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141 Cards in this Set
- Front
- Back
what are five rule-routs for unilateral nasal mucopurulent discharge in a dog?
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1. neoplasia
2. fungal rhinitis 3. oronasal fistula 4. foreign body 5. early 2ndary bacterial infection |
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what are some diagnostic tests that can be done for a unilateral nasal discharge?
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1. nasal airflow
2. cytology 3. CBC/chem/UA 4. nasal and oral rads 5. rhinoscopy 6. histopathology 7. ± culture 8. fungal titers |
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how do you interpret Aspergillus hyphae on a nasal smear?
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may or may not be an incidental finding, depending on clinical signs. Aspergillus is a common surface contaminant on the nasal mucosa of dogs
|
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what is the main pathologic lesion of Aspergillosis in dogs?
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destruction of nasal turbinates
|
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how does immunosuppression relate to Nasal Aspergillosis in dogs?
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it does not
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what facial shapes of dogs predisposes them to Aspergillosis?
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mesaticephalic and dolichocephalic
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what is the three presenting clinical signs of nasal Aspergillosis in dogs?
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1. UNILATERAL mucopurulent nasal discharge with INTERMITTENT EPISTAXIS
2. nasofacial discomfort (pain) 3. depigmentation of nares due to licking (they lick because it is painful) |
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what bones are NOT affected by nasal Aspergillosis and thus differentiates this disease radiographically from neoplasia?
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no lysis or deviation of vomer or frontal bones
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what are the radiographic signs of nasal Aspergillosis in the dog?
- location and laterality of lesions - 3 Roentgen signs - DDx from osteosarcoma or other bone neoplasia |
- unilateral or bilateral; caudal nasal cavity and frontal sinuses
1. loss of nasal turbinates 2. increase in soft tissue or fluid density 3. multiple, well-defined lytic zones '- no lysis or deviation of vomer or frontal bones |
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what is the best imaging modality to assess the cribriform plate?
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CT
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what does nasal Aspergillosis in the dog look like under rhinoscopy?
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- turbinate destruction
- white/gray mats, plaques, or granulomas |
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comment on serology for nasal Aspergillosis:
- indication - specificity - response to treatment |
- indicated as a supportive diagnostic only
- false positives, so not too specific - CANNOT use to assess response because titers do not drop significantly |
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what are two topical medications used for nasal Aspergillosis? Which is the most effective and why?
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1. clotrimazole
2. enilconazole - better because it gives off vapors that are equally effective as topical, so it hits all parts of nasal cavity; expensive |
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what is the basic commonly-used procedure for using Clotrimazole or Enilconazole to treat nasal Aspergillosis in the dog?
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1. anesthesia
2. multiple tube placement 3. infusion for 1 hour '- may take several treatments - may require sinus trephination |
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how long after treatment with Clotrimazole or Enilconazole do clinical signs associated with nasal Aspergillosis typically resolve?
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2 weeks
|
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what are two alternatives to anesthesia/tube placement/1 hour infusion for dogs with nasal Aspergillosis?
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1. trephination and placement of tubes into sinuses and nasal cavities; infusion of enilconazole or clotrimazole BID x 7-10 days.
2. If topical is too risky (e.g., disruption of cribriform plate), systemic itraconazole for 2-3 months up to 1 year |
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what surgical procedure can improve topical antifungal therapy for nasal Aspergillosis?
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debulking
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what are two long-term complications of canine nasal Aspergillosis?
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1. meningoencephalitis (rare)
2. chronic bacterial rhinitis |
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which agent most commonly causes fungal rhinitis in cats?
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Cryptococcus neoformans
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what are three common presenting complaints that suggest feline Cryptococcosis?
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1. facial swelling/deformity
2. sneezing 3. mucopurulent ± hemorrhagic nasal discharge - either unilateral or bilateral |
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in feline Cryptococcosis, what clinical sign indicated a prognosis that is:
- guarded? - grave? |
- guarded: ophthalmic lesions (nervous tissue involvement)
- grave: CNS signs |
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what are 8 clinical signs of feline Cryptococcosis?
