Respiratory Disease (Begin Exam 2 Material)
Fluoroscopy is useful for _____ disease (i.e., _____)
dynamic; airway collapse
Voice impairment (voice change), this is pertinent esp. in hunting dogs (look for change in bark)
dysphonia
Feeling desperate to breathe, a sensation that animals cannot describe to us
dyspnea
3 causes of crackles (rales)
edema, pneumonia, fibrosis
Normal respiratory observations: 1. no visible _____ 2. inspiration and expiration are _____ 3. _____ at end of expiration
effort; proportionate; pause
Movement from unilateral to bilateral nasal discharge could indicate _____
erosion
Ultrasonography is useful for: 1. _____ 2. _____ masses 3. pulmonary masses near the _____ 4. can also use US to guide for _____
pleural effusions; mediastinal; thoracic wall; aspirates
Friction rubs are commonly heard with _____ or _____disease
pleural; pericardial
Apneustic breathing occurs due to damage to the _____ or upper _____
pons; medulla
You can have _____ crackles that are worse after a cough
post-tussive
For nasal radiography, you should provide _____ information
preliminary
Exercise testing can be used to look at _____ of disease over time, as well as a good monitoring tool to assess _____
progression; therapy
B lines indicate _____ or _____
pulmonary edema; pneumonia
_____ disease can result in exercise intolerance
pulmonary parenchymal
Indications for thoracic CT: 1. _____ masses 2. _____ masses 3. _____ lung disease 4. _____ disease - less used currently 5. _____ disease (i.e., _____)
pulmonary; mediastinal; interstitial; airway; vascular; pulmonary thromboembolism
The fact that sound travels better through something dense, as long as there are not changes in media to allow reflection of sound, accounts for the reason that BV sounds are often actually increased in the thick lung filled with _____ (as in pneumonia) or _____ (as in edema)
pus; fluid
_____ are the most commonly used diagnostic modality for respiratory disease
radiographs
Bronchiectasis may be difficult to dx on _____, a _____ can help you better see this
radiographs; CT
Imaging for respiratory disease: 1. _____ - most often used in general practice for respiratory problems, this is helpful but is not always the best thing 2. _____ - real-time radiography 3. _____ 4. _____
radiography; fluoroscopy; ultrasonography; computed tomography
When you hear suspected crackles, be sure to listen over the _____ to make sure the sound are not referred sounds
trachea
Fluoroscopy: 1. useful for detecting dynamic collapse of the airways - _____ or _____ 2. can use _____ fluoroscopy 3. useful esp. if you can elicit a _____ 4. availability may be _____, but it would be worthwhile to refer to a clinic that has access to this
trachea; mainstem bronchi; resting; cough; limited
A honking cough usually indicates _____
tracheal collapse
_____ is meant to be a quick way to assess the lungs in an emergency setting
ultrasonography
_____ is used to look for signs that have been associated with certain findings
ultrasonography
You can see respiratory disease in >_____ place (e.g., intra and extra thoracic tracheal collapse)
1
3 types of airway washes
1. transtracheal wash (TTW) 2. endotracheal wash (ETW) 3. bronchoalveolar lavage (BAL)
1000 m walk test (1000 m): 1. walk _____ in a quiet, air conditioned straight hallway 2. dog walks at their _____ pace on leash 3. record _____
1000 m; own; time
Normal respiratory rate is _____-_____ bpm at rest, _____ bpm in the hospital
12-18; 30
You can evaluate temperature before and after exercise testing, if dogs are unable to bring their temperature back down within _____ minutes, this is a problem
15
2 types of exercise testing: 1. _____ walk test (6MWT) 2. _____ walk test (1000m)
6 minute; 1000 m
Vertical lines that go down through the tissue
B lines
_____ on US indicate fluid in the pulmonary parenchyma
B lines
Respiratory conditions (i.e., _____) can cause systemic effects
Blastomycosis
_____, _____, and _____ are all part of the minimum database
CBC; chemistry; UA
For the cost and time, it would be more cost effective to do a _____ as opposed to nasal radiographs
CT
_____ can be given if you do not see good movement during the sedated laryngeal exam because there is a chance that you could be missing movement due to the animal being too sedate
Dopram
_____ are the poster-child for stertor
English Bulldogs
There has to be a low _____ for a patient to get to the point of cyanosis
SpO2
Hyperresonance on percussion can indicate the presence of _____
air
Sound does not travel well through _____
air
The main mechanism for dogs to cool themselves is through the _____, this is the reason that dogs in respiratory distress can over heat
airway
Sound waves travel from the _____, through the _____, through the _____ space, through the _____, and into your stethoscope. So, anything that gets in the way can cause _____ bronchovesicular sounds.
