Clin Med- Intro to Respiratory 1

untimely's version from 2015-04-24 01:22

intro and nasal

Question Answer
each anatomical division also has a clear...clinical division
If you see mouth breathing in a _________(animal), you should start to really worrycat
any presenting respiratory compliant can EMERGENCY
list of presenting complaints for respDyspnea, Open Mouth Breathing, ADR, Lethargy, Tachypnea, Anorexia, Vomiting/Gagging, Exercise intolerance, collapse, Stridor/Stertor, Fever, Cyanosis
upon initial presentation of resp. problems, what is the first thing you should do for the animal? (explain why)KEEP THEM CALM!! Exercise, excitement, and temperature can exacerbate distress (excitement can dec airway size even more). Also excitement can cause negative pressure (inflammation and edema), cause inc inspiratory effort, or if there is a obstruction (esp DYNAMIC where the extra breathing could suck the obstruction in, but could be static too)
Things Dr C said: #1 thing with laryngeal paralysis they need is--?ACE!!! they need to calm down and breathe.
When you begin to evaluate upon initial presentation, what are three things you should check? (reasoning?)(1) Use of accessory muscles (Abdominal press/restrictive component--> are they having inc InSpirATorY or EXPIRATORY effort?) (2) Discoloration of mucous membranes (pale? cyanotic?) (3) Poor refill time? (perfusion)
what are adventitious breath sounds?abnormal sounds, you can pick these up on ascultation
what should you think if you are hearing increased HEART sounds?sound travels faster through fluid- inc heart sound means it could be a chest full of fluid
what heart ascultation abonrmalities might indicate a problem with the lungs?Increased heart sounds, Muffled heart sounds
can asculting tell you about the upper airway?yes there can be referred uper airway sounds
*CRACKLES AND WHEEZES-- which is bronchial and which is vesicular?bronchial= wheeze. vesicular= crackles
*what is the #1 sign of nasal dz?nasal discharge
*what are 2 things that ALL nasal diseases have?mucosal edema, Inflammation!! (–+/-secondary bacterial infections if damage is bad enough)
what if there's a dog with nasal dz but you don't see any discharge?theyre swallowing it
what are some types of nasal discharge?serous, mucopurulent +/-blood, Epistaxis
what are some clinical signs that might relate to nasal disease/discharge?Sneezing, Stertor, Facial Deformity, –+/-Systemic illness signs
*what are the 3 things that are up noses most often?FBs, fungi, neoplasia
which fungi likes dog noses and which likes cat noses?DOG= aspergillus. CAT=cryptococcus
Why do you usually only see bacterial infections in the nose secondary to problems?theyre supposted to be filters! noses are in butts all the time. so bacteria are NOT primary pathogens of noses. dont see primary bact infxns
if there is a resp problem, why might you ask about travel?some places are full of fungus
why might a CS of dysphagia show up in nasal dz?nose and mouth are connected and closely related
What should you never forget to do on a physical exam for nasal dz?PALPATE THE FACE! FULL ORAL EXAM! (teeth!) OCULAR EXAM! (eye can't go in bc mass behind it).
Things Dr. C said: it's really important to check if the nasal problem/breathing is unilateral or bilateral!! How can you see if theyre breathing from each nostril? use glass slide. if see 2 condensations, then both sides working. but if 1 big and one little one, or only through one.....can say unilateral nasal obstruction. youll look like a rockstar
what are some reasons there would be unilateral breathing through nostrils?foreign bodies!! Cancer usually starts uni but can move to bi. Fungi does whatever it wants.
Three major reasons for serous nasal discharge?NORMAL, VIRAL, or it is the early sign of causes of mucopurulent discharge before it progresses to that.
Viral infections cause what kinda nasal discharge? what are three examples of viruses that do this?can be serous, usually progresses to mucopurulent (+/- blood). feline herpesvirus, calicivirus, and canine influenza can do this
Fungal infections will cause what kind of nasal discharge? What are 4 examples of agents which can affect the nasal passages?usually mucopurulent (+/- blood), but they can also cause epistaxis. aspergillosis(dogs), cryptococcus (cats), Penicillium, and Rhinosporidium like noses
