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34 Cards in this Set
- Front
- Back
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Cough Signals Dz in what Region of Respiratory System?
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Large Airways
~~~ Trachea ~~~ Bronchi ~~~ Non Productive (Usually) ~~~ ~~~ Compression ~~~ ~~~ Irritation ~~~ ~~~ Inflammation ~~~ Productive ~~~ ~~~ Oversecretion of Mucous ~~~ ~~~ Hemorrhage Lung ~~~ Parenchyma ~~~ Productive (Usually) ~~~ Via Junk in Airways ~~~ ~~~ Pus ~~~ ~~~ Edema ~~~ ~~~ Hemorrhage Wheezes ~~~ Small Airway Narrowing ~~~ ~~~ Bronchoconstriction ~~~ ~~~ Bronchial Wall Thickening ~~~ ~~~ Exudates or Fluid ~~~ ~~~ Masses or Other External Airway Compression |
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What are 5 major differential diagnoses for chronic cough in a 6 year old dog?
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Allergic Tracheobronchitis
~~~ ~~~ Young to Middle Age Tracheal Collapse ~~~ Middle Aged Toy and Miniature Dogs ~~~ Progressive ~~~ ~~~ Respiratory Distress “usually after years of chronic cough” ~~~ Most Presented at 4 to 8 Years Chronic Bronchitis ~~~ Middle Age or Older small Breeds Pulmonary Neoplasia ~~~ Generally Older Cardiogenic Pulmonary Edema ~~~ Mitral Valve Endocardiosis ~~~Middle Age and Older Small Breed Irritant Tracheobronchitis ~~~ Many dogs Parasitic Tracheobronchitis ~~~ NIET ~~~ Young Dogs most commonly infected as Pups |
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When you are presented with a dog with a cough what is your general diagnostic approach
- what tests in what order? |
Physical Exam
~~~ Tracheal Palpation Auscultation ~~~ Airways ~~~ Lungs ~~~ Heart Thoracic Rads ~~~ Inspiratory ~~~ Expiratory ~~~ Mets CBC ~~~ Inflammation ~~~ Parasite Screen Transtracheal Wash ~~~ Cytology Fecal Exam ~~~ Parasites Serology ~~~ Parasites Bronchoalveolar Lavage Bronchoscopy Fluoroscopy |
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What is the most Common cause of Cough in the Cat?
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Feline Bronchial Dz
~~~ aka Asthma Other DDx ~~~ Lung Parasites ~~~ Heart Worm Dz |
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Through what Two Major Mechanisms can Mitral valve insufficiency result in in cough?
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Pulmonary Edema
~~~ Pulmonary Hypertension ~~~ Fluid Accumulates in Airways Left Atrial Enlargement ~~~ Tracheal Elevation and Separation of Mainstem Bronchi ~~~ Compression of Bronchi and Trachea |
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In what animals can mitral valve insufficiency be common and why?
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Middle Age and Older
Small Breed Via Endocardiosis |
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What diseases typically cause a Tracheal Wash containing evidence of Chronic or ongoing Hemorrhages?
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Pulmonary Neoplasm
Mycotic Infection Heartworm Dz Thromboembolism Foreign Body Lung Lobe Torsion Coagulopathies Congestive Heart Failure ~~~ Minimal Hemorrhage Occurs in Some Animals |
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What are the clinical features of Kennel Cough in Dogs?
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Severe Cough
~~~ Sudden Onset ~~~ Exacerbated by ~~~ ~~~ Exercise ~~~ ~~~ Excitement ~~~ ~~~ Tracheal Palpation Systemic Signs ~~~ Usually None ~~~ Rarely Secondary Bacterial Pneumonia |
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How can you make a Diagnosis of Kennel Cough in Dogs?
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History of Exposure
~~~ Within 2 Weeks of Onset Presenting Signs ~~~ Severe Cough If Systemic ~~~ Illness ~~~ ~~~ ie Fever, Lethargy, Productive Cough ~~~ Crackles ~~~ Cough Persists > 10 Days Then ~~~ Thoracic Rads ~~~ CBC ~~~ Transtracheal Wash |
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How will you Treat Kennel Cough in Dogs?
