudged/hazy - No air bronchograms - Often the “default” pattern |
|
|
what are seven causes of a linear interstitial pattern in a chest radiograph?
|
1. Artifact (underexposed, expiration)
2. Geriatric change (Normal old dogs and cats) 3. Pulmonary edema 4. Viral pneumonia (distemper) 5. Hemorrhage 6. Neoplasia 7. Pulmonary fibrosis |
|
|
in an interstitial nodular pattern:
- how large is a "mass"? - how large is a "nodule"? |
- mass is > 3 cm
- nodule is < 3 cm |
|
|
what is a miliary pattern?
|
an interstitial pattern characterized by multiple small nodules, 2-3 mm in size
|
|
|
what are eight causes of an interstitial nodular pattern?
|
1. Artifact of chest wall
2. Primary neoplasia 3. Metastatic neoplasia 4. Fungal granulomas 5. Abscess 6. Hematoma 7. Fluid filled bulla 8. Parasitic cyst |
|
|
What lung pattern would be associated with artifacts of chest wall (e.g. nipple, cutaneous mass)?
|
nodular interstitial pattern
|
|
|
What lung pattern would be associated with primary neoplasia?
|
nodular interstitial pattern
|
|
|
What lung pattern would be associated with metastatic neoplasia?
|
nodular interstitial pattern
|
|
|
What lung pattern would be associated with fungal granulomas?
|
nodular interstitial pattern
|
|
|
What lung pattern would be associated with an abscess?
|
nodular interstitial pattern
|
|
|
What lung pattern would be associated with hematoma?
|
nodular interstitial pattern
|
|
|
What lung pattern would be associated with a fluid filled bulla?
|
nodular interstitial pattern
|
|
|
What lung pattern would be associated with a parasitic cyst?
|
nodular interstitial pattern
|
|
|
What lung pattern would be associated with an artifact from an underexposed film and/or expiratory radiograph?
|
linear interstitial pattern
|
|
|
What lung pattern would be associated with geriatric change in normal old dogs and cats?
|
linear interstitial pattern
|
|
|
What lung pattern would be associated with pulmonary edema?
|
linear interstitial pattern
|
|
|
What lung pattern would be associated with distemper viral pneumonia?
|
linear interstitial pattern
|
|
|
What lung pattern would be associated with pulmonary fibrosis?
|
linear interstitial pattern
|
|
|
What lung pattern would be associated with bronchopneumonia?
|
alveolar pattern
|
|
|
What lung pattern would be associated with aspiration pneumonia?
|
alveolar pattern
|
|
|
What lung pattern would be associated with hemorrhage?
|
alveolar pattern
|
|
|
What lung patterns would be associated with pulmonary edema?
|
alveolar or linear interstitial pattern
|
|
|
What lung pattern would be associated with lung lobe torsion?
|
alveolar pattern
|
|
|
What lung pattern would be associated with pulmonary thromboembolism?
|
alveolar pattern
|
|
|
What lung pattern would be associated with neoplasia?
|
alveolar or (nodular) interstitial pattern
|
|
|
What lung pattern would be associated with a bronchial foreign body?
|
alveolar pattern
|
|
|
what are four causes of cavitated masses in a chest radiograph?
|
- neoplasia
- abscess - bulla - parasitic cyst |
|
|
bronchial pattern:
- what causes it? - what do they look like end-on? - what do they look like longitudinally? |
- Thickened bronchial walls
- End-on: “donuts” - Longitudinal: “railroad tracks” |
|
|
what is a vascular pattern on a chest radiograph?
|
pulmonary arteries and/or veins increase in prominence resulting in an increased pulmonary opacity
|
|
|
what are two advantages and a limitation of ultrasonography of the lower airway and respiratory parenchyma?
|
1. Visualization of non-aerated tissues
2. Aids in fine needle aspirates of diseased area - Limitations: pathology needs to be against body wall |
|
|
when is a tracheal wash useful for diagnosing lower airway/parenchymal disease?
|
Major airways must be involved to be valuable
|
|
|
for what diseases is a BAL most specific?
|
1. smaller airway disease
2. localized disease |
|
|
what are three uses of bronchoscopy in the diagnosis of lower airway and parenchymal disease and what is a contraindication for this procedure?
