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345 Cards in this Set
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List two environmental organisms that may cause fungal rhinitis.
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Aspergillus fumigatus
Penicillum spp. |
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Is it possible for a nasal swab to turn up fungal colonization without causing clinical signs?
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Yes
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True or false: Fungal rhinitis is associated with immunocompromise
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False
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Does fungal rhinitis stay local or go systemically?
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Local usually
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What kind of dog breeds are more susceptible to nasal aspergillosis?
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Dolichocephalic breeds
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Describe the discharge typically seen with canine nasal aspergillosis.
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Unilateral at onset
Mucopurulent to epistaxis |
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This pathogen can cause ulceration and depigmentation of the nares.
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Aspergillus fumigatus
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You are radiographing the nasal cavity of a dog with unilateral mucopurulent nasal discharge and you see turbinate atrophy and destruction on the R side of the skull. The right frontal and maxillary sinuses are opaque too. What is a likely differential?
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Nasal aspergillosis
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Turbinate atrophy seen with nasal depigmentation and ulceration is consistent with...
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Nasal aspergillosis
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How would you collect a diagnostic sample for nasal Aspergillus infection?
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Rhinoscopy
Traumatic nasal flush Blind nasal rhinoscopy -- NOT nasal exudate!!! |
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On nasal cytology you see branching, non-pigmented septate hyphae. This is consistent with the appearance of...
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Aspergillus
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Diagnosis of nasal aspergillus is definitively made based on demonstration of...
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Fungal invasion of tissues
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Describe the usefulness of an antigen test for nasal aspergillosis.
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Inconclusive w/o other evidence b/c may be part of normal flora.
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Drug of choice for treatment of nasal aspergillosis.
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Clotrimazole
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List two ways to administer clotrimazole to treat nasal aspergillosis.
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Catheter/tube into nose
Trephination |
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Describe the tube method of treating nasal aspergillosis with clotrimazole.
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Protect airway (ETT and pack off pharynx)
2 catheters thru external nares Infuse clotrimazole Let patient sit for 15-20 mins in each psoition: Dorsal, sternal, R and L lateral |
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True of false: Even if aspergillosis is only evident in one nostril, treatment should be bilateral
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True
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Which sinus is most commonly trephined in the dog to treat nasal aspergillosis?
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Frontal
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How often and for how long should the sinuses be infused with clotrimazole to treat nasal aspergillosis?
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Once daily for 3-4 days
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Cure rate for a single infusion of clotrimazole into the nasal cavity in cases of nasal aspergillosis.
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90%
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Infusion may be repeated if nasal aspergillosis does not improve this long after treatment.
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2 weeks
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A complication of nasal aspergillosis in 25% of affected dogs.
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Bacterial rhinitis
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If you treat nasal aspergillosis systemically, which drug is most effective: Ketoconazole or itraconazole?
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Itraconazole
(65% cure rate versus 50% cure rate with ketoconazole) |
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When treating nasal aspergillosis systemically, expect improvement within...
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Couple of weeks
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Usual duration of systemic treatment for nasal aspergillosis.
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Several months
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Is nasal cryptococcosis usually associated with immunocompromise?
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No
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How is Cryptococcus usually acquired?
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Inhalation
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Is Cryptococcosis usually a nasal cavity local disease or does it go systemically?
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Local
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This feline nasal disease is associated with sneezing and nasal discharge, facial swelling, nodular skin lesions, ophthalmic signs, lymph node enlargement, and neurologic signs. A "Roman nosed" appearance is characteristic.
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Nasal cryptococcosis
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To diagnose Cryptococcus via cytology, you would need one of these samples.
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Nasal and cutaneous exudates
CSF analysis |
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These fungal organisms affect the nasal cavity and are identified easily by their large polysaccharide capsule.
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Cryptococcus
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Treat Cryptococcus until the capsular antigen titer...
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Is negative
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First choice for treatment of nasal cryptococcosis.
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Itraconazole
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How long should treatment for Cryptococcus be given?
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At least 2 months
1 month past resolution of CS Until titer is negative |
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3 drugs that may be used to treat cryptococcosis.
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Itraconazole (1st)
Fluconazole Ketoconazole |
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How is the magnitude of a Cryptococcus titer related to prognosis?
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Not related
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True or false: Treatment for Cryptococcus may extend into chronic maintenance dosing in some cats.
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True
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How frequently are nasal neoplasms malignant in the dog?
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80-90%
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Two common sites to which nasal neoplasias may metastasize
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Lung
Regional lymph nodes |
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These dog breeds are predisposed to nasal neoplasias.
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Dolichocephalic breeds
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Dogs of this age group are more likely to have nasal neoplasia.
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Over 8 years
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In an older patient with a chronic history of nasal disease, a primary rule-out may be...
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Nasal neoplasia
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Most common nasal tumor in dogs.
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Carcinoma
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2nd most common nasal tumor of dogs
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Sarcoma
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List some clinical signs associated with nasal neoplasia.
