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150 Cards in this Set
- Front
- Back
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True/False. The SNS proves innervation to all of the tracheobronchial tree, unlike the PNS.
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False. The opposite is true. SNS innverates to the level of the large airways but not the small airways.
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Stimulation of which muscarinic receptor by ACh results in increased Ca++ and therefore smooth muscle contraction?
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M3
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What actions on the airway does M3 receptor mediate?
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smooth muscle contraction
airway vasodilation mucus secretion |
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True/False. Small airways do not respond to SNS stimuli at all.
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False. There are a large number of b2 receptors in small airways, they respond to circulating Epi.
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What does stimulation of b2 receptors in the ariway do?
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increase cAMP, PKA activation and subsequent decrease in levels of Ca++.
bronchodilation Improve mucus clearance inhibit ACh release |
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What is the major neurotransmitter group of the eNANC system? What do these NT do?
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tachykinin
smooth muscle contraction vasodilation plasma protein leakage inflammatory cell activation mucus secretion facilitate ACh transmission |
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What neurotransmitters are involved in the iNANC system?
What do they (generally) do? |
NO
smooth muscle relaxation decreases AWSM proliferation decrease platelet aggregation and adhesion Antagonistic to ACh! |
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True/False. NO works through cAMP as mediator
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False. cGMP
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True/False. Inflammatory mediators influence the release of neurotransmitters from airway nerves.
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True
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Histamine
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Chemotaxis
H1 ---SM contraction, microvascular leakage, edema H2 ---bronchodilation, negative feedback |
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Serotonin
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mast cell degranulation
vasoconstriction bronchoconstriction microvascular leakage |
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Prostaglandins
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Bronchoconstriction
airway hyperreactivity bronchodilation (PGE2) chemoattraction |
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Leukotrienes
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anaphylaxis
contraction increased microvascular permeability mucous production chemoattraction |
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Platelet Activating Factor
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airway constriciton
microvascular leakage chemoattractant sustained bronchial hyper-responsiveness |
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Which substances stimulate the production of reactive oxygen species?
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cytokines
leukotrienes prostaglandins PAF |
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Common causes of restictive disease
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pleuropneumonia
pneumonia pulmonary edema obesity |
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Common causes of obstructive disease
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canine bronchitis
feline asthma equine inflammatory airway disease equine recurrent airway obstruction |
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True/False. Restrictive disease is characterized by loss of elastance.
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False. Loss of compliance, increase in elastance.
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On the pressure/volume curve, what represents compliance and what represents work of breathing?
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Compliance- slope
WOC- area above curve |
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True/False. Airway resistance is lower at high lung volumes.
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True. Airways are tethered open more at higher lung volumes.
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What are common histopathologic features of chronic bronchitic disease?
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goblet cell hypertrophy, hyperplasia
mononuclear cell infiltration increased T epithelial hyperplasia |
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True/False. The high number of neutrophils seen on cytology for chronic bronchitic disease are due to a primary infectious component.
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False. Not usually in chronic cases
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Common histiopathologic features of airway hyperreactivity?
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increased mucus production
mucosal edema thickening of epithelial basement membrane infiltration of airway walls by inflammatory cells |
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True/False. Airway reactivity in cats with asthma is strongly linked to second hand smoke.
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True.
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What is the predominant cell type seen in equine inflammatory airway disease?
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40-90% neutrophils
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Define acute lung injury
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rapid progression of clinical lung disease with:
radiographic infiltrates lung stiffening positive end-expiratory pressure increased inflation pressures PAO2/FIO2 < 300 mmHg |
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What is clinically seen in acute lung injury?
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tachypnea
hypoxemia edema restrictive breathing |
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True/False. Macrothromboembolism and bronchopneumonia are examples of ALI
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False.
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What are some etiologies for ALI?
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Damage to barrier by sepsis or trauma
Ventilator-induced Transfusion-Related Acute Lung Injury (TRALI) |
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What are 2 components of ventilator-induced lung injury?
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Oxygen toxicity
over-inflation |
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True/False. alveolar flooding and interstitial infiltration with proteinaceous fluid and cells underlies the distrubance in gas exchange.
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True.
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True/False. One characteristic feature of ALI is the uniform distribution of the disease in the lung.
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False- non-uniform distribution of disease structurally and functionally. Dependent areas tend to be worse.
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What are some functional effects of ALI on respiration?
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V/Q mismatch or shunt
loss of functional surfase area for gas exchange loss of compliance (requirement of higher inflation pressure) Decreased function residual capacity (increased recoil, and filling or airspaces with fluid) |
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What is the progression of pathogenesis of ALI?
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Endothelial damage
Edema and neutrophilic inflammation Cytokines, proteases and oxidants released Fibrin formation Microthrombosis |
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True/False. Histologically, hyaline membranes may be seen in the early phase of ALI.