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Uncomplicated
~~~ Self Limiting ~~~ Rest 7 Days ~~~ ~~~ Minimize Airway Induced Airway Irritation Cough Suppressants ~~~ Contraindicated if ~~~ ~~~ Productive ~~~ ~~~ Radiographic Evidence Pneumonia Antimicrobials ~~~ Controversial via Self Limiting ~~~ Efficacy against Bordatella ~~~ ~~~ Clavamox ~~~ ~~~ Enrofloxacin ~~~ ~~~ Doxycycline Corticosteroids ~~~ Contraindicated |
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What are the Typical Clinical Features of Tracheal Collapse in Dogs?
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Non Productive Cough
~~~ Goose Honk ~~~ Worsens With ~~~ ~~~ Exercise ~~~ ~~~ Excitement ~~~ ~~~ Collar Pressure ~~~ Easily Elicited by Tracheal Palpation Progression Results In ~~~ Respiratory Distress ~~~ ~~~ Induced by ~~~ ~~~ ~~~ Exercise ~~~ ~~~ ~~~ Excitement ~~~ ~~~ ~~~ Overheating End Expiratory Snap |
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How can you Diagnose Tracheal Collapse in Dogs?
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Inspiratory and Expiratory Rads
~~~ Lateral ~~~ Neck and Thorax ~~~ Inspiratory Collapse Localizes to ~~~ ~~~ Cervical Trachea ~~~ Expiratory Collapse Localizes to ~~~ ~~~ Thoracic Thorax ~~~ 60% Diagnostic Fluoroscopy ~~~ Evaluates All Phases of Respiration ~~~ Grades Tracheal Collapse ~~~ Foreign Bodies ~~~ Mass Lesion ~~~ Identify Mainstem Bronchial Collapse Tracheal Wash ~~~ Cytology ~~~ Culture ~~~ Indicated For ~~~ ~~~ Recent Worsening of Clinical Signs ~~~ ~~~ via ~~~ ~~~ ~~~ Bacterial Bronchitis ~~~ ~~~ ~~~ Allergic Bronchitis |
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How will you Medically Treat Tracheal Collapse in Dogs?
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Weight Loss
~~~ Obese Patients Harness ~~~ Instead of Collar Avoid Environmental Exacerbation ~~~ Dust ~~~ Smoke ~~~ Extreme Cold Airway Humidification ~~~ Perodically Avoid Behavioral Exacerbation ~~~ Extreme Excitement ~~~ ~~~ Pre-emptive Phenobarb before Medicine Exams etc ~~~ Overheating Bronchodilators ~~~ Mitigates concurrent Small Airway Dz Cough Suppressants ~~~ Especially During Acute Exacerbation of Signs Antibiotics ~~~ Only if Indicated by Tracheal Wash Cytology Corticosteroids ~~~ SHORT TERM ONLY ~~~ ~~~ 2 to 3 Days Max ~~~ Acute Severe Respiratory Distress ONLY |
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What Concurrent Disorders can make the Symptoms of Tracheal Collapse Acutely Worsen in an Adult Dog?
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Chronic Bronchitis
~~~ Permanent Airway Changes ~~~ ~~~ Squamous Metaplasia of Epithelium ~~~ ~~~ Increased Mucous Production ~~~ ~~~ Impaired Mucociliary Transport Laryngeal Paralysis ~~~ 30% of Dogs with Tracheal Collapse |
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When might Surgery be indicated in a Dog with Tracheal Collapse?