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Unilateral nasal discharge (mucopurulent to hemorrhagic)
Sneezing Nasofacial deformity Epiphora Exophthalmia Stertorous respiration Dyspnea Oral cavity invasion Neurologic signs if intracranial metastasis |
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Prognosis of dog with nasal neoplasm without treatment.
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3-6 months
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Prognosis of dog with nasal neoplasm who receives surgery.
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3-6 months
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When nasal neoplasms are treated with radiotherapy, what is the estimated survival time?
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12-16 months
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List three factors that influence survival time with nasal neoplasms.
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Histologic tumor type
Clinical stage Species |
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True or false: Dogs with nasal neoplasms have a better prognosis than do cats.
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False. Cats do better.
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From where do feline nasopharyngeal polyps originate?
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Inner ear
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Cause of feline nasopharyngeal polyps
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Sequela of chronic inflammation, often caused by viral upper respiratory infection
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Do feline nasopharyngeal polyps typically occur unilaterally or bilaterally?
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Unilaterally
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Nasopharyngeal polyps occur in this age group of cats most frequently
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Under 5 years
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Clinical signs associated with nasopharyngeal polyps include...
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Stridor
Sneezing Nasal discharge Change in voice/dysphagia Vestibular signs |
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How is a nasopharyngeal polyp diagnosed?
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Visualize during oral or otoscopic exam
Radiographic eval of tympanic bullae |
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How are nasopharyngeal polyps treated?
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Traction/avulsion (30-40% recur)
Ventral bulla osteotomy (Recurrence rate under 2%) |
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Possible complications of treatment for nasopharyngeal polyps
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Horner's syndrome
Recurrence |
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Is Horner's syndrome more common following a traction/avulsion of a nasopharyngeal polyp or bulla osteotomy?
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Bulla osteotomy
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List three mycotic lung diseases.
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Blastomycosis
Histoplasmosis Coccidiomycosis |
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Describe the pathenogenesis of Blastomycosis.
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Spore inhalation
Pulmonary infection Hematogenous dissemination by leukocytes |
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True or false: Blastomyces is a dimorphic fungus.
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True
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List some of the respiratory signs associated with blastomycosis.
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Exercise intolerance
Dyspnea Coughing Crackles, wheezes Increased breath sounds |
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This body system is affected in 85% of Blastomycosis cases.
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Respiratory
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List some non-respiratory CS associated with blastomycosis.
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Lameness
Draining skin lesions Undulant fever Ocular signs (uveitis, chorioretinitis) Lymphadenopathy |
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Which bones tend to be affected by Blastomyces?
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Long bones of appendicular skeleton
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List some lab findings associated with Blastomycosis.
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Non-regenerative anemia
Leukocytosis, lymphopenia Polyclonal gammopathy Hypercalcemia |
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Why can blastomycosis be associated with hypercalcemia?
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Causes granulomatous reaction
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A miliary interstitial lung pattern is associated with this group of diseases.
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Mycotic pneumonias
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Is the periosteal reaction caused by Blastomyces diffuse or pallisading?
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Diffuse
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You do cytology on a transtracheal wash and see basophilic yeasts with thick, refractile double walls. This is characteristic of...
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Blastomycosis
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Which is better for diagnosis Blastomycosis: Ab or Ag testing?
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Antigen testing: Superior se/sp
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Inflammation type associated with blastomycosis.
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Granulomatous
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Treatment for Blastomycosis includes a combination of these drugs...
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Azole antifungals (Itraconazole/Ketoconazole)
Amphotericin B |
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Recovery rate of blastomycosis when treated.
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80%
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Most deaths from blastomycosis occur within...
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First 7 days of treatment
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Negative prognostic indicators seen with blastomycosis
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Severe dyspnea and lung disease
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What is the mechanism behind treatment-associated death in cases of blastomycosis?
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Inflammatory response generated by rapid fungal die-off.
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How long should treatment for blastomycosis last?
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1. Expect at least 3-6 months
2. Treat one month past resolution of CS 3. May need to treat forever. |
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Describe the pathenogenesis of histoplasmosis.
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Microconidia inhalation
Pulmonary infection Hematogenous dissemination |
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Fungal respiratory pathogen prevalent in the US Midwest
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Histoplasma
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Fungal respiratory pathogen prevalent in the SE US.
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Blastomyces
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Clinical signs associated with Histoplasmosis.
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Respiratory CS
Lymphadenopathy Hepatospenomegaly Weight loss Icterus Fever Ophthalmic lesions |
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How do the clinical signs for histoplasmosis differ from blastomycosis?
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Histoplasma causes cranial abdominal organ enlargement, GI mucosal invasion, V/D, uveitis
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This fungal disease may cause non-regenerative anemia, cytopenia, and fulminant hepatic disease with DIC.
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Histoplasmosis
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On a cytology, you find small, thick celled intracellular yeasts clustered within macrophages. The yeasts each have a clear "halo" around them. This is consistent with the appearance of...
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Histoplasma
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Hepatic and splenic enlargement are associated with this mycotic disease.
