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SAM > Examination of the nervous system > Flashcards

Examination of the nervous system Flashcards

1
Q

Exam methods

A 
HISTORY
Observe (inspection?)
Touch (palpation)
Pain (palpation)
Additional
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2
Q

History

A

More important than in any other problem
Exact problem/duration/constant vs periodic/changes before

Additionally:
environment and housing 
Feeding 
Other animals 
Vaccinations 
Breed-predisposition and age
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3
Q

Observe (general impression?)

A

Inspection without movement:

  • body posture
  • head position
  • eye position and movement
  • consciousness
  • reaction to stimuli

Inspection with movement:

  • walking
  • turning
  • sitting and standing
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4
Q

Touch- physical exam without causing pain

A 
Palpation
Postural reactions
Spinal reflexes
Cranial nerves 
Sensitivity of skin and mucus membranes

Must differentiate from orthopoedic problems

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5
Q

Pain- exam of pain perception

A

supf vs deep

Instruments: reflex hammer, artificial clamp/needle, penlight

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6
Q

Goal of physical exam

A

Locate the problem! if not neurologic is likely to be metabolic, orthopoedic or toxic

If is neurologic: need to check if its central: brain/SC or peripheral

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7
Q

Additional exams

A 
X-ray
Myelography
CT
MRI
Lab exams
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8
Q

Myelography

A

contrast injected into subarachnoid space

Diagnose compression of the SC

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9
Q

CT

A

Contrast IV or orally
Enhances density differences btw lesions and the surrounding parenchyma
Good for demonstrating vessels
Better images of bone, soft tissues, and air-filled lungs
Sedation is required

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10
Q

MRI

A

Good anatomical detail of soft tissues (higher water content) but anaesthesia is needed

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11
Q

EEG

A

Electroencephalography

Surface activity of the electrical activity of the cerebrum

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12
Q

EMG

A

Electromyography

Electrical activity of the muscles

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13
Q

Lab exams

A

CSF- obtain through occipital puncture
Blood- haematology and biochem
Urine- pathogens, toxins, metabolic alterations

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14
Q

Exam of the head

A

Inspection

Palpation

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15
Q

Inspection of the head

A

Posture:
-Abnormal head position: lateral turn, tilted, opisthotonus, weakness of neck muscles

-Turning/tilt of the head and neck

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16
Q

Palpation of head

A 
Shape 
Mobility
Ears 
Signs of pain
Facial expression
Detailed exam of the eyes
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17
Q

Palpation- shape

A

if symmetrical or asymmetrical changes

e.g hydrocephalus bulging of skull

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18
Q

Palpation- facial expression

A

eyelids
nostrils
ears

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19
Q

Palpation- detailed exam of the eyes

A

Position and mobility of eyeballs and pupils

Anisocoria when pupil size is not the same

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20
Q

Exam of spine

A

Inspection

Palpation

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21
Q

Inspection of spine

A

Curved spine not primary neuro disorder- could be due to malnutrition during growth
Kyphosis- dorsal elevation
Lordosis- concave
Scoliosis- lateral curvature

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22
Q

Palpation of spine

A

Shape
Position- luxation
Sensitivity- induce pain!

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23
Q

Mental status is an examination of..

A

Thalamocortex

  • thalamus: relay centre
  • cortex: goal directed behaviour

Brainstem

  • coordinates vital functions
  • ARAS
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24
Q

Mental status

A

Consciousness

Behaviour

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25
Q

Mental status- consciousness

A

Reduced mental function:

  • depressed/obtuned
  • somnolentia=drowsiness
  • delirium
  • dementia

Increased

  • excitation
  • aggression
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26
Q

Episodic alteration of consciousness

A

Narcolepsy- fall into deep sleep suddenly
Syncope- loss of consciousness sever heart problems cause cerebral hypoxia
Seizure- clonic-tonic

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27
Q

Behaviour

A 
Alterations in behaviour 
Decreased/ increased reactivity
Cognitive dysfunction
Involuntary postures 
Involuntary compulsive movements
Special behaviour abnormalities 
Seizures/convulsions 
Other forms of convulsions
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28
Q

Alterations in behaviour

A 
Aggression
Vocalisation
Abnormal sexual activity
Excitation
Mania e.g tail-biting
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29
Q

Decreased reactivity

A

Standing in the manger?- lead poisoning
Head press- hydrocephalus
Dementia
Deep coma

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30
Q

Cognitive dysfunctions

A

Usually related to age
Somnolence
Changes in sleep-wake cycles
Abnormal urination/defecation

