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