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Histoplasmosis
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Where can Histoplasma organisms be found for cytologic sampling?
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Intestinal mucosa
Spleen and liver Bone marrow Lung LN |
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Where can Blastomyces organisms be found for cytologic sampling?
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Draining skin lesions
Transtracheal wash LN |
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How useful is the antibody test for diagnosis of histoplasmosis?
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Not useful. Must demonstrate organism.
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Treatment for an uncomplicated case of histoplasmosis. (Drug and duration)
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Itraconazole for a minimum of 2-4 months
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Treatment for a fulminant case of disseminated histoplasmosis.
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Amphotericin B +/- itraconazole
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Prognosis for pulmonary histoplasmosis.
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Good to fair
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Prognosis for disseminated histoplasmosis.
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Guarded to grave
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Fungal disease prevalent in SW US.
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Coccidiomycosis
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This fungal respiratory agent is unique in that it is spread by both hematogenous and lymphatic distribution.
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Coccidioides
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Describe the pathenogenesis of coccidiomycosis.
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Inhalation of mycelial arthrospores
Spore transformation in lung to spherule Hemotogenous and lymphatic distribution |
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A dog presents with a history of wt loss, fever, inappetance, localized lymphadenopathy and bone swelling of the R hindlimb, a draining skin lesion on the R 3rd digit, and chorioretinitis. No significan historical data except that the dog just went on vacation to the Grand Canyon with its owner. What is a primary ruleout?
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Coccidiomycosis
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On a chest radiograph of a dog with coccidiomycosis, what kinds of lesions would you expect to see?
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Milary to nodular interstitial pattern
Hilar lymphadenopathy |
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List two fungal respiratory agents that may cause proliferative lesions on bones of the appendicular skeleton.
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Blastomyces
Coccidioides |
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Describe the challenges assoicated with diagnosing coccidiomycosis.
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Organism hard to find on cytology
Arthrospores are infectious to humans so culture is hazardous. |
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How is coccidiomycosis diagnosed?
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Antibody test and compatible CS
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Drug of choice for treatment of coccidiomycosis.
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Ketoconazole
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Prognosis for coccidiomycosis.
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Very good. 90% improve, and 60% recover completely
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How long must coccidiomycosis be treated?
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Simple case: 1 month past resolution of CS.
If 2+ organ systems affected, treat minimum of 1 year |
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Species responsible for verinous pneumonia in cats.
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Aelurostrongylus abstrusus
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Where do feline lungworms reside in the lungs?
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Terminal bronchioles and alveoli
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How are feline lungworms transmitted?
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Live and reproduce in lungs
Transtracheal migration, larvae pass into feces. Slugs eat larvae Cats eat slug or transport host Cycle begins anew |
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Most common clinical sign associated with verminous pneumonia
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Asymptomatic
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Respiratory signs associated with verminous pneumonia.
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Dry, non-productive cough
Wheezes Dyspnea |
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Most common method for diagnosing Aelurostrongylus abstrusus infection
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Routine fecal floatation
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Four methods for diagnosing Aelurostrongylus abstrusus
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Fecal floatation--larvae
Throacic radiographs (patchy alveolar infiltrate) TTW- eosinophils Hemogram-- eosinophils |
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Treatment for Aelurostrongylus abstrusus infection
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Ivermectin, 1 SQ injection
OR Fenbendazole bid for 2 weeks |
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Lung fluke of dogs and cats
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Paragonimus kellicotti
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Where do Paragonimus flukes reside in the host?
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Cystic structures in pulmonary parenchyma
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Describe the life cycle of Paragonimus kellicotti.
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Adult flukes in lung lay eggs
Eggs coughed up and swallowed---> Passed in feces Snail eats egg IH eats snail Dog eats IH |
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Clinical signs associated with Paragonimus kellicotti infestation.
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Subclinical
Coughing, wheezing, dyspnea |
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How is Paragonimus kellicotti diagnosed?
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Thoracic radiography (pulmonary cysts, secondary inflammation, pneumothorax)
TTW or fecal (operculated ova) |
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What radiographic signs are seen on a thoracic radiograph with Paragonimus infestation?
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Pulmonary cysts
Secondary inflammation Pneumothorax |
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This parasite can cause spontaneous pneumothorax when cystic lesions spontaneously pop.
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Paragonimus kellicotti
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Singet ring lesions on thoracic radiograph are indicative of bullous cystic lesions often caused by...
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Paragonimus kellicotti
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How is Paragonimus infestation treated in cats and dogs?
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Fenbendazole bid for 2 weeks in either species
Praziquantel tid for 2 weeks in dogs |
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In which species is primary lung cancer more common: cats or dogs?
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Dogs
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Most common primary lung tumor of dogs and cats
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Adenocarcinoma
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How common is primary lung cancer in dogs and cats?
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Uncommon
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How common is metastatic lung cancer in dogs and cats?
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Very common
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List some sources of secondary lung cancer.