|
1. Visualization
2. Removal of FB 3. Specimen collection (biopsies, cytology, culture) - Contraindicated in unstable animals |
|
|
lung aspirates:
- what radiographic pattern of disease is it indicated for? - what types of disease does it ID? - what are two complications? |
- indicated in diffuse disease or mass lesion
- identification of fungal organisms, neoplastic cells, and inflammatory cells - complications include pneumothorax and hemorrhage |
|
|
how is a lung biopsy attained?
|
surgically through a thoracotomy
|
|
|
what are the best serological tests for:
- toxoplasmosis? - coronavirus (e.g. FIP)? - blastomycosis? - histoplasmosis? - coccidiomycosis? - cryptococcosis? |
- toxoplasmosis: IgG and IgM titers
- coronavirus (e.g. FIP): titers, never to be interpreted alone - blastomycosis: titers - histoplasmosis: titers - coccidiomycosis: titers - cryptococcosis: AGID, slide agglutination test |
|
|
To diagnose lower airway and parenchymal disease and what are three uses of blood gas measurement?
|
1. Differentiates hypoventilation from other causes of hypoxemia
2. Monitor response to therapy 3. Determine acid/base status |
|
|
Pulse Oximetry:
- what affects its interpretation? - what is the cut-off for hypoxemia and what does it equate to in paO2? |
- Interpretation can be affected by vasoconstriction, local blood stasis, poor cardiac output, and location of probe
- SpO2 < 90% = hypoxemia and this is equal to 60 mmHg |
|
|
what are two causes of feline Asthma/Allergic Bronchitis?
|
1. Reversible airway obstruction
2. Eosinophilic inflammation |
|
|
what are two causes of feline Acute Bronchitis?
|
1. Reversible airway obstruction of shorter duration (1-3 months)
2. Neutrophilic, macrophagic inflammation |
|
|
what are three causes of feline Chronic Bronchitis?
|
1. Fibrosis of airways
2. Mixed inflammation 3. Preceded by previous respiratory disease |
|
|
what is the typical signalment for feline asthma/allergic bronchitis, or acute bronchitis?
|
Young to middle-aged cats
|
|
|
what is the typical signalment for feline chronic bronchitis?
|
- older cats
- those with a previous history of bronchial disease |
|
|
what are three clinical signs of feline bronchial disease in the stable patient?
|
1. Tachypnea
2. Periods of open-mouth breathing, particularly after exercise (not normal to have an adult cat with open mouth breathing, even after playing) 3. Cough (often confused with hair balls; ask owners how often do they cough up hairballs) |
|
|
what is the medical term for an acute asthmatic crisis?
|
status asthmaticus
|
|
|
comment on the history and clinical signs of a patient in status asthmaticus.
|
1. No other clinical signs may precede this
2. Dyspnea – open-mouth breathing, cyanosis |
|
|
for a cat with feline bronchial disease, what do you hear on auscultation and see on physical exam?
|
1. Wheezing or increased Bronchovesicular sounds
2. Increased tracheal sensitivity 3. Otherwise normal |
|
|
feline bronchial disease:
- what is fairly common to see in a CBC? - what radiographic pattern will you see? |
- CBC :+/- eosinophilia (at least 25% will show this)
- Radiographs: Bronchial pattern, severe cases mix of patterns; difficult to distinguish from other disease |
|
|
why would you perform a fecal flotation test on a cat with asthma?
|
to look for lungworms (Aelurostrongylus abstrusus)
|
|
|
what are four procedural/empirical diagnostics for feline bronchial disease?
|
1. Endotracheal wash (e.g. eosinophilic, neutrophilic)
2. Fecal flotation (for Aelurostrongylus abstrusus) 3. Heartworm Test 4. Response to Treatment |
|
|
what are three drug classes commonly used to treat feline bronchial disease and what is one drug class that is contraindicated?
|
1. corticosteroids
2. bronchodilators 3. leukotriene inhibitors - CONTRAINDICATED: antihistamines |
|
|
why is prednisolone used in feline patients, as opposed to prednisone?
|
prednisone is a prodrug and some cats lack the enzyme to activate it. Prednisolone is the active form of prednisone.
|
|
|
in the stable feline asthmatic patient, what are two glucocorticoids commonly used (and their routes of administration)?
|
1. prednisolone (PO)
2. Depo-Medrol™; methylprednisolone acetate (IM or SC) |
|
|
in the feline patient in status asthmaticus, what are two glucocorticoids commonly used (and their routes of administration)?