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1. facial swelling/deformity
2. sneezing 3. mucopurulent ± hemorrhagic nasal discharge - either unilateral or bilateral 4. ulcerative lesion on nasal planum 5. granulomatous lesion from the nares 6. submandibular lymphadenopathy 7. ophthalmic lesions (NB: Px guarded) 8. CNS signs (grave) |
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what do ocular lesions look like in feline Cryptococcosis?
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fungal plaques on the retina
|
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what are 2 clin path diagnostic tests to confirm feline Cryptococcosis?
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1. cytology - FNA of lesion/nasal discharge
2. serology - cryptococcal capsular antigen titer |
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what is a diagnostic to rule-in neurological feline cryptococcosis?
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positive titer of CSF
|
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what are three antifungals used to treat feline cryptococcosis?
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1. fluconazole (slower, less $)
2. itraconazole (faster, more $) 3. ketoconazole |
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treating feline cryptococcosis with antifungals:
- minimum time - when do you stop - how long can this take? |
- minimum 2 months
- Tx one month beyond resolution or until titer is negative - prolonged Rx in some (1 year) |
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in feline cryptococcosis, comment on using serology for monitoring response to therapy.
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titer may be used to monitor response to therapy
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feline cryptococcosis prognosis:
- overall - how does magnitude of titer correlate? - 3 negative prognostic indicators |
- overall, good
- MAGNITUDE OF TITER IS NOT PROGNOSTIC - FeLV/FIV cats, ocular lesions, and CNS lesions are negative prognostic indicators |
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what age group of animals are most predisposed to nasal neoplasia?
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older animals (> 8 years)
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what general breed class of dogs is overrepresented for nasal neoplasia?
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dolichocephalic breeds
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how commonly are nasal tumors malignant?
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most: 80-90%
|
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what are the three most common BASIC types of nasal neoplasias?
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1. epithelial (carcinomas)
2. mesenchymal (sarcomas) 3. discrete round cell tumors |
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what are the 3 most common types of nasal carcinomas?
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1. adenocarcinoma (dogs)
2. SCC 3. undifferentiated carcinoma |
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what are the 3 most common types of nasal sarcomas?
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1. chondrosarcoma
2. fibrosarcoma 3. undifferentiated sarcoma |
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what are the 3 most common types of nasal discrete round cell neoplasms?
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1. lymphoma (cats)
2. transmissible venereal tumor (rare) 3. mast cell tumor (rare) |
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what are 9 clinical signs of nasal neoplasia?
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1. unilateral to bilateral nasal discharge
2. sneezing 3. nasofacial deformities 4. ex- or enophthalmia 5. open mouth breathing 6. oral deformity 7. dysphagia 8. stertor 9. CNS signs |
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what is a radiographic indicator that may help to distinguish nasal fungal infection from nasal neoplasia?
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if there is bony lysis of the vomer/fontal bone, that suggests neoplasia over fungal rhinitis
|
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what two diagnostics are used to stage nasal neoplasia?
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1. evaluation of local lymph nodes
2. thoracic radiographs |
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for which type of nasal neoplasias is radiation indicated? How does radiation therapy affect prognosis in most cases?
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- carcinomas and sarcomas
- palliative, not curative |
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for which two types of nasal neoplasias is chemotherapy indicated?
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1. lymphoma
2. mast cell tumor |
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what are three basic factors that affect the median survival time of nasal neoplasia?
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1. tumor type (aCA, sarcoma > SCC, undifferentiated)
2. clinical stage (mets → lungs and extensive local invasion shorten time) 3. species (cats tolerate better than dogs) |
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Blastomycosis:
- genus and species - morphology - species it infects |
- Blastomyces dermatitidis
- dimorphic - mostly dogs |
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what is the basic pathogenesis of systemic Blastomycosis in the dog?
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1. spore inhalation
2. pulmonary infection 3. hematogenous dissemination |
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Generally, what system is most affected by blastomycosis in dogs?
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respiratory
|
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what are 4 respiratory signs of blastomycosis in dogs?