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Thyroid, mammary carcinoma
OSA, chondrosarcoma Hemangiosarcoma Malignant melanoma |
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Most frequent respiratory sign of lung cancer.
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Cough
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List some respiratory CS of lung neoplasia.
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Cough
Hemoptysis Dyspnea, tachypnea Exercise intolerance Crackles, wheezes |
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List some non-respiratory CS seen with lung cancer.
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Cachexia
Lameness seen with hypertrophic osteodystrophy |
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Diffuse pallisading periosteal reaction that ascends up the metacarpals/metatarsals in response to a pulmonary tumor.
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Hypertrophic osteodystrophy
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This kind of lung neoplasia (primary/secondary) usually appears as a solitary soft tissue nodule that may be solid or cystic.
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Primary
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This kind of lung neoplasia (primary/secondary) usually appears with miliary or diffuse "popcorn" lesions.
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Secondary
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How can one differentiate the miliary pattern of mycotic pneumonia from that of metastatic neoplasia?
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Neoplastic nodules will be more discrete
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This species may develop Lung-Claw Syndrome as a sequelum of lung neoplasia.
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Cat
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A cat comes in with severe lameness and swelling of his front digits. On radiograph, there are numerous expansile and osteoproductive lesions in the digits of both the left and right limbs. Aspirates of the masses show ciliated respiratory epithelium! What is the likely problem?
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Metastatic neoplasia originating from a primary lung tumor.
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Treatment for primary lung tumor.
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Lung lobectomy
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Treatment for secondary lung tumors
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Metastatectomy (palliative)
Chemotherapy |
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Prognosis for lung neoplasia
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Guarded to grave
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The prognosis for lung neoplasms is better if the mass is under this size
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3 mm
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List a major negative prognostic indicator in lung neoplasia.
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Hilar lymphadenopathy
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Immune mediated hypersensitivity reaction of dogs, usually idiopathic in origin.
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Eosinophilic bronchopneumopathy
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Clinical signs associated with eosinophilic bronchopneumopathy.
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Chronic cough +/- productivity
Exercise intolerance/dyspnea Crackles, wheezes |
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How is eosinophilic bronchopneumopathy diagnosed?
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Hemogram--> eosinophils
Thoracic radiographs (interstitial pattern hilar pneumopathy, pulmonary vascular change) Cytology to confirm DX |
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Cytology samples to diagnose eosinophilic bronchopneumopathy should be taken in one of these 3 ways.
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TTW, BAL, lung aspirate
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Eosinophilic inflammation seen on a BAL is consistent with this lung disease.
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Eosinophilic bronchopneumopathy
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Eosinophilic bronchopneumopathy is occasionally seen in association with...
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Heartworm disease
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Radiographic patterns seen with eosinophilic bronchopneumopathy.
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Severe miliary-interstitial pattern
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Treatment for eosinophilic bronchpneumopathy.
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Prednisone at immunosuppressive dose
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Long term treatment for eosinophilic bronchopneumopathy is based on...
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CS resolution
Thoracic radiographs |
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An obstructive vascular disease that causes V/Q mismatching.
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Pulmonary thromboembolism
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What are the three thrombotic risk factors of Virchow's triad?
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Vascular stasis
Endothelial damage Hypercoagulability |
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How can PLE lead to a pulmonary thromboembolism?
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Lose antithrombin III, which causes hypercoagulability
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List some diseases that can predispose an animal to pulmonary thromboembolism.
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Cardiac disease
IMHA DIC Pancreatitis Sepsis Cushing's disease/steroids Neoplasia Hypoalbuminemia |
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List some clinical signs associated with pulmonary thromboembolism.
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Peracute onset severe dyspnea
Cough, hemoptysis, exercise intolerance |
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An angiogram would be useful to diagnose this respiratory disease.
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Pulmonary thromboembolism
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How does pulmonary thromboembolism cause respiratory distress?
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Prevents gas exchange between alveolus and blood
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If an animal is too dyspneic to undergo anesthesia for an angiogram, how can pulmonary thromboembolism be diagnosed?
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Thoracic radiograph showing interstital pattern + predisposing disease like IMHA
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Why is oxygen not necessarily an effective treatment for pulmonary thromboembolism?
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Oxygen may reach the lungs but it cannot diffuse into the bloodstream.
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Describe the treatment for fulminant PTE.
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Treat underlying disease
Heparin to prevent +/- bronchodilators, oxygen |
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Prognosis for pulmonary thromboembolism.
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Very poor. Many patients die
Prevention is best policy |
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Accumulation of lymph in the pleural space
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Chylothorax
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How does elevated central venous pressure contribute to chylothorax?
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Impedes empting of thoracic duct into the cranial vena cava
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True or false: Traumatic thoracic duct avulsion requires surgical repair.
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False. Collateral lymphatic circulation usually established within 3 days.
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Possible etiologies of chylothorax include...
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Trauma-- rarely
Neoplasia Cardiac disease Dirofilariasis Lung lobe torsion Diaphragmatic hernia Caval thrombosis Idiopathic |
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Most common cause of chylothorax
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Idiopathic (60-70%)
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Describe chyle.
