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92 Cards in this Set

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What divides the nasal passages? Describe it.
Nasal septum
-Cartilaginous dorsally and boney (vomer bone) ventrally
Compare the nasal septum in horses to that of cats and dogs.
Horses: whole nasal passage divided into two halves & at nasopharynx the openings are separate choanae
Dogs & cats: single opening into the nasopharynx
The nasal passages contain _____, which the respiratory epithelium is attached to and the meatuses, which are ________.
Conchae
meatuses: cavities b/w the conchae
The dorsal, middle and ventral conchae of the more rostral nasal passages become the _________, that overly the _______.
ETHMOID CONCHAE which overly the CRIBIFORM PLATE
What separates the nasal passages from the calvarium (dome of the skull)?
cribiform plate
Where is olfactory neuroepithelium found?
Inside the ethmoid turbinates
What lines the nasal and ethmoid conchae?
Ciliated pseudocolumnar epithelium
-cilia are present in nasal passages
Why is it diagnostically relevant that nasal passages contain cilia?
Nasal biopsies can be used to diagnose ciliary dyskinesia
What happens to large particles (5- 30 um) that enter the airways? small particles? Smallest particles (<1 um)?
-Large particles: trapped by mucociliary apparatus in nasal passages and cilia carry them towards nasopharynx
-smallest: settle out in alveoli and are removed by alveolar macrophages
-Small particles: settle in bronchioles
The sense of smell is an important component of appetite in what species?
Carnivores
Different species have different numbers of sinuses that drain into the nasal passages at the ______ meatus.
middle
What is the major sinus?
Frontal sinus
-has several components or recesses
What sinus is unique to the cat?
a functional sphenoid sinus that communicates w/ nasal passages
True or false. Maxillary sinuses are true sinuses.
False, not true sinuses
Other than trapping particles what is the function of the nasal passages?
Warms and humidifies air via rich capillary network in nasal epithelium
Inspired air is warmed and humidified in the nasal passages, what happens to expired air in the nasal passages? Why?
Cooled and dried to preserve both heat and moisture
What causes nasal congestion?
Capillaries become distended w/ blood
______ and _______ secretions moisten the nose and nasal passages and contribute to cooling.
Nasal glands
Nasolacrimal secretions
Do animals preferentially breathe through their mouth or nose? Can they breathe through one nostril?
Nose preferably and can breathe through one nostril
When sneezing occurs it indicates that disease is present in ______ and/or ______.
Nasal passages and/or sinuses
What is the purpose of sneezing?
Protect the lower airways from noxious and infectious substances
What nerve is located in the nasal mucosa and is stimulated by noxious substances in the nasal passages?
Subepithelial myelinated endings of the trigeminal nerve
Other than noxious stimuli, what can trigger a sneeze?
Strong light
Explain the sneeze reflex.
-rapid inspiration
- contraction of thyroarytenoideus muscles --> closes vocal folds
-abdominal muscles contract--> increasing pressure of trapped air
-caudal aspect tongue pushes up against soft palate & prevents air from entering oral cavity
-vocal folds abduct and air is forcibly released
Reverse sneezing is a ______ reflex.
Aspiration reflex
With reversed sneezing there is a paroxysmal ____ phase that often occurs in an animal standing w/ head and neck extended.
Inspiratory phase
Other than being an aspiration reflex, what can cause reverse sneezing?
Stimulation of trigeminal nerve endings in the nasal mucosa, with a heavy concentration on the lateral aspects of nasopharyngeal mucosa
Explain the mechanism of reverse sneezing.
-Stimulation of CN V
- rapid contraction of inspiratory muscles and muscles of the larynx resulting in vocal fold adduction and narrowing of larynx
-increases air pressure w/in trachea and pleura
-glottis opens --> sudden rapid inspiration of air
What is the function of reverse sneezing?
Sudden rapid inspiration of air helps move debris from nasopharynx into oropharynx to be swallowed or expectorated
What prevents debri from moving into the lower airways during reverse sneezing?
Subsequent narrowing of the glottis and coughing
Reverse sneezing is suggestive of disease in the _______.
Nasopharynx
What are the 4 traits used to describe nasal discharge?
1) Type
-serous, mucoid, purulent, mucopurulen, sanguinous, epistaxis
2) Amount
-scant, copious
3) Location
-unilateral, bilateral
4) Frequency
-intermittent, continuous
What are the 2 characteristics of serous discharge?
Clear and acellular
How does a mucus discharge appear? What produces it?
Clear or more opaque than serous and results from increased mucus production by goblet cells.
-acellular
What are the characteristics of purulent discharge?
Contains abundant neutrophils and bacteria that gives it a white, yellow or green appearance
What are the only 2 acellular discharges?