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True
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Describe hyaline membranes.
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Formation of fibrinous/proteinaceous/cellular casts that line alveoli and further disturb gas exchange
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If the patient survives the early phase of ALI, what results?
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a) return to normal
b) fibrosis |
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What are the 2 phases of ALI?
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Early exudative phase
Late organizing phase (repair and fibrosis) |
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What is the defining characteristic of Adult Respiratory Distress Syndrome?
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PaCO2/FIO2 < 200 mmHg
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What are the clinical stages of ALI/ARDS?
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1- sudden onset of progressive dyspnea and tachypnea
2- progressive hypoxemia without hypercapnia +/- chest infiltrates on radiography 3- hypoxemia < 300 or 200 mmHg, mild hypercapnia, increasing A-a gradient, increased inflation pressures relative to volume 4- Respiratory failure (hypercapnia) |
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How might one distinguish ALI from pulmonary fibrosis on CT?
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ALI is gravity dependent while fibrosis is gravity independent
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If a dog suspected to have ALI is given a deep breath, what would we expect to see in terms of compliance?
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Compliance should improve with a deep breath as more collapsed alveoli open up ("recruitment").
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Define respiratory distress.
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outwardly evident, labored respiratory efforts or ventilation i.e. the clinically apparent inability to adequately ventilator and/or oxygenate.
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True/False. Inspiratory dyspnea is usually related to alveolar hypoventilation or inadequate gas exchange.
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True.
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True/False. Expiratory dyspnea is associated usually with extrathoracic obstruction.
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False. Intrathoracic
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What type of bronchodilator would be used in the:
a) larger airways b) smaller airways |
a) parasympatholytics (where most cholinergic receptors are)
b) sympathomimetics (b-receptors located in small airways) |
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Which type of bronchodilator does not act on receptors of autonomic nervous system?
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Phosphodiesterase inhibitors such as methylxanthines- induce diuresis
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albuterol
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b-adrenergic agonist in aerosol form
used as rescue drug in large animals and small |
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clenbutyrol
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b-adrenergic agonist
oral large animal |
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terbutaline
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b-adrenergic agonist
oral small animal |
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Long-term use of b-adrenergic agonists may be limited by what?
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tachyphylaxis due to downregulation of the beta receptor
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What are the clinical effects of cholinergic antagonists?
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Inhibit AWSM contraction
Increase viscosity of mucus decrease ciliary beating |
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What is one side effect of cholinergic antagonists?
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Decrease GI motility (ileus)
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Of the muscarinic antagonists: atropine, glycopyrrolate and ipratropium, which is available as an inhalant?
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Ipratropium
large animal mostly |
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What are the desired effects of the methylxanthines?
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Relax AWSM
Vasodilation Diuresis Stimulate respiratory center in CNS |
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What are some side effects of the methylxanthines?
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CNS excitation, nervousness, seizures
sweating GI stimulation (vomiting, diarrhea) Cardiac arrhythmias |
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True/False. Beta-2 agonists may be used to treat pulmonary edema
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True. Increase alveolar fluid clearance
decrease endothelial permeability |
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What is the source of airway distress in Recurrent Airway Obstruction?
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bronchoconstriction
persistent progressive airway inflammation |
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What are the effects of corticosteroids?
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Decrease expression of genes involved in innate and adaptive immune responses
Decrease healingf |
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What are some undesirable side effects of systemic corticosteroids?
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gastric ulceration
suppression of endogenous cortisol PU/PD weight gain muscle weakness vulnerable to infection |
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What are some complications of inhaled corticosteroids?
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must be used with appropriate delivery device
dose of inhaler must be adjustable variable distribution in dyspneic patients |
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What is the relative potency of the inhaled corticosteroids?
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fluticasone > beclomethasone > triamcinolone
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How are the preventative effects of mast cell degranulation blockers mediated?
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Block chloride channels
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What is an example of a mast cell degranulation blocker and in what cases is it used?
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Comolyn
Horses w/ RAO Cats w/ asthma |
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True/False. Common antitussives are opiates.
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True.
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What are some important contraindications of antitussives?
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caution in patient with increased respiratory secretions or receiving nebulization
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What is the relative efficacy of the antitussives?
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Codeine < Hydrocodone < Butorphanol
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Which drugs are indicated to facilitate clearance of respiratory secretions?
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Mucokinetic, expectorant and mucolytic agents
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What are the 3 ways the mucokinetics, expectorants and Mucolytics work?
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Directly affect secretions and ciliary escalator
Act indirectly via the gastropulmonary mucokinetic vagal reflex dissolve mucus |
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What are the inhalational mucokinetic/expectorant agents that are empirically used to induce coughing and liquefy tenacious secretions?
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Water
Saline NaHCO3 |
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What is the mechanism of hygroscopic agents?