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Grossly pink to white
Opaque Cream layer rises after standing |
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What comprises the "cream" layer of chyle that rises to the top of a standing sample?
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Chylomicrons
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Is chyle a transudate, modified transudate, or exudate?
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Modified transudate to exudate
(High cellularity and TP) |
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Primary cell type in chyle.
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Small lymphocytes
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How does the trigylceride content of chyle compare to that of serum?
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Chyle has higher TG level
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Chyle will have a pleural cholesterol: pleural TG ratio within this range.
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Under 1 (more TG)
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When may chyle have a low triglyceride level?
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Anorectic patient
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Silent chest is a trademark sign of...
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Pleural effusion
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First treatment for a dyspneic patient with silent chest.
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Thoracocentesis
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Treatment for pleural effusion that can be both diagnostic and therapeutic.
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Thoracocentesis
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Why in a patient with pleural effusion would you do thoracocentesis before radiographs?
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1. Alleviates dyspnea
2. Thoracic structures more easily visualized |
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Treatment for chylothorax
|
Treat primary disease to stem pleural effusion
Thoracocentesis may need to be repeated PRN Surgery for idiopathic chylothorax |
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Best treatment for idiopathic chylothorax (highest success rate).
|
Thoracic duct ligation with partial pericardectomy.
90% success |
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List some surgical treatments for idiopathic chylothorax
|
Thoracic duct ligation
Pleuroperitoneal drainage Duct ligation plus partial pericardectomy |
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List some medical treatments for idiopathic chylothorax.
|
Low fat diet
MCT supplementation Intermittent thoracocentesis Rutin supplementation (reduces lymphatic leakage) |
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How is chylothorax associated with intestinal lymphangiectasia?
|
It isn't
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Why are MCT's fed to address chylothorax?
|
Bypass lymphatic transport systems
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How does Rutin treat idiopathic chylothorax?
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Reduces lymphatic leakage
Increases lymphatic protein removal and macrophage phagocytosis |
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Success rate in using Rutin to treat idiopathic chylothorax
|
50% improve or resolve
|
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When is surgery NOT the best treatment for idiopathic chylothorax?
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Restrictive pleuritis present
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Chronic pleural effusion may lead to...
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Restrictive pleuritis
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Persistent respiratory distress in a chylothorax patient that remains after thoracocentesis may be the result of...
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Restrictive pleuritis
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True or false: Chyle is a benign, non-irritating body fluid.
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False. May cause inflammatory to restrictive pleuritis
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When lungs are fibrosed into place and can no longer expand effectively, this is known as...
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Restrictive pleuritis
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True or false: Neoplastic pleural effusions sometimes exfoliate tumor cells into the fluid.
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True
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This kind of pleural effusion varies widely in composition depending upon its cellular cause. It may be hemorhhagic, inflammatory, neoplastic, or obstructive in nature.
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Neoplastic pleural effusion
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This pleural neoplasia requires histologic confirmation and cannot be diagnosed solely on effusion fluid.
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Mesothelioma
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Most pleural neoplasms may be diagnosed by...
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Pleural fluid cytology
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In cases of pleural effusion, if more than 2 chest taps must be done within 24h, this next step should be taken.
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Chest tube
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This pleural neoplasm is treated with a combination of chemo and radiation.
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Lymphosarcoma
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This pleural neoplasia is treated with intracavitary chemotherapy and carries a very poor prognosis.
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Mesothelioma
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This pleural neoplasm is treated with surgical excision, chemo, and radiation.
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Thymoma
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Accumulation of air in the pleural space is referred to as...
|
Pneumothorax
|
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List the two major classifications of pneumothorax
|
Traumatic
Spontaneous |
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Which is more common: Traumatic pneumothorax or spontaneous pneumothorax?
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Traumatic
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Spontaneous pneumothorax is most common in which species: Dog or cat?
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Dog
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List some causes of spontaneous pneumothorax.
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Neoplasia
Abcess, pneumonia Heartworm disease Bronchial disease Idiopathic bullae Paragonimus infestation |
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List some clinical signs associated specifically with spontaneous pneumothorax
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Anorexia and wt loss
Exercise intolerance Cough |
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List some clinical signs associated specifically with traumatic pneumothorax
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History of trauma
Concurrent wounds or fractures |
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List some clinical signs associated with pneumothorax regardless of etiology.
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Dyspnea
Cyanosis Muffled cardiac sounds Silent chest |
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List some Roentgen signs associated with pneumothorax.
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Retraction of pleura away from chest wall
Radiolucent space between lung and chest wall Dorsal displacement of heart Atelectasis of lung Lung margins don't extend to chest wall |
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Minor lung lacerations causing pneumothorax will usually resolve within...