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Recommended for ALL Dogs with
~~~ Moderate to Severe Clincial Sighsn ~~~ ≥50% reduction of Tracheal Lumen ~~~ Clinical Signs Refractory to Medical Therapy Do It Before ~~~ Animal is in Severe Respiratory Distress Not Recommended for Dogs with ~~~ Laryngeal Paralysis or Collapse ~~~ Generalized Cardiomegaly ~~~ Bronchial Collapse ~~~ Bronchitis ~~~ Chronic Pulmonary Dz |
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What is the Best Surgery for Tracheal Collapse in a Dog?
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Extraluminal Prostheses
~~~ Individual Rings ~~~ Spiral Ring ~~~ Cervical Trachea ~~~ Thoracic Trachea ~~~ ~~~ Most Proximal Portion ONLY Intraluminal Stents ~~~ Serious Complications ~~~ Thoracic Trachea ~~~ ~~~ Salvage for Severe Refractory Collapse |
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What finding would Contraindicate Surgical Treatment of Tracheal Collapse in a Dog?
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Mainstem Bronchial Collapse
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When you are presented with a Dyspneic Cat, What Clinical Findings will convince you that the Most Likely Diagnosis is Asthma?
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Cough
~~~ Elicits with Gentle Tracheal Palpation Auscultation ~~~ Wheezing ~~~ Crackles Paroxysmal Respiratory Difficulty Sneezing Retching ~~~ +/- Vomiting Best Dx ~~~ Tracheal Wash Cytology ~~~ ~~~ ≥20% Eosinophils Most Cats ~~~ ~~~ Predominant Cell is Often Neutrophils ~~~ Do NOT Perform in Acutely Dyspneic Cat ~~~ ~~~ Broncho Constriction = Death = Law Suit |
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How will you treat a Cat in Status Asthmaticus?
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Oxygen
Bronchodilator ~~~ If Cat can make it another 30 minutes ~~~ ~~~ Aminophylline PO ~~~ ~~~ Terbutaline PO ~~~ In a bit of a Hurry ~~~ ~~~ Aminophylline IM or Slow IV ~~~ Would REALLY Like to SAVE the CAT NOW ~~~ ~~~ Terbutaline SQ Epinephrine SQ or IV ~~~ Watch the Arrhythmias Atropine ~~~ Block Vagal Bronchoconstrictive Drive Glucocorticoids ~~~ Prednisolone Sodium Succinate IV or IM ~~~ Dexamethasone IV |
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After successful treatment of a Cat in Status Asthmaticus what are the Options for Long Term Medical Management?
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Avoid Exposure to Environmental Triggers
~~~ Smoke ~~~ Dusty Litter Box ~~~ Aerosols Maintain Adequate Airway Hydration ~~~ Systemic Hydration ~~~ Kitty Steam Baths ~~~ ~~~ Only Helps Upper Airways ~~~ Ultrasonic Nebulizer Tx ~~~ Deep Breathing ~~~ ~~~ Active Play ~~~ ~~~ Coupage Antimicrobials ~~~ Only If Tracheal Wash Yields Isolates ~~~ Base on Sensitivity ~~~ First Line ~~~ ~~~ Clavamox ~~~ Mycoplasma ~~~ ~~~ Doxycycline Bronchodilators ~~~ Only in Conjunction with Steroids ~~~ Theophylline Aerosol ~~~ Terbutaline Aerosol Steroids ~~~ Aerosol ~~~ Routinely in Cats with Eosinophilic Airway Dz ~~~ Helpful in Cats With ~~~ ~~~ Non Eosiniphilic Bronchitis ~~~ ~~~ ~~~ Once Secondary Infections Controlled ~~~ ~~~ ~~~ Acute ~~~ ~~~ ~~~ Chronic ~~~ High Dose ~~~ ~~~ 3 Weeks ~~~ Taper ~~~ ~~~ Over 3 Weeks ~~~ ~~~ q24 Hrs to E3D ~~~ Repository Injections (DepoMedrol) ~~~ ~~~ NIET ~~~ ~~~ ~~~ Unless you want to Induce Refractory Dz Cyproheptadine ~~~ Cats that are Still Symptomatic on High Dose Bronchodilators and Steroids ~~~ Reverses Serotonin Mediated Bronchoconstriction |
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Radiographically, what is the difference between a Vascular pattern, a Bronchial pattern, an Alveolar pattern and an Interstitial pattern?