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1. coughing
2. tachypnea/dyspnea 3. increased broncho-vesicular sounds: crackles, wheezes 4. exercise intolerance |
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besides respiratory signs, what are six other clinical signs of blastomycosis in dogs?
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1. inappetence, weight loss
2. lameness 3. draining skin lesions 4. fever 5. ocular signs 6. lymphadenopathy |
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what are two ocular signs of blastomycosis in the dog?
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1. lesions on the retina
2. corneal neovascularization |
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blastomycosis in dogs:
- erythrogram - leukogram - 2 blood chem abnormalities |
- RBC: normochromic, normocytic, non-regenerative anemia
- WBC: leukocytosis, lymphopenia - chem: hyperglobulinemia (polyclonal), hypercalcemia |
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what pulmonary radiographic pattern is consistent with canine blastomycosis?
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diffuse interstitial pattern
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cytology of blastomycosis in the dog:
- size of yeast - appearance of yeast |
- 5-20 μm
- thick, refractile, double-wall |
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comment on serology in the diagnosis of canine blastomycosis?
- reliability - samples |
- it is reliable
- blood, urine |
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what is the major histopathological lesion of canine blastomycosis?
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granulomatous inflammation
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what are three drugs used to treat blastomycosis in the dog?
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1. itraconazole (used most often)
2. fluconazole 3. Amphotericin B |
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what is the trade-off between using itraconazole and fluconazole when treating fungal infections systemically?
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- itraconazole is more potent and thus has a shorter course; however it is expensive
- fluconazole is less potent, so course of treatment is longer, but overall, it is less expensive than using itraconazole |
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canine blastomycosis prognosis:
- what % of dogs are treated successfully - how long after clinical presentation do animals usually die? - comment on relapses |
- 80% are treated successfully
- most deaths occur within the first 7 days - relapses depend on the severity of lung disease; some patients require prolonged treatment of 6 months or more |
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Histoplasmosis
- genus and species - morphology - species it infects |
- Histoplasma capsulatum
- dimorphic - dogs and cats |
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what is the basic pathogenesis of systemic Blastomycosis in the dog?
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1. microconidia inhalation
2. pulmonary infection 3. hematogenous dissemination |
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what are 7 clinical signs of Histoplasmosis?
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1. respiratory signs (cough, dyspnea)
2. lymphadenopathy 3. hepatosplenomegaly 4. weight loss (vomiting, diarrhea) 5. icterus (note that hepatic infection is common) 6. fever 7. ophthalmic lesions |
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what blood abnormality can fulminant hepatic disease caused by Histoplasma cause?
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DIC
|
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laboratory findings of histoplasmosis:
- erythron - leukogram - bone marrow |
- erythron: non-regenerative anemia
- leukogram: ± cytopenias - bone marrow infiltration (±) |
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what pulmonary radiographic pattern is consistent with histoplasmosis?
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diffuse miliary to nodular interstitial pattern
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in histoplasmosis, what does the liver look like on ultrasound
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grossly enlarged with a moth-eaten appearance to the parenchyma
|
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cytology of histoplasmosis:
- size of yeast - appearance of yeast |
- 3-4 μm
- intracellular organism with a halo |
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comment on serology in the diagnosis of canine histoplasmosis?
- reliability - samples |
not useful
|
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what are three drugs used to treat blastomycosis in the dog?
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1. itraconazole (used most often)
2. fluconazole 3. Amphotericin B |
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in what 5 tissues can you isolate Histoplasma for diagnostic purposes?
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1. intestinal/rectal mucosa
2. spleen 3. liver 4. bone marrow 5. lung 6. lymph nodes |
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prognosis of Histoplasmosis with:
- disseminated disease - pulmonary disease |
- disseminated: guarded to grave
- pulmonary: good to fair |
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what are 2 complications of using systemic Amphotericin B to treat fungal infections? What are 2 routes of administration?
|
- CNS signs, nephrotoxicity
- administer IV or SQ |
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Coccidiomycosis
- genus and species - species it infects |
- Coccidioides immitis
- mostly dogs |
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what is the basic pathogenesis of systemic Blastomycosis in the dog?