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24-48h
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Typical treatment for traumatic pneumothorax
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Cage rest
Intermittent thoracocentesis or thoracostomy tube |
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Most common cause of generalized SC emphysema
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Laceration of cervical portion of trachea
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Treatment protocol for spontaneous pneumothorax
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Conservative Tx for 2-4 days (rest, thoracocentesis or chest tube)
If persistent pneumothorax, surgical repair of inciting cause |
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True or false: Most cases of spontaneous pneumothroax require surgical repair.
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True
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These characteristics are non-traditional descriptors of lung radiographic patterns.
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Increased opacity
Distribution Rings and lines Size of lobe |
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Source of most radiographic opacity seen in normal lung
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Blood vessels
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Homogenous, uniform radiographic lung opacity that varies from solid and opaque to faint or fluffy. Result of fluid or exudate filling the air spaces of the lung
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Alveolar
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Lobar sign, silhouetting, and air bronchograms are all indicators of severity with this radiographic lung pattern.
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Alveolar
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Most common and most severe radiographic lung pattern.
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Alveolar
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Radiographic silhouetting of the heart may be seen with these diseases...
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Severe alveolar pattern
Pleural effusion Mediastinal mass |
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Diseases that cause this radiographic pattern tend to progress or resolve quickly.
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Alveolar pattern
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These two forms of pneumonia tend to be ventrally distributed.
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Aspiration
Bronchopneumonia |
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This form of pneumonia is usually diffusely distributed.
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Hematogenous
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List three major causes of an alveolar lung radiopacity.
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Pneumonia
Edema Hemorrhage |
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If a thoracic radiograph shows a hilar alveolar pattern, how can you determine whether or not it is cardiogenic in origin?
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Look at heart size
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This condition will create an alveolar pattern on one side with a mediastinal shift toward the affected side.
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Atelectasis
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How can you determine whether atelectasis is persistent or merely due to immobility under anesthesia?
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After radiographic dx of atelectasis, inflate patient's lungs by bagging several times, and retake radiograph. See if alveolar pattern and mediastinal shift persist.
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This radiographic lung pattern is not uncommon to see in geriatric dogs.
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Linear interstitial pattern
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This radiographic lung pattern is marked by an overall increase in hazy, linear opacities. Vasculature is smudged but still visible. The appearance has been described as "ground glass."
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Linear interstitial pattern
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This radiographic lung pattern may appear as an artifact in an expiratory or underexposed radiograph.
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Linear intersitial pattern
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In a dog with a cough and a heart murmur, you see an interstital opacity in the hilar region of the lungs over the heart base. How can you determine whether or not it is due to cardiogenic pulmonary edema or due to an expiratory artefact?
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Take a DV view and see if the interstitial hilar patters persists.
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List some causes of a linear interstitial lung pattern on a thoracic radiograph.
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Artifact
Geriatric change Pulmonary edema Hemorrhage Pneumonia Neoplasia Fibrosis |
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In the event of pulmonary edema or pneumonia, which radiographic pattern indicates a more severe disease: alveolar or intersitital?
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Alveolar
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Radiographic lung pattern marked by single or multiple circumscribed opacities of varying sizes.
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Nodular intersitital pattern
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List some diseases that may cause a nodular intersitital pattern on a lung radiograph.
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Neoplasia
Fungal pneumonia Abcess Granuloma |
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In an older indoor dog with a nodular intersitital lung pattern on thoracic radiographs, what would your primary differential diagnosis be?
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Neoplasia
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In a younger, active dog with a nodular intersitital lung pattern on thoracic radiographs, what would your primary differential diagnosis be?
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Fungal pneumonia
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Primary cause of a nodular intersitital lung pattern on a thoracic radiograph in a foal.
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Rhodococcus abcesses
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In this radiographic lung pattern, there are thickened bronchial walls visible in the periphery as well as in the hilus. The end-on bronchi look like donuts, while the longitudinal thickened bronchi look like railroad tracks.
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Bronchial pattern
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List some possible causes of a bronchial lung pattern on radiograph.
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Bronchitis (especially chronic)
Feline asthma Pulmonary parasites Pneumonia |
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On a thoracic radiograph, the pulmonary veins appear much larger than their accompanying pulmonary arteries. What disease process is most likely occuring?
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Venous congestion of left sided heart failure
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to take
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,الأَخْذ,أَخَذَ يَأخُذ
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List the differential diagnoses for a patient who comes in with a "seizure."
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Seizure
Vestibular disease Cataplexy Syncope |
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Initial treatment for a patient with status epilepticus who is not hypocalcemic or hypoglycemic.
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Valium 0.5-1 mg/kg
May repeat 3 times at 10 min intervals |
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If valium is used to stop status epilepticus but ictus begins again 20 minutes later, what is the next course of action
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Another dose valium + phenobarbital (2-15 mg/kg)
Valium CRI |
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How long after administration does valium cross the BBB?
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3-5 minutes
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What is the course of action if valium has no effect on status epilepticus?
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Propofol induction
(Gas anesthesia as a last resort) |
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List some complications of status epilepticus?