Mucus and serous
What are the characteristics of mucopurulent discharge?
opaque w/ some neutrophils & bacteria giving it a yellow or green tinge
-differs from purulent which has abundant neutrophils
What are the characteristics of a sanguinous discharge appear?
Blood mixed w/ serous, mucoid or purulent discharge
How is epistaxis different from a sanguinous discharge?
Epistaxis is just blood
Sanguinous is mixed w/ serous, mucoid or purulent discharge
What are 9 infectious differential diagnoses for sneezing and nasal discharge in dogs & cats?
1) feline upper respiratory infection complex
2) canine infectious tracheobronchitis
3) B. bronchiseptica
4) Aspergillosis
5) Cryptococcus neoformans
6) Pneumonyssus caninum
7) Cuterebra
8) Capillaria aerophilia
9) Linguat. serrata
What are 6 types of neoplasia in dogs and cats that could result in sneezing and nasal discharge?
1) Adenocarcinoma
2) Squamous cell carcinoma
3) Lymphosarcoma
4) Fibrosarcoma
5) Chondrosarcoma
6) Osteosarcoma
What are 3 inflammatory causes of sneezing and nasal discharge in cats and dogs?
1) Allergic rhinitis
2) Lymphoplasmacytic rhinitis
3) Chronic hyperplastic rhinitis
What are some infectious causes of sneezing and nasal discharge horses and ruminants? (there's a ton!)
Influenza, EHV-1, EHV-4, rhinovirus, early strangles, gutteral pouch mycosis, early bacterial pneumonia/pleuritis, Manheimia hemolytica, P. multocida, H. somnus, IBR, BHV-1, PIV3, Mycoplasma, abscess, septicemia, nasal bots, lungworm
What are some inflammatory and other causes of sneezing and nasal discharge in horses and ruminants?
Overflow nasolacrimal ducts
Cysts
Polyp
Tumor
COPD
Trauma
Decreased cleaning
Choke
Cleft palate
Megaesophagus
What are some "other" causes of sneezing and nasal discharge in cats and dogs?
Foreign body
Nasopharyngeal polyp
Oronasal fistulae
Truama
Nasopharyngeal stenosis
Dysphagia
Ciliary dyskinesia
Cleft palate
In general, what type of nasal discharge does inflammatory diseases cause?
Serous to mucoid discharge
-can get secondary infection resulting in a purulent discharge
What are 2 infections that can result in epistaxis (not sanguinous discharge)?
1) Nasal aspergillosis**
-commonly presents w/ epistaxis
2) Nasal Cryptococcus
What are the most common discharges caused by a nasal tumor?
Mucoid, mucopurulent, sanguinous and epistaxis
What does a persistently unilateral discharge indicate about location of the lesion?
Likely rostral to choanae
What does a foul odor to nasal discharge suggest?
Presence of primary or secondary bacterial infection
What are 6 local diseases that can result in epistaxis in a dog or cat?
1) Trauma
2) Neoplasia
3) Aspergillosis
4) Oronasal fistula
5) Foreign body
6) Severe infection/ inflammatory disease
What are 7 systemic diseases that can cause epistaxis in dogs and cats?
1) Hypertension
2) Vasculitis
3) Coagulopathy
4) Thrombocytopenia
5) Hyperviscosity syndromes
6) Multiple myeloma
7) Polycythemia
What are 3 systemic diseases that can result in epistaxis in ruminants and horses?
1) Purpura hemorrhagica
2) EIPH
3) Caudal venal thrombosis
What are some local diseases that can cause epistaxis in horses and ruminants?
1) Guttural pouch mycosis
2) Ethmoid hematoma
3) Trauma
4) Retropharyngeal abscess
5) Polyp
6) Tumor
7) Foreign body
8) sinus infection
9) nasal bots
10) dehorning
What is a suspected cause of nasal discharge and sneezing in a young dog with recurrent pneumonias?
ciliary dyskinesia
What animals typically get nasopharyngeal polyps and stenosis?
Younger cats
What breeds more commonly get nasal aspergillosis?
Young large breed dogs w/ a predisposition for german sheps
Nasal tumors are more common in _____ dogs.
Older
What is high on your differentials for a young cat w/ a history of viral upper respiratory infections and chronic nasal discharge w/ or w/o respiratory distress?
Polyp
What is high on your differentials for a cat that was recently adopted from a humane society with chronic nasal discharge?
Likely has or had feline upper respiratory infection complex
What is high on your differentials for a 12 year old golden w/ chronic nasal discharge of 5 months that has recently developed exophthalmus?
Nasal tumor
What is high on your differentials for a dog with acute onset of sneezing and facial rubbing?
