Small Animal > Resp 1 & 2 > Flashcards

Resp 1 & 2 Flashcards

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1
Q

What are the five main categories of causes of respiratory and airway disease?

A
  • Infectious (viral, bacterial, fungal)
  • Neoplastic
  • Foreign body
  • Structural (polyps)
  • Inflammatory (chronic rhinosinusitis)
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2
Q

How can you categorize nasal discharge?

A
  • Type of discharge (blood, serous, mucopurulent)
  • Location (unilateral or bilateral)
  • Chronicity
  • Seasonality vs. environmental
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3
Q

What should a physical exam for nasal discharge include?

A
  • Thorough oral examination (requires anesthesia)
  • Evidence of ocular disease (indicates viral disease in cats)
  • Fundic examination
  • Is ocular retropulsion decreased (indicates mass, fungal disease, neoplasia, or abscess
  • Palpate the muzzle for bony abnormalities or pain
  • Lesions on nose (masses or depigmentation)
  • Submandibular lymphadenopathy
  • Patency of nares (with glass slide)
  • Otic examination
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4
Q

How can you start to diagnose epistaxis and/or nasal discharge (five)?

A
  • CBC/Chem/UA (check for platelet disorders)
  • Screen for infectious diseases (retroviral testing in cats and respiratory pathogen PCRs)
  • Coagulopathy testing and blood pressure (epistaxis)
  • Rhinoscopy
  • Biopsy
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5
Q

Which three diagnostics are typically required for diagnosis of chronic nasal disease?

A
  • Rhinoscopy
  • Biopsy
  • CT scan
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6
Q

What is a top differential for patients presenting with mucopurulent nasal discharge?

A

Primary bacterial rhinitis

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7
Q

True or False: Primary bacterial rhinitis is common in cats and dogs

A

False. There is usually some underlying trigger so bacterial component is secondary

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8
Q

True or False: Patients presenting with mucopurulent nasal discharge are much more likely to have a primary bacterial infection

A

True

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9
Q

True or False: Cultures are a good diagnostic tool for the diagnosis of primary bacterial rhinitis

A

False. Superficial or mucous bacterial cultures are not useful as it is not a sterile enviornment and usually the bacteria is not the primary cause

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10
Q

Which agent causes canine sinonasal aspergillosis?

A

Aspergillus fumigatus

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11
Q

True or False: Canine sinonasal aspergillosis is an opportunistic fungal infection

A

True (therefore disease is related to a large dose or the failure of a patient to resist the infection)

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12
Q

What are the clinical signs of canine sinonasal aspergillosis (four)?

A
  • Unilateral or bilateral mucopurulent discharge +/- epistaxis
  • Sneezing
  • Sensitivity of nasal bones (due to atrophy of nasal turbinates and destruction of mucosa +/- bone)
  • Nasal depigmentation and ulceration (with chronicity)
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13
Q

True or False: Patients with sinonasal aspergillosis typically do not have systemic clinical signs

A

True

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14
Q

Systemic (and often fatal) sinonasal fungal disease is caused by which pathogen?

A

Aspergillus terreus (seen in German Shepherds and is typically fatal)

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15
Q

How can canine sinonasal aspergillosis be diagnosed (four)?

A
  • Rhinoscopy (will see fungal plaques)
  • Biopsy of fungal plaques seen on rhinoscopy
  • Cytology of fungal plaques seen on rhinoscopy
  • CT (destruction of turbinates and frontal sinuses)
  • Serology

Radiographs are not very helpful for this disease

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16
Q

How can canine sinonasal aspergillosis be treated (two)?

A
  • Topical antifungals (delivered directly into the rostral nasal cavity +/- frontal sinus) (flush or cream)
  • Debridement
  • Systemic antifungals (if necessary)

May require multiple treatments to be effective

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17
Q

What should be done before flushing the nasal cavity with topical antifungals?

A

CT should be done beforehand to ensure the integrity of cribriform plate

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18
Q

What are the two types of canine inflammatory rhinitis?

A

Lymphoplasmacytic and eosinophilic/allergic

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19
Q

What are the clinical signs of canine inflammatory rhinitis?

A
  • Sneezing
  • Typically mucoid to mucopurulent bilateral discharge
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20
Q

True or False: Patients with inflammatory rhinitis typically do not have systemic clinical signs

A

True

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21
Q

How can idiopathic lymphoplasmacytic rhinitis be diagnosed (three)?