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Metabolic abnormalities (hyperthermia and acidosis)
Cerebral and pulmonary edema Neuronal death and cortical necrosis |
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Primary epilepsy usually presents at this age
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1-5 years
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Why is phenobarb by itself not a good first-tier drug for treatment of status epilepticus?
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Takes 20 mins to cross BBB. So piggyback with valium if valium isn't working alone.
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Side effect of concern when using inhalant anesthetics as anticonvulsants.
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Dysregulation of cerebral blood flow
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When a propofol CRI is run for seizure control, it should initially run for how long?
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4 hours
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When bringing a dog out of a propofol CRI, if the animal starts to seize again, how should you respond?
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Re-induce propofol CRI and maintain for twice as long.
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How can you smooth the recovery from a propofol CRI?
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Add valium CRI or taper propofol rate
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Inflammatory brain diseases tend to emerge at this age.
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1-5 years
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What is the prognostic value of a Small Animal Coma Score?
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Lets you measure progress over time. One score is not enough to base a prognosis on.
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Goal in managing traumatic brain injury
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Maintain cerebral perfusion pressure
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What therapies are used to treat elevated intracranial pressure?
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Furosemide 2-5 mg/kg IV
Mannitol 0.5-1 mg/kg over 20 mins Elevate head Fluid therapy (low volume) Elevate head Avoid jugular vein compression |
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Four points of interest when evaluating coma patients
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Level of consciousness
Body posture PLR Brainstem reflexes |
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Three components of the Small Animal Coma Scale
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Motor activity
Brainstem reflexes Level of consciousness |
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Two benefits of mannitol diuresis
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Maintain blood flow
Osmotic diuresis from cerebral space |
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When the vestibular nuclei on one side are activated they stimulate the extensor muscles on which side?
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Ipsilateral
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When the vestibular nuclei on one side are activated they inhibit the extensor muscles on which side?
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Contralateral
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Severe head tilt is more commonly seen with this form of vestibular disease.
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Peripheral
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In the nystagmus seen with peripheral vestibular disease, the fast phase go away from or toward the lesion?
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Away
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In this form of vestiblar disease, nystagmus changes with body position.
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Central vestibular disease
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Postural reaction deficits most commonly occur with this form of vestibular disease
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Central
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Is Horner's syndrome more frequently associated with peripheral or central vestubular disease?
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Peripheral
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When does congenital vestibular disease usually manifest itself?
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Birth to 2 weeks of age
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Prognosis for congenital vestibular disease
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Good
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Is congenital vestibular disease usually peripheral or central?
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Peripheral
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Hyperthyroidism may cause this kind of vestibular disease.
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Peripheral
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Treatment for vestibular disease of neoplastic origin.
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Surgery +/- radiation +/- chemotherapy
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Prognosis for vestibular disease of neoplastic origin
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Guarded
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Acute non-progressive peripheral vestibular disease most commonly seen in geriatric dogs.
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Idiopathic vestibular disease
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True or false: Idiopathic vestibular disease is always peripheral in origin.
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True
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How long does it typically take for idiopathic vestibular disease to resolve?
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72h- 2 weeks
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Treatment for idiopathic vestibular disease
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None unless pt needs anti-nausea medication
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Most common cause of peripheral vestibular disease in dogs and cats
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Otitis media and otitis interna
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How is otitis interna diagnosed?
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Otic exam, myringotomy, imaging, culture
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Describe a myringotomy
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Puncture eardrum, infuse saline, aspirate fluid to flush debris
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What are some radiographic indicators of otitis media or interna?
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Thickened, opaque bullae that may point to inner ear involvement
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How is otitis media treated?
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Thorough flushing
4-6 weeks abx +/- bulla osteotomy |
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Prognosis of otitis media-associated vestibular disease
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Good
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List some drugs known to cause ototoxicity
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Aminoglycosides (polymixin B, erythromycin, vancomycin, chloramphenicol, monocycline)
Cisplatin Furosemide Salicylates Some ear flushes |
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True or false: Otic damage caused by aminoglycoside usage is reversible
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False :-(
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Most common signalment for Granlomatous Meningoencephalitis
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Young small female dogs
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How is granulomatous meningoencephalitis diagnosed?
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MRI, CT, CSF, biopsy
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How is granulomatous meningoencephalitis treated?
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Immunosuppressive steroid dose
Radiation |
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Prognosis for granulomatous meningoencephalitis
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Guarded.
Survival about 1 year |
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List two major infective causes of vestibular disease.
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Rocky Mountain Spotted Fever
Ehrlichiosis |
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Systemic signs associated with rickettsial diseases
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Retinal hemorrhage
Thrombocytopenia Lymphadenopathy |
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How is rickettsial vestibular disease diagnosed?
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MRI, CSF, titers
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What treatment is there for Rocky Mountain Spotted Fever?
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Doxycycline 2-4 weeks
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Prognosis for rickettsial vestibular disease.
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Good
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Acute, non-progressive, +/- transient vestibular disease may be attributed to a...
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Vascular anomaly of some sort
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List some diseases that can interrupt brain vasculature and cause central vestibular disease.
