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Neuro Test II
UTCVM spring 2014 Thomas
174
Veterinary Medicine
Graduate
03/23/2014

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Cards

Term
with a head trauma patient you want to maintain the intracranial pressure to be _____mmHg less than mean systemic arterial pressure
Definition
70
Term
What do you always give a head trauma patient
Definition
Mannitol
Term
Normal Intracranial Pressure (ICP) is around _____mmHg
Definition
10
Term
Why might an increased ppCO2 be a problem in a head trauma patient
Definition
inc CO2 cause reflexive vasodilation in brain which increase ICP even further and for potential dangerous decrease perfusion
Term
When assessing a patient with a coma scale what would you call them if 'Awake and alert but responding inappropriately'
Definition
Delirious
Term
With severe brainstem injury, you will get an _______posture because a lack of _________.
Definition
Opisthotonos (decerebrate rigidity); Inhibition
Term
What is the main reason to do radiographs for a head injury
Definition
check for cervical fractures
Term
With head injury what drug is contraindicated and backed up by lots o data at least in humans
Definition
Steroids
Term
In head trauma patients that are deteriorating despite medical therapy, you should perform (what dx test) to determine if they need surgery
Definition
CT
Term
What coma scale score is the cutoff for good prognosis?
Definition
8
Term
Any time you have a skull fracture especially near nasal passage where they start to get neck pain and a fever, you should worry because they probably have:
Definition
meningitis
Term
Name a behavior commonly NOT associated with forebrain disease?
Definition
Aggressive
Term
With a forebrain lesion, the patient will turn in circles (away/towards) the lesion
Definition
towards
Term
A dog become less interactive, agitated at night and can't sleep, turns in circles, and is now presenting with seizures- where is a likely location for a lesion?
Definition
Forebrain
Term
Where is CSF absorbed?
Definition
Subarachnoid space
Term
A toy breed puppy is hard to house train- just not that smart. what's a presumptive dx?
Definition
Hydrocephalus
Term
Adult hydrocephalus can be seen in cats secondary to which infectious disease?
Definition
FIP
Term
In a few hydrocephalus cases, they can be medically managed which would be use of what two drugs?
Definition
Steroids, Diuretics
Term
Shunting works well in most hydrocephalus patients but some may have complications. The most common complication is a clog _____segment of shunt
Definition
ventricle
Term
You have a patient with waxing and waning forebrain signs especially after they eat. Presumptive dx:
Definition
Hepatic Encephalopathy
Term
You suspect hepatic encephalopathy what two lab test will you perform
Definition
Bile Acids and Blood Ammonia
Term
During a seizure, EEGs are ( more/less) synchronized with (higher/lower) amplitudes
Definition
More; Higher
Term
Dog comes in presenting with myoclonus: Most likely they have:
Definition
Canine Distemper Virus
Term
What type of protein is better to reduce amount of ammonia produced by gut bacteria?
Definition
Dairy
Term
Tx for hepatic encephalopathy that helps by decreasing colonic production of amino acids as well as ion trapping of ammonia
Definition
Lactulose
Term
Term for a focal seizure with some loss of consciousness
Definition
Complex Focal
Term
Dog with episodes of apparent abdominal pain and diarrhea. can't find any GI problem... what neuro problem might they have?
Definition
Focal seizures with just autonomic signs
Term
What three lines of evidence ( whipple's triad) are needed to dx hypoglycemia ( dont think too hard kinda obvious)
Definition
1. Symptoms likely cause by hypoglycemia 2. Patient Hypoglycemic 3. Signs improve with giving glucose
Term
A long term change that predicts a future seizure
Definition
Prodrome
Term
Term for electrical activity that starts to change right before a seizure and causes all kinds of sensations
Definition
Aura
Term
Term for phase where seizure happens
Definition
Ictus
Term
An elderly patient presents with seizures. Top differential:
Definition
Brain tumor
Term
Definition of epilepsy
Definition
Any disorder/disease that causes recurring seizures over long period of time
Term
If suspect a brain tumor, why do a CSF tap?