|
1. Solu-Delta Cortef™; prednisolone sodium succinate (IV or IM)
2. Dexamethasone (IV or IM) |
|
|
in the stable feline asthmatic patient, what are three bronchodilators commonly used, their mechanism of action, and their routes of administration?
|
1. aminophylline (PDE inhibitor) PO
2. theophylline (PDE inhibitor) PO 3. injectable terbutaline (β-agonist) SC or PO |
|
|
in the feline patient in status asthmaticus, what are two bronchodilators commonly used, their mechanism of action, and their routes of administration?
|
1. injectable terbutaline (β-agonist) SC or PO
2. aminophylline (PDE inhibitor) IM |
|
|
what are two leukotriene inhibitors used in cats with bronchial disease and their effectiveness?
|
- Singulair™, Accolate
- limited effectiveness |
|
|
what are two inhalants used as topical treatments in cats with asthma (and their drug class)?
|
1. fluticasone (glucocorticoid antiinflammatory)
2. albuterol (bronchodilator) |
|
|
canine chronic bronchitis:
- typical signalment - key history/clinical sign - possible etiology - timing of progression - three other clinical signs |
- middle- to older-aged dogs
- Harsh nonproductive or productive cough that has occurred daily over > 2 months - Could allergic bronchitis precede development? - Slowly progressive over months to years 1. Post-tussive gagging in dogs 2. No systemic signs 3. Exercise intolerance |
|
|
what are four clinical signs on PE of canine chronic bronchitis?
|
1. Inspiratory/ expiratory crackles or expiratory wheezes
2. Increased expiratory phase and effort 3. Sensitive tracheal palpation 4. If cough productive, mucoid, mucopurulent, +/- hemorrhagic sputum |
|
|
what are nine diagnostic tests that can be performed to rule-in or rule-out canine chronic bronchitis?
|
1. CBC: ± neutrophilia; monocytosis with chronicity
2. Radiography ± bronchial pattern 3. Tracheal Wash – neutrophilic or mixed inflammatory infiltrate; if uncomplicated culture is negative 4. Bronchoscopy/BAL – hyperemic airways with excessive mucus production; helps r/o other disease 5. Fluoroscopy - r/o collapsing trachea 6. Fecal flotation (lung worms) 7. heartworm test 8. echocardiography 9. Chem/UA |
|
|
what are four bronchodilators (and mechanism of action) used to treat canine chronic bronchitis?
|
1. Aminophylline (PDE inhibitor)
2. theophylline 3. Terbutaline (B-agonist) 4. Albuterol (inhaler) (B-agonist) |
|
|
which glucocorticoid is used to treat canine chronic bronchitis?
|
prednisone, tapered to lowest effective dose
|
|
|
what are two antitussives used in a dog with chronic bronchitis?
|
1. Torbugesic
2. Hydrocodone |
|
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antitussives in chronic bronchitis:
- when are they indicated in the cat? - when are they indicated in the dog? - what is a disadvantage of them? |
- not indicated in cats with chronic bronchitis
- Coughing often incessant, esp. if bronchomalacia is involved - Disadvantage is that may limit natural airway clearance that cough helps provide |
|
|
what are five non-pharmaceutical ways to manage canine chronic bronchitis?
|
1. Nebulization/Loosen airway secretions – do not use diuretics
2. Treat secondary infections – keep healthy mouth (acute exacerbation – antibiotic tx may be warranted) 3. Weight loss 4. Limitations on activity/excitement (with sedatives if needed) 5. Air quality |
|
|
what is bronchiectasis?
|
destruction of elastic and muscular components of airways leading to irreversible dilation of airways
|
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comment on the signalment/clinical signs associated with bronchiectasis (3)
|
- Occurs primarily in dogs, secondary to other chronic inflammatory disease
- Productive cough - Bacterial pneumonia may also be present |
|
|
what are two ways to diagnose bronchiectasis?
|
1. radiographs
2. bronchoscopy (rarely needed) |
|
|
treatment of bronchiectasis:
- what disease has a similar treatment? - risks of treatment - what drugs are usually contraindicated? - what are two supportive therapies? |
- similar to chronic bronchitis
- will predispose patient to recurrent bacterial pneumonia, so need to treat secondary infection - probably don't want to use antitussives - nebulization to loosen secretions, ± expectorants as supportive therapies |
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pathophysiology of bacterial pneumonia:
- most common form - what patients are at risk? - how contagious is it? |
- common: aspiration pneumonia
- at risk: immunocompromised animals, underlying respiratory disorder (ciliary dyskinesis, chronic bronchitis) - Not contagious (viral can be) |
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what is the most common agent that causes bacterial pneumonia in puppies?
