Sa Medicine Ii -- Pneumonia

Front 1

Typically, pneumonia develops in animals with ______ _____ ______.

Back 1

-- impaired respiratory defeses

Front 2

Most bacterial inf of the lungs are caused by?

Back 2

Commensal organisms of the lungs

Front 3

Normal defense mechanisms of the lungs?

Back 3

-- filtration of lg. particles in nasal turbinates

-- clearance via mucociliary apparatus

-- alveolar macrophages

(E.g. sm, aerosolized bacteria)

-- surfactant antibacterial properties

-- lymphoid cells throughout airways

Front 4

Which regions are most susceptible to bacterial colonization?

Back 4

-- bronchoalveolar regions (bronchioles)

>> major site of deposition of small particles

>> epithelium is not protected by a mucus layer

>> no protection from alveolar macrophages

>> narrow bronchioles

Front 5

Most common isolates from dogs with pneumonia?

Back 5

-- gram negative infections

Front 6

Most common isolates from cats with pneumonia?

Back 6

-- Strep spp.

-- Mycoplasma spp

Front 7

Anaerobic + aerobic bacteria are more capable of damage together than either alone. T/F?

Back 7

-- true >> act synergistically

Front 8

Factors that may predispos an animal to pneumonia?

Back 8

-- viral, parasitic, or fungal resp infection

-- poor nutritional status

-- immunosuppression

-- altered consciousness

-- NM disease (e.g. megaesophagus)

-- bronchial disease

-- laryngeal disease

-- anesthesia

Front 9

Things that can cause immunosuppression in animals?

Back 9

-- glucocorticoids

-- diabetes mellitus

-- hyperadrenocorticism

-- stress

Front 10

Clinical findings of animals with pneumonia?

Back 10

-- cough, nasal discharge, fever, tachypnea, dyspnea, crackles, wheezes, anorexia, lethargy, dehydration, weight loss

Front 11

Fever is an inconsistent finding with bacterial pneumonia. T/F?

Back 11

-- True

Front 12

Cats often have a concurrent URI with pneumonia. T/F?

Back 12

-- true

Front 13

CBC/chem with pneumonia?

Back 13

-- inflammatory leukogram +/- left shift

-- sometimes, low albumin

(inflammation, inc. vascular permeability, etc)

Front 14

Diagnosis of pneumonia?

Back 14

-- radiographs

>> bronchial, alveolar, interstitial, mixed pattern

-- cytology/culture via TTW/BAL

Front 15

Lung aspirates are rarely used. Why? Exception?

Back 15

-- low yield

-- consolidated lung lobe

Front 16

Dorsal caudal distribution of pneumonia suggests?

Back 16

-- hematogenous spread

-- bacterial pneumonia in cats

Front 17

Cytology sample suggestive of pneumonia?

Back 17

-- large numbers of degenerative neutrophils w/ intracellular organisms

Front 18

Absence of bacteria on cytology rules out infection. T/F?

Back 18

-- false, absence of bacteria DOES NOT rule out infection

Front 19

Special cultures for pneumonia?

Back 19

-- aerobic bacteria

-- mycoplasma

-- anaerobic if abscesses or consolidation noted

Front 20

Treatment of pneumonia?

Back 20

-- treat infection w/ abx 2-4 wks past clinical signs

-- supportive care with O2 supplementation

-- nebulization to inc. ciliary activity

-- IV fluids to inc. ciliary activity

-- bronchodilators

-- ventilation

-- coupage?

Front 21

Abx for pneumonia: how long should you treat?

Back 21

-- 2-4 wks past resolution of radiographic lesions

Front 22

Prognosis for uncomplicated pneumonia? Persistence of pneumonia may indicate?

Back 22

-- good

-- persistence: FB, abscess, neoplasia

Front 23

Poor prognostic factors for pneumonia?

Back 23

-- hypoalbuminemia

-- thrombocytopenia

-- sepsis

-- megaesophagus

-- sudden acquired retinal degeneration (SARDS)

Front 24

Necrotizing hemorrhagic pneumonia in dogs, esp. in kennels, shelters, and research colonies?

Back 24

-- Strep equi zooepidemicus

Front 25

Mycobacterial pneumonia pathogen that is reportable?

Back 25

-- M tuberculosis

>> granulomatous lesions

>> organisms don't stain with routine stains

Front 26

Differential for cats with pneumonia in CO & NM? Important to remember?

Back 26

-- Yersinia pestis

>> zoonotic disease

>> dx: cytology + FA/culture/serology

Front 27

What can you do to help inform antibiotics choice if you can't wait for C&S?

Back 27

-- gram stain

Front 28

Rods are usually gram _____, while cocci are usually gram _____.