A
  • Biopsy (will see lymphoplasmacytic inflammation of the nasal mucosa)
  • Rhinoscopy (hyperemia +/- edema of mucosa or discharge) - not very rewarding
  • CT (inflammatory lesions or mucous)
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22
Q

How can lymphoplasmacytic canine inflammatory rhinitis be treated?

A
  • Air humidification
  • Corticosteroids
  • Address dental disease if present
  • Treat possible allergens (allergy testing + immunotherapy)
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23
Q

True or False: NSAIDs are beneficial for lymphoplasmacytic canine inflammatory rhinitis

A

False

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24
Q

How can allergic canine inflammatory rhinitis be treated?

A
  • Air humidification
  • Corticosteroids
  • Anti-histamines
  • Trial anti-parasitic medication (nasal mites)
  • Identify possible allergens
  • Allergy testing
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25
Which agent is a common cause of nasal mites?
Pneumonyssoides caninum
26
What are the clinical signs of nasal mites?
- Sneezing - Possibly mild serous nasal discharge
27
How can nasal mites be treated (three)?
- Milbemycin oxime - Ivermectin - Selamectin
28
What are the clinical signs of nasal foreign bodies in dogs (four)?
- Acute onset sneezing - Unilateral epistaxis - Unilateral mucopurulent discharge (with chronicity) - Pawing at face
29
Which agents are involved in primary feline upper respiratory disease (six)?
- Calicivirus - Herpesvirus - Mycoplasma spp. - Bordetella bronchiseptica - Chlamydophila felis - Streptococcus spp.
30
True or False: The incidence of feline upper respiratory infections increase dramatically in multiple cat environments
True
31
What are the clinical signs of calicivirus in cats (five)?
- Oral ulcerations - Hypersalivation - Pyrexia - Sneezing, conjunctivitis, ocular, and nasal discharge (but not as common as FHV) - Lameness (rare)
32
How is calicivirus transmitted?
Respiratory, ocular, and oral secretions (usually by contact with contaminated environment) *Aerosol is not a common route*
33
What are the clinical signs of herpesvirus in cats?
- Serous ocular and nasal discharge (often becomes mucopurulent) - Corneal dendritic ulcers - Conjunctivitis and ulcerative keratitis - Pyrexia - Sneezing
34
How can feline infectious upper respiratory disease be diagnosed?
- PCR (assesses for FHV-1, FCV, C. felis, B. bronchispetica, and Mycoplasma) - Culture
35
What are the clinical signs of Chlamydophila felis?
Conjunctivitis without nasal signs
36
What are the clinical signs of Mycoplasma?
Conjunctivitis without nasal signs
37
How can upper respiratory tract infections in cats be treated?
- Lysine and anti-virals (famciclovir) for herpesvirus - Use nebulizers/humidifiers - Provide warmed stinky food and clean nasal secretions (cats need to smell their food to eat it) - Ensure proper hydration - Antibiotics if severe or persistent They are most often self-limiting
38
When are antibiotics indicated for feline URT infections (two)?
- If signs persists for > 10 days - If pyrexia, lethargy, or anorexia is present Do not use antibiotics based on presence of mucopurulent discharge alone
39
What is a good first choice antibiotic to treat URT infections with?
Doxycycline
40
What is the most common cause of feline chronic rhinosinusitis?
Viral (secondary to nasal turbinate damage from previous FHV-1 infection)
41
What are the clinical signs of feline chronic rhinosinusitis?
- Sneezing - Stertor - Nasal discharge - Preservation of airflow Cats are typically healthy but may be inappetent with copious nasal discharge
42
What is the most common feline respiratory fungal disease?
Feline nasal cryptococcus
43
Which agent causes feline nasal cryptococcus?
Cryptococcus gatti (Cryptococcus neoformans is also common)
44
True or False: Feline nasal cryptococcus is is an opportunistic fungal infection
True
45
True or False: Feline nasal cryptococcus is contagious
False. The infection is obtained from the environment via inhalation of spores and is not contagious
46
What are the clinical signs of nasal cryptococcus?
- Granulomatous lesions on bridge of nose or extending from nasal cavity - Unilateral or bilateral mucopurulent or hemorrhagic nasal discharge - Secondary ocular disease (retinal detachment) - Secondary neurological, skin, or systemic disease
47
How can nasal cryptococcus be diagnosed (two)?
- LCAT (latex capsular agglutination test) of serum or CSF - Cytology of nasal swabs
48
