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Exam 1 - Generalized Neuromuscular Disease Flashcards

1
Q

what is a differential for acute disease of the muscle in generalized neuromuscular disease?

A

polymyositis

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2
Q

what are differentials for acute disease of the neuromuscular junction in generalized neuromuscular disease?

A

tick paralysis

botulism

myasthenia gravis

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3
Q

what are differentials for acute disease of the nerves in generalized neuromuscular disease?

A

acute idiopathic polyradiculoneuritis - coonhound paralysis

infectious causes

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4
Q

what is a differential for acute disease of alpha motor neurons in generalized neuromuscular disease?

A

myelitis - especially rabies

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5
Q

what neuromuscular diseases may present acutely non-ambulatory tetraplegic & will mimic a high cervical fracture or severe brain injury prior to the neuro exam?

A

tick paralysis, botulism, myasthenia gravis, acute idiopathic polyradiculoneuritis, & myelitis (rabies)

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6
Q

what should be in the standard diagnostic work-up for neuromuscular disease?

A

history of prescription drugs

CBC/chem with creatine kinase

met check - chest rads to r/o megaesophagus, thymoma, & aspiration pneumonia & abdominal ultrasound/rads

endocrine testing - thyroid & hyperadrenocorticism

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7
Q

what makes up a lower motor neuron unit?

A

cell body (CNS), axon (PNS - ventral root, nerve), muscle, & neuromuscular junction

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8
Q

how do patients with acute idiopathic polymyositis present clinically?

A

weakness, stilted gait, atrophy, inability to open jaw, megaesophagus, & dysphonia

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9
Q

what lab abnormalities may be seen with acute idiopathic polymyositis?

A

creatine kinase is typically very high

inflammatory leukogram is possible

negative paired infectious disease titers

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10
Q

how is acute idiopathic polymyositis diagnosed?

A

muscle biopsy is supportive

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11
Q

how is acute idiopathic polymyositis treated?

A

immunosuppression - corticosteroids are the 1st line
azathioprine as a 2nd line or adjunct treatment

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12
Q

how is acute idiopathic polymyositis monitored?

A

serial CKs to monitor remission

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13
Q

what are some causes of infectious polymyositis?

A

neospora - dog

toxoplasma - dog & cat

hepatozoon - dog

FIV - cat

sarcocytis - dog

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14
Q

in a patient with suspected infectious polymyositis, what do you expect the nature of their history to be?

A

chronic problem

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15
Q

tick paralysis effects what part of the neuromuscular system?

A

pre-synaptic neuron

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16
Q

what is the typical onset of tick paralysis?

A

3-7 days

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17
Q

T/F: the absence of ticks on a dog rules out tick paralysis

A

false

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18
Q

how is tick paralysis treated?

A

pull the ticks, treat with acaricides, & shave long thick coats

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19
Q

what diagnostics should be done for a suspected tick paralysis case?

A

bloodwork & CSF tap - usually normal

thoracic radiographs

patient gets better upon removal of ticks

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20
Q

what is the agent that causes botulism?

A

clostridium botulinum

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21
Q

what is the pathogenesis of botulism?

A

blocks the release of ACh at the presynaptic membrane of the neuromuscular junction

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22
Q

how is botulism diagnosed?

A

usually based on history & clinical signs

bloodwork & CSF are typically normal

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23
Q

how is botulism treated?

A

supportive care

recovery can take weeks

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24
Q

what is the most common type of myasthenia gravis in dogs?