Back 28

-- rods: gram negative

-- cocci: gram positive

Front 29

Gram negative bacteria assoc. with pneumonia? Anaerobes?

Back 29

Gram Negatives:

-- E. coli, Klebsiella, Proteus

-- Pasteurella, Bordetella, Pseudomonas

Anaerobes

-- Bacteroides spp.

-- Clostridium spp.

-- anaerobes are larger/abnormally shaped

Front 30

Gram positive bacteria?

Back 30

Strep or staph spp., enterococcus spp.

Front 31

Bacteri_____ drugs are preferred, but bacteri_____ drugs may be used w/ a competent immune system.

Back 31

bactericidal drugs are preferred, bacteriostatic drugs may be used w/ competent immune system

Front 32

Abx levels within the parenchyma are similar to serum, but airway levels may not be. Why?

Back 32

blood-bronchoalveolar barrier limiting penetration

>> may be more easily penetrated w/ inflammation, more difficult once inflammation subsites

Front 33

Good antibiotic choices for airway infections?

Back 33

-- tetracyclines (bacteriostatic)

-- macrolides (static >> cidal)

-- chloramphenicol (static >> cidal)

-- fluoroquinolones (cidal)

>> more lipid soluble

Front 34

Drugs that are less lipid soluble?

Back 34

-- penicillins (cidal
-- cephalosporins (cidal)

-- aminoglycosides (cidal)

-- sulfas (cidal)

Front 35

Intracellular bacteria?

Back 35

-- Chlamydia

-- Mycoplasma

-- Bordetella

Front 36

Antibiotics for intracellular bacteria?

Back 36

-- chloramphenicol

-- macrolides

--lincosamides (static)

-- tetraccyclines

-- fluoroquinolones

Front 37

Three phases of aspiration pneumonia?

Back 37

1. immediate airway response to the aspirate

2. inflammatory response

3. bacterial colonization

Front 38

First phase of aspiration pneumonia?

Back 38

-- lasts about 4h

-- chemical burn from acidic aspirate
-- bronchoconstriction + inc. capillary permeability

-- edema in tissues of airways

-- airway obstruction

>> food particles, bronchoconstriction, inc. mucus, exudate

--hypoxia & V/Q mismatch (collapse/atelectasis)

Front 39

Second phase of aspiration pneumonia?

Back 39

-- 4-6h after aspiration, lasts 1-2 days

-- large # neutrophils enter alveolar space

-- inc. capillary permability

>> fluid loss into interstitium

>> fluid loss may cause hypotension

-- hypoxia results in pulm. vasoconstriction

>> may result in pulmonary hypertension

-- fever + consolidation of lung lobes

Front 40

Final phase of aspiration pneumonia? Associated with which pathogens?

Back 40

--secondary bacterial infection

>> E. coli, Klebsiella, Strep, Pasteurella

Front 41

Animals that are predisposed to aspiration?

Back 41

-- sedated/anesthesia

-- NM disorders

-- pharyngeal/esophageal motility disorders

-- chronic vomiting

-- seizures

-- altered mentation

-- delayed gastric emptying

Front 42

Factors that influence morbidity of aspiration pneumonia?

Back 42

-- acidity (pH <2.4)

-- gastric fluid volume ( >0.4 ml/kg)

-- size of particulate (obstructs small airways)

Front 43

Clinical signs of aspiration?

Back 43

-- lethargy

-- cyanosis

-- tachypnea

-- dyspnea

-- fever

-- acute respiratory distress syndrome (ARDS)

-- death

-- +/- signs of regurg., vomiting, seizures, etc.

Front 44

Thoracic rads of aspiration pneumonia?

Back 44

bronchial or alveolar pattern

most often in right middle or cranial lung lobes

>> radiographic signs can lag

Front 45

Viral causes of pneumonia in dogs?

Back 45

-- canine parainfluenza virus (CPI)

-- canine adenovirus 2 (CAV-2)

-- distemper (CDV)

-- canine influenza

Front 46

Viral causes of pneumonia in cats?

Back 46

-- Feline Herpes Virus

-- feline calici virus

Front 47

Viral pneumonia occurs due to?

Back 47

-- inflammation of the alveolar epithelium, interstitium, and pulmonary capillary epithelium

>> often progresses to bronchiolitis

Front 48

Airway defenses against viruses?

Back 48

-- mucociliary apparatus

-- opsonization and neutralization via Ig

-- complement fixation/cell lysis

-- cytokine formation

-- lymphocytes (cytotoxic T-cells)

-- alveolar macrophages (phagocytosis, etc)

Front 49

Sequelae to viral infection in lung?

