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56 Cards in this Set
- Front
- Back
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What is the actual process that results in a cough?
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Sudden, forceful expiration against a closed glottis followed by opening of the glottis and turbulent airflow through this opening
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Explain a typical cough reflex.
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-Air is rapidly inspired, the epiglottis and focal folds close to entrap air in the airways.
-Diaphragm, internal intercostals and abdomen muscles rapidly and forcefully contract -epiglottis and vocal folds open and air that was at an increased pressure in airways is rapidly expelled |
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What is the purpose of coughing?
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When air under pressure is expelled intent is for it to carry foreign material with it
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What receptors are responsible for initiating the cough reflex?
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Irritant receptors in the airways
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The irritant receptors responsible for the cough reflex are particularly concentrated in the ______ and ______, but also occur in other areas of the respiratory tract.
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Concentrated in larynx & carina
-also present in trachea, bronchi, bronchioles and even alveoli |
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The trachea of what animal is much less sensitive to mechanical stimulation compared to other species?
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Horses
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What are some stimuli of the irritant receptors in the airway?
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Fluid, noxious gases, and particulate matter inside airways or external compression
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What receptors are primarily responsible for responding to mechanical stimulation in the airways?
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Rapidly adapting stretch receptors in the mucosa of the tracheobronchial tree
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What in the airway is responsible for responding to chemical stimulation?
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C-fibers in close proximity to blood vessels in the airways
-also respond to mechanical stimulation |
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Are the proximal or distal airways more susceptible to mechanical stimulation? Chemical?
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-Proximal airways more susceptible to mechanical stimulation
-distal airways more susceptible to chemical stimulation |
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What happens after the mechanical, chemical or irritant receptors are stimulated in the airways?
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Neuropeptides (substance P, calcitonin, gene related peptide etc.) are release--> afferent sensory fivers run through vagus n to medulla in brain (cough center)----> efferent fibers stimulates mm. of larynx, trachea, bronchi, diaphragm, intercostals and abdominal muscles
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What is the "expiratory reflex"?
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When there is direct stimulation of the larynx (such as intubation) and cough occurs w/o inspiration
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_______ can also cause a cough (mechanism unknown) as a result of stimulation of irritant receptors and vagally-mediated reflex bronchoconstriction.
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Bronchoconstriction
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What are the 2 systems typically investigated for the source of a cough?
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Cardiovascular
Respiratory |
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What are some important aspects of history when trying to diagnose the source of a cough?
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Geography, environment, other animals affected, previous illness, vaccine status, duration of illness/signs, progression, time/character of cough, treatment & response to treatment
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when an animal has a cough a complete physical exam should be performed with particular attention paid to what aspects?
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Symmetry of head, the nares, nasal discharge, ocular discharge, sinus percussion (LA), mucous membrane color/refill, palpaiton of neck (lnn, salivary glands, HR/rhythm, jugular pulse/distension, femoral pulse character
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Collapsing trachea is most common in what breeds?
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Toy breeds
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What age of horses are affected by Rhodococcus equi?
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Foals
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What horses are most prone to COPD?
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Stabled, mature horses
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What dogs are predisposed to bronchitis?
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American Cocker Spaniels
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Is a young cat with acute onset of a cough and dyspnea more likely to have feline asthma or a pulmonary mass?
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Feline asthma
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What part of history would suggest shipping fever in cattle?
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Recent stressors
-long travel, no preconditioning |
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Clinical signs (cough) in animals in the same environment might suggest what etiology?
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Infectious or toxic
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Pulmonary edema is generally associated with what condition? What can be found during the physical exam that would be suggestive of this condition?
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Left sided heart failure (mitral valve regurgitation)
-a murmur on left in the presence of a cough (dog, NOT cat) is more suggestive of heart disease than a murmur on the right |
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Pulmonary edema is typically associated with left-sided heart failure, whereas right sided heart failure can be associated with pulmonary ________.
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Hypertension
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A toy breed dog presents to you with a cough, tracheal sensitivity and a heart murmur on the left and right side with equal intensity. What are some possible conditions contributing to the cough?
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Collapsing trachea
Chronic bronchitis Mitral valve regurgitation Left atrial enlargement Pulmonary edema |
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What are the diagnostics used to evaluate the respiratory system? (there's a laundry list of em!)
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CBC, fibrinogen (LA), chemistry panel, clotting profile, urinalysis, fecal analysis, heartworm testing, nasal/ pharyngeal swabs, serology viral isolation/culture, measures of oxygenation/ventilation (arterial blood gas, pulse ox), diagnostic imaging (rads, ultrasonography cross-sectional imaging), endocscopy, thoracoscopy, and tissue/fluid sampling
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What are 2 conditions that could cause a cough that might present as anemia on the CBC?
