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What are the 3 kinds of diagnoses we try to make?
- physiologic diagnosis- clinical signs
- anatomic diagnosis- localization, morphologic
- etiologic diagnosis- underlying cause
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The ____________ guides the differential diagnoses and selection of diagnostic tests.
anatomical location of disease
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What clinical signs may be associated with disease of the nasal cavity, paranasal sinuses, and/or teeth?
sneezing, nasal d/c, pawing/rubbing face
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Where is reverse sneezing localized to?
nasopharynx
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Where do audible respiratory noises localize to in terms of disease? (4)
[upper airways] soft palate, larynx, trachea, principal bronchi
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Where might halitosis localize to in terms of disease? What does it usually indicate?
nose to lungs; necrosis and/or infection
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Where does coughing localize to in terms of disease? (3)
larynx to tracheal-bronchial tree, +/- lungs, sometimes pleura
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Where do tachypnea and hyperpnea localize to in terms of disease? (4)
lungs and pleural space, diaphragm, non-respiratory causes of altered ventilation
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What non-respiratory causes of altered ventilation can cause tachypnea/hyperpnea? (4)
acidosis, drugs, anxiety, pain [look-alikes- make you think of resp disease]
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What do altered ventilatory patterns and paradoxical breathing mean?
non-specific but a sign of severity
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What are causes of cachexia with respiratory disease? (5)
pulmonary neoplasia, chronic pneumonia, congestive heart failure, granulomatous diseases of the lung, systemic mycoses
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What consideration should you make when taking an animal's temperature?
- a true fever is caused by infectious, immune-mediated diseases or neoplastic processes
- hyperthermia is common in dogs with upper airway obstruction (not a true fever)
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How does hypoxemia affect heart rate?
bradycardia
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Why is it important to sedate animals that have respiratory distress?
anxiety can exacerbate respiratory distress (can't breathe--> fearful--> hyperventilation--> worsening air intake)
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What are the most likely reasons for cyanosis (obvious desaturation)? (2)
hypoventilation, V/Q mismatch [maybe also high altitude and low FiO2, congenital heart disease, hemoglobin abnormality]
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An old cat comes in with respiratory distress. After it's stabilized, what should you make sure to check for?
thyroid mass
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____________ is often associated with sinusitis in dogs.
Canine tooth root abscess
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What are non-cardiac causes of jugular venous distention? (2)
large pleural effusion compressing the CVS, mediastinal mass
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What should you rule out in a dog with intermandibular swelling?
cranial vena cava syndrome due to a mediastinal mass
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What postures might animals assume to minimize respiratory effort and respiratory distress? (6)
neck extension, elbow abduction, standing, reduced swallowing, open mouth to increase oropharyngeal diameter, sitting position (favorable alters diaphragmatic function)
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Overt noise during respiration usually indicates...
upper airway obstruction.
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Inspiratory noise usually indicates...
upper airway disease/obstruction.
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Expiratory noise usually indicates...
obstruction/disease of the carina or distally.
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What kind of ventilatory pattern does pleural space disease cause?
rapid, progressively increased inspiratory excursions
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What ventilatory pattern does parenchymal disease cause?
expiratory dyspnea
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What ventilatory pattern dose bronchial disease cause?
expiratory dyspnea
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What ventilatory pattern does disease at the carina cause?
expiratory dyspnea
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Describe paradoxical breathing.
normally the thorax and abdomen move in the same direction; with paradoxical breathing, caudal ribs and abdomen move in the opposite direction (ribs elevate while flank sinks)
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What does paradoxical breathing indicate?
severe respiratory distress
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What does fast shallow breathing often indicate? (4)
[stiff lungs] edema, fibrosis, inflammation, disseminated neoplasia
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What does stertor sound like, and what does it usually indicate?
snoring; pharyngeal obstruction
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What does stridor sound like, and what does it usually indicate?
inspiratory high-pitched sound; glottic obstruction
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With upper airway obstruction, there is __________ inspiratory phase.
longer
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What kind of diseases cause a tracheal snap or honk?
tracheal collapse
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What is reverse sneezing, and why does it occur?
spasmodic inspiration against a closed glottis; trying to clear the nasopharynx
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What are lower airway sounds? (5)
bronchial breathing (bronchovesicular sounds), accentuated or attenuated bronchial sounds, rhonchus (low pitched), wheeze, crackles
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What does rhonchus sound like, and what does it usually indicate?
low pitched snoring sound over the lungs; exudate or mucus in the airway
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Wheezing is an __________ sound that occurs due to __________.
expiratory; bronchial obstruction
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What do crackles sound like, and what causes them?
velcro being ripped apart; lung infiltrates or fibrosis
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You hear crackles on auscultation. What is your next move?
thoracic rads
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You hear soft or muffled heart sounds in a patient with respiratory distress. What is at the top of your list?
effusion, CHF
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What should you do for a pleural effusion? What should you not do?
- Should: tap the chest
- Should NOT: diuresis
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What is emergency therapy for an animal with inspiratory dyspnea and obstructive noises? (4)
oxygen, butorphanol, cool down (fan, alcohol) +/- intubate/ventilate
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What is emergency therapy for an animal with inspiratory dyspnea, increased effort, and muffled sounds/ dull percussion? (4)
thoracocentesis!!, T-FAST, oxygen, butorphanol
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What is emergency therapy for an animal with tachypnea with adventitious sounds? (4)
T-FAST, oxygen, butorphanol, +/- furosemide
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What does T-FAST mean?
thoracic focused assessment with sonography for trauma
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What is the emergency therapy for an animal with murmur/gallop/arrhythmia with pulmonary crackles or tachypnea? (3)
furosemide, oxygen, butorphanol
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What is the emergency therapy for an animal with an expiratory wheeze? (3)
oxygen, butorphanol, Beta-2 agonist (terbutaline) or inhaled albuterol
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What are some simple diagnostic tests you can start with for an animal in respiratory distress? (2)
place a glass slide in front of nostrils--> see if passing air through both nostrils, dental probe canine (look for root abscess)
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What disease processes might US be useful for diagnosing? (3)
laryngeal motor dysfunction (laryngeal paralysis), pleural effusion/ mediastinum, lungs
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What drug is often given during anesthesia to stimulate respiration during a laryngeal exam?
Doxapram (respiratory stimulant)
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What are the lung lobes in dogs and cats?
- Right: cranial, middle, caudal, accessory
- Left: cranial, middle caudal
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What is the normal cellularity of BALF?
70-80% macrophages (except cats, eos can be 25% normally)
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What are your options for culturing the airways and lungs? (3)
brush, pipette, scope channel
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What organism should you always request when sending resp samples for culture?
Mycoplasma (ESP IN CATS)
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In dogs, it may be normal for the _________ to not be sterile.
trachea
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What large organism may be seen on cytology due to oropharyngeal contamination?
Simonsiella spp.
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