Back 49

-- epithelial cells are damaged

>> protein-rich fluid enters the alveoli along with neutrophils, cellular debris, and macrophages

-- type I pneumocytes are injured

Front 50

FIP can cause what pulmonary pathology?

Back 50

-- pulmonary granulomas

Front 51

Infection of pathogens causing viral pneumonia occurs how?

Back 51

-- inhalation of aerosolized virus

-- contact with secretions/fomites

Front 52

Canine Distemper Virus is what kind of virus? What kind of tropism does this virus have?

Back 52

-- RNA morbilivirus

-- epithelial tropism

Front 53

Signs of distemper virus?

Back 53

-- biphasic fever (5 & 11 days postexposure)

-- ocular and nasal discharge (mucopurulent)

-- dyspnea and cough

-- anrexia, vomiting, diarrhea

-- blindness, seizures, myoclonus

Front 54

Radiographs of dog with distemper?

Back 54

-- diffuse interstitial pattern progressing to bronchial or alveolar pattern

Front 55

Definitive diagnosis of distemper?

Back 55

-- virus isolation (blood)

-- IHC

-- PCR (tissues, blood, urine)

-- ELISA for antigen

Front 56

Detection of distemper via FA or PCR in epithelial tissues is not diagnostic if dog has been previously vaccinated. T/F?

Back 56

-- FALSE

-- detection of distemper in epithelial tissues IS diagnostic if dog has been previously vaccinated

>> does not spread beyond non-lymphoid organs

Front 57

Distemper (CDV) is a core vaccine. T/F?

Back 57

-- true

Front 58

CDV vx regimen?

Back 58

-- stars as early as 3 wks of age

-- every 3-4 wks until 16 wks of age

-- booster in 1 y

Front 59

Canine Adenovirus II is associated with what?

Back 59

-- infectious tracheobronchitis

Front 60

Thoracic radiographs of Canine Adenovirus II?

Back 60

-- bronchointerstitial lung pattern

-- crnaioventral alveolar infiltrates

Front 61

Canine parainfluenza virus I has similar lesions/radiographic findings as CAV-II. T/F?

Back 61

true

Front 62

H3N8 Canine Influenza is derived from equine influenza virus. T/F?

Back 62

true

Front 63

Canine influenza H3N8 virus incubation period? Who sheds the virus?

Back 63

-- 2-5 days incubation

-- 7-10 days viral shedding (after incubation)

-- all infected dogs shed virus
(whether they develop clinical signs or not)

Front 64

Canine influenza H3N8 signs? Signs are similar to?

Back 64

--cough for 3 wks

-- unresponsive to antibiotics and cough suppressants

-- purulent nasal discharge (2nd bacterial inf)

-- fever

-- tachypnea/dyspnea, lung consolidation (rare)

-- similar to kennel cough

Front 65

Diagnosis of canine influenza?

Back 65

serologic tests (paired titers), PCR (nasal swab)

Front 66

Nasal swab & PCR for canine influenza must be done within ___ days while virus is still being shed.

Back 66

within 7 days

Front 67

PCR for canine influenza is ____ specific.

Back 67

strain specific

Front 68

There is a vaccine for the which canine influenza viruses?

Back 68

-- H3N8 and H3N2

-- non-core vx

Front 69

Cats are susceptible to avian influenza virus ____.

Back 69

H5N1

Front 70

Cats are not susceptible to H3N8. T/F?

Back 70

true

Front 71

H3N2 influenza virus can be shed for up to __ wks, so longer isolation periods are recommended than for H3N8.

Back 71

shed for up to 3 wks

Front 72

Cats are susceptible to both H3N2 and H3N8. T/F?

Back 72

False.
Cats are only susceptible to H3N2 (maybe).

Front 73

Fungal pathogens that may cause pneumonia? Which are endemic to Oregon?

Back 73

-- Histoplasma

-- Blastomyces

-- Coccidioides

-- Cryptococcus spp. (endemic to OR)

Front 74

Which of these fungal organisms also causes GI tract symptoms?

Back 74

Histoplasma

Front 75

Which of these fungal organisms also cause CNS signs? Uveitis/retinitis?

Back 75

all of them

Front 76

Which of these fungal organisms also cause bone infections?

Back 76

-- histoplasmosis

-- blastomycosis

-- coccidiomycosis

Front 77

Which of these fungal organisms also cause restrictive pericarditis?

Back 77

-- coccidiomycosis

Front 78

What do ketoconazole, itraconazole, and fluconazole do? Side effect?

Back 78

inhibit synthesis of ergosterol (fungal wall)

>> interfere with cytochrom P450

Front 79

Why is it important to give azole drugs with food?

Back 79

increased bioavailability when given with meals (acid pH)

Front 80

Ketoconazole has the ____ side effects and is ____ expensive.