How can nasal cryptococcus be treated?
- Oral anti-fungals (itraconazole or fluconazole) (if confined to nasal cavity) for 6+ months - Injectable anti-fungals (Amphotericin B) (if there is CNS involvement)
49
What is the prognosis of nasal cryptococcus?
Good for cases without CNS involvement
50
What is a top differential for feline nasal cryptococcus?
Nasal planum SCC
51
Which factors exacerbate tracheal collapse (five)?
- Obesity - Chronic coughing (cardiac or lower airway disease) - Structural or concurrent respiratory disease (BOAS) - Stress and anxiety - Increased pressure on trachea (tight collars)
52
What are the clinical signs of tracheal collapse?
- "Goose honk" cough that worsens with excitement or exercise - Exercise intolerance - Respiratory distress (often brought on by coughing, heat, or stress)
53
How can tracheal collapse be diagnosed (three)?
- Radiographs (inspiratory and expiratory) - Fluoroscopy - Tracheobronchoscopy
54
Why is fluoroscopy useful for the diagnosis of tracheal collapse?
It allows you to assess the trachea dynamically and without sedation
55
Why is it important to try and perform radiographs during both inspiration and expiration when trying to diagnose tracheal collapse?
During inspiration, the intrathoracic pressure is negative, which tends to narrow the extra-thoracic (cervical) trachea During expiration, the intrathoracic pressure is positive, which tends to narrow the intrathoracic trachea *Expiration is key for diagnosis*
56
Why is a tracheobronchoscopy useful for the diagnosis of tracheal collapse?
It allows you to determine the grade of tracheal collapse as well as assess for mainstem bronchial collapse
57
How can tracheal collapse be treated medically (four)?
- Antitussives (hycodan, butorphanol, loperamide) - Bronchodilators (reduces spasm of the smaller airways) - Trazodone (to decrease stress and anxiety) +/- Glucocorticoids (use with caution and only if not responding to sedation and cough suppressants) (can be used for a few days to decrease tracheal irritation)
58
How can tracheal collapse be prevented (three)?
- Weight loss - Use a harness instead of a collar (anything that stimulates a cough will worsen this condition) - Avoid overexcitement or stressful situations
59
How can tracheal collapse be treated surgically?
Intraluminal or extraluminal stents (does not replacement medical treatment and preventative strategies plus has several complications)
60
Which type of tracheal collapse is most likely to require tracheal stenting?
Malformation type
61
Which breeds are more at risk for hypoplastic trachea?
English Bulldogs, Bostons, and French Bulldogs
62
Which pathogens are more commonly involved in canine respiratory disease complex (CRDC) (three)?
- Parainfluenza - Adenovirus 2 - Bordetella bronchiseptica
63
When should a diagnostic workup be done for CRDC?
- If there's no improvement within 7 days - If there's signs of pneumonia
64
What is an effective treatment option for complicated CRDC?
Doxycycline (antibiotics are not recommended unless patient is pyrexic, lethargic, or inappetent)
65
What is a common tracheal parasite?
Oslerus osleri
66
How can tracheal parasites be diagnosed?
- Baermann - Visualization - Wash (ET, BAL)
67
How can tracheal parasites be treated?
- Fenbendazole - Ivermectin
68
Which dogs are more commonly affected by canine chronic bronchitis?
Small breeds
69
What are the clinical signs of canine chronic bronchitis?
- Harsh cough (daily > 2 months) - Exercise intolerance - Increased respiratory effort
70
How can canine chronic bronchitis be diagnosed?
- Exclude other causes of cough (ex. minimum database, fecal testing, HW antigen testing) - Thoracic radiographs (will be normal or have an interstitial, bronchial or broncho-interstitial pattern - can also rule out heart disease) - Airway cytology and culture (ETW, bronchoscopy)
71
How can canine chronic bronchitis be treated (six)?
- Oral or inhalant glucocorticoids (start with oral if institute inhalational) (prednisone 1 mg/kg and fluticasone) - Bronchodilators (theophylline, albuterol) - Weight loss - Airway humidification if excess secretions - Antibiotics if infection present
72
What are the consequences of canine chronic bronchitis (four)?
- Damage to elastic and muscular components and ciliary mechanisms - Bronchiectasis (permanent airway dilation) - Bronchomalacia (airway collapse) - Predisposition to pneumonia Therefore this disease can be managed but not cured due to the secondary effects it causes
73
