respiratory SAM

True or false

Cats dont want to eat when they lose their sense of smell

• True they become anorexic

If you see oral and nasal ulcers, what respiratory virus?

• Calicivirus (FCV)

If you see conjunctivitis and cornea ulcers what respiratory virus?

• Feline herpes virus (FHV)

Which animals get pneumonia more those infected with herpes virus or calicivirus

• Feline calicivirus

If cat has chronic conjunctivitis which should be on your differential

• Chlamydophila felis (bacterial)

True or false

Feline upper respiratory infection disease is self limiting in most cats

• true

• give supportive care ie nutritional fluids

Do vaccines against FHV and FCV prevent an infection?

• No just decreases disease severity

Which animal gets nasopharyngeal polyps

• young kittens and young cats (3yr)

• may originate from eustachian tube

• can grow towards nasopharynx or middle ear

Bacterial rhinitis is always primary or secondary

• Secondary

• figure out the primary cause

What are some clinical features with nasopharyngeal polyps

• Stertorous breathing

• serious / mucopurulent nasal discharge

• if in ear = otitis, head tilt, nystagmus or horners syndrome

Good ways to diagnose nasal pharyngeal polyps is CT, gross visualization, scope, How do you definitively diagnose

• Histopathology

• will come back as a inflammatory fibrous tissue

Treatment for a nasopharyngeal polyp

• Traction avulsion

• ventral bulla osteotomy (bullae involvement)

Recurrence rate with a traction avulsion is 41% how can you decrease this?

• Give prednisolone post surgery

Possible complications with a removal of polyp

• transient horner syndrome

• may return if all tissue not removed

• excellent prognosis

what is test of choice for cryptococcus?

• Blood antigen

What imaging modality gives you the most information when you are looking at nasal disease?

• CT

• rhinoscopy not so much because of limited space in there and swelling of tissues

Most common nasal cancer in cats

• Lymphoma

• adenocarcinoma

• SCC

• lymphoma metastasizes 5 to 10% of the time to the lungs

what are two things that can cause bone lysis

• tumor antifungal

Majority of nasal tumors are benign or malignant

• Malignant meaning they are highly invasive

Three nasal tumors dogs can get

• Adenocarcinoma

• fibrosarcoma

• chondrosarcoma

• (carcinoma, followed by sarcoma)

What breed of dogs get nasal tumors more commonly

• Dolichophallic

What is the most common clinical signs with a nasal tumor?

• chronic nasal discharge

• often unilateral, but can progress to bilateral

• serous mucoid or mucopurulent

• other clinical signs include sneezing, facial deformity, neurologic abnormalities

CT would be best option if you want to diagnosis a nasal tumor but if you only have radiographs what is your approach?

• Lay them on their back and straight through maxilla

• can also do a skyline view through the nostrils

Treatment of choice for nasal tumors

• Radiation therapy (13 mo mst)

• add chemotherapy if dealing with lymphoma

Cryptococcus clinical signs in cats and dogs

• cats = nasal cavity (most common) skin, CNS, eyes, SQ

• Dogs = CNS most common

• note: lungs can be affected in both species

How do you diagnosis cryptococcus

• First look at the clinical signs which can be nasal discharge facial deformity in a young cat

• capsule antigen test can also ID by cytology

• note: culture is not common for this

Functions of the capsule in the pathogenicity of cryptococcus

• Inhibits plasma, cell function, phagocytosis, leukocyte, migration, and compliment

When you are doing a blood antigen test for cryptococcosis what is the basis for the test?

• The capsular antigen

• Note: cryptococcosis is a budding yeast 4-7mm with a polysaccharide capsule

What is the definitive diagnosis for cryptococcosis

• cytology

Treatment of choice for cryptococcosis

• Fluconazole

• Best for CNS and ocular penetration

How long do you treat for cryptococcosis

• 6 to 12 months and at least two months beyond clinical resolution

• negative titer

• reassess antigen at three and six months post discontinuation for relapsing assessment

Prognosis for cats with cryptococcosis

• Good if no CNS involvement

• CNS involvement equals guarded prognosis

• FELV / FIV cats are less likely to respond to treatment

True or false

Aspergillus can be a normal inhabitant of the nasal mucosa in many animals

• True

What is a common signalment for aspergillus dogs?