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Chronic renal disease
Hypothyroidism Diabetes mellitus Hyperadrenocorticism |
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Treatment for vestibular disease of vascular origin
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Time, treatment of primary disease
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Prognosis for vascular-origin vestibular disease
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Good
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List some characteristics of bilateral peripheral vestibular disease.
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Absent oculocephalic reflex
Wide, swinging head excursions Crouched posture Normal conscious proprioceptive response |
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Explain paradoxical central vestibular disease.
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Cerebellum usually dampens excessive stimulation from vestibular nuclei.
If cerebellum damaged, loss of signal modulation causes relative increase in stimulation on the affected side. Head tilt and proprioceptive deficits on the less excited side. |
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Drug associated with central vestibular disease
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Metronidazole
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How long after beginning of metronidazole treatment may central vestibular signs be seen?
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3-14 days
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This drug can help speed recovery from metronidazole toxicity.
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Diazepam
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Lesions to this brain area can cause a head tilt to the opposite side.
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Cerebellum
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Most common cause of neurologic signs in cats.
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FIP
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Virus that causes FIP.
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Corona virus
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Does FIP more commonly cause generalized or focal CNS signs?
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Generalized
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True or false: If a serological test is negative for feline coronavirus, then the animal cannot have FIP.
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False
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Cell type that predominates in CSF with FIP infection
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Neutrophils
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Most common cause of fungal encephalitis in cats.
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Cryptococcus
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Good diagnostic test for Cryptococcus.
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Capsular antigen test
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A patient with Cryptococcal encephalitis may alse have these clinical signs.
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Respiratory signs
Cutaneous lesions Ocular lesions |
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Treatment for cryptococcus encephalitis in cats.
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Amphotericin B with fluconazole
Treat until Ag tests negative |
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Why use fluconazole instead of ketoconazole to treat cryptococcus encephalitis?
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Crosses BBB
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Prognosis for cryptococcal encephalitis
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Fair to good
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Toxoplasma can affect these organ systems in cats.
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Pulmonary
CNS Liver Heart Pancreas Eye |
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Best diagnostic criteria for toxoplasmosis in cats
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Response to treatment
(Titers hard to associate with CS) |
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Drugs used to treat toxoplasma in cats
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Clindamycin
Sulfonamides |
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3 most common infectious encephalidities in the cat
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FIP
Cryptococcus Toxoplasma |
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Idiopathic, non-suppurative inflammatory encephalitis seen in cats. Mirrors GME in dogs.
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Feline polioencephalitis
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Treatment for feline polioencephalitis
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None known
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Disease of cats characterized by skin ripples, biting or licking flank, vocalization, sz like activity
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Feline hyperesthesia syndrome
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Treatment for feline hyperesthesia syndrome
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Corticosteroids
Phenobarbital Amitryptyline |
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List some causes of metabolic encephalopathies in cats
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Hypoglycemia
Hepatic encephalopathy |
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Diagnosis of hepatic encephalopathy is made based on...
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Elevated ammonia, bile acids, Decreased albumin, BUN
Bilirubinuria U/S Scintigraphy |
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Treatment for hepatic encephalopathy
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Lactulose
Neomycin Diet Shunt ligation |
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With a lesion located at the level of the midbrain rostrally, conscious proprioception deficits will be on which side with relation to the lesion?
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Opposite
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Are primary or metastatic brain tumors more common in cats?
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Primary
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Most common feline brain tumor
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Meningioma
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Median survival time for meningioma in cats who eschew treatment.
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2 months
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Mean survival for meningioma in cats who recieve surgery
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26 months
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Neurologic disorder caused by occlusion of one or more cerebral BV
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Ischemic encephalopathy
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This feline brain disorder occurs more frequently in summer and may be linked to Cuterebra migration.
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Ischemic encephalopathy
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How is ischemic encephalomyelopathy diagnosed?
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CT/MRI
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Ivermectin, antihistamines, and steroids are all used to treat this feline brain disorder...
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Ischemic encephalopathy
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Hypervitaminosis A may cause this disease in the cat.
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Spinal exostosis
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Degenerative myelopathy in the cat is often associated with this disease...
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FeLV
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CS associated with diskospondylitis in the cat
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Chronic, progressive back pain
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On a spinal radiograph in a cat, you see vertebral endplate lysis. This is typical of this disease.
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Diskospondylitis
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3 agents that cause diskospondylitis in the cat
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Streptococcus
Actinomyces E. coli |
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Most common spinal cord tumor of cats
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Lymphosarcoma
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In cats, lymphosarcoma is often associated with this disease.
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FeLV
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In the cat, plantigrade gait is characteristic of...
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Generalized motor unit disease
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Is chronic relapsing neuropathy more common in cats or dogs?
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Cats
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A generalized polyneuropathy of cats marked by a remitting/relapsing course and inflammatory infiltrates in peripheral nerves
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Chronic relapsing neuropathy
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Is diabetic neuropathy more common in cats or dogs?
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Cats
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