What are the two main types of feline lower airway disease?
- Feline asthma - Feline chronic bronchitis
74
In feline asthma, the clinical signs are caused as a result of what?
The result of the airway narrowing
75
Which cat breeds are more predisposed to asthma?
Siamese cats
76
Which changes can be present in feline patients radiographically with bronchitis/asthma (four)?
1. Bronchial pattern (can also be interstitial) 2. Collapse of R middle lung lobe (middle picture) 3. Hyperinflation (lungs may appear hyperlucent and diaphragm expands past the last rib) 4. Flattening of the diaphragm Radiographs can be normal in 23% of cats
77
What can cats have on a CBC concurrently with feline asthma?
Peripheral eosinophilia
78
How can feline asthma be diagnosed?
- Airway sampling (will depend on presentation) - Cytology - Culture (look for Mycoplasma)
79
Increased ___________ on cytology is most typical of feline chronic bronchitis
Neutrophils
80
Increased ___________ on cytology is most typical of feline asthma
Eosinophils
81
How can you treat feline asthma or bronchitis in an emergency setting?
- Oxygen - Anxiolytics (butorphanol) - Injectable steroids (dexamethasone) - Bronchodilators (injectable aminophylline, terbutaline, or inhalant albuterol)
82
True or False: Inhalant steroids are an appropriate emergent therapy for cats with respiratory distress secondary to asthma
False. Inhalant steroids are not immediately effective and therefore are not appropriate for emergencies
83
How can you treat chronic feline asthma or bronchitis long-term?
- Oral prednisolone (tapered to lowest effective dose) - Inhalant steroids (fluticasone) +/- Bronchodilators (only appropriate for intermittent acute flares as chronic use can promote bronchospasm)
84
What causes canine eosinophilic lung disease?
Hypersensitivity response (but rule out other causes of eosinophilic disease such as parasites or neoplasia)
85
Which age of dogs are most commonly affected with eosinophilic lung disease?
Young to middle aged dogs
86
True or False: Eosinophilic lung disease is not commonly systemic
True
87
What are the clinical signs of canine eosinophilic lung disease?
- Coughing - Gagging - Retching - Nasal discharge (28-50%) - Tachypnea or dyspnea - Exercise intolerance
88
How can canine eosinophilic lung disease be diagnosed?
- CBC - Radiographs - Bronchoscopy (mucus, thick/irregular mucosa, granulomas) - Airway sampling (increased cellularity with predominance of eosinophils) - Can consider heartworm antigen testing or fecal tests
89
How can canine eosinophilic lung disease be diagnosed on CBC?
Peripheral eosinophilia
90
How can canine eosinophilic lung disease be diagnosed on radiographs?
Typically abnormal with a bronchial to bronchointerstitial pattern
91
How can canine eosinophilic lung disease be diagnosed from a BAL?
Increased cellularity with predominance of eosinophils
92
How can canine eosinophilic lung disease be treated?
- Prednisone (1-2mg/kg/day to start) - Fluticasone may work in some dogs for chronic management - Dewormer to reduce potential allergens
93
List six differentials for epistaxis
- Canine sinonasal aspergillosis (unilateral or bilateral) - Feline nasal cryptococcus (unilateral or bilateral) - Nasal foreign body (acute unilateral) - Platelet disorder (bilateral) - Systemic disease (hypertension, hyperviscosity) - Trauma
94
Name seven differentials for nasal discharge
- Nasopharyngeal polyps (cats) - Frontal sinus disease - Feline nasal cryptococcus (unilateral or bilateral) - Severe dental disease (oronasal fistula) - Vomiting/regurgitation (aspiration into nasal cavity) - Migrating foreign body - Nasal planum/alar fold disease
95
Practice question: What is the top differential for a German short-haired pointer with acute unilateral epistaxis?
Foreign body
96
Practice question: What is the top differential for a cat with chronic unilateral decreased nasal outflow?
Nasal tumour
97
Practice question: What is the top differential for a Rottweiler with acute bilateral epistaxis?
Coagulation disorder
98
Practice question: What is the top differential for a German Shepherd with bilateral mucopurulent discharge?
Sinonasal aspergillosis
99
Practice question: What is the top differential for a poodle with chronic coughing for 6 months?
Chronic bronchitis
100
Practice question: What is the top differential for a Weimaraner with intermittent coughing and gagging that has no travel or history of a heart murmur?
Eosinophilic lung disease
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