Back 80

-- most side effects

-- least expensive

Front 81

Fluconazole is the _____ expensive and has the _____ side effects.

Back 81

-- most expensive

-- fewest side effects

Front 82

Side effects of ketoconazole?

Back 82

-- anorexia, vomiting, diarrhea

-- hepatotoxicity

-- light hair coat

-- thrombocytopenia

-- adrenal insufficiency

Front 83

Side effects of itraconazole?

Back 83

-- intestinal signs

-- skin eruptions

-- hepatotoxicity

Front 84

Side effects of fluconazole?

Back 84

-- GI

-- less likely to be hepatotoxic

Front 85

Only ____azole can be given IV.

Back 85

fluconazole

>> all are available as oral formulations

Front 86

Amphotericin B mechanism of action?

Back 86

binds irreversibly to sterols (e.g. ergosterol)

>> membrane permeability change, cell lysis

Front 87

Amphotericin B is effective against? Not effective against?

Back 87

-- Histoplasma

-- Blastomyces

-- Coccidioides

-- Crytpococcus

-- Candida

-- Zygomyces

-- NOT effective against Aspergillus spp.

Front 88

Side effects of Amphotericin B?

Back 88

nephrotoxic (esp. IV doxycholate prep)

vomiting, anorexia, hypokalemia, hypomagnesemia, phlebitis

Front 89

Histoplasma is found where?

Back 89

Missisippi, Missouri, Ohio River valleys

Front 90

Histoplasma is usually found where? Incubation period? Clinical signs?

Back 90

-- liver, spleen, LNs

-- incubation period: 12-16 days

-- clinical signs: cough, tachypnea, dyspnea

Front 91

Serology for diagnosis of Histoplasma?

Back 91

not useful

Front 92

Diagnosis of Histoplasma?

Back 92

FNA, lung aspirates, lavage/wash, pleural effusion

Front 93

Blastomyces is found where?

Back 93

Great Lakes region

Front 94

Clinical signs of Blasto infection?

Back 94

cough, dyspnea, fever, lethargy, exercise intolerance

Front 95

Radiographs of Blasto infection?

Back 95

miliary nodular interstitial pattern

Front 96

Diagnosis of Blasto infection? Serology?

Back 96

-- ELISA test for antigen in urine

--serology is poor

Front 97

ELISA test for Blasto: high ____, poor ____. Why?

Back 97

high sensitivity, poor specificity

>> cross-reacts with other fungal organisms

Front 98

Blasto prognosis for dogs? Cats?

Back 98

-- dogs: good in absence of severe respiratory disease, guarded in dog with severe respiratory signs

-- cats: do not respond as well to therapy

Front 99

Where is Coccidioides found?

Back 99

-- Southwest US

Front 100

Clinical signs of Coccidioides?

Back 100

-- cough, fever, lethargy, weight loss, anorexia

-- bony involvement common

-- restrictive pericarditis can occur

Front 101

Diagnosis of Coccidioides?

Back 101

-- organism ID on cytology and histopathology

-- serology: titer > 1:32

Front 102

Which animals get Coccidioides?

Back 102

-- rare in cats

-- most common in young male dogs

>> esp. Doberman Pinschers, Boxers

Front 103

Which animals get Blasto?

Back 103

-- more common in young male dogs

-- uncommon in cats

Front 104

Which animals get Histoplasma?

Back 104

-- cats of any age

-- younger dogs

>>much more common in dogs

Front 105

Where is cryptococcus located?

Back 105

Pacific Northwest

Front 106

Which dogs are most commonly affected by Crypto?

Back 106

-- Great Danes

-- Doberman pinschers

-- German shepherds

Front 107

Clinical signs of crypto?

Back 107

-- rhinitis

-- eyes, CNS, pulm. parenchyma, LNs, and skin may also be involved

Front 108

Radiographs of crypto?

Back 108

nodular pulmonary pattern

Front 109

Diagnosis of crypto?

Back 109

-- organism ID

-- serology

Front 110

Aspergillus causes what?

Back 110

-- most commonly causes fungal rhinitis in the dog, occasionally has been isolated in lungs of dogs and cats

Front 111

Who gets Aspergillus?

Back 111

-- german shepherds

-- young, ill, immunosuppressed cats

Front 112

Radiographs of aspergillus?

Back 112

-- may be normal

-- pleural effusion, lung consolidation, interstitial or alveolar pattern

Front 113

The only antifungal that might work against Aspergillus?

Back 113

Itraconazole

Front 114

Who gets Pneumocystis carinii?

Back 114

-- young, immunosuppressed animals

-- Mini dachshunds

-- Cavalier King Charles spaniels

-- cats on immunosuppressive therapy

Front 115

Diagnosis of pneumocystis?