Definition
rule out other diseases
Term
Because brain tumors cause a lot of local edema, what drug is great to make the patient feel almost instantaneously better?
Definition
Prednisone
Term
Which species is more likely to have good post-op prognosis for a meningioma? Dog or Cat?
Definition
Cat
Term
Gliomas of _________cell types are pretty bad and ______ breed are predisposed.
Definition
Astrocytes; Boxers
Term
Which kind of epilepsy do you really wanna rule out before saying it's idiopathic epilepsy
Definition
Structural/Metabolic
Term
Age range for onset of idiopathic epilepsy
Definition
1-5 yrs
Term
Which cranial nerve do dogs get nerve sheath tumors on?
Which muscles can be unilaterally atrophied on presentation?
Definition
Trigeminal; Masseter/Tempoarlis
Term
Adult miniature poodle presents with forebrain disease. You do a CSF tap and see a mixed mononuclear white cell population. Tentative Dx:
Definition
Granulomatous Meningoencephalitis (GME)
Term
Most common location for a choroid plexus tumor
Definition
4th ventricle
Term
Just in case he gets picky from the notes, what two chemo (antineoplastic) drugs can be used to tx GME or NME?
Definition
Procarbazine; CCNU
Term
What other organ is also commonly affected in both cases of Canine Distemper Virus and FIP?
Definition
eye
Term
Brain MRI of cat shows enhancement of meninges and little granulomas around choroid plexus. Dx:
Definition
FIP
Term
A cat develops resp signs followed acute circling, hemiparesis and blindness in late summer, what's a top differential?
Definition
Cuterebra
Term
A hypoglycemic pup might present with ______pupils
Definition
Dilated
Term
3 parts of the brainstem
Definition
midbrain, pons, medulla
Term
the brainstem has LMN for cranial nerves ____ through ____
Definition
III-IX
Term
Which part of brain functions to maintain consciousness?
Definition
Brainstem
Term
If a dog loses sense of smell, and you are actually sure of it, it is most commonly gonna be from a lesion in the_____.
Definition
nose
Term
dogs have how many cones?
Definition
2
Term
The more ( medial/lateral) a fiber originates in retina, the more likely it is going to cross-over at the optic chiasm
Definition
Medial
Term
Fibers coming from retina all go to the optic tract, but then ones involved in the pupillary light reflex go to the ______ while the ones for vision go to the_______.
Definition
Brainstem; Thalamus (Ithink)
Term
What nerve provides motor fibers to the sphincter pupillae muscle and needs to be intact for PLR?
Definition
Oculomotor
Term
If you have ventrolateral strabismus and a dilated pupil, what nerve might be damaged?
Definition
Oculomotor
Term
CN III
Definition
Oculomotor
Term
CN I
Definition
Olfactory
Term
CN II
Definition
Optic
Term
What eye muscles are NOT controlled by CN III?
Definition
Dorsal Oblique, Lateral Rectus, Retractor bulbi
Term
If you have medial strabismus, what nerve might be affected?
Definition
Abducens
Term
CN VI
Definition
Abducens
Term
This nerve, _______, is stupid because it only controls the _____ muscle and is rarely singularly affected
Definition
Trochlear; Dorsal oblique
Term
What two muscles does the CN VI control?
Definition
Lateral rectus; Retractor Bulbi
Term
CN IV
Definition
Trochlear
Term
Sometimes dogs can get idiopathic inflammation of this cranial nerve, ______, which may manifest as _______ paralysis.
Definition
Trigeminal; Jaw
Term
Controls face sensation and muscles for mastication
Definition
Trigeminal
Term
CN V
Definition
Trigeminal
Term
How to tx trigeminal neuritis
Definition
don't- will resolve spontaneously
Term
Motor to facial muscles and lacrimal glands
Definition
Facial
Term
CN VII
Definition
Facial
Term
Animal is blind with absent PLR lesion could be where?
Definition
Retina, Optic chiasm, Optic Tract
Term
Animal is blind with normal PLR. Lesion could be where?
Definition
Forebrain
Term
If tongue is wrinkled on one side. What nerve is affected?
