Clin Med - Respiratory 1

pbhati17's version from 2017-03-02 04:18

Intro & Nasal

Question Answer
Wach 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 be...An EMERGENCY
List of presenting complaints for respDyspnea
Open Mouth Breathing
Exercise intolerance
Upon initial presentation of resp. problems, what is the 1st thing you should do for the animal? (explain why)KEEP THEM CALM!! Exercise, excitement & temperature can exacerbate distress (excitement can ↓ airway size even more). Also excitement can cz negative pressure (inflammation & edema), cz ↑ 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 w/ laryngeal paralysis they need is-?ACE!!! they need to calm down & breathe.
When you begin to evaluate upon initial presentation, what are 3 things you should check? (reasoning?)(1) Use of accessory muscles (Abdominal press/restrictive component → are they having ↑ 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 auscultation
What should you think if you are hearing ↑ HEART sounds?Sound travels faster through fluid - ↑ heart sound means it could be a chest full of fluid
What heart auscultation abnormalities might indicate a problem w/ the lungs?↑ heart sounds, Muffled heart sounds
Can auscultating tell you about the upper airway?Yes there can be referred upper airway sounds
*CRACKLES & WHEEZES-which is bronchial & which is vesicular?Bronchial = Wheeze
Vesicular = Crackles
*What is the #1 sign of nasal dz?Nasal discharge
*What are 2 things that ALL nasal dzs have?Mucosal edema, Inflammation!! (–+/-2⁰ bacterial infxns if damage is bad enough)
What if there's a dog w/ nasal dz but you don't see any discharge?Theyre swallowing it
What are some types of nasal discharge?Serous
Mucopurulent +/-blood
What are some CS that might relate to nasal dz/discharge?Sneezing
Facial Deformity
+/- Systemic illness signs
*What are the 3 things that are up noses most often?FBs
Which fungi likes dog noses & which likes cat noses?DOG = Aspergillus
CAT = Cryptococcus
Why do you usually only see bacterial infxns in the nose 2° to problems?Theyre supposed to be filters! noses are in butts all the time. So bacteria are NOT 1° pathogens of noses. Dont see 1° bact infxns
If there is a resp problem, why might you ask about travel?Some places are full of fungus


Question Answer
Why might a CS of dysphagia show up in nasal dz?Nose & mouth are connected & 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 & 1 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.
3 major reasons for serous nasal discharge?NORMAL, VIRAL, or it is the early sign of czs of mucopurulent discharge before it progresses to that
Viral infxns cz what kinda nasal discharge? What are 3 examples of viruses that do this?Can be serous, usually progresses to mucopurulent (+/-blood). Feline Herpesvirus, calicivirus & canine Influenza can do this
Fungal infxns will cz what kind of nasal discharge? What are 4 examples of agents which can affect the nasal passages?Usually mucopurulent (+/-blood), but they can also cz epistaxis. aspergillosis(dogs), Cryptococcus (cats), Penicillium & Rhinosporidium like noses
Parasites cz what kind of nasal discharge? What are 2 examples of parasites which like the nasal cavity?Usually mucopurulent (+/-blood). 2 examples are Pneumonyssoides (nasal mites) & Capillaria (nematode)
A foreign body usually produces what kind of nasal discharge?Mucopurulent (+/-blood), but can also cz epistaxis
Neoplasia usually czs what kind of nasal discharge? What are 3 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 & what kinda nasal discharge does it usually produce?CATS, usually mucopurulent (+/-blood)
What are 4 examples of Extensions of oral dz which can affect the nasal cavity & what kind of discharge does this result in?Mucopurulent (+/-blood). 3 oral dzs affecting the nasal cavity are: tooth root abscess, oronasal fistula, deformed palate
Allergic Rhinitis usually czs what kind of nasal discharge?Mucopurulent (+/-blood)
Feline chronic Rhinosinusitis usually czs what kind of nasal discharge?Mucopurulent (+/-blood)
Canine chronic Rhinitis → what should you know about getting this back on your biopsy 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).