Back 115

-- airway samples, special stains must be used

-- BAL

Front 116

Which parasites cause verminous pneumonia during their migration?

Back 116

-- Toxocara spp.

-- Ancylostoma spp.

Front 117

Why might fecals be negative with verminous pneumonia?

Back 117

-- lung migration occurs before eggs are shed in the feces

Front 118

Where does Oslerus osleri like to live?

Back 118

-- mucosa of the distal trachea, tracheal bifurcation, mainstem bronchi

Front 119

Oslerus osleri is a _____ nematode that causes what clinical signs?

Back 119

-- metastrongyloid nematode

-- cough

Front 120

Pathology of Oslerus osleri infection? Diagnosis?

Back 120

-- nodules that cause airway obstruction and dyspnea

-- zinc centrifugation for diagnosis, bronchoscopy

Front 121

Filaroides milksi and hirthi cause what kind of disease?

Back 121

-- interstitial pneumonia

>> eosinophilic, granulomatous, or mononuclear

Front 122

Filaroides milksi and hirthi live where? Diagnosis?

Back 122

deep in the alveoli and terminal bronchioles

>> infect dogs

diagnosis: zinc sulfate centrifugation

Front 123

Aleurostrongylus abstrusus infects which spp? Where do adult worms live?

Back 123

infects cats, adult worms live in bronchioles and alveolar ducts

Front 124

Clinical signs of Aleurostrongylus abstrusus can mimic what?

Back 124

inflammatory airway disease

Front 125

Aleurostrongylus abstrusus diagnosis?

Back 125

Baermann

Front 126

Crenosoma vulpis infects? Where do adults live?

Back 126

-- infects wild dogs in NE US and Europe

-- occasionally infect domestic dogs

-- adult nematodes live in bronchi and bronchioles

Front 127

Crenosoma vulpis causes what clinical sign?

Back 127

-- bronchitis

>> cough, nasal discharge

>> diffuse bronchial or bronchointerstitial pattern is most common

Front 128

Diagnosis of Crenosoma vulpis?

Back 128

Baermann

Front 129

Capillaria aerophila infects who? Causes what kind of disease?

Back 129

-- infects dogs and cats

-- causes bronchitis

>> live in mucosa of trachea and bronchi

Front 130

Signs of Capillaria infection?

Back 130

-- asymptomatic

-- cough, dyspnea, wt. loss, bronchopneumonia

Front 131

Paragonimus kellicotti infects who?

Back 131

-- dogs and cats in Great Lakes, Midwest, Gulf of Mexico

Front 132

Pathogenesis of Paragonimus?

Back 132

-- adult flukes live in subpleural cysts that communicate with bronchi

Front 133

Clinical signs of Paragonimus infection?

Back 133

-- chronic cough, exercise intolerance, weight loss, occasional hemoptysis

-- spontaneous pneumothorax from cyst rupture

Front 134

Lesions from Paragonimus are most common?

Back 134

-- right caudal lung lobe

Front 135

Diagnosis of Paragonimus?

Back 135

-- zinc centrifugation or fecal sedimentation

-- cavitary lesions on radiographs

Front 136

Treatment of Pargonimus?

Back 136

fenbendazole or praziquantel

>> fluke

Front 137

Treatment of lungworms in general?

Back 137

-- fenbendazole

-- ivermectin

-- levamisole

-- praziquantel

Front 138

Heartworm effects on lung? Clinical signs?

Back 138

-- pulmonary hypertension

-- vascular compromise of pulmonary tissue

-- interstitial disease due to inflammatory mediators from worm antigen

-- eosinophilic pneumonitis due to immune-mediated destruction of microfilaria

-- clinical signs: cyanosis, crackles, muffled lung sounds

Front 139

Causes of Eosinophilic Pneumonia?

Back 139

-- hypereosinophilic syndrome (paraneoplastic)

>> eosinophilopoiesis in bone marrow

-- parasitic infections, e.g. heartworm, lung worm

-- chronic bacteria and fungal infections

-- asthma, bronchitis

-- Idiopathic pulmonary fibrosis (IPF)

-- lymphoma, mast cell tumors

Front 140

Causes of protozoal pneumonia?

Back 140

-- Toxoplasma gondii

>> multisys. inf., immunocompromised animals

-- Neospora caninum

>> myositis, encephalitis

Front 141

Respiratory infections of Toxoplasma are most common when?

Back 141

-- most common with transplacental and transmammary transmission

>> kittens are most commonly affected

Front 142

Definitive diagnosis of Toxoplasma?