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Hemorrhage, coagulopathy
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An acute polycythemia can occasionally be noted in animals with a cough in cases of prolonged _______.
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hypoxemia (paO2< 60mmHg)
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Chemistry panels and urinalysis are rarely specific for respiratory diseases, so what's the point of running them in an animal with a cough?
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May provide additional info on the general health of the patient as well as info to create a proper diagnostic plan
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What's the purpose of collecting samples from lymph nodes, nasal swabs, pharyngeal swabs, bronchoalveolar lavage, and lung aspirates?
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Can be collected for cytology, culture and virus isolotion/ culture/IFA/PCR
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What is the purpose of performing an ultrasound on an animal with a cough?
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To evaluate soft tissue structures in cervical area and thoracic wall as well as pleura and pleural fluid
-obtain diagnostic samples -some cases of parenchymal disease where lung lobe assumes abnormal soft-tissue consistency (mass, abscess, consolidation, hemorrhage) |
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MRIs may be used to evaluate soft tissue tissues in the neck when you have a dog with a cough, but why are CTs preferred for the thorax?
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Effects of movement associated w/ ventilation on images acquired via MRI
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What diagnostic imaging do you want to use if you suspect a pulmonary thromboembolism?
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CT w/ contrast administration or ventilation/ perfusion studies
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What do we use endoscopy for when trying to discover the origin of a cough?
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Often employed to allow visualization of the airways as well as aid in diagnostic sampling
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What do we use thorascopy for when trying to diagnose the origin of a cough?
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To evaluate intrathoracic structures w/ minimal invasion
-obtaining diagnostic samples |
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What do the diagnostics used to evaluate the cardiovascular system include?
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Minimum database (CBC, chem panel, urinalysis +/- fecal, HW test)
thoracic rads BP electrocardiogram Echocardiogram |
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What may be seen to signify heartworms as a cause of a cough (other than + HW test) on a diagnostic workup?
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Eosinophilia
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What will you see on blood work of an animal with a portosystemic shunt as the underlying cause of a cough?
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Absolute polycythemia
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What do you expect to see on bloodwork of an animal with endocarditis as the source of a cough?
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Inflammatory leukogram with a left shift
Thrombocytopenia (+/-) |
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What is the purpose of running a chemistry panel when evaluating the cardiovascular system in a dog with a cough?
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Guiding therapeutic decisions but rarely renal failure may be noted secondary to low output heart failure
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______ is very important in the diagnostic evaluation of cardiac disease.
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Thoracic radiographs
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What do you need to make sure to evaluate on thoracic radiographs in a dog with a cough?
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Size and position of heart and its chambers
Pulmonary vasculature Pulmonary parenchyma Pleura |
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Is hypertension or hypotension more commonly found in animals with a cough due to cardiovascular disease? Why?
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Hypotension as the result of heart failure and treatment of heart disease
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How is the electrocardiogram helpful in cardiac workup of a dog with a cough?
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Evaluate chamber size and rhythm disturbances associated w/ different types of cardiac dz
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When are echocardiograms performed in an animal with a cough?
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in patients suspected to have cardiac disease to definitely identify the cause and severity of disease
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What is treatment for coughs aimed at?
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Treating underlying etiology in most cases
-some instances treatment of cough itself is not necessary due to mild symptoms (infectious tracheobronchitis, mild collapsing trachea) or contraindicated (bacterial pneumonia |
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When is treating the cough itself contraindicated? indicated?
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Contraindicated: bacterial pneumonia
Indicated: if cough significalntly impacts patient comfort or aggravates inflammation (severe bronchitis) |
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What are the most effective cough suppressants?
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Those that act centrally=opioids
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True or false. Morphine has anti-tussive effects and is commonly used for a cough suppressant.
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False, is an anti-tussive, but not commonly used bc of its side effects
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What are some more commonly used cough suppressants?
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Butorphanol
Hydrocodone Dextromorphan (over the counter opioid), codeine |
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What are the 2 most effective cough suppressants?
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Butorphanol
Hydrocodone |
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How can you treat the underlying cause of a cough due to cardiogenic pulmonary edema?
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Diuretics
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How can you treat a cough due to infectious causes? Inflammatory airway disease?
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Infectious: antibiotics, antifungals
Inflammatory airway diseases: glucocorticoids |
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Bronchoconstriction can be seen with various respiratory diseases but is most pronounced in ______.
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Feline asthma
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What can be used to treat a cough due to bronchoconstriction (feline asthma)?
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Bronchodilators: bronchoconstriction leads to mechanical irritation and cough
-some bronchodilators may also have anti-inflammatory effects or enhance mucociliary clearance |