airway; lung; pleural; chest wall; diminished
Increased BV sounds are usually associated with something within the _____ or the _____
airway; pulmonary parenchyma
Ultrasonography is not useful for _____ or _____
airways; aerated lung
The _____ pattern will have air bronchograms on radiographs, everything but the bronchi are filled
alveolar
Hypoventilation can be seen with _____ or an injury to the _____
anesthesia; brain
Awake/sedated thoracic CT: 1. when patient cannot undergo _____ 2. drawbacks - _____ artifact, lack of fully _____ images
anesthesia; movement; inspiratory
Possible causes of panting: 1. _____ 2. _____ 3. _____ in dogs 4. _____/_____ balance 5. _____ or _____ defects 6. _____ administration 7. _____ and _____ disease (e.g., Cushing's syndrome, hepatic encephalopathy)
anxiety; exercise; excitement; thermoregulation; acid/base; anemia; RBC; drug; metabolic; endocrine
Not breathing
apnea
3 causes of wheezes: 1. _____ 2. _____ filled airways 3. _____: chronic, severe bronchitis
asthma; mucus; COPD
_____ can be an artifact noticed in thoracic CT from general anesthesia
atelectasis
Because breath sounds are a reflection of air flow, they may be diminished over areas with little air flow, for instance over an _____ lung lobe
atelectic
General physical exam: 1. _____ 2. body _____ 3. _____ and _____ 4. membrane _____ 5. _____ exam 6. other body _____
attitude; condition; coat; skin; color; cardiac; systems
With nasal radiographs, you are primarily looking for _____
bone erosion
Exercise testing is good with _____ breeds to screen fore more functional dogs for breeding
brachycephalic
If you hear diminished BV sounds, do not forget that the animal may not have taken an adequate _____ to make an evaluation. Holding off the _____ for a few seconds may cause the next few breaths to be _____ and therefore more auscultable.
breath; nostrils; deeper
Respiratory patients are usually only stable enough for a _____ physical exam
brief
The _____ pattern will have donuts and railroad tracts on radiographs
bronchial
Fluoroscopy is used in the respiratory system, this is the best method for detecting _____, esp, if you can elicit a cough while they are on the table
bronchial collapse
Chronic enlargement of bronchi/bronchioles
bronchiectasis
Bronchitis can cause enough inflammation to cause _____, this creates an obstruction and therefore wheezes
bronchomalacia
Weak cartilage in bronchial walls
bronchomalacia
Scoping the bronchus and trachea
bronchoscopy
When you hear normal lung sounds, you say that you are hearing normal _____ sounds
bronchovesicular
_____ breath sounds (normal) and _____ breath sounds (abnormal) require a stethoscope to be heard
bronchovesicular; adventitious
Ways to collect microbiologic cultures: 1. _____/_____ - do NOT brush noses 2. _____/_____ 3. _____
brush/swab; wash/lavage; biopsy
When sound waves have to travel through multiple media, the sound waves tend to bounce off the denser medium (like the pleural effusion) back into the _____ instead of going right through the chest wall to the listener
chest
You can look for signs of _____ with an endoscope
collapse
You should check chest compressibility in cats because if a cat has a large mass in the mediastinum the chest will not _____ as easily as it does in a normal cat
compress
With nasal CT you can give _____ so you can highlight tumors or things that are very vascular