parasites cause what kind of nasal discharge? what are two examples of parasites which like the nasal cavity?Usually mucopurulent (+/- blood). Two exapmples are Pneumonyssoides (nasal mites) and Capillaria (nematode)
a foreign body usually produces what kind of nasal discharge?mucopurulent (+/- blood), but can also cause epistaxis
neoplasia usually causes what kind of nasal discharge? what are three neoplasias which like the nose?mucopurulent (+/- blood), OR epistaxis. carcinoma, sarcoma, lymphoma all really like the nose
Nasopharyngeal polyp--> who does this usually occur in, and what kinda nasal discharge does it usually produce?CATS, usually mucopurulent (+/- blood)
what are 4 examples of Extensions of oral disease which can affect the nasal cavity, and what kind of discharge does this result in?mucopurulent (+/- blood). Three oral dzs affecting the nasal cavity are: tooth root abscess, oronasal fistula, deformed palate
Allergic rhinitis usually causes what kind of nasal discharge?mucopurulent (+/- blood)
Feline chronic rhinosinusitis usually causes what kind of nasal discharge?mucopurulent (+/- blood)
Canine chronic rhinitis--> what should you know about getting this back on your bx results? also what kinda nasal discharge results from this?mucupurulent (+/- blood). This result often comes back when you just didn't get what was actually causing the problem (such as fungus or FB being hard to get).
Nasal disease, such as trauma, FB, or neoplasia can all cause what kinda nasal discharge?EPISTAXIS! (note, FB and neoplasia can also be mucopurulent)
*Systemic diseases cause which type of nasal discharge?EPISTAXIS!
Three examples of clotting disorders which could cause epistaxis?Thrombocytopenia, Thrombocytopathia, Coagulation defect
vasculitis of the nasal cavity can lead to...epistaxis
Hyperviscosity syndrome/Polycythemia (where blood viscosity is increased/ excessive RBCs) will affect the nasal cavity how?leads to epistaxis
what should you know about what causes what for which type of nasal discharge?Basically anything that causes mucopurulent discharge can START OUT as serous, and also anything that can cause mucopurulent discharge can progress to epistaxis, or epistaxis can lead to mucopurulent
what 4 things would you want to do as an initial diagnoses for all species?(1) hx (2) physical exam (3) Funduscopic exam (eye exam) (4) Thoracic radiographs (do in case 3 main causes have gone to metastasized, might not want to bother with other tx)
what are 2 additional initial diagnostics you'd want to do for dogs specifically?Nasal swab cytology, aspergillosis titer
what are 4 additional initial diagnostics you'd want to do for cats specifically?Nasal swab cytology(get snot on glass slide and look at it. if fungus, easy to see), Cryptococcal antigen titer, Viral testing (for FeLV/FIV, and then +/- herpesvirus and calicivirus) ((viruses can cause nasal discharge and then damage to let 2* infection take place)
If there is initial presentation of nasal problems INCLUDING HEMORRHAGE, what extra things should you do? (5 general, and what two things for dogs?)Do a CBC, platelet count, coag panel (coag factors), BMBT (check platelets), and arterial blood pressure (hypertension can cause bleeding). If it is a DOG, you also want to do a tick borne dz panel and von Willebrand’s factor assay
if you want to do advanced diagnostics, what must you do first?anesthesia
what are three advanced diagnostic techniques you could do? in order of how youd do them(remember anesthesia first) (1) Nasal Radiography/CT/MRI (note: for head rads, CT is NOT more expensive than rads) (2) complete oral exam (3) rhinoscopy
what are some benifits of doing a rhinoscopy?you can get a BIOPSY, and also a DEEP NASAL CULTURE (usually to find fungi, can also find bact)--- benefits include Biopsy, cytology, cultures, flushes, etc
what should you know about a Exploratory rhinotomy with turbinectomy?not recc. all you did was pull out the turbinates, and now they can just shoot bigger snot balls at you
what are two different kinds of rhinoscopy? be careful not to do what?Flexible (soft--can go through front. or go through mouth and turn up camera and do retroflex and see choana (And FBs love to go there) ) and rigid Retroflex view (careful that you dont go through medial canthus. if past that with rigid, can stab ethmoids.)