Back 142

-- identification of Toxoplasma in tissues

>> antibody titers present in normal dogs/cats

Front 143

Neospora is an _____ cause of respiratory disease.

Back 143

-- uncommon

Front 144

What is the most common interstitial lung disease of small animals?

Back 144

Idiopathic pulmonary fibrosis

Front 145

Who gets Idiopathic Pulmonary Fibrosis (IPF)?

Back 145

Westies

other small terrier-ish dogs

Front 146

IPF is thought to be what?

Back 146

-- end-result of chronic inflammation in the pulmonary parenchyma

-- abnormal healing response to an insult that results in fibrosis

-- increased amount of fibrous tissue

Front 147

IPF occurs in dogs with what?

Back 147

-- paraquat poisoning

-- hyperadrenocorticism

Front 148

Clinical signs of IPF?

Back 148

-- exercise intolerance

-- dyspnea

-- tachypnea

-- cyanosis

-- syncope

-- cough is less common

-- crackles may be auscultated

Front 149

Radiographs of IPF?

Back 149

-- may be normal

-- interstitial pattern

-- bronchitis

-- right heart enlargement, RHF

Front 150

Diagnostics for IPF?

Back 150

-- TTW/BAL to rule out other causes

-- lung biopsy for definitive diagnosis (rare)

-- CT: peripheral reticulation, honeycombing, traction bronchiectasis (don't narrow)

Front 151

Treatment of IPF?

Back 151

-- bronchodilators

-- glucocorticoids

-- pulmonary vasodilators (sildenafil)

-- oxygen if needed

-- manage collapsing trachea, bronchitis

>> inc. quality of life

Front 152

MST of IPF?

Back 152

15.5 mo (~1y)

Front 153

______ is more common than _____ neoplasia.

Back 153

-- metastatic is more common than primary

Front 154

Increased risk of primary lung tumors in?

Back 154

-- dogs in urban environments

-- brachycephalics exposed to cigarette smoke

Front 155

Clinical signs of pulmonary and bronchial neoplasia?

Back 155

-- often asymptomatic
>> tumors may be incidental findings

-- cough, dyspnea, tachypnea, wheezes, heptysis, lameness have been reported

Front 156

Radiographs for pulmonary neoplasia?

Back 156

three view thorax

Front 157

Malignant lung tumors?

Back 157

-- adenocarcinoma (dogs, cats)

-- SCC (dogs, cats)

-- bronchial carcinoma (cats > dogs)

-- alveolar carcinoma (dogs > cats)

-- hemangiosarcoma (dogs > cats)

-- sarcoma (dogs, cats)

-- malignant fibrous histiocytoma (dogs)

Front 158

When does pulmonary edema occur?

Back 158

-- increased hydrostatic pressure

-- decreased oncotic forces

-- lymphatic obstruction

-- increased vascular permeability

Front 159

Increased pulmonary vascular pressures occur due to?

Back 159

-- fluid within the alveoli, decreased pulmonary compliance, airway compression

Front 160

Hypoxemia with pulmonary edema occurs due to?

Back 160

-- V/Q mismatch

Front 161

Causes of non-cardiogenic pulmonary edema?

Back 161

--electrocution

-- seizure/head trauma

-- acute airway obstruction (strangulation)

-- systemic disease >> ARDS

-- pulmonary injury

-- hypoalbuminemia (low oncotic pressure)

-- vasculitis

-- near drowning

--pheochromocytoma

Front 162

Causes of pulmonary injury?

Back 162

pneumonia, smoke inhalation, contusion, hypoxia, lung lobe torsion

Front 163

Clinical signs of non-cardiogenic pulmonary edema?

Back 163

-- moist cough

-- resp. distress

-- cyanosis

-- orthopnea

-- crackles

Front 164

Pathogenesis of non-cardiogenic pulmonary edema?

Back 164

-- vascular damage/permeability

>> protein rick fluid leaks out

>> water follows

Front 165

Treatment of non-cardiogenic pulmonary edema?

Back 165

-- oxygen

-- ventilation

-- furosemide (neurogenic or volume component)

-- alpha agonists/dopamine

(neurogenic: dec. cerebral blood flow)

--synth. colloids/albumin (low oncotic pressure)

-- careful with fluid admin

>> risk exacerbating edema

Front 166

Cause of exogenous lipid pneumonia?

Back 166

inhalation of oils (animal, vegetable, mineral)

Front 167

Pathophysiology of aspirated oils?

Back 167

-- interfere with mucociliary apparatus

-- overwhelm/damage alveolar macrophages

-- cause inflammation & fibrosis

Front 168

Pathology of endogenous lipid pneumonias?

Back 168

-- accumulation of cholesterol or other lipids in the alveoli

-- can occur due to damage of epithelial cells

Front 169

Causes of endogenous lipid pneumonias?