contrast
Friction rubs are often mistaken for _____
crackles
Alveoli or tiny airways popping open, these are "discontinuous" sounds
crackles (rales)
Pulmonary parenchyma disease: 1. respiratory phase most affected = _____, _____, or _____ 2. other associated characteristics = _____, increased _____ sounds
crackles; bronchovesicular
_____ and _____ can sometimes be heard together
crackles; wheezes
3 types of adventitious breath sounds that require a stethoscope to be heard: 1. _____: rales; course/fine 2. _____ (rhonchi) 3. _____
crackles; wheezes; friction rubs
For inspiration, the ribs should be pulled _____, _____; the diaphragm should contract and push the _____ back
cranial; dorsal; abdominal contents
The _____ has to be intact to do a nasal wash, this is where nasal CT could come into play
cribriform plate
Bluish discoloration
cyanosis
Abnormal respiratory observations continued: 1. _____ 2. _____, _____, nasal _____ 3. _____ movement of chest/abdomen 4. _____, _____, _____ 5. lots of other potential clues!
cyanosis; cough; sneeze; discharge; pardoxical; wounds; lumps; asymmetry
_____ bronchiectasis = traditional bronchiectasis (widening of airways)
cylindrical
Additional diagnostic modalities for respiratory disease depend on what you are _____ with
dealing
With Kussmaul breathing you will see _____ breathing
deep constant
Sedated laryngeal exam: 1. _____ breaths (dopram can be used) 2. need an _____ watching breaths 3. the larynx should open on _____ 4. _____ is useful in cats
deep; observer; inspiration; US
History that should be taken for a cough: 1. _____ (moist, dry, productive, honking) 2. _____ and _____ 3. _____ 4. _____ events that trigger the cough 5. _____ of day 6. any other _____/_____ affected 7. cats - ask about _____ and if they have produced anything
description; onset; duration; frequency; precipitating; time; signs/systems; vomiting
In terms of stridor, the _____ of the airway determines the pitch of the sound
diameter
Abnormal respiratory observations: 1. _____ rate (not a pant) 2. _____ appearance 3. _____ effort - a lot of movement when the animal is breathing 4. _____ nostrils 5. _____ lips 6. reluctance to _____ 7. _____ elbows 8. _____ neck 9. cats breathing through their _____
excessive; anxious; abdominal; flaring; drawn; lie down; abducted; outstretched; mouths
_____ testing can also be used to evaluate respiratory patients
exercise
Exercise testing is useful in animals that have a component of _____
exercise intolerance
Wheezes are generally loudest on _____. They may improve with _____. You often will see _____ present too.
expiration; bronchodilators; crackles
Asthma can be too fast to see _____ effort (this is especially true in cats)
expiratory
Lower airway disease: 1. respiratory phase most affected = _____ 2. other associated characteristics = _____, "abdominal _____"
expiratory; wheezes; push
Advantages of nasal CT: 1. _____ and _____ of disease 2. nasal turbinate _____ 3. _____ involvement 4. _____ involvement 5. _____ integrity 6. _____ evaluation 7. _____ evaluation 8. used for _____ planning, the treatment choice for nasal tumors
extent; location; erosion; sinus; soft tissue; cribriform plate; lymph node; bullae; radiation
Crackles (rales) are often a _____ sound that can be difficult to hear
faint
Restriction to breathing will cause _____, _____ breaths. Essentially _____ breathing that is NOT panting.