Pharyngeal and Laryngeal Diseases

Question Answer
Stridor and Sturdor--> which localizes where?STRIDOR= laryngeal (stride on your throat so you can't breath), STURDOR=paryngeal/nasal (your nasal cavity is more sturdy than your soft throat)
what are 6 signs you'd encounter in paryngeal dz?(1) sturdor (2) Reverse sneezing (3) Gagging (4) Retching (5) Dysphagia (6) Airway obstruction (Usually later in disease process)
what are 3 signs you'd encounter in Laryngeal Diseases?(1) resp distress (2) stridor (3) +/-systemic signs
do you see possibly systemic signs in phrayngeal or laryngeal dz? why?laryngeal, because of risk of Aspiration pneumonia
laryngeal dz--> Respiratory distress and Stridor--> this is due to what? is the presentation usually acute or chronic/gradual onset?Due to progressive airway obstruction. Often an ACUTE presentation.
If you do a physical exam but you see no clinical signs, what might you have to do to see the problem?exercise them
if there is laryngeal dz, what must you do on PE? if there is also stridor, what might you also wanna do?complete PE (exercise if no CSs obvious), and palpate neck!! CHECK IF THERE IS A STRIDOR, and if there is also stridor, Auscultation of chest and neck (trachea)
(who tends to get Laryngeal paralysis a lot?)old hunting dogs
what is the MAJOR laryngeal dz dogs and cats can get? (then list a few more)MAJOR ONE: Laryngeal paralysis. (There might also be: Laryngeal neoplasia, Obstructive laryngitis, Laryngeal collapse, Web formation, Trauma, Foreign body, Extraluminal mass, Acute Laryngitis)
what are the MAJOR 4 Pharyngeal Diseases in Dogs and Cats (then list a few more)MAJOR ONES: Brachycephalic airway syndrome*, Elongated soft palate*, Nasopharyngeal polyp* (cats love this one), Lymphoma* in cats. (Others include Foreign body, other neoplasias, Abscess, Granuloma, Extraluminal mass)
diagnostics with Imaging might help you detect what problems?Masses, Foreign bodies, the state of the trachea
Laryngoscopy/ Pharyngoscopy--> explain the difference between these two thingsLaryngoscopy just uses the laryngoscope, that thing you use to intubate. It isn't fancy, no cameras, none of that shit. it is not the same as endoscopy. For pharyngoscopy, you ARE going deeper in, THEN need to use endoscope.
what are the three kinds of Laryngoscopy/ Pharyngoscopy she listed?direct, retroflex, trachea
what are some things imaging in general can show you about laryngeal/pharyngeal dz?Radio-dense foreign bodies, Masses, Soft palate abnormalities
**which view do you want to take in imaging, and what does this allow you to see?only want a lateral, because on a DV the verts are in the way. With a lateral you can see Larynx, caudal nasopharynx, cranial trachea
what is flouroscopy, and why is it desirable as a tool for imaging the larynx/pharynx?it's like a "real time radiograph" with contrast. Not used often because of high levels of radiation, but you can watch the swallowing apparatus and such
what are two things ultrasound is really useful for in the larynx and pharynx?good for detecting motion (such as in a dynamic obstruction) and also for guided mass aspiration.
what are some benefits of using CT/MRI for imaging of pharyngeal / laryngeal dz?good for looking at masses and how locally invasive they are. This will allow you to determine if you want to do an incisional or excisional biopsy, or bother at all, with all of the delicate tissues oft he neck in this region
If you want to do Laryngoscopy/Pharyngoscopy, you must put them under anesthesia. what are some things you must be careful of, when you have anesthesia and pharyngeal/laryngeal dz in combination?you must be cautious to do Constant monitoring during recovery!! (Esp bulldogs. dont pull that tube out till it's sitting up and looking at you). repair might be necessary at this time. Also carefully titrate your anesthesia (so if you are using propofol, make sure fix it right then and there, quickly!).
what are some things you can evaluate and fix while doing laryngoscopy/pharyngoscopy? (remember this must be done under anesthesia)Evaluate dynamic function (when dog breathes in, the arretnoid cartilages should be opening during this time (if one doesnt move- unilateral laryngeal paralysis) ), can also assess and perhaps remove excess Soft palate and everted saccules (make sure you have enough time with what anesthesia you choose to do!). you can also perform a mass bx
what's doxapram? what does it do?a drug which can inc the signal to breathe. makes mm move a little faster. if give them too much propofol can give them