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Attract water molecules by absorption/adsorption.
Ex- propylene glycol |
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What are true mucolytics?
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Disrupt the bond of mucoprotein strands
Thiols or enzymes |
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True/False. A b-adrenergic agonist may act as a mucokinetic/expectorant agent.
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True. Increase ciliary clearance
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When might diuretics be used in respiratory distress?
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Adjunct therapy for pulmonary edema
Prevention of exercise-induced pulmonary hemorrhage |
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Define analeptic.
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stimulates a depressed respiratory center.
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True/False. The margin of safety of analeptics is fairly wide.
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False.
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What are therapeutic uses of analeptics?
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barbiturate poisoning
drowning neonatal asphyxia heat or lightning shock |
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What are some examples of Respiratory stimulants?
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Doxapram
Methylxanthines Lobeline Amphetamine |
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What are the mechanical functions of the respiratory system that can be measured?
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lung volumes
compliance resistance tissue hysteresis |
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What are the gas exchange functions that can be evaluated?
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ventilation-perfusion matching
shunt diffusion capacity dead space |
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An esophageal balloon or pressure transducer in the esophagus measures what?
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pleural pressure
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True/False. Pleural pressure is negative on inspiration and slightly positive on expiration.
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False. Always negative, though relatively less on expiration.
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The integral of flow is what measurement?
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Tidal volume
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Define Pulmonary Resistance
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change in pleural pressure divided by the change in airflow at 2 points of equal volume.
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Define Dynamic compliance
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change in volume relative to the change in pleural pressure from the start to end ot inspiration.
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What is a less invasive method of measuring pleural pressure?
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oscillometry, but also includes pressures generate by other components of the respiratory system (airways, prenchyma, chest wall)
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In oscillometry, what is a hallmark of small airway obstruction?
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frequency dependence- a drop in Rrs with increased input frequency.
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What are the remodeling changes seen with inflammation of airway hyperreactivity?
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epithelial hyperplasia and infolding
thickening of the lamina propria, smooth muscle, and adventitia with collage and inflammatory cells |
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Which parameters may be used in bronchoprovocation testing?
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Pulmonary resistance (Rl)
Resistance of the respiratory system (Rrs) Dynamic compliance (Cdyn) |
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What is the pathophysiology of feline asthma?
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bronchospasm
V/Q mismatch hypoxemia |
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What is the only system that can measure airway obstruction in cats?
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barometric whole body plethysmography
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What is the estimation used in whole body plethysmography in cats?
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Alveolar pressure (Paw) as derived from the inverse of the pressure change in the box is estimated to be about airway resistance (Raw). Normally would also account for flow.
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Why is head out plethysmography more accurate than whole body plethysmography in cats?
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Can also measure flow:
Raw = Paw/flow |
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Define respiratory inductance plethysmography.
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Sensors measure rib and abdominal motion are in bands. Measurements are summed for tidal volume and minute ventilation.
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True/False. Displacement of chest and abdomen is greater than volume measure at the nose during airway obstruction.
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True.
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What conditions result in elevated FRC?
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asthma
emphysema COPD heaves |
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Which conditions result in reduced FRC?
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pneumonia
cancer |
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How does one measure FRC?
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Helium dilution
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How is diffusion capacity tested?
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rate of clearance of inhaled carbon dioxide. Must be under anesthesia to standardize minute ventilation.
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What is the name of the test for measuring dead space?
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capnography (exhaled CO2 monitoring)
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What does a high A-a gradient indicate?
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V/Q mismatch or shunt
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True/False. The worse the shunt, the less likely increasing the fraction of inspired oxygen will improve PaO2.
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True
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What are normal pulmonary artery pressure in the adult mammal?
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15-20 mmHg
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What are some etiologies for pulmonary hypertension?
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hypoxic vascoconstriction
atherosclerosis thromboembolism pneumonectomy chronic lung disease |
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True/False. Pulmonary wedge pressures can be used to monitor the predisposition toward cardiogenic pulmonary edema.
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True.
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What are 2 diseases caused by Bovine Herpesvirus 1?
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Infectious Bovine Rhinoracheitis
Infectious Pustular Vulvovaginitis |
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What characterizes IBR?
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Upper respiratory infection with nasal discharge
cough ulcerative mucosal lesions fever reduced appetite dyspnea |
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True/False. Bovine Herpes 1 can travel cell to cell and avoid extracellular antibodies.
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True.
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Which cell type are affected by Bovine Herpes 1?
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epithelial cells and eventually nerves of upper airways
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How does Bovine Herpes Virus present histologically?
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Intranuclear inclusions in epithelial cells
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True/False. The case-fatality rate of IBR is moderate to high.