Definition
Hypoglossal
Term
CN XII
Definition
Hypoglossal
Term
On the side of the lesion with Horner's Syndrome, The pupil is (Larger/Smaller), the globe is (protruding/sunken) and the face may be (cold/warm)
Definition
smaller; sunken; warmer
Term
Sympathetic innervation to the head comes out of spinal cord at segments _______.
Definition
T1-T2
Term
Intention tremors result with disease in this part of CNS
Definition
Cerebellum
Term
What would you treat a little dog who presents with tremors all over but otherwise OK neuro exam
Definition
steroids
Term
Puppy weimeraners present with generalized tremors especially in pelvic limbs. Dx:
Definition
Congenital Hypomyelination
Term
Treatment for congenital hypomyelination
Definition
nothing but tend to grow out of it at 6 months
Term
Dobermans, Englich Bulldogs, and Boxers are more predisposed to get this movement disorder:
Definition
Idiopathic head bobbing
Term
With idiopathic head bobbing, are tremors more likely to happen at rest or be instigated by something like eating?
Definition
rest
Term
This movement disorder is just one muscle group and persists even under general anesthesia
Definition
Myoclonus
Term
Treatment for Tetanus
Definition
Antibiotics and muscle relaxants
Term
What strange movement disorder is characterized by alternating flexion of pelvic limbs and only documented in Doberman's?
Definition
Dancing Doberman Disease
Term
Because of vestibular system, if head leans to right, you will get extension and rigidity of the (right/left) limbs
Definition
Right
Term
When referring to "central" vestibular disease, which two CNS structures could be involved?
Definition
Brainstem; Cerebellum
Term
A head tilt where one ear is lower than other indicates what kind of CNS disease?
Definition
Vestibular
Term
Head turn indicates what kind of CNS disease?
Definition
Forebrain
Term
If a peripheral vestibular lesion, a head tilt will be (towards/away) from the lesion.
Definition
Towards
Term
When trying to determine if a vestibular lesion is central or peripheral, what function do you test for?
Definition
Proprioception
Term
If there are postural deficits along with vestibular signs, you can safely say the lesion is (peripheral/central)
Definition
Central
Term
After ______ days with vestibular disease, spontaneous nystagmus will disappear. However ______ nystagmus will still be present to test for.
Definition
2-3; Positional
Term
If a patient has vertical nystagmus, they have vestibular disease from a (central/peripheral) lesion
Definition
Central
Term
A dog presents with horizontal nystagmus where the fast phase moves to the right. If this is due to a peripheral lesion, it should be on the (right/left) side of the animal
Definition
Left
Term
_______ nystagmus is where there is equal speed in both directions. It is not due to vestibular disease and ______breeds in cats and ______ breeds in cows tend to get it congenitally.
Definition
Pendular; Oriental; Holstein
Term
Lots of things can cause a strabismus, but if it is in this direction,_________, then vestibular disease should be a differential.
Definition
Ventral
Term
Paralysis of which cranial nerve might be alongside vestibular disease since both can be caused middle ear infection.
Definition
Facial
Term
What syndrome can be seen with vestibular disease because of nerves coursing alongside the middle ear?
Definition
Horner's
Term
What are the four classic signs of Horner's Syndrome in the Ipsilateral eye?
Definition
Small pupil, Drooping upper eyelid, Protruding 3rd eyelid, Enophthalmos (sunken globe)
Term
Why might you get dry eye alongside vestibular disease?
Definition
Facial nerve course near middle ear, controls lacrimal glands
Term
Why might you wanna hold back giving drugs for vestibular disease on a long term?
Definition
Might slow down brain's compensation
Term
Most common organism to cause Otitis media-interna
Definition
Staphylococcus sp.
Term
Dog presnts with head shaking and yawning with facial paralysis. Tentative Dx:
Definition
Otitis Media-interna
Term
a 12 year old dog comes in with head tilt and no other signs. You originally suspected brain tumor or stroke but dog spontaneously improved. What did they have?
Definition
Canine idiopathic vestibular syndrome
Term
This vestibular disease in cats is curiously seen during the warmer months.