fast; shallow; rapid
_____ causes some of the loudest crackles you will ever hear
fibrosis
Ways to collect cytologic/histopathologic samples: 1. _____ aspirate 2. _____ sample 3. _____ 4. _____
fine needle; brush; wash; biopsy
Hyporesonance on percussion can indicate the presence of _____ or _____
fluid; mass
_____ is a good way to tell about dynamic changes in the airways
fluoroscopy
Just like the name implies, kind of "creaky"
friction rubs
_____ are the least common adventitial sound heard in small animals
friction rubs
When collecting samples from the nose, you should collect for a _____ culture and _____, but you should not culture for _____ because they are normally found here
fungal; histopath; bacteria
Compared to nasal radiographs, nasal CT is not that much more expensive by the time you put your patient under _____ for radiographs
general anesthesia
_____ is required to get the best images from thoracic CT
general anesthesia
Exercise testing is not widely done in _____, but it is a useful tool
general practice
_____ sign on US = normal, good contact, no fluid
glide
Dogs that have a severely impaired respiratory system will start the exercise testing off _____, but then will _____ or _____
good; slow down; stop
Coughing cats history: 1. coughing is often confused with unsuccessful vomiting _____ 2. vomiting can be seen with _____ disease
hairballs; HW
With exercise testing you can evaluate pre and post-exercise _____, _____, _____, _____, and _____
heart rate; respiratory rate; mucous membrane color; temperature; SpO2
_____ or _____ is required for the full set of images for nasal radiography
heavy sedation; general anesthesia
Fine crackles are _____ pitched vs coarse crackles that are _____ pitched
high; low
So much info can come from these that it can tell you where the disease is localized and can help you develop your differential list: 1. _____/_____ 2. physical _____ 3. _____/_____
history/signalment; exam; auscultation/percussion
Diagnostic modalities for respiratory disease: 1. _____/_____ 2. physical _____ 3. _____/_____ 4. routine _____ 5. _____
history/signalment; exam; auscultation/percussion; MDB (minmum database); radiography
The _____, _____ and _____ are often enough to begin treatment, and make intelligent choices for the next diagnostic steps
history; signalment; physical exam
Kussmaul breathing is very specific for _____
metabolic acidosis
High levels of CO2 in blood
hypercapnia
Deep breathing
hyperpnea
"Over-breathing", either breathing too fast or too deep
hyperventilation
"Under-breathing", either breathing too shallow or too slow
hypoventilation
Low oxygen levels in the blood
hypoxemia
Low oxygen levels in tissues/cells
hypoxia
For awake/sedated animals, they can be placed in a tube that _____ them enough so that they do not create too much movement artifact
immobilizes
With Cheyne-Stokes respiration, you will see a rapid _____ in breathing and then a _____
increase; pause
Improved medium for sound waves results in _____ BV sounds
increased
Bronchovesicular breath sounds are normal sounds, but: 1. _____ implies disease - may be hard to hear early on in your career 2. _____ implies disease
increased; decreased
Bronchomalacia is most often due to a long standing _____ disease in the airway that cause the _____ of the airway to break down
inflammatory; structure
Tracheal collapse will not be captured on normal thoracic radiographs if they are taken correctly, during _____
inspiration
Crackles (rales) are generally the loudest on _____. They may be worse after a _____.