Back 169

-- obstructive lower airway disease

-- inhalation of noxious substances

-- primary lipid disorders

-- fat emboli

-- dietary deficiency of pantothenic acid

-- idiopathic (cat)

-- secondary to neoplasia, crypto, PTE (cat)

Front 170

Clinical findings with lipid pneumonia?

Back 170

-- tachypnea

-- cough

-- respiratory distress

-- cyanosis

-- crackles

-- anorexia

-- lethargy

-- wt loss

Front 171

Thoracic radiographs with lipid pneumonia?

Back 171

-- may be normal

-- diffuse, nodular, interstitial pattern

-- patchy interstitial infiltrates

-- pulmonary nodules and pleural effusion

Front 172

What kind of pleural effusion with lipid pneumonia?

Back 172

-- chylous or modified transudate

Front 173

Cytology of the airways with lipid pneumonia?

Back 173

-- mcrophages with large amounts of lipid

Front 174

Treatment for exogenous and endogenous lipid pneumonia?

Back 174

-- exogenous: supportive care

-- endogenous: resolve underlying issue

Front 175

Pathophysiology of smoke inhalation?

Back 175

-- CO2 dilutes amount of oxygen

-- CO competes with oxygen for binding Hb

-- encourages anaerobic glycolysis and production of lactate (CO2, CO, cyanide)

-- direct thermal injury to pulm. epithelium

>> inflammation and edema formation

-- chemical irritants and particulates

>> bronchoconstriction, worsening hypoxia

Front 176

Clinical signs of smoke inhalation?

Back 176

-- may appear normal initially

-- mild to severe respiratory distress

-- alert/lethargic/ comatose, seizures/ataxic

-- crackles and wheezes on auscultation

-- coughing/gagging/ptyalism

-- pawing at face (local irritation)

-- MM wnl or hyperemic/edematous

-- conjunctivitis/corneal irritation

Front 177

Lab work for animals with smoke inhalation?

Back 177

-- metabolic acidosis

-- hypoxemia (blood gas or pulse ox)

Front 178

Treatment of smoke inhalation?

Back 178

-- IV fluids

-- oxygen

-- bronchodilators

-- prophylactic antibiotics?

-- glucocorticoids?

Front 179

Hypoxia is worst for smoke inhalation when?

Back 179

-- 24 - 48 h after exposure

Front 180

Normal pulmonary arterial pressures during systole and diastole?

Back 180

-- systole: < 25 mmHg

-- diastole: <10 mmHg

Front 181

Pulmonary hypertension is defined as?

Back 181

-- mean pulmonary arterial pressures > 25 mmHg

-- > 30 mmHg during systole

Front 182

Pulmonary hypertension can be arterial or venous in etiology. T/F?

Back 182

true

Front 183

Causes of pulmonary arterial hypertension?

Back 183

-- congenital L >> R shunts (e.g. PDA, VSD)

-- pulmonary disease (e.g. COPD, IPF, neoplasia)

-- thromboembolism (e.g. IMHG, PLE/PLN, DIC)

-- parasites (HW, Angiostrongylus)

-- vasculitis/arteritis

-- high altitude disease

-- idiopathic

Front 184

Causes of pulmonary venous hypertension?

Back 184

-- disease of left heart (LV failure, myocardial dz)

Front 185

What does endothelin 1 do?

Back 185

-- arterial and venous constriction

Front 186

What does prostacyclin do?

Back 186

-- vasodilator, inhib. platelets, antiproliferative

Front 187

What does thromboxane do?

Back 187

-- vasoconstrictor

Front 188

What does nitrous oxide do?

Back 188

-- vasodilator

-- inhibits platelets

-- inhibits smooth muscle proliferation

Front 189

What do natriuretic peptides do?

Back 189

-- vasodilators

-- inhibit cell growth

Front 190

In pulmonary hypertension, the _____ pathway is upregulated, and the ______, _____, and _____ pathways are down regulated.

Back 190

-- endothelin

-- prostacyclin

-- thromboxane

-- nitrous oxide

Front 191

Result of endothelin upregulation in pulmonary hypertension?

Back 191

-- prolif. of pulmonary aa. intima, adventitia

-- vascular muscle hypertrophies

-- adventitia

Front 192

Cardiac consequences of pulmonary hypertension?

Back 192

-- right ventricular hypertrophy

(initially concentric, later eccentric)

Front 193

What causes mortality from pulmonary hypertension?

Back 193

-- right ventricular failure

-- ascites

-- low CO

Front 194

Clinical signs of pulmonary hypertension?