• Young males who are outdoors a lot

True or false

Aspergillus can form fungal plaques that invade nasal mucosa can be secondary to other nasal disease and can be secondary to immune deficiency

• True

Aspergillosis is acute or chronic nasal disease

• Chronic

What is the key feature with aspergillosis

• nasal discharge

• mucoid mucopurulent bloody

• can be unilateral / bilateral

what common clinical feature will you see on the external nares with dogs with aspergillosis?

• Depigmentation and ulceration

Do you commonly see aspergillosis back in the nasal pharynx

• No commonly located at the nasal location and will cause turbinate damage

What is a common way you can diagnose aspergillosis

• Rhinoscopy and then biopsy the fungal plaque

If you do a rhinoscopy and you do not see any fungal plaques to biopsy what is there another way you can diagnosis aspergillosis

• Do a serum antibody titer since it is a high specificity test

• if it comes back positive that means it is positive

Aspergillosis antigen test is only good for

• systemic disease, not local nasal disease

• sensitivity for sinonasal disease with antigen testing is 23% so not good

How do you treat nasal aspergillosis?

• Intranasal topical clotrimazole infusion

• not orally

If you want to do rhinoscopy but also want to do imaging. What do you need to do first

• Imaging

Bacterial rhinitis is usually secondary and a thorough evaluation of what other causes is required

• foreign body

• nasal tumor

• fungal

• dental disease

Fly larvae, nasal mite, and nematodes that are nasal related

• Larvae = cuterebra

• nasal mite = pneumonysspodes caninum

• nematode = eucoleus boehmi and linguatula serrata

What is a diagnosis of exclusion when you are thinking of nasal disease

• Rhinitis

• On biopsy nasal mucosa shows some type of inflammatory changes

• chronic signs of nasal disease such as (sneezing and discharge)

If a young cat shows up with signs of stertor / strider chronically, what are three differentials

• Nasopharyngeal polyp

• stenotic nurseries

• cryptococcosis

two common reasons why an animal will get nasopharyngeal stenosis

• post anesthetic reflux

• chronic upper respiratory infection

signs of upper airway, respiratory problem

• inspiratory dyspnea

• inspiratory noise

• cough (larapara)

• dysphasia, gagging

Which area is stertor and stridor

• stertor = pharynx, palate

• stridor = larynx

Most common etiology for laryngeal paralysis

• Idiopathic (GOLPP)

What is GOLPP

• Geriatric onset laryngeal paralysis polyneuropathy

What endocrine disease is most commonly associated with laryngeal paralysis

• Hypothyroidism

• less commonly Addisons

clinical signs with laryngeal paralysis

• older larger breed dog with change in phonation, stridor, coughing after eating drinking

When diagnosing laryngeal paralysis what should you always have

• IV catheter

• ET tube ready

What is a common complication after surgery with laryngeal paralysis

• increased risk for aspiration, pneumonia

What are the anatomic abnormalities associated with brachycephalic airway syndrome

• Primary = stenotic nares, elongated soft palate

• secondary = everted laryngeal saccules, laryngeal collapse

• genetic = hypoplastic trachea

what is a common secondary effect related to the GI system you see with BOAS

• Gastro-esophageal reflux

• hiatal hernia

True or false

laryngeal collapse is a poor prognostic indicator for BOAS

• true

• if severe permanent tracheostomy is a salvage procedure

What is obstructive laryngitis

• Non-neoplastic infiltration of larynx

• clinical signs = upper airway obstruction (phonation, stridor )

Treatment options for obstructive laryngitis

• corticosteroids

• conservative excision of obstructing tissue

• prognosis = variable

True or false

primary laryngeal neoplasia is common

• false

• neoplasia oringating from larynx uncommon

Two common areas where neoplasia arises from that can compress and invade larynx

• thyroid carcinoma

• lymphoma

most common primary laryngeal neoplasia in dogs and cats

• Dogs = carcinoma

• cats = lymphoma

what is the main clinical sign with tracheal bronchial disease?