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Vascular Pattern
~~~ Mismatch of Artery and Vein Size ~~~ Cranial Lobes on Lateral View ~~~ ~~~ Pulmonary Artery Dorsal to Bronchus ~~~ ~~~ Pulmonary Vein Ventral to Bronchus ~~~ Caudal Lobes on VD View ~~~ ~~~ Pulmonary Artery Lateral to Bronchus ~~~ ~~~ Pulmonary Vein Medial to Bronchus Bronchial Pattern ~~~ Tram Lines and Doughnuts ~~~ Bronchial Dilation ~~~ Bronchial Wall Thickening Alveolar Pattern ~~~ Air Bronchograms ~~~ ~~~ Visible Stripes of Air ~~~ Opaque Alveoli Silhouette Airways Interstitial Pattern ~~~ Reticular Pattern ~~~ ~~~ Present in Younger Animals ~~~ ~~~ Increased in Older Animals ~~~ ~~~ Thickening of Interstitium via ~~~ ~~~ ~~~ Fluid ~~~ ~~~ ~~~ Cells ~~~ Nodular Pattern ~~~ ~~~ Focal Interstitial Accumulations of Cells |
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Name One Dz that Can Result in each of the following Bronchial Patterns in a Dog: Vascular Pattern
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Vascular Pattern
~~~ Arteries Bigger than Veins ~~~ ~~~ Pulmonary Hypertension ~~~ ~~~ ~~~ ie Mitral Valve Insufficiency ~~~ ~~~ Pulmonary Thromboembolism ~~~ ~~~ Heartworm Dz ~~~ Veins Bigger than Arteries ~~~ ~~~ Congestion ~~~ ~~~ ~~~ Left Side Heart Failure ~~~ Both Arteries and Veins Enlarged ~~~ ~~~ Left to Right Shunts ~~~ ~~~ ie PDA, VSD, ASD |
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Name One Dz that Can Result in each of the following Bronchial Patterns in a Dog: Bronchial Pattern
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Bronchial Pattern
~~~ Feline Bronchitis ~~~ Allergic Bronchitis ~~~ Bacterial Bronchitis ~~~ Pulmonary Parasites ~~~ +/- Bacterial Pneumonia |
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Name One Dz that Can Result in each of the following Bronchial Patterns in a Dog: Alveolar Pattern
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Alveolar Pattern
~~~ Pulmonary Edema ~~~ ~~~ Left Side Heart Failure ~~~ Bacterial Pnemonia ~~~ Aspiration Pneumonia ~~~ Pulmonary Hemorrhage ~~~ ~~~ Contusion ~~~ ~~~ Thrombolembolism, Systemic Coagulopathy ~~~ ~~~ Neoplasia ~~~ ~~~ +/- Mycotic Pneumonia |
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Name One Dz that Can Result in each of the following Bronchial Patterns in a Dog: Interstitial Pattern.
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Interstitial Pattern
~~~ Reticular ~~~ ~~~ Pulmonary Edema (Mild) ~~~ ~~~ Allergic Lung Dz (PIE – Pulmonary Infiltrate with Eosinophils) ~~~ ~~~ +/- Bacterial Pneumonia ~~~ ~~~ +/- Viral Pneumonia ~~~ ~~~ Neoplasm ~~~ ~~~ Pulmonary Fibrosis ~~~ Nodular ~~~ ~~~ Mycotic Pneumonia ~~~ ~~~ ~~~ Diffuse Nodular (Typically) ~~~ ~~~ Neoplasm ~~~ ~~~ Parasites ~~~ ~~~ ~~~ Aelurostrogylus ~~~ ~~~ ~~~ Paragonimus ~~~ ~~~ Abscess ~~~ ~~~ PIE |
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What are the Specific Recommended Treatments for Bacterial Pneumonia?