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31
Q

Involuntary postures

A

Head tilt

Opisthotonus

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32
Q

Involuntary/ compulsive movements

A

Walking in circles

Compulsive walking in circles- pacing

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33
Q

Special behaviour abnormalities

A

Hallucination- partial epilepsy
Paraesthesia- psychogenic dermatitis- Aujeszky’s disease
May lead to automutilation

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34
Q

Seizures

A

Usually associated with
Regarding muscle function
Classification
Other forms

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35
Q

Seizures are usually associated with

A

Loss of consciousness (involvement of reticular formation)
Increased or decreased voluntary muscle tone- urination/defecation
Visceral muscle activity
Altered behaviour

36
Q

Seizures: regarding muscle function

A

Tonic
Clonic
Toncio-clonic

37
Q

Classification of seizures

A

Partial- localized but may become generalized
Complex partial- partial seizure with loss of consciousness
Generalized- diffuse in brain, generalized tonic-clonic
Structural- intracranial disease e.g hydrocephalus
Extra-cerebral- metabolic reasons e.g hypoglycaemia
Secondary epilepsy due to e.g distemper

38
Q

Other forms of convulsions

A 
Do NOT necessarily have to be associated with the CNS
Tetanus 
Tetany 
Tremor 
Tic
Myoclonus 
Fibrillation
39
Q

Tetanus

A 
inflamm
Tail-lifting 
Opisthotonus 
Spastic tetraparesis- extensor muscles are activated 
Risus sardonicus
Salivation
40
Q

Exam of proprioception i.e the postural reactions

A 
Wheelbarrowing test
Hopping tests
Knucking over 
Placing reactions 
Extensor postural thrust reaction
41
Q

What is ataxia

A

Lack of coordination during muscle function (movement)

Usually caused by CNS damage

42
Q

Ataxia- classification by signs

A

Static- signs even in standing position- the most severe
Locomotive
Intentional: head tremor when fine movement is required

43
Q

Ataxia- classification by anatomical origin

A

Cortical
Cerebellar
Vestibular
Spinal

44
Q

Cortical ataxia

A

Circling
Lateral head turn
Behavioural and mental state alterations

45
Q

Cerebellar ataxia

A 
Wide based stance 
Dysmetria or hypermetria 
Nystagmus 
Balance issues 
Conscious centre still normal
46
Q

Vestibular ataxia

A

Ipsilateral head tilt
Leans/falls/rolls to the affected side but no circling
ALWAYS nystagmus
Bilateral lesions- extreme swaying of head

47
Q

Spinal (proprioceptive)

A

Paresis/ paralysis
Hindlimbs ALWAYS
Knuckle over
Lethargic and weak

48
Q

What is paresis, paralysis/plegia

A

Abnormal posture or movement due to reduced or increased muscular tone

49
Q

paresis, paralysis/plegia - extraneural forms

A

Rhabdomyopathy
NM junction
Vascular

50
Q

paresis, paralysis/plegia - diagnostic methods

A

Inspection
Palpation
Evaluation of muscle tone
Need to determine if its atony, hypo or hypertony

51
Q

paresis, paralysis/plegia- classification

A

By severity
By affected limbs
By muscle tone
By origin- related to motor neuron nucleus

52
Q

Classification based on severity

A

paresis- partial loss of strength

paralysis/plegia- complete loss of strength

53
Q

Classification based on the affected limbs

A

mono: one limb e.g N radialis or fibularis
tetra: all limbs
para: hind limbs
hemi: ipsilateral (same side)

54
Q

Classification based on muscle tone

A

spastic, rigid

atonic, flaccid

55
Q

Classification based on origin- motor neuron nucleus

A

UMN: above the nucleus
LMN: in/below the nucleus

56
Q

paresis, paralysis/plegia: non-neuro

A

Botulism

Ionophore ABx in chickens

57
Q

Olfactory nerve

A

Use food to examine but block vision- otherwise II would be examined

Hyposomia- partial lack of smell
Anosomia- complete lack of smell

58
Q

Optic nerve

A

Vision! (amaurosis=complete blindness)

Falling cotton test
Leading into objects
Pupillary light (+III)
Menace (+VII)

59
Q

Oculomotor nerve

A

Examination of pupils

Anisocaria= both pupils not the same size
Mydriasis
Miosis
Horner’s syndrome- symp

*therefore pupillary light reflex?

60
Q

Oculomotor, trochlear and abducent nerves

A

Position and movement of eyeballs
Normal- eyeballs move simultaneously and their axis are parallel
Physio nystagmus- movement of head
Patho nystagmus- horizontal, vertical, rotary
Strabism- abnormal position of eyeballs, the axis are not parallel (like cross-eyed?)