A

acquired form

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25
what is the pathogenesis of acquired myasthenia gravis?
autoantibodies are directed against the acetylcholine receptors at the neuromuscular junction
26
what are the clinical signs of acquired myasthenia gravis in dogs?
muscular weakness & excessive fatiguability - ocular, facial, oropharyngeal, esophageal, & limb musculature
27
what is the pathogenesis of congenital myasthenia gravis?
animal is born with too few acetylcholine receptors
28
in working up a suspected myasthenia gravis dog, what is the first step?
take radiographs use to use tensilon but not much anymore
29
in working up a suspected myasthenia gravis dog, what is the second step?
determining if it is congenital or acquired
30
how is congenital myasthenia gravis diagnosed?
intercostal muscle biopsy
31
how is acquired myasthenia gravis diagnosed?
acetylcholine receptor antibody test met screen thyroid problems (thymoma)
32
this condition often occurs secondary to what neuromuscular disease?
myasthenia gravis
33
how is myasthenia gravis in dogs treated?
anti-acetylcholinesterase meds probably for life bailey chair feedings - avoid problems with megaesophagus/aspiration pneumonia serial AChR Ab titers to monitor
34
T/F: 50-60% of dogs diagnosed with myasthenia gravis die within 1 year of the diagnosis
true
35
what kind of disease is idiopathic acute polyradiculoneuritis?
acquired demyelinating disease
36
what does idiopathic acute polyradiculoneuritis affect?
spinal nerve roots
37
what is the typical presentation of a dog with idiopathic acute polyradiculoneuritis?
rapid (12-24 hour) onset of ascending flaccid paralysis
38
how is idiopathic acute polyradiculoneuritis diagnosed?
history of exposure - bloodwork & CK are often normal, CSF often has elevated protein EMG, NCV, & muscle/nerve biopsy
39
how is idiopathic acute polyradiculoneuritis treated?
supportive care
40
what bacteria causes idiopathic acute polyradiculoneuritis
campylobacter
41
what is the pathogenesis of rabies?
virus enters body through saliva/CSF/CNS tissue of infected animal & migrates up the nerves to the spinal cord & then travels to the brain & then down from cranial nerves viruses arrives in saliva - animal is now infectious
42
what are the infectious materials that can spread rabies?
saliva, CNS tissue, & CSF
43
what is the latency period of rabies?
2-26 weeks
44
between dogs & cats, which are more likely to be affected by rabies?
dogs more so than cats
45
T/F: once clinical signs of rabies begin, death occurs within 7-10 days
46
what may be the first clinical sign seen with rabies?
ascending lower motor neuron paresis
47
what disease is an important consideration in a patient presenting with acute, progressive, neurological signs?
rabies
48
what are some general clinical signs of rabies?
altered mentation, CN paresis, multifocal/diffuse neurological signs
49
what is the typical history of an animal infected with rabies?
outdoor, unvaccinated animal presenting with progressive disease
50
what would you expect your results to be in evaluating CSF in a rabies patient?
lymphocytic pleocytosis
51
what is the gold standard for rabies diagnoses?
IFA virus detection in the brain - negri bodies may be seen in later parts of the disease
52
what is this? what disease is it common in?
negri body - rabies
53
T/F: titers are diagnostic for diagnosing rabies
false
54
how can rabies be diagnosed in humans?
skin biopsies
55
how do you make a definitive diagnosis of rabies?
necropsy of the animal to look at the brain
56
what is the recommended treatment for rabies?
euthanasia
57
why not freeze or shoot a rabies suspect?
need the brain intact for samples
58
if a vaccinated animal is bitten by a rabies suspect, what should happen?
quarantined for 45 days and boostered
59
if a rabies vaccinated animal bites a person, what should be done? what if they are unvaccinated?
observed for 10 days for signs of rabies
60
what should you do if a wild animal bites a person? why?
euthanize! any animal that has bitten people & has neurological signs compatible with rabies
61
if an animal that is unvaccinated is bitten by an animal known to have rabies, what should you do?
vaccinate & quarantined for 6 months or euthanized
62
what are some less common differentials for acute neuromuscular disease?
coral snake envenomation blue green algal intoxications black widow spider envenomation rare toxicities - lasalocid & other ionophores
63
an animal presents with acute flaccid non-ambulatory tetraparesis, on physical exam/neuro exam, you find that the animal has a weak gag reflex and signs of regurgitation, what are the two diagnostics you'll pursue next?