• Coughing due to airway irritation

collection of highly contagious, infectious diseases of canine respiratory tract

• Canine infectious respiratory disease complex

• also referred to as kennel cough / infectious tracheobronchitis

Dogs with CRDC present with mil cough sneeze, discharge and fever.

If complicated with bacterial infection, can progress to pneumonia

In most dogs signs of disease are mild and self limiting which resolve on their own within how many days

• 7-10 days

• note: so if you have a chronic case this should not be on your list

CIRDC has an acute onset and most dogs who also have fever, lethargy, hyporexia in addition to the cough and nasal ocular discharge have secondary ____

• Bacterial infection

• Note: most dogs remain active and have a normal appetite

True or false

If animal shows up with clinical signs and history consistent with CIRDC further diagnostics are not routinely needed

• True

If a dog does not have secondary bacterial disease in the lungs with CIRDC what can you give them as a treatment option?

• cough suppressant such as hydrocodone and butorphanol

• dont give if there is bacterial infection present in lungs

When would you want to give antibiotics with CIRDC

• signs greater than one week or suspected bacterial infection

Collapsing trachea is common in what breed of dogs

• Toy and small breed dogs

• risk factors are increased with genetics and obesity

What age do these dogs commonly get collapsing trachea

• middle-aged

• signalment to look out for is middle-aged, small dog

What is the primary clinical sign with a collapsed trachea?

• Nonproductive cough (goosehonk)

• cough worsens with excitement, exercise, heat and pressure on neck

Three physical exam findings that can lead you to diagnosing collapsing trachea

• cough elicited by tracheal palpation

• inspiratory effort (extra thoracic collapse)

• expiratory effort (intrathoracic collapse)

True or false

Absence of tracheal collapse on radiographs does not rule it out

• True because it can be dynamic

Three ways you can diagnose, collapsing trachea, other than history and physical exam

• radiograph

• fluoroscopy

• bronchoscopy

True or false

medical management treatment for collapsing trachea is adequate for many animals

• True

In addition to weight loss, avoiding collars, heat and excitement what are other treatment options you would add for medical therapy with collapsing trachea

• cough suppressant

• corticosteroids

• bronchodilators if you suspect bronchitis

• and antibiotics if infection present

When is tracheal stenting recommended

• dogs in which airway obstruction is a significant component of their disease

When would you manage a dog medically with tracheal collapse

• if cough is their only clinical sign

What are key features of asthma

• Broncho constriction is reversible

• predominant eosinophilic inflammation

Key features with chronic bronchitis

• neutrophilic inflammation

• permanent change with bronchoconstriction

• usually a sequelae

clinical sigs associated with feline lower airway disease

• cough

• wheezing

• dyspnea

• tachypnea

Why might you see a collapsed right middle lung lobe in cats with asthma

• mucous plug

• right middle lung lobe is the most ventral so you would look here for other things such as aspiration pneumonia

What are features you would see on thoracic radiographs with feline lower airway disease

• Bronchial to interstitial pattern

• hyperinflation

• collapsed right middle lung lobe

• spontaneous pneumothorax

• can also be normal

Treatment options for lower airway disease in cats

• control irritant

• steroids

• bornchodilator’s

Common inhalation drugs used for feline asthma

• Fluticasone (corticosteroid)

• Albuterol (bronchodilator)

What is the most common cause of chronic cough in middle age to older dogs

• canine chronic bronchitis

Definition of canine chronic bronchitis

• cough occurring on most days for two or more executive months without any other active disease

True or false

chronic cough is a key feature of canine chronic bronchitis

• True

true or false

Broncho constriction is a key factor with canine chronic bronchitis

• False

• which is why you see minimal response with bronchodilators

What breed and age of dog usually gets canine chronic bronchitis

• small breed older dogs

How do you diagnosis canine chronic bronchitis

• if breed is matching

• no systemic signs of illness

• chronic cough lasting months to years

• diagnosis of exclusion

What might you see on radiographs with advanced stages of canine chronic bronchitis

• Bronchiectasis

What can occur secondary to canine chronic bronchitis

• right ventricular enlargement due to pulmonary hypertension

Treatment for canine chronic bronchitis

• corticosteroids

• bronchodilator (theophylline)

• cough suppressant

• adjunct = weight loss, avoid neck collar, mucus clearance, dental care avoid irritant