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False. Is low unless complicated by secondary infection
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Ovine Herpesvirus 2
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Malignant Catarrhal Fever:
mucopurulent inflammation of conjunctiva and oral and nasal mucosa ulcerations of mouth and esophagus fatal? |
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Name 2 more Bovine respiratory infections that predispose to bacterial infection.
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Respiratory Syncytial Virus (BRSV)
Parainfluenza 3 |
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Mycoplasmal disease of cattle and sheep and goats, endemic in Africa and Asia but eradicated from the U.S.
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Contagious Bovine Pleuropneumonia
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Name the components of Bovine Respiratory Disease Complex.
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Shipping Fever Pneumonia
Pasturella Pneumonia Pneumonic Pasteruellosis Mannheimia haemolytica |
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Name the agents responsible for predisposing to Bovine Respiratory Disease Complex.
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Bovine Herpesvirus-1
Respiratory Syncytial virus Bovine viral diarrhea virus Parainfluenza 3 |
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What are the bacterial/mycoplasmal agents of Bovine Respiratory Disease Complex?
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Mannheimia hemolytica
histophilus somni pasteurella multocida mycoplasma bovis |
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True/False. Mannhemia hemolytica is commensal in the tonsils of cattle but causes disease if it colonizes deeper lung tissue.
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True.
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Clinical course of M. hemolytica?
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cranioventral fibrinopurulent pleuropneumonia
hemorrhage/coagulation necrosis vasculitis |
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Which bacterial agent of bovine respiratory disease complex characteristically forms thrombi?
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Histophilus somni
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young calves
cranioventral pneumonia extensive fibrinopurulent pneumonia bronchiectasis long term |
Enzootic calf pneumonia
IBR, Parainfluenza-3, BRSV, Adenoviruses, Reoviruses, Rhinoviruses Mycoplasmas M. haemolytica, P. multocida, Corynebacterium pyogenes |
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Fusobacterium necrophorum
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Calf Diphtheria
colonizes pharyngeal tissue foul rancid breath slaivation nasal discharge dysphagia anorexia death |
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Infection of calves following abrasion of oral mucosa or vocalization
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Calf Diphtheria
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Bovine respiratory disease caused by ingestion of tryptophan and metabolism to 3-methyl indole
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acute bovine pulmonary edema and emphysema aka Fog Fever
congestion, hyaline membranes proliferation of type II pneumocytes |
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How does Bovine Herpesvirus 1 avoid neutralizing antibodies?
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New viral particles spread directly cell to cell
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Where does BoHV hide during latency?
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trigeminal ganglia neurons
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Causative agent of Malignant Catarrhal Fever.
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Ovine herpesvirus type 2
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True/False. Bovine Respiratory Syncytial virus and BoHV may enhance the effects of M. Hemolytica leukotoxin.
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True.
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What are SPF animals?
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Specific pathogen free
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Which respiratory pathogen of rodents is also a causitive agent of otitis media?
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Cilia-associated bacillus
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What is the most common primary neoplastic disease in the animal lung?
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bronchio-alveolar carcinoma.
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What is the second most common location for primary chondrosarcoma in the dog?
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nasal cavity
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True/False. Nasopharyngeal, gutteral pouch, larynx and tracheal primary neoplasias are rare in animals.
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True.
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What is the most common malignant neoplasm of the lungs of mammals?
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metastatic melanoma
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What cell type is likely the origin of bronchoalveolar carcinomas in dogs?
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Type II epithelial cells due to presence of lamellar bodies.
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Type of lung neoplasia seen in sheep?
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Jaagsiekte
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Cell type responsible for carcinoid tumors of the lung?
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Kulchitsky cells
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In which species is mesothelioma seen?
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Dog, Horse, Pig
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In acid-base physiology, which are dependent variables?
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H+ depends on K'w, Ptot, PCO2 and SID
OH- HP P- HCO3- |
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What are the 3 independent variables of biological fluids?
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SID
Ptot PCO2 |
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Evaluation of acid-base status requires evaluation of which variables?
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SID (serum electrolytes)
serum proteins PCO2 |
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What is the normal SID of plasma?
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42 mEq/L
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Increased SID
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alkalosis (hyperchloremic acidosis)
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Decreased SID
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metabolic acidosis
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Hypoproteinemia causes what acid/base imbalance?
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Metabolic alkalosis
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True/False. Proteins are the major weak acids in plasma, so hyperproteinemia results in metabolic acidosis.
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True.
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Changes of what are the major mechanism of body fluid interactions among compartments?
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SID changes
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From the Peter Stewart perspective, how does the kidney act to raise serum pH?
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Excretes more Cl- than Na+, raising plasma SID
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True/False. Movement of HCO3- in or out of plasma or renal tubules alters [H+]
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False. Both are dependent variables and therefore cannot influence each other.
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From the Peter-Steward perspective, how is gastric pH lowered?
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Creates a high negative SID (Cl- > Na+)
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