61
Q

Trigeminal nerve

A

Sensory: feeling of face, palpebral and conreal reflex
Motor: temporal and masseter muscles
-paralysis- sagging lower jaw
-tic- repeated contractions of chewing muscles, can be seen with distemper
-trismus- tonic spasm of chewing muscles, can be seen with tetanus and myositis

Tests: corneal (lateral canthus) and palpebral (medial canthus) reflexes

62
Q

Facial nerve

A

Facial: taste to rostral 1/3 of tongue

Motor: muscles of facial expression
menace (+II) palpebral (+5) and corneal (+5) reflexes

Paralysis: nasal plane drawn towards healthy side i.e asymmetry
Ptosis: sagging of upper eyelid
Lip sagging
Ear sagging (central)

63
Q

Vestibulocochlear nerve

A

Hearing
Deafness= anacusis
Congenital- white dog argentino

Vestibular
Dysfunction is vestibular syndrome
Ipsilateral head tilt, leaning, and falling
Nysatgmus- horizontal

64
Q

Glossopharyngeal and vagus nerves

A 
Pharynx and larynx
Caud 2/3 of tongue: glossopharyngeal sensory and vagus is motor 
Paralysis:
-dysphagia 
-laryngeal paralysis

Test: swallowing/gag reflex- after swallowing dogs always lick their nose

65
Q

Accessory nerve

A

Motor: to traps, sternocephalicus, brachiocephalicus

Paralysis:
Bilateral sagging of head
Atrophy of above muscle groups

66
Q

Hypoglossal

A

Motor to tongue!!

Paralysis: abnormal protruding and retracting

67
Q

What is a spinal reflex?

A 
Involuntary and immediate response to an appropriate stimulus 
0= areflexia 
1= hyporeflexia
2= normoreflexia
3= hyperreflexia
4= hyperreflexia with clonus
68
Q

Abnormal reflexes

A

Reflex irraditation- reaches a wider muscle group

Contralateral/crossed reflex- other side of the body

69
Q

Classification of spinal reflexes

A

Proprioceptive/myotatic/stretch
=normal body position against gravity
Nociceptive (painful) reflexes

70
Q

What are the proprioceptive reflexes

A

Thoracic limb

  • extensor carpi radialis
  • triceps
  • biceps

Pelvic limb reflexes

  • patellar
  • achilles
71
Q

Extensor carpi radialis reflex

A

Afferent and Efferent nerve: N. radialis
Center: C7-T1
Hit muscle belly

72
Q

Triceps reflex

A

Afferent and effernt nerve: N. Radialis (same as ext carpi radialis)
Center C7-T1 (same an ext carpi)
Hammer just prox to olecranon

73
Q

Biceps reflex

A

Afferent and efferent nerve: N. musculocutaneous
Center: C6-C8
Foreginger on tendon of biceps and is struck with the other finger

74
Q

Patellar reflex

A

Afferent and efferent nerve: N. Femoralis
Center: L4-L6
Hammer on tendon

75
Q

Achilles reflex

A

Afferent and efferent nerve: N. Sciaticus tibialis
Center: L6-S2
Directly over the hock caudally

76
Q

What are the nociceptive reflexes

A

Flexor (withdrawal) reflex
Perineal reflex
Panniculus

77
Q

Flexor (withdrawal) reflex

A

Thoracic limb:
Center: C6-T1
All flexor muscles no pain involved because the animal moves limbs before there’s time to cause pain

Pelvic limb
Center: L4-S1…. same as above for the rest

78
Q

Perineal reflex (is it supposed to say perianal?)

A 
Afferent nerve: N. pudendalis 
Efferent nerve:
-anal sphincter: N. pudendalis 
-tail flexion: N. rectalis caudalis 
Center: S1-S3
Tone and then contraction of tail is checked
79
Q

Panniculus reflex

A

Afferent nerves: spinal segments
Efferent nerve: N. thoracicus lateralis

Aids in location spinal injury- shaking of skin
Start in lumbar, then work cranially

80
Q

Examination of pain perception: types of pain

A

Superficial pain
Deep pain
Spinal pain

81
Q

Superficial pain

A

Skin/ mucus membranes: hemostat/needle
Pain provoking percussion

Normal: twitch/withdrawal and behavioural e.g crying

Pathway: receptor - spinal ggl.- thalamus- cortex

82
Q

Evaluation of superficial pain

A

Normaesthesia
Hyperaesthesia
Anaesthesia
Paraesthesia

83
Q

Deep pain

A

Only if supf is absent

Squeeze digit/ claw with hemostat

84
Q

Spinal pain

A

Not all spinal diseases can cause it

Not always neural clinical signs, but always pain at lesion which can cause behavioural changes

85
Q

History of spinal pain

A

Stiff neck, not leaning down to bowl to eat

Not jumping on sofa or climbing stairs

SAM (16 decks)

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