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1. inhalation of mycelial arthrospores
2. spore transformation in lung to spherule 4. hematogenous and lymphatic dissemination |
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what are 6 clinical signs of coccidiomycosis in dogs?
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1. weight loss, fever
2. inappetence 3. lymphadenopathy (marked, localized) 4. lameness (painful bone swelling) 5. draining cutaneous lesions 6. ophthalmic signs |
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what is the main laboratory finding of coccidiomycosis in dogs?
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± hyperglobulinemia
|
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what two pulmonary radiographic patterns are consistent with histoplasmosis?
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1. diffuse miliary to nodular interstitial pattern
2. HILAR LYMPHADENOPATHY |
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comment on fungal culture for diagnosis of coccidiomycosis in dogs?
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don't do it because they are very dangerous to humans
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what is the most useful blood test to diagnose coccidiomycosis?
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serology
|
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what are 3 drugs used systemically to treat coccidiomycosis in dogs?
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1. ketoconazole
2. itraconazole 3. fluconazole |
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prognosis of coccidiomycosis
- % that improve - % overall recovery rate - how long do you have to treat? |
- 90% improve
- 60% recover - treat for a minimum of 1 year |
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what is the genus and species of feline lungworm?
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Aelurostrongylus abstrusus
|
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where in the cat does Aelurostrongylus abstrusus like to hang out?
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(feline lungworm)
terminal bronchioles and alveoli |
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in symptomatic cases of feline lungworm, what are some clinical signs?
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- dry, non-productive cough
- wheezes, dyspnea |
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what are four ways to diagnose Aelurostrongylus abstrusus (feline lungworm)?
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1. Hemogram showing eosinophilia
2. Thoracic radiographs 3. transtracheal wash - recovery of eosinophils 4. fecal flotation to detect larvae |
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what are two drugs used to treat feline lung worms and their route of administration?
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1. ivermectin PO or SC (note SC burns very badly, but is safe)
2. fenbendazole PO |
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what is the genus and species of the dog lung fluke?
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Paragonimus kellicotti
|
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Paragonimus kellicotti:
- common name - where does it like to hang out? |
- dog lung fluke
- resides in CYSTIC STRUCTURES in the pulmonary parenchyma |
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what are three thoracic radiographic signs of the dog lung fluke, Paragonimus kellicotti?
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1. pulmonary cysts
2. secondary inflammation 3. PNEUMOTHROAX (consequence of cyst) |
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what are two drugs used to treat canine lung flukes?
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1. fenbendazole
2. praziquantel |
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who most commonly gets primary pulmonary neoplasias?
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dogs >> cats
|
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what are the three most common primary pulmonary neoplasias in dogs and which is most common?
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1. adenocarcinoma (most common)
2. SCC 3. bronchoalveolar carcinoma |
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what are the six most common secondary (metastatic) pulmonary neoplasias?
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1. thyroid carcinoma
2. mammary carcinoma 3. osteosarcoma 4. chondrosarcoma 5. hemangiosarcoma 6. malignant melanoma |
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what are 5 respiratory clinical signs of pulmonary neoplasia?
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1. cough (most frequent)
2. hemoptysis 3. dyspnea/tachypnea 4. exercise intolerance 5. crackles, wheezes |
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what are the two most common non-respiratory clinical signs of pulmonary neoplasia?
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1. cancer cachexia
2. lameness (hypertrophic pulmonary osteoarthropathy) |
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how do primary and secondary pulmonary neoplasia most commonly differ in their radiographic presentation?
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- primary: single nodule/mass in the lung
- secondary: multiple |
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what are the three most common laboratory findings of pulmonary neoplasia?
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1. hypercalcemia
2. hyperglobulinemia 3. proteinuria |
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what are three methods to obtain samples from the lung to diagnose possible pulmonary neoplasia?
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1. ultrasound-guided FNA
2. thoracotomy 3. TTW/BAL (if airways involved) |
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what two diagnostic techniques are used to stage pulmonary neoplasia?
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1. ultrasound
2. bone marrow |
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what are two common paraneoplastic conditions of pulmonary neoplasia?