Question Answer
Nasal dz, such as trauma, FB, or neoplasia can all cz what kinda nasal discharge?EPISTAXIS! (note, FB & neoplasia can also be mucopurulent)
*Systemic dzs cz which type of nasal discharge?EPISTAXIS!
3 examples of clotting disorders which could cz epistaxis?Thrombocytopenia
Coagulation defect
Vasculitis of the nasal cavity can lead to...Epistaxis
Hyperviscosity syndrome/Polycythemia (where blood viscosity is ↑/ excessive RBCs) will affect the nasal cavity how?Leads to epistaxis
What should you know about what czs what for which type of nasal discharge?Basically anything that czs mucopurulent discharge can START OUT as serous & also anything that can cz 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 czs have gone to metastasized, might not want to bother w/ 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 & look at it. if fungus, easy to see), CryptoCoccal antigen titer, Viral testing (for FeLV/FIV & then +/-Herpesvirus & calicivirus) ((viruses can cz nasal discharge & then damage to let 2° infxn take place)
If there is initial presentation of nasal problems INCLUDING HEMORRHAGE, what extra things should you do? (5 general & what 2 things for dogs?)Do a CBC, platelet count, coag panel (coag factors), BMBT (check platelets) & arterial blood pressure (hypertension can cz bleeding). If it is a DOG, you also want to do a tick borne dz panel & von Willebrand’s factor assay
if you want to do advanced diagnostics, what must you do 1st?Anesthesia
What are 3 advanced diagnostic techniques you could do? in order of how youd do them(Remember anesthesia 1st)
(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 benefits of doing a Rhinoscopy?You can get a BIOPSY & also a DEEP NASAL CULTURE (usually to find fungi, can also find bact) - benefits incld:
What should you know about an exploratory Rhinotomy w/ turbinectomy?Not recc. all you did was pull out the turbinates & now they can just shoot bigger snot balls at you
What are 2 different kinds of Rhinoscopy? be careful not to do what?Flexible (soft-can go through front. or go through mouth & turn up camera & do retroflex & see choana (& FBs love to go there) ) & rigid Retroflex view (careful that you dont go through medial canthus. if past that w/ rigid, can stab ethmoids.)

Pharyngeal & Laryngeal Dzs

Question Answer
Stridor & 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 dz process)
What are 3 signs you'd encounter in Laryngeal dzs?(1) Resp distress
(2) Stridor
(3) +/-systemic signs
Do you see possibly systemic signs in phrayngeal or laryngeal dz? Why?Laryngeal, bc of risk of Aspiration pneumonia
Laryngeal dz → Respiratory distress & 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 CS, 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) & palpate neck!! CHECK IF THERE IS A STRIDOR & if there is also stridor, Auscultation of chest & neck (trachea)
(Who tends to get Laryngeal paralysis a lot?)Old hunting dogs
What is the MAJOR laryngeal dz dogs & 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 dzs in Dogs & Cats (then list a few more)MAJOR ONES: Brachycephalic airway syndrome*, Elongated soft palate*, Nasopharyngeal polyp* (cats love this one), Lymphoma* in cats. (Others incld Foreign body, other neoplasias, Abscess, Granuloma, Extraluminal mass)
Diagnostics w/ Imaging might help you detect what problems?Masses
Foreign bodies
The state of the trachea
Laryngoscopy/ Pharyngoscopy → explain the difference btwn these 2 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
Pharyngoscopy, you ARE going deeper in, THEN need to use endoscope.
What are the 3 kinds of Laryngoscopy/ Pharyngoscopy she listed?Direct
What are some things imaging in general can show you about laryngeal/pharyngeal dz?Radio-dense foreign bodies
Soft palate abnormalities
**Which view do you want to take in imaging & what does this allow you to see?Only want a lateral, bc on a DV the verts are in the way. W/ a lateral you can see Larynx, Caudal nasopharynx, Cranial trachea
What is flouroscopy & why is it desirable as a tool for imaging the larynx/pharynx?It's like a "real time radiograph" w/ contrast. Not used often bc of ↑ levels of radiation, but you can watch the swallowing apparatus & such
What are 2 things ultrasound is really useful for in the larynx & pharynx?Good for detecting motion (such as in a dynamic obstruction) & also for guided mass aspiration.
What are some benefits of using CT/MRI for imaging of pharyngeal / laryngeal dz?Good for looking at masses & 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, w/ 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 & 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 & 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 & there, quickly!).
What are some things you can evaluate & fix while doing laryngoscopy/pharyngoscopy? (remember this must be done under anesthesia)Evaluate dynamic fxn (when dog breathes in, the arytenoid cartilages should be opening during this time (if 1 doesnt move-unilateral laryngeal paralysis) ), can also assess & perhaps remove excess Soft palate & everted saccules (make sure you have enough time w/ what anesthesia you choose to do!). You can also perform a mass biopsy
What's Doxapram? what does it do?A drug which can ↑ the signal to breathe. Makes mm move a little faster. if give them too much Propofol can give them