Nasal foreign body
What is high on your differentials for a horse w/ copious purulent discharge on lowering of the head?
Guttural pouch empyema
Nasal discharge in a horse after exercise suggests the lesion is located where?
Lower respiratory tract
-animals w/ lower respiratory disease may manifest w/ other signs such as cough, exercise intolerance, cyanosis etc
Why is it so important to look at facial symmetry and eye position in an animal with nasal discharge?
Changes are seen w/ neoplasia
Why is a good oral exam imperative in animals with nasal discharge?
Evaluate dental arcade (oronasal fistula) as well as soft palate (nasopharyngeal polyp, cleft palate)
-may be possible to evaluate pharynx
-may have to sedate/anesthetize to get better view
What may be seen on a minimum database of an animal w/ epistaxis?
Anemia, polycythemia or thrombocytopenia
What do you expect to see on a minimum database of an animal with inflammatory disease or vasculitis? parasites?
Inflammatory or vasculitis: neutrophilia, fibrinogen increase (LA)
Parasites: eosinophilia
What does it mean if the chemistry panel of an animal with epistaxis shows hyperglobulinemia?
Related to diseases that can cause hypertension (hyperadrenocorticism, renal failure) or other causes of epistaxis (liver disease)
How urinalysis help determine underlying cause of epistaxis?
Might reflect underlying diseases
-proteinuria, isosthenuria
When is a fecal analysis indicated for nasal discharge?
When its serous, mucoid, or serosanguinous discharge
Radiographs of what parts of the body can help determine the cause of nasal discharge?
Skull to evaluate nasal passages, sinuses, bullae, guttural pouches, retropharyngeal area, pharynx & dental arcade
What diagnostic imaging is preferred to further evaluate boney structures of the head?
CT
-also good for evlauating integrity of cribiform plate when concern about extension of disease (aspergillus, neoplasia) into calvarium
When would you want to perform an MRI to determine the cause of nasal discharge?
Helpful in evaluating soft tissue structures so can better define tumors in soft tissues as well as differentiate nasal discharge from a tumor
What is rhinoscopy used for?
Aid in sample collection and allows visualization of nasal passages, nasopharynx and in some cases the frontal sinus
What do you call a surgical approach into the nasal passages, which may be necessary for surgical biopsy and removal of foreign bodies?
Rhinotomy
What can you use to detect cryptococcal organisms?
Evaluate nasal discharge
Why are cultures of nasal discharge not very helpful?
Often grow a population of mixed commensal organisms
In large animals, centesis is sometimes performed on the _______ to retrieve diagnostic samples.
Paranasal sinuses
How are samples sometimes obtained from the guttural pouch?
May be catheterized blindly or via endoscopy
What can you do with nasal biopsies?
Used for histopathology, culture and electron microscopy (ciliary dyskinesia)
How are nasal biopsies obtained?
Blindly, via nasal flushes, endoscopically, guided by cross-sectional imaging or surgically
What must be done prior to taking a nasal biopsy?
Biopsy instrument is measured to the level of the medial canthus prior to performing procedures to prevent penetration into calvarium
-also should take BP, clotting times, platelet count, BMBT in cases of epistaxis
What are 4 treatments that are non-specific but can help reduce nasal secretions, improve appetite and quality of life?
1) Humidification
2) Saline nasal drops
3) Decongestants
-may increase discharge and congestion when stopped
4) Mucolytics
When are antihistamines useful for nasal discharge?
For allergic rhinitis
-can also try leukotriene antagonists
When are antibiotics helpful for treating nasal discharge in dogs and cats?
Feline upper respiratory and canine infectious respiratory disease (infectious tracheobronchitis) or treat secondary infections
Are antibiotics most useful for acute or chronic respiratory infections in dogs and cats?
Acute
-for chronic antibiotics are used to address secondary infections
-common for signs to improve but not resolve
What is a common treatment for lymphoplasmacytic rhinitis?
Immunosuppression- glucocorticoids (prednisone, prednisilone)
When are NSAIDs used for nasal discharge treatment?
COX inhibitors used for various nasal carcinomas
-may help w/ lymphoplasmacytic rhinitis as well
What is Yunnan baiyao and what is it best suited to treat?
Herbal used for healing and pain relief, best to decrease bleeding associated w/ nasal tumors
What is the treatment of choice for nasal aspergillosis?
Topical antifungal treatments w/ clortrimazole and enilconazole
What is the treatment for nasal cryptococcus?
Surgical debulking OR
medical management w/ oral azoles (used most commonly)
-itroconazole effective in most cases but fluconazole is recommended if there is CNS or ocular involvement
-amphotericin B w/ flucytosine in cats w/ severe CNS signs
-monitor w/ serology