|
Bordatella
|
|
|
pneumonia is a disease of which part of the respiratory system?
|
parenchyma
|
|
|
what are seven clinical signs of bacterial pneumonia?
|
1. Systemic signs – lethargy, pyrexia, anorexia
2. Tachypnea to Dyspnea 3. Increased Respiratory Phase/Effort (inspiration most notable) 4. Soft, productive cough 5. Nasal discharge 6. Crackles or increased bronchovesicular sounds 7. Pale or cyanotic mucous membranes |
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|
radiographs of bacterial pneumonia:
- patterns - distribution - two other radiographic signs |
- mixed bronchial, interstitial, and alveolar pattern is common
- cranioventral distribution common with aspiration pneumonia - consolidation of lung lobe - pleural fissure lines |
|
|
what are five common diagnostic tests for bacterial pneumonia?
|
1. radiographs
2. CBC - inflammatory leukogram with left shift 3. ± Blood Gas 4. Pulse Oximetry 5. Bacterial culture of BAL or possible tracheal wash |
|
|
what are three ways to treat bacterial pneumonia?
|
1. Oxygen
2. Loosen Secretions – nebulization and coupage (tapping the chest to help secretions) 3. Antimicrobial Therapy |
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comment on the antimicrobials used to empirically treat mild bacterial pneumonia.
|
Single agent therapy with β-lactam (potentiated penicillin, cephalosporin) fluoroquinolone (2nd or 3rd-line choices), or TMS
|
|
|
comment on the antimicrobials used to empirically treat moderate bacterial pneumonia.
|
- Single agent therapy with B-lactam ( potentiated penicillin, cephalosporin) fluoroquinolone (2nd or 3rd-line choices), or TMS
- also can use a combination of a β-lactam with a fluoroquinolone |
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|
comment on the antimicrobials used to empirically treat severe/unstable bacterial pneumonia.
|
Combination therapy is necessary with beta-lactam and fluoroquinolone or aminoglycoside (reserved for resistant infections)
|
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|
when is culture of sputum, BAL, or tracheal wash indicated in cases of bacterial pneumonia? (4)
|
1. recurrent infection
2. nonresponsive to empirical treatment 3. chronicity 4. minimize costs |
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|
what are two classes of drugs to use sparingly in the initial treatment of bacterial pneumonia (and their intended effects)?
|
1. Diuretic (furosemide): one dose to decrease alveolar fluid in unstable animal
2. Glucocorticoids: Anti-inflammatory doses - first 24-48 hours |
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|
what pathological process is found first in aspiration pneumonia?
|
inflammation
|
|
|
what are four predisposing factors for aspiration pneumonia?
|
1. Megaesophagus
2. Gastroenteric disease 3. Laryngeal paralysis 4. Anesthesia induced regurgitation |
|
|
what is the most common form of canine viral pneumonia?
|
canine influenza virus
|
|
|
canine influenza viral pneumonia:
- where is it most commonly found? - how contagious is it? |
- commonly found in kennel situations
- very contagious |
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|
canine influenza viral pneumonia:
- how severe is it? - how is it diagnosed? - how is it treated? - how is it prevented? |
- Mild to Severe presentation
- Diagnosis is through serology - Treatment must be aggressive supportive and prevention/treatment of secondary bacterial pneumonia - Prevention – vaccine (not a preventative; questionable; reduces clinical signs) |
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|
what are the most common forms of fungal pneumonia in:
- dogs? - cats? |
- dogs: blastomycosis (in this area), coccidiomycosis (in the SW); histoplasmosis is possible but not as common
- cats: histoplasmosis and cryptococcosis most common; blastomycosis and coccidiomycosis are possible but not as common |
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|
in addition to pneumonia, what other lesions are common with blastomycosis? (3)
|
skin, bone, ocular
|
|
|
in addition to pneumonia, what other lesions are common with coccidiomycosis? (3)
|
bone, joint, CNS
|
|
|
in addition to pneumonia, what other clinical sign is common in dogs with histoplasmosis?