Back 194

-- cyanosis

-- dyspnea

-- cough

-- exercise intolerance

-- syncope

-- crackles and wheezes

-- inspiratory/expiratory effort

-- heart murmur

-- RHF (ascites, distended jugular, big liver)

Front 195

_____ testing is imperative is pulmonary hypertension is a major complication of ____ dz in the dog.

Back 195

-- heartworm testing, heartworm dz

Front 196

Other diagnostic tests for pulmonary hypertension?

Back 196

-- testing for hypercoagulability

-- testing for signs of PTE

Front 197

Radiographs with pulmonary hypertension?

Back 197

-- may be normal

-- may have right-sided cardiac enlargement, pulmonary infiltrates, enlarged tortuous pulmonary arteries

-- may have signs of RHF

Front 198

Definitive diagnosis of pulmonary hypertension?

Back 198

echocardiogram or cardiac catheterization to measure RH and pulmonary arterial pressures

Front 199

Treatment of pulmonary hypertension?

Back 199

-- resolve underlying diseases

-- oxygen and NO for acute resp. distress

-- sildenafil (pulmonary vasodilator)

-- epoprostenol (prostacyclin analog)

-- endothelin antagonists (bosentan)

-- pimobendan

-- L-arginine

Front 200

What is the effect of pulmonary thromboembolism?

Back 200

-- obstruct pulmonary vv.

-- hypoxia

-- reflex vasoconstriction

-- inc. pulmonary vascular resistance

-- inc. right heart outflow resistance

-- inflammatory mediators
>> endothelial damage and vasoconstriction

Front 201

In dogs, ___% of pulmonary vasculature must be occluded before an inc. in pulmonary pressure occurs. Why?

Back 201

-- 60% of pulmonary vasculature occluded

-- recruitment of unused pulmonary vv. and capillary dilation

Front 202

Diseases that can cause vascular injury (predisposing to PTE)?

Back 202

-- HW disease

-- immune-mediated disease

-- pancreatitis

-- sepsis

-- trauma

-- surgery

-- neoplasia

-- chronic respiratory disease

Front 203

Causes of hypercoagulable state?

Back 203

-- DIC

-- sepsis

-- necrotizing pancreatitis

-- PLN/PLE

-- hyperadrenocorticism

-- glucocorticoid tx

-- immune-mediated disease

-- neoplasia

-- Diabetes Mellitus

Front 204

Causes of slowed blood flow?

Back 204

-- cardiac disease

-- hypotension

-- chronic respiratory disease

-- atherosclerosis

Front 205

Three things that contribute to thrombus formation (where are thrombi likely to form)?

Back 205

-- areas of endothelial damage

-- areas where blood flow is stagnant

-- in hypercoagulable states

Front 206

Clinical signs of PTE?

Back 206

-- dyspnea/tachypnea

-- coughing, hemotpysis,

-- cyanosis

-- lethargy, syncope

-- collapse and sudden death (marked drop CO)

-- muffled heart & lung sounds (pleural effusion)

-- crackles & wheezes (underlying resp. dz)

-- heart murmur (tricuspid insuff., split S2)

Front 207

Radiographic changes with PTE?

Back 207

-- may be minimal

-- may see pleural effusion

-- may see interstitial/alveolar pattern

-- enlarged main pulmonary a.

-- pulmonary aa. tortuous and blunted

Front 208

Labwork signs for PTE?

Back 208

-- hypoxemia, normocapnia, hypocapnia

-- thrombocytopenia in some cases

-- inc.fibrinogen, inc. D-dimers, dec. AT-III

Front 209

Treatment of PTE?

Back 209

-- address underlying disease

-- change IV catheters

-- oxygen supplementation

-- can try: aspirin, clopidogrel, low MW heparin, heparin, warfarin, rivaroxaban (factor Xa inhib.)
-- thrombolysis: streptokinase, tPa

Front 210

What is Acute Respiratory Distress Syndrome (ARDS)?

Back 210

-- response to disease

-- exaggerated inflamm. response w/ resp. failure

>> pulmonary edema

-- acute resp. distress, bilateral pulmonary infiltrates, normal pulmonary arterial pressure

-- PaO2:FIO2 is < 200 (normal is 400)

Front 211

Most common causes of ARDS in dogs?

Back 211

-- sepsis

-- pneumonia

Front 212

Causes of pulmonary bullae?

Back 212

-- large, air-filled structures within parenchyma or on pleural surface due to breakdown of alveolar structures

-- trauma, inf., parasites, inflammation, neoplasia

Front 213

Most pulmonary bullae are?

Back 213

-- idiopathic

>> esp. large breed, deep chested dogs

Front 214

Pulmonary bullae and blebs may cause pneumothorax. T/F?

Back 214

-- true