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1. hypertrophic pulmonary osteoarthropathy
2. lung-digit syndrome |
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how is primary pulmonary neoplasia treated?
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lung lobectomy
|
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what are 2 ways in which secondary pulmonary neoplasia is treated?
|
1. metastasectomy if < 3 nodules; palliative
2. chemotherapy; variable response |
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(an idiopathic) condition characterized by chronic cough, wheezes, exercise intolerance/dyspnea and is caused by an immune-mediated hypersensitivity reaction in the lungs
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eosinophilic pneumonia
|
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define eosinophilic pneumonia
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(an idiopathic) condition characterized by chronic cough, wheezes, exercise intolerance/dyspnea and is caused by an immune-mediated hypersensitivity reaction in the lungs
|
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what are 3 typical clinical signs of eosinophilic pneumonia?
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1. CHRONIC cough ± productive
2. exercise intolerance/dyspnea 3. crackles, wheezes |
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what are three radiographic signs of eosinophilic pneumonia?
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1. interstitial or alveolar pattern
2. hilar lymphadenopathy 3. pulmonary vascular change |
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what is the predominate finding on a hemogram or lung diagnostic procedure such as TTW, BAL, or lung aspirate, of eosinophilic pneumonia?
|
eosinophils
|
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if you suspect eosinophilic pneumonia, what are two ancillary tests that you should perform?
|
1. fecal (rule out lungworms or lung flukes)
2. heartworm test |
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what drug is used to treat eosinophilic pneumonia?
|
prednisone
|
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what are 3 risk factors for pulmonary thromboembolism?
|
1. vascular stasis
2. endothelial damage 3. hypercoagulability |
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what is the pathogenic factor that leads to hypoxemia and hypocapnia with pulmonary thromboembolism?
|
V/Q mismatch
|
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what are 8 diseases that can cause pulmonary thromboembolism?
|
1. cardiac disease
2. IMHA 3. DIC 4. pancreatitis 5. sepsis 6. Hyperadrenocorticism (Cushing's or iatrogenic) 7. neoplasia 8. hypoalbuminemia |
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what is the major clinical sign of pulmonary thromboembolism?
|
PERACUTE onset of SEVERE DYSPNEA
|
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what should be high on your rule-out list if an animal presents with dyspnea, but there are no changes on thoracic radiographs?
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pulmonary thromboembolism
|
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if a pulmonary thromboembolism shows up on a radiograph, what will it look like?
|
a wedge-shaped region in the lung that is more radioopaque than the rest of the lung field
|
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what is the first-line treatment for pulmonary thromboembolism?
|
oxygen therapy
|
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what are the two first-line treatments for a cat presenting with acute respiratory distress?
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1. oxygen
2. sedation |
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in treating a cat with acute respiratory distress, what do you have to always keep in mind when performing diagnostic tests on the animal?
|
minimize stress, or they could collapse and die. Use minimal handling (e.g. thoracocentesis >> radiographs for suspected pleural effusion)
|
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increased respiratory effort on inspiration indicates what type of respiratory disease?
|
restrictive
|
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what are 6 etiologies for pleural neoplasia?
|
1. mediastinal LSA
2. mesothelioma 3. primary lung tumor 4. metastatic tumors 5. HSA 6. thymoma |
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what are six ways to diagnostic tests for pleural neoplasia?
|
1. laboratory tests
2. radiographs 3. ultrasound 4. pleural fluid characteristics 5. aspiration/biopsy (lung aspirate, mediastinal mass, ± u/s guidance) 6. histology (mesothelioma, because this tumor does not exfoliate well) |
|
what are two ways to treat pleural lymphosarcoma?
|
1. combination chemotherapy
2. radiation |
|
what are three ways to treat pleural metastatic tumors?
|
1. chemotherapy - systemic, intra-cavitary
2. intermittent thoracocentesis 3. metastasectomy |
|
what are one way to treat pleural mesothelioma?
|
- intracavitary chemotherapy (note: poor Px for this disease)
|
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what are three ways to treat pleural thymoma?