|
diarrhea
|
|
|
radiography of fungal pneumonia:
- differentials - pattern - two other radiographic signs |
- may be difficult to discern from neoplasia or other causes of pneumonia
- most often diffuse nodular pattern; diffuse, miliary, or nodular pattern - pleural effusion and occasional mass lesions may also be seen |
|
|
what are four basic ways in which fungal pneumonia is diagnosed?
|
1. radiographs
2. serology 3. CBC, Chem, UA 4. cytology |
|
|
what are typical CBC, Chem, UA findings of fungal pneumonia?
|
nonspecific findings: normochromic, normocytic anemia, leukopenia, leukocytosis, hyperglobulinemia, proteinuria
|
|
|
where are samples taken for cytology to diagnose fungal pneumonia? (5)
|
- Skin lesions (blasto)
- Fine needle aspirate lung - Tracheal wash or BAL - Lymph nodes - Other affected organs (spleen, liver, nasal cavity) |
|
|
what are the two most common systemic antifungals used in the treatment of fungal pneumonia?
|
1. itraconazole
2. fluconazole |
|
|
when is Amphotericin B used in fungal pneumonia?
|
may act faster than others and used in life-threatening illness; also crosses BBB (i.e. you suspect CNS infection
|
|
|
how long are animals typically on systemic antifungals to treat fungal pneumonia?
|
minimum of 60-90 days; often longer; after anti-fungal is discontinued, chance of recurrence can be high
|
|
|
besides antifungals, what drug is used in the initial stages of fungal pneumonia?
|
prednisone (anti-inflammatory doses)
|
|
|
what are three species of lung worms?
|
1. Paragonimus kellicotti (cats and dogs)
2. Aelurostrongylus abstrusus (cats only) 3. Capillaria aerophila (usually asymptomatic) |
|
|
what are three diagnostic procedures to detect parasitic pneumonia?
|
1. fecal flotation (Baermann technique)
2. radiographs 3. tracheal wash |
|
|
radiographs of parasitic pneumonia:
- pattern - lesions |
- Bronchial to interstitial pattern; occasionally alveolar
- Single or multiple solid or cavitary mass lesions (paragonimus) |
|
|
what is found in a tracheal wash in an animal with parasitic pneumonia?
|
- Organism or eggs
- Eosinophilic inflammation |
|
|
what two drugs are used to treat parasitic pneumonia?
|
- Fenbendazole
- Ivermectin (Aelurostrongylus) |
|
|
primary pulmonary tumors:
- most common type of tumor - how malignant are they? - how are they treated? |
- usually carcinomas
- malignant, begin as single mass lesions - Surgical lobectomy of benefit if caught early (b/c they are slow to metastasize) |
|
|
how can metastatic pulmonary tumors present?
|
multi-nodular, single nodule, or mass
|
|
|
what is "digit/lung syndrome"?
|
cats with digital carcinoma usually have primary tumor in lungs (carcinoma on digits of cats → take chest rads)
|
|
|
which musculoskeletal disease of dogs is associated with lung tumors?
|
hypertrophic osteopathy
|
|
|
what are six techniques used to diagnose pulmonary neoplasia?
|
1. Radiographs or CT
2. Ultrasound (if near the chest wall) 3. Fine Needle Aspirate/Cytology (if near the chest wall) 4. Biopsy/Histopathology (the best, but not easy to get) 5. BAL 6. Cytology of other involved organs |
|
|
how are the following pulmonary neoplasias commonly treated:
- solitary mass/nodule? - metastatic? |
- solitary mass/nodule: surgical removal ± lung lobectomy
- Metastatic (Sx not very beneficial): chemotherapy – systemic or intracavitary |
|
|
what are five clinical signs of pulmonary contusions?
|
1. Cough
2. tachypnea 3. dyspnea 4. blood from mouth, nose 5. fractured ribs |
|
|
what are radiographic findings of pulmonary contusions? What other two things should you rule out?
|
- interstitial and alveolar pattern; lung consolidation
- rule out concurrent diaphragmatic hernia and/or pneumothorax |
|
|
what is the safest fluid to use when treating pulmonary contusion?
|
hypertonic saline
|
|
|
what are four ways to manage a pulmonary contusion?
|
1. Oxygen
2. Fluid and Blood Loss – use HYPERTONIC SALINE, careful of crystalloid use and fluid overload 3. Diuretics – furosemide, mannitol (if concurrent head trauma) 4. Ventilator |
|
|
describe the movement of pleural fluid
|
Parietal pleural capillaries → pleural space → visceral pleural capillaries and lymphatics
|
|
|
what are four pathophysiologic mechanisms of pleural effusion (and exemplary associated diseases)?