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Antimicrobials
~~~ IV if Severe Illness ~~~ Base on Sensitivity ~~~ Before Sensitivity Results ~~~ ~~~ Cephalexin ~~~ ~~~ TMS ~~~ ~~~ Clavamox Cats with Consolidated Lung ~~~ Clindamycin Documented RESISTANT G-ve Infection ~~~ Enrofloxacin Duration ~~~ Past Clinical and Radiologic Dz Resolution ~~~ ~~~ Min 2 Weeks ~~~ Typically ~~~ ~~~ 4 to 8 Weeks |
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How can a Diagnosis of Pulmonary Neoplasia be made if a Tracheal Wash is NON Diagnositic?
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Clinical Signs
~~~ Dogs ~~~ ~~~ Nonproductive Cough ~~~ Cats ~~~ ~~~ Weight Loss ~~~ ~~~ Lethargy Radiographs ~~~ Primary (ie Pulmonary) ~~~ ~~~ Discrete Mass in ONE Lung Lobe (usually) ~~~ Secondary ~~~ ~~~ Multiple Masses FNE Aspirates ~~~ Can Confirm |
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What is the Optimal Surgical Approach for Removal of a Primary Lung Tumour in the Right Middle Lobe?
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Lateral (Intercostal) Thoractomy
~~~ 5th Intercostal Space on Right Provides Best Exposure For ~~~ Lobectomy ~~~ Lymphnode Biopsy |
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What are the Major Complications related to Surgical Removal of a Primary Lung Tumour in the Right Middle Lung Lobe?
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Hemorrhage
Pneumothorax Lameness ~~~ via Severing Latissimus dorsi ~~~ usually Resolves within 2 Days Subcutaneous Edema or Seroma ~~~ Ventral Aspect of Incision (occasional) |
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What are the Common Surgical Approaches to the Thoracic Cavity?
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Intercostal (Lateral) Thoracotomy
Median Sternotomy |
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What are the Advantages and Disadvantages of the Common Surgical Approaches to the Thoracic Cavity?
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Intercostal Thoractomy
~~~ Good ~~~ ~~~ Lobectomy ~~~ ~~~ Heart ~~~ ~~~ Most Great Vessels ~~~ ~~~ Lymphnodes ~~~ Bad ~~~ ~~~ Bilateral Removal of Pericardial Sac ~~~ ~~~ Compromised Ventilation ~~~ ~~~ ~~~ Good Lung will be Dependent Median Sternotomy ~~~ Good ~~~ ~~~ Bilateral Partial Lobectomy ~~~ ~~~ Caudal Vena Cava ~~~ ~~~ Main Pulmonary ??? ~~~ ~~~ Both Sides of Pericardial Sac ~~~ Bad ~~~ ~~~ Complete Lobectomy ~~~ ~~~ Delayed Healing via Sternebral Shifting ~~~ ~~~ ~~~ tf Leave as Many Intact as Possible |
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What is the Typical Clinical Presentation (Signs, Test Results) in a Dog with Blastomycosis?
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Fever
Coughing Dyspnea Anorexia Nasal Discharge Progressive Loss of Condition Subcutaneous Granulomas ~~~ Purulent ~~~ Ulcerative Uveitis Chorioretinitis Chest Rads ~~~ Diffuse Nodular Interstitial Pattern ~~~ Enlarged Bronchial Lymphnodes |
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What Organs besides Lung are Often involved in Blastomycosis in a Dog?
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Skin
Eyes Bone |
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What Tests can help make a Diagnosis of Blastomycosis in a Dog?
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Cytology
~~~ Tracheal Wash ~~~ BAL ~~~ Transthoracic Biopsy ~~~ Granulomatous Skin Nodules ~~~ Thickwalled Refractile Single Budding Yeasts Serology ~~~ Paired Samples ~~~ AGID for AntiBody Fungal Isolation ~~~ Definitive ~~~ Difficult and Time Consuming |