|
1. surgical excision
2. combination chemotherapy 3. radiation |
|
what is the most common etiology of chylothorax?
|
idiopathic
|
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besides idiopathic (the most common cause), what are 7 other etiologies of chylothorax?
|
1. trauma (rare)
2. neoplasia 3. cardiac disease (e.g. HCM in cats) 4. dirofilariasis 5. lung lobe torsion 6. diaphragmatic hernia 7. caval thrombosis |
|
pleural fluid characteristics of chylothorax:
- what type of transudates are most common? (2) - what are two common cell types that are found in the fluid? |
- modified transudate or exudate
- cells: small lymphocytes and NON-DEGENRATE neutrophils |
|
what are 2 ways in which triglycerides can be used to diagnose chylothorax? What is one limitation of these calculations?
|
1. [TG in pleural fluid] > [TG in serum]
2. pleural cholesterol/pleural TG < 1 - note that [TG] can be low with anorexia |
|
how is secondary chylothorax treated?
|
- treat primary cause, if possible
- if not treatable, repeated thoracocentesis PRN |
|
what are two common surgical procedures to treat chylothorax if medical Rx fails?
|
1. thoracic duct ligation (20-60% success)
2. pleuroperitoneal drainage |
|
what are four ways in which idiopathic chylothorax is managed medically?
|
1. dietary modification - low fat (↓ volume of fat in thoracic duct)
2. supplement MCT (questionable efficacy, supposedly bypasses intestinal lacteals) 3. intermittent thoracocentesis 4. supplementation with Rutin™ PO TID |
|
what are 3 mechanisms by which Rutin™ is proposed to manage chylothorax?
|
1. ↓ lymphatic leakage
2. ↑ lymphatic protein removal 3. ↑ lymphatic macrophage phagocytosis |
|
using Rutin™ to treat chylothorax, what is the success rate in:
- resolving effusion? - reducing (improving) effusion? |
- resolves 25%
- reduces (improves) 25% |
|
in what manifestations of chylothorax is surgery contraindicated?
|
restrictive pleuritis that is chronic and inflammatory and/or persistent respiratory distress post-thoracocentesis
|
|
what are six causes of spontaneous pneumothorax?
|
1. idiopathic pulmonary bullae
2. rupture of pulmonary parasitic cyst 3. neoplasia 4. abscess, pneumonia 5. heartworm disease 6. bronchial disease |
|
what are the three classifications of pneumothorax and the definition of each one (in parentheses, some examples of causes)?
|
1. open - free communication between pleural space and environment (gun shot, bite/stab wounds, rib fractures)
2. closed - no communication between pleural space and external environment (e.g. traumatic injury/rupture of airways or lung parenchyma) 3. tension - flap of skin or soft tissue acts as a one-way valve in an open or closed pneumothorax (e.g. air enters pleural space on inspiration, but not expiration) |
|
what are three clinical signs of traumatic pneumothorax?
|
1. history of trauma
2. other contusions/injury 3. acute dyspnea |
|
what are four clinical signs of spontaneous pneumothorax?
|
1. anorexia, weight loss
2. exercise intolerance 3. cough 4. acute dyspnea |
|
what are five radiographic signs of pneumothorax?
|
1. retraction of pleura away from chest wall
2. radiolucent space between lung and chest wall 3. dorsal displacement of heart 4. atelectasis of lung 5. lung margins don’t extend to the chest wall |
|
what are four basic ways to treat traumatic or spontaneous pneumothorax?
|
1. cage rest
2. intermittent thoracocentesis 3. thoracostomy tube 4. ± surgery |
|
in traumatic/spontaneous pneumothorax, how long does a minor pleural lesion take to heal (e.g. with cage rest)
|
24-48 hours
|
|
what are three indications for thoracostomy tube in pneumothorax?
|
1. rapid air accumulation
2. if frequent thoracocentesis is needed 3. spontaneous pneumothorax (very often) |
|
what are two indications for surgery to treat pneumothorax?
|
1. persistent pneumothorax > 3 days
2. imaging evidence of air leakage (e.g. gaping hole in the lung) |