|
1. Decreased oncotic pressure (hypoalbuminemia)
2. Increased capillary hydrostatic pressure (congestive heart failure) 3. Increased capillary membrane permeability (vasculitis, sepsis) 4. Lymphatic dysfunction or obstruction (neoplasia, chylothorax) |
|
|
what are four history findings of pleural disease?
|
1. Owners seldom note change in respiratory pattern until advanced stages
2. Lethargy 3. Inappetence 4. Weight Loss |
|
|
physical exam findings of pleural disease:
- cough - auscultation - percussion - changes in the mediastinum - respiratory phase changes |
- No cough
- Auscultation – muffled heart sounds, decreased bronchovesicular sounds - Percussion – may detect fluid/air line - Mediastinum – not as compressible in cats - Increase in Inspiratory Phase/ Respiratory Effort (Severe disease, you see both ↑insp and ↑exp) |
|
|
what is the first-line treatment for pleural disease?
|
thoracocentesis
|
|
|
what five things are analyzed in pleural fluid?
|
1. Physical characteristics- color, turbidity
2. Total protein 3. Cell counts – WBC’s, RBC’s 4. Cytology: (Inflammatory cells, bacteria, neoplastic cells, etc.) 5. Culture |
|
|
pleural fluid: characterize a pure transudate
- appearance - protein - cellularity |
- Clear, colorless
- Protein < 2.5 – 3.0 g/dL - Cellularity < 1000 cells/μL, mononuclear |
|
|
pleural fluid: characterize a modified transudate
- appearance - protein - cellularity |
- Clear, colorless
- Protein 2.5-3.5 g/dL - Cellularity 1000-5000 cells/μL, mononuclear and neutrophilic |
|
|
pleural fluid: characterize an exudative transudate
- appearance - protein - cellularity |
- Cloudy
- Protein > 3.0 g/dL - Cellularity > 5000 cells/μL, neutrophils, macrophages, eosinophils, lymphocytes |
|
|
Classify pleural fluid that is:
- Clear, colorless - Protein < 2.5 – 3.0 g/dL - Cellularity < 1000 cells/μL, mononuclear |
pure transudate
|
|
|
Classify pleural fluid that is:
- Clear, colorless - Protein 2.5-3.5 g/dL - Cellularity 1000-5000 cells/μL, mononuclear and neutrophilic |
modified transudate
|
|
|
Classify pleural fluid that is:
- Cloudy - Protein > 3.0 g/dL - Cellularity > 5000 cells/μL, neutrophils, macrophages, eosinophils, lymphocytes |
exudative transudate
|
|
|
what are two causes of a pleural pure transudate?
|
1. Hypoalbuminemia
2. Congestive Heart Failure |
|
|
what are four causes of a pleural modified transudate?
|
1. Congestive Heart Failure
2. Neoplasia 3. Lung lobe torsion 4. Diaphragmatic Hernia |
|
|
what are six causes of a pleural exudative transudate (septic and non-septic)?
|
- Non-septic: FIP, neoplasia, hemorrhage, chronic diaphragmatic hernia or lung lobe torsion
- Septic: Bacterial infection |
|
|
what are five etiologies of pyothorax?
|
1. Penetrating wound or bite
2. Foreign Body 3. Extension of pneumonia 4. Extension of discospondylitis 5. Hematogenous spread |
|
|
comment on the bacteria found in pyothorax.
|
- Bacteria: mix of anaerobes and aerobes
- E. coli, Streptococcus , Pasteurella, Nocardia, Bacteroides, Fusobacterium, and Actinomyces |
|
|
what are three clinical signs in the HX/PE in pyothorax?
|
1. Fever in < 50% of cases
2. Restrictive breathing pattern 3. Acute or insidious onset |
|
|
what are four techniques used in the diagnosis of pyothorax?
|
1. Radiographs
2. Thoracocentesis/Pleural Fluid Analysis 3. Culture of Pleural Fluid 4. CBC – inflammatory leukogram, ± left shift |
|
|
what are the two main ways to treat pyothorax?
|
1. thoracostomy tube
2. antimicrobial therapy (culture or empirical) |
|
|
what are three antimicrobials used in the empirical treatment of pyothorax?