Definition
Feline idiopathic vestibular syndrome
Term
A young cat presents with upper resp and vestibular signs. It's not a tumor but rather a:
Definition
Nasppharyngeal Polyp
Term
Nasopharyngeal polyps arise from the _______ and are seen in (old/young) (dogs/cats)
Definition
Tympanic bulla; young; cats
Term
12 yo dog comes in with vestibular signs and pain upon opening the mouth- you think:
Definition
neoplasia
Term
What endocrinopathy can cause peripheral vestibular signs
Definition
Hypothyroidism
Term
What disinfectant can cause ototoxicity and subsequent peripheral vestibular signs and deafness?
Definition
Chlorhexidine
Term
What antibiotic group can cause ototoxicity and subsequent peripheral vestibular signs and deaness?
Definition
Aminoglycosides
Term
A dog presents with vertical nystagmus and a history of colitis.... what are you thinking caused the Nystagmus?
Definition
Metronidazole tox
Term
What three general groups of diseases can result in central vestibular signs ( think VIN)
Definition
Vascular; Inflammatory; Neoplasia
Term
An older hypertensive dog with CKD presents with vestibular signs. Would you guess this to be central or peripheral vestibular disease?
Definition
Central
Term
In REM are waves slower/faster/the same as when awake
Definition
Same
Term
How long is the sleep cycle in dogs
Definition
30 min
Term
Brainstem inhibits all muscles but ______ and ______ during sleep
Definition
Respiratory; Intraocular
Term
Molecule important in coordinated muscular inhibition during sleep
Definition
Hypocretin
Term
Term for sudden onset of flaccid paralysis
Definition
Cataplexy
Term
Disorder with excessive sleepiness and inappropriate muscle inhibition when awake
Definition
Narcolepsy
Term
Canine narcolepsy episode are often (random/after stimulus)
Definition
Stimulus
Term
Narcolepsy is sometimes familial in these two breeds:
Definition
Labradors; Dobermans
Term
This type of narcolepsy occurs because of a mutation in a hypocretin receptor
Definition
Familial
Term
This type of narcolepsy occurs because of loss of hypocretin production
Definition
Sporadic
Term
Two drugs groups used to treat narcolepsy episodes
Definition
TCAs; SSRIs
Term
The _____action of drugs to treat narcolepsy is the most important to prevent episodes while the ______ effects are important for excessive sleepiness.
Definition
adrenergic; dopamine
Term
Drug to tx excessive sleepiness in narcoleptic patients
Definition
Amphetamines etc.
Term
How do you treat both Autoimmune polmyositis and Masticatory muscle myositis
Definition
immunosuppressive dose of steroids over long time to taper
Term
This myopathic disease is likely to have megaesophagus, the presence of which worsens prog
Definition
Autoimmune Polymyositis
Term
The most common pathogen involved in infectious myositis in dogs
Definition
Neospora
Term
You do NOT wanna use immunosuppressive drugs to treat this autoimmune neuromuscular disease
Definition
Myasthenia Gravis
Term
Vascular neuromyopathies in cats are usually due to ____; while in dogs because of ________.
Definition
Heart Disease; Cushings/Hypothyroid/etc
Term
If have patient with weak pelvic limbs, always check______.
Definition
Femoral Pulses
Term
(Cats/Dogs) can have chronic manifestations of vascular neuromyopathies, and (cats/dogs) usually get them as a result of a thrombus
Definition
Cats; dogs
Term
A CKD cat presents with ventroflexion of neck- what is a likely myopathy?
Definition
Hypokalemic myopathy
Term
What's more common: Congenital or Acquired Myasthenia Gravis?
Definition
Acquired
Term
What breed might spontaneously recover from congenital myasthenia gravis while al other have poor prog?
Definition
Miniature Daschund
Term
If a dog has a thymoma, it prob has this neuromuscular disease:
Definition
Myasthenia Gravis
Term
What are three things to look for on thoracic radiograph of a Myasthenia gravis patient?