inspiration; cough
Pulmonary fibrosis looks _____ (that is very shallow) because it is restrictive due to lung scarring
inspiratory
_____ can be done while the patient is under general anesthesia to help avoid artifacts for thoracic CT
inspiratory hold
If you suspect tracheal collapse, for thoracic radiography: 1. _____ and _____ radiographs should be taken 2. _____ should also be included
inspiratory; expiratory; cervical trachea
Apneustic breathing will have a long _____ phase and a long _____ phase, and then a long _____
inspiratory; expiratory; pause
Pleural space disease: 1. respiratory phase most affected = _____ 2. other associated characteristics = _____, _____ pattern, _____ or _____ lung sounds
inspiratory; shallow; rapid; dull; absent
Upper airway disease: 1. respiratory phase most affected = _____ 2. other associated characteristics = _____, _____
inspiratory; stridor; stertor
The _____ pattern will present as fuzzy or nodules (unstructured or structured) on radiographs
interstitial
Smaller animals have to be directly _____ with the scope
intubated
Friction rubs are heard more commonly in _____ animals than they are in _____ animals
large; small
Stridor is heard most commonly with _____ disease
laryngeal
Stridor can be heard in labs with _____
laryngeal paralysis
Fast, shallow breathing usually indicates that something is restricting breathing such as _____ disease or _____ disease
laryngeal; pleural
Scoping the larynx
laryngoscopy
For nasal radiography, you should obtain a full set of images: 1. _____ 2. _____ VD of nasal cavity 3. _____ frontal sinus
lateral; open mouth; rostral caudal
Thoracic radiographs: 1. _____ and _____ (or _____if the patient is distressed) 2. _____ view - when neoplasia is suspected
lateral; ventrodorsal; dorsoventral; three
Three views for thoracic radiographs
left lateral, right lateral, VD or DV
Percussion - the smaller the patient, the _____ useful the technique
less
Possible causes of diminished bronchovesicular sounds: 1. _____ flow - e.g., shallow breath 2. _____ - anything that pulls the lung lobe away from the chest wall (e.g., atelectic lung) 3. _____ - air between the lung and the chest wall (e.g., pneumothorax) 4. _____ - something dense between the lung and chest wall (e.g., diaphragmatic hernia)
low; retraction; attenuation; reflection
It is harder in cats than in dogs to differentiate lung vs heart because cats can have severe heart disease without the presence of a _____
murmur
With wheezes, on inspiration as the lung tissue fills you get pulling open of the airway and not as much sound, on expiration you have a more _____ airway and thus a _____ sound
narrowed; louder
Percussion is important in the _____ of large dogs
nasal sinuses
3 types of biopsies for the upper airways
nasal, thoracoscopy, thoracotomy
Types of washes that can be done on the upper airways: 1. _____ flush 2. _____ wash
nasal; airway
Stertor is most common with _____ disease, but it can be due to _____ in some breeds (i.e., pugs)
nasal; elongated soft palates
Stertor can be heard in cats with _____
nasopharyngeal polyps
Three view thoracic radiographs should be done when _____ is suspected
neoplasia
_____ can also be seen on US
nodules
History that should be taken for a patient that is presenting for coughing or increased respiratory effort: 1. respiratory _____ 2. _____ 3. _____ respiratory effort 4. change in _____
noise; dysphonia; increased; exercise tolerance
You can use fine needle aspirate sampling techniques for _____ as well as the _____
nose masses; lungs
Deep breathing = _____ (like _____)
obstructive; lar par
History that should be taken for nasal discharge: 1. _____ and _____ 2. _____ (i.e., mucoid, mucopurulent, bloody) 3. changes in _____ 4. _____ or other noises 5. _____ vs _____ (or movement from one to the other) 6. changes in appearance to other _____ structures 7. _____ (general or when eating) 8. any other signs of _____
onset; duration; appearance; appearance; sneezing; unilateral; bilateral; facial; pain; illness
Paradoxical movement of the chest and abdomen is movement in the _____ direction of normal breathing
opposite
Cannot breathe if reclining
orthopnea
Hyperventilation is NOT equivalent to _____ (dead space movement)
panting
One of the biggest side effects of STEROIDS is _____, warn clients about this unless you want a 3 am phone call
panting
Expiration should be _____, but opposite of inspiration
passive
Respiratory _____ often suggest localization of disease (inspiratory, expiratory, mixed)
patterns
Specific, named patterns associated with specific conditions and diseases
patterns of breathing
On US, nodules can be seen on the _____of the lungs
periphery
When there is something dense between the lung and the chest wall, such as fluid, a mediastinal mass, or abdominal contents that have penetrated a rent in the diaphragm, there is a _____ of sound. It is the change in _____ that is responsible for the loss of sound.