|
1. Amoxicillin/clavulanic acid
2. Clindamycin 3. Metronidazole with Beta-lactam |
|
|
chylothorax:
- appearance of pleural fluid - primary cell type - comment on triglyceride concentrations |
- Milky white to pink opaque
- Primary cell type is small lymphocyte, with chronicity many neutrophils may be present (as much as 50%) - Pleural fluid triglyceride > serum triglyceride |
|
|
what are six etiologies of chylothorax?
|
1. Idiopathic
2. Trauma to thoracic duct 3. Neoplasia: mediastinal, thoracic wall, or lymphatic 4. CHF (due to hydrostatic pressure changes) 5. Dirofilariasis 6. Obstructive disease to Thoracic Duct |
|
|
what breed type of cats and which two breeds of dog are predisposed to chylothorax?
|
- oriental breed cats
- Afghan Hound, Shiba Inu |
|
|
what are four ways to medically treat chylothorax?
|
1. Thoracocentesis
2. Low-fat diet 3. Rutin (an Aspergillus glycoside nutriceutical) 4. Octreotide – somatostatin analogue |
|
|
what are two ways to surgically treat chylothorax?
|
1. Thoracic duct ligation/ +/- pericardectomy
2. Pleuroperitoneal shunt |
|
|
what characterizes a non-septic pleural exudate as hemorrhagic?
|
PCV is at least 25% of peripheral blood
|
|
|
what are five intrathoracic causes of hemothorax?
|
1. Trauma
2. Neoplasia 3. Lung Lobe Torsion 4. Parasitic Infection 5. Pulmonary Infarct |
|
|
what are two extra-thoracic causes of hemothorax?
|
1. Coagulopathy – (rodenticide)
2. Thrombocytopenia |
|
|
what is the big difference between the external nares in the avian versus mammal?
|
they are made of horn and cannot be closed via muscle; some species of birds have specialized feathers called filoplumes at the perimeter of the nares
|
|
|
what is the major structural difference between the avian and mammalian nasal passages?
|
mammals' nasal passages open into the pharynx at the level of the soft palate; avians' nasal passages open into a choana, which lies directly over the glottis
|
|
|
what is the largest sinus in the bird? How does it differ from the mammal?
|
infraorbital sinus. The rostral wall is covered only by skin, so swelling is easily discernible
|
|
|
what is the difference between the pharynx of the mammal and the avian?
|
in the mammal, it opens directly to the nasal passages; in the bird it does not?
|
|
|
the guttural pouch in horses is part of which structure?
|
pharynx
|
|
|
what is the difference between the glottis of the mammal and the avian
|
- mammal: glottis is fixed in size and the epiglottis protects the trachea from foreign bodies
- avian: no epiglottis; the glottis is muscular and closes to protect from foreign bodies |
|
|
what is the difference between the mammalian and avian larynx?
|
mammals have vocal folds; avians do not have vocal folds, but they still have a laryngeal apparatus; birds use their syrinx to make sounds
|
|
|
what is the difference between the mammalian and avian trachea?
|
the cartilaginous rings on the trachea are incomplete in the mammal and complete in the avian
|
|
|
what is the difference between the bronchi of the mammal versus the avian?
|
- mammals: mucociliary elevator ends at primary bronchi; cartilaginous rings disappear at the level of the secondary bronchi.
- avians: cartilaginous rings present to the secondary bronchi; mucociliary elevator is present through primary bronchi. Secondary and tertiary bronchi form parabronchial arcades to allow recurrent air exchange via the air sacs |
|
|
compare the lung parenchyma of the mammal versus the avian
|
- mammal: dead-end alveoli undergo gas exchange as the lung expands and contracts. Lymph nodes are present.
- avian: air capillaries replace the "dead end" alveoli via the parabronchial arcades. Lymphatics are present, but no lymph nodes. Most of the movement of air is accomplished via the air sacs, not the lungs expanding and contracting. |
|
|
what are four diseases that can mimic feline allergic bronchitis?
|
1. Heartworm disease
2. Aelurostrongylus 3. Mycoplasma bronchopneumonia 4. Acute irritant causing bronchospasm |
|
|
what is the most important drug to treat asthma/bronchospasm?
|
glucocorticoids?
|
|
|
what is "flail chest"?
|
Paradoxical movement due to fractured ribs – chest falls inward upon inhalation
|