Definition
Megaesophagus; Thymoma; Aspiration pneumonia
Term
What is the tensilon test
Definition
see response of a patient to quick acting anti-cholinesterase
Term
Tensilon test is used to dx:
Definition
Myasthenia Gravis
Term
Hallmark of this disease is exercise-induced stiffness, tremors, and weakness that resolve with rest
Definition
Myasthenia Gravis
Term
Methimazole therapy in cats may somtimes trigger this autoimmune neuromuscular disease
Definition
Myasthenia Gravis
Term
Avoid these five antibiotic groups in patients with neuromuscular disease
Definition
Aminglycosides; Polymixins; Lincomycin; Tetracyclines; Penicillamine
Term
cats have a better prog than dogs for myasthenia gravis b/c less likely to develop ________.
Definition
Aspiration pneumonia
Term
Dog presents tetraplegic but can still wag tail
Definition
Acute Idiopathic Polyradiculoneuritis (Coon Hound Paralysis)
Term
This immune-mediated disease is very hard to manage, however they will fully recover with good supportive care when recumbent over several weeks
Definition
Acute Idiopathic Polyradiculoneuritis (Coon Hound Paralysis)
Term
Where does neospora common affect puppies
Definition
lumbosacral nerve roots
Term
Rigid extension of back legs in puppies
Definition
Neospora
Term
Dog dropped jaw that can't close with corneal ulcers- what neuro problem could it be?
Definition
Trigeminal Neuritis
Term
Four differentials when a dog presents with trigeminal neuritis
Definition
Rabies, Trauma, Hematopoetic neoplasia, neospora
Term
Tx and Prog for trigeminal neuritis
Definition
Supportive; god- spontaneous recovery in few weeks
Term
Classic clinical sign of diabetic neuropathy - usually only seen in cats
Definition
Plantigrade Stance
Term
Older large breed dog presents with weird neuropathy of cranial nerves +/- ataxia..... what lab value should you test for?
Definition
T4
Term
Most commom site for peripheral nerve sheath tumor
Definition
Brachial Plexus
Term
Dog presents with SEVERE unilateral thoracic limb pain and can palpate a mass in axial region. Mabye it's:
Definition
Peripheral Nerve Sheath Tumor
Term
Unilateral temporalis atrophy think:
Definition
Trigeminal Nerve Sheath Tumor
Term
An old large breed dog presents with laryngeal paralysis- what might be happening and what might happen?
Definition
Degenerative Neuropathy (GOLPP); continued generalized neuropathy
Term
Dog presents with front limb paw dragging and an ipsilateral horner's.... what is damaged?
Definition
Brachial Plexus
Term
Biggest prognostic indicator for a brachial plexus avulsion is:
Definition
pain perception distal limb
Term
Type Nerve Injury with worst prognosis
Definition
Neurotomesis
Term
Type nerve injury that can be distinguished from other types after one week.
Definition
Neuropraxia
Term
Three types of nerve injury in order severity (least-->most)
Definition
Neuropraxia-Axonotmesis-Neurotmesis
Term
Four main differentials for laterally recumbent neuromuscular patient
Definition
Coonhound paralysis, Tick paralysis, Botulism, Fulminant Myasthenia gravis
Term
What is the cardinal clinical sign associated with myopathic syndrome
Definition
Weakness
Term
Postural reactions and spinal reflexes are usually ______ with a myopathic syndrome, but the clinician must _______ in order to be sure.
Definition
normal; support their weight
Term
Muscular dystrophies are usually X-, Y-, or autosomal linked
Definition
X
Term
You have a young MC golden retriever presnt with progressive weakness. On blood chem find a CK through the roof; what does he have?
Definition
Muscular Dystrophy
Term
Masticatory Muscle Myositis is unique in that is specific to masticatory muscles only- how come it specifically targets just these muscles?
Definition
They are embryologically different from all other muscle and have 2M fibers
Term
What drug might affect an antibody titer and give a false negative for Masticatory Muscle Myositis?
Definition
Steroids
Term
You diagnose this disease with a 2M antibody titer and a muscle biopsy
Definition
Masticatory Muscle Myositis
Term
Boxers that present with this disease are likely to develop concurrent lymphoid neoplasia and lupis
Definition
Autoimmune Polymyositis
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