reflection; medium
With a sedated laryngeal exam, you are looking for movement during the correct phase of _____. You can see _____ movement occur if they are breathing in the wrong direction.
respiration; paradoxical
Exercise testing in dogs is adapted from human medicine for humans with _____ and _____ conditions
respiratory; cardiac
Cheyne-Stokes respiration occurs due to damage to _____ centers, _____ failure, or _____
respiratory; heart; altitude
Shallow breathing = _____ (like _____)
restrictive; fibrosis
_____ the endoscopu is used to look at the soft palate
retroflexing
Scoping the nose
rhinoscopy
3 types of endoscopy used to evaluate the upper airway
rhinoscopy, laryngoscopy, bronchoscopy
In larger dogs with stridor, this noise can sound more like _____ in a horse
roaring
_____ and _____ are non-specific, but are often useful for respiratory diseases as well as other problems
routine minimum database (MDB); ancillary diagnostics
Brush samples are done through the _____, you run the brush up and down on the _____ to get biopsy samples
scope; mucosa
_____ is important in respiratory patients, i.e., poodles and labs will have different differential lists
signalment
Obstruction to breathing will cause _____, _____ breaths. Essential _____ breathing.
slow; deep; slow
Malacia =
softening
Lung or heart can be very hard to tell, and they often go together: 1. heart _____ 2. heart _____ 3. heart _____ 4. pulse _____ 5. _____ 6. special tests - _____, _____, _____, etc.
sounds; rhythm; rate; quality; history; rads; echo; BNP
Snoring sound that is localized to the pharyngeal area
stertor
Sonorous breathing, like a snore
stertor
_____ and _____ are two breathing noises that a stethoscope is not required to hear
stertor, stridor
6-minute walk test (6MWT): 1. measured distance in a quiet, air conditioned _____ hallway 2. dog walks at their _____ pace on leash 3. record distance walked within _____
straight; own; 6 minutes
Harsh, high pitched sound typically heard on inspiration
stridor
Inspiratory sound that is high pitched because they are breathing against a laryngeal area that has a restriction
stridor
Wheezes require a stethoscope to hear, if an owner says they hear wheezes they are usually talking about _____
stridor
Palpation of the respiratory system: 1. palpate for _____ 2. presence of _____ or _____ spots are important in nasal and facial things 3. SQ _____ - crackly, specific to a tear in the airway 4. cardiac _____ 5. _____ (felt with grade 5/6 murmur) 6. chest _____, esp. in cats
symmetry; soft; hard; emphysema; PMI; thrill; compressibility
Fast breathing
tachypnea
Slow, deep breaths are more pronounced in animals with severe _____ airway obstructions
upper
Stridor localizes to the _____ airway, usually to the _____ area
upper; laryngeal
Stertor localizes to the _____ airway, most likely the _____ area
upper; nasopharyngeal
General history that should be taken: 1. _____ history (esp. Bordatella with respiratory problems) 2. recent _____/_____ 3. _____ status 4. routine health _____ 5. existing _____ conditions 6. recent introduction to other _____
vaccination; boarding/travel; heartworm; maintenance; medical; animals
The _____ pattern will have big arteries or veins on the radiograph
vascular
_____ bronchiectasis = bubbling
vericose
Uses of endoscopy on the upper airways: 1. _____ 2. collect _____ samples 3. perform _____
visualize; diagnostic; treatment
_____ is one of the most common clinical signs of HW disease in cats
vomiting
Causes of "wet lungs" that result in increased BV sounds: 1. edema - _____ 2. pneumonia - _____ 3. contusions - _____
water; pus; blood
Chunk taken out of periphery, indicates infarction
wedge sign
_____ on US indicates pulmonary thromboembolism
wedge sign
Narrowed or collapsed airways, "continuous" or "musical" sounds
wheezes
With bronchiectasis, the airways become _____ than they should be
wider