thoracic rads & arterial blood gas
64
an animal presents with acute flaccid non-ambulatory tetraparesis, on physical exam, its respirations are showing weak chest inspiratory expansion, open-mouth breathing, & labored respirations, what two diagnostics will you pursue next?
thoracic rads & arterial blood gas
65
why would you pursue thoracic rads & arterial blood gas in an animal presenting with acute flaccid non-ambulatory tetraparesis with labored breathing & regurgitation/weak gag reflexes?
looking for megaesophagus/aspiration pneumonia & to see if the animal is ventilating well
66
an animal presents with acute flaccid non-ambulatory tetraparesis has a PaCO2 > 45mmHg, what should you consider?
mechanical ventilation
67
an animal presents with acute flaccid non-ambulatory tetraparesis has a PaCO2 < 45mmHg, what should you consider?
monitor their breathing pattern & blood gases every 4-6 hours & provide O2 supplementation
68
an animal presents with acute flaccid non-ambulatory tetraparesis has megaesophagus & aspiration pneumonia, what are your next steps?
avoid oral feeding - consider an NG or G tube check AChAb titers provide O2 supplementation
69
what are the 8 main categories of chronic generalized LMN disease for differentials?
1. endocrine 2. infectious 3. non-infectious inflammatory 4. paraneoplastic 5. metabolic 6. degenerative 7. drug-related 8. idiopathic
70
what chemo drugs may cause neuromuscular problems?
cisplatin & vincristine
71
T/F: certain antibiotics cause neuromuscular junction blocking effects
true
72
what 5 antibiotic classes can cause neuromuscular junction blocking effects?
1. aminoglycosides - gentamycin 2. lincomycin - precursor to clindamycin 3. penicillamine 4. polymixins 5. tetracyclines
73
what cancer is most frequently identified in causing polyneuropathy?
insulinomas
74
other than insulinomas, what cancer can cause polyneuropathy?
lymphoma
75
what cancer causes myopathy in boxers?
lymphoma
76
what tumor can cause an associated myopathy?
thymoma
77
T/F: myasthenia gravis can occur secondary to neoplasia and affect the neuromuscular junction
true - common with thymomas
78
what is myotonia?
disturbance in muscle relaxation after voluntary contraction or percussion
79
congenital myotonia typically affects what animals?
young dogs
80
acquired myotonia can be caused by what drug?
glucocorticoids
81
what causes congenital myotonia?
malformation in the chloride channels which can cause constant contraction of voluntary muscles
82
what is the typical presentation of a dog with congenital myotonia?
sudden onset stiffness with intact consciousness
83
what is the typical presentation of acquired myotonia?
stiff, stilted gait
84
what breed is associated with hypokalemic myopathy?
burmese cats
85
what is the pathogenesis of hypokalemic myopathy?
hyperpolarization of the sarcolemma resting membrane prevents muscle contraction
86
T/F: hypokalemic myopathy may be associated with renal disease, diet, and hyperthyroidism in cats
true
87
what disease has this typical presentation
hypokalemic myopathy
88
what is the pathogenesis of hyperkalemia causing neuromuscular problems?
membrane depolarization - leads to weakness, bradycardia, & atrial standstill
89
what are 2 examples of metabolic diseases that have hyperkalemia?
post-renal disease & addisons
90
what is the pathogenesis of hypocalcemia causing neuromuscular problems?
calcium interacts with sodium channels to reduce excitability & threshold - depolarization leads to weakness, tetany, tremors, tachycardia, hyperthermia, & seizures
91
what is the pathogenesis of hypomagnesemia causing neuromuscular problems?
Mg is a part of an ATP molecule, so low Mg causes weakness, tremors, seizures, cardiac arrhythmias secondary to energy depletion (similar to grass staggers)
92
what is the most common lab abnormality in critically ill patients?
hypomagnesemia
93
what electrolyte abnormality may be common in brachycephalic dogs?
hypomagnesemia
94
what diagnostic test may I use to rule in polymyositis?
creatine kinase
95
if i'm concerned about disease affecting the neuromuscular junction, what diagnostics and history questions would be helpful?
tick search/tick treatment - treat regardless myasthenia gravis titers & chest rads carrion or garbage eater - botulism
96
how can hypoglycemia cause LMN disease signs?
ATP depletion - weakness and seizures as a result
97
what are your top 6 differentials for neuromuscular disease?
1. rabies 2. coonhound paralysis 3. tick paralysis 4. myasthenia gravis 5. myositis 6. botulism

CFT I (30 decks)

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