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spinal surgery 1 > General Knowledge > Flashcards

General Knowledge Flashcards

1
Q

What is the difference between paraparesis and paraplegia?

A

Paraparesis is the presence of voluntary movement and paraplegia is the absence of voluntary movement

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2
Q

What structures can be affected in a neuromuscular disease?

A

The muscle, the nerve or the neuromuscular junction

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3
Q

What differentiates UMN from LMN lesions?
a) Speed of onset of lesion
b) Response to medication
c) Presence or absence of segmental spinal reflexes and muscle tone
d) Presence or absence of proprioception

A

Presence or absence of segmental spinal reflexes and muscle tone

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4
Q

What is the most important prognostic indicator with spinal cord injury?

A

The presence of nociception

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5
Q

Which drug is contraindicated in cases of head trauma?

A

Corticosteroids

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6
Q

What characterise central blindness or a post-chiasmatic lesion on cranial nerve examination:

A

absent menace response and normal pupillary light reflexes

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7
Q

The decerebellation posture is:

A) characterised by opisthotonos only.
B) of very poor prognosis and is not reversible.
C) always associated with a comatose mental status.
D) associated with a lesion affecting the caudal fossa.

A

D) associated with a lesion affecting the caudal fossa

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8
Q

What is the difference between paraparesis and paraplegia?

A

Paraparesis is the presence of voluntary movement and paraplegia is the absence of voluntary movement

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9
Q

What differentiates UMN from LMN lesions?
A) Presence or absence of proprioception
B) Presence or absence of segmental spinal reflexes and muscle tone
C) Response to medication
D) Speed of onset of lesion

A

B) Presence or absence of segmental spinal reflexes and muscle tone

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10
Q

In cases of central vestibular syndrome:

A) the head tilt is always associated with mentation changes.
B) postural reactions deficits are not expected .
C) the pathological nystagmus is always horizontal.
D) the pathological nystagmus can be horizontal, rotatory or vertical.

A

D) the pathological nystagmus can be horizontal, rotatory or vertical.

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11
Q

What is the most important prognostic indicator with spinal cord injury?

A

The presence of nociception

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12
Q

A dog with L4-S1 lesion will have what signs in pelvic and thoracic limbs?

A

LMN signs in pelvic limbs normal thoracic limbs

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13
Q

A dog with a C6-T2 lesion will have what signs in thoracic and pelvic limbs?

A

LMN signs in thoracic limbs and UMN pelvic

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14
Q

A dog with T3-L3 lesion will have what signs in pelvic and thoracic limb?

A

UMN signs in pelvic limbs and normal thoracic,

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15
Q

A dog with a C1-C5 lesion will have what signs in thoracic and pelvic limbs?

A

UMN signs in thoracic and pelvic limbs

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16
Q

Which of the following might be found on CSF analysis in a patient with steroid responsive meningitis-arteritis? 

Neutrophilic pleocytosis

Eosinophilic pleocytosis 

Lymphocytic pleocytosis 

Mixed cell pleocytosis

A

Neutrophilic pleocytosis

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17
Q

When performing a Computed Tomography, a contrast agent can be injected:

A) intravenously or intrathecally (CT-myelogram) at a dose of 0.2 ml/kg body weight.
B) intravenously at 2 ml/kg body weight or intrathecally (CT-myelogram) at a dose of 0.2 ml/kg body weight.
C) intravenously or intrathecally (CT-myelogram) at a dose of 2 ml/kg body weight.
D) intravenously at 0.2 ml/kg body weight or intrathecally (CT-myelogram) at a dose of 2 ml/kg body weight.

A

B) intravenously at 2 ml/kg body weight or intrathecally (CT-myelogram) at a dose of 0.2 ml/kg body weight.

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18
Q

Which of the following statements regarding spinal radiography is incorrect?

A) In cases of discospondylitis the radiographic changes are always visible.

B) Often sedation or anaesthesia is required to obtain diagnostic quality spinal radiographs.

C) Rotation of the vertebral column will make interpretation challenging and evaluation of the key features such as the disc space and foramen unreliable.

D) Survey spinal radiographs are of great value in cases of spinal trauma.

A

A) In cases of discospondylitis the radiographic changes are always visible.

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19
Q

What is the most common side effect from the options below following injection of the non-ionic contrast material for a myelograph?

A) Hypertension 
B) Bradycardia 
C) Myelomalacia 
D) Anaphylaxis 

A

B) Bradycardia 

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20
Q

Normal CSF appears as:

A) A green tinged fluid
B) A blood tinged fluid 
C) A clear fluid
D) A yellow tinged fluid

A

C) A clear fluid

21
Q

When using Computed Tomography, ionizing radiation are normally used to acquire images:

A) in the sagittal plane.
B) in the dorsal plane.
C) in the transverse plane.
D) in the sagittal, transverse, and dorsal plane.

A

C) in the transverse plane.

22
Q

In case of a metallic implant near the vertebral column:

a) advanced imaging of the vertebral column with CT and/ or MRI should not be undertaken.
b) both an MRI scan and a CT can be performed safely.
c) performing a Computed Tomography is safer than performing an MRI scan.
D) performing an MRI scan is safer than performing a Computed Tomography.

A

c) performing a Computed Tomography is safer than performing an MRI scan.

23
Q

Following myelography, how long is CSF analysis difficult to interpret for? 

A

7 days

24
Q

What is the most common clinical signs associated with cervical disc herniation?

A

Neck pain

25
Q

Following the start of a new AED therapy in a dog with phenobarbitone, when is it appropriate to check serum levels?

A

Following the loading period,

2 - 3 weeks after therapy begins,

2 - 3 times a year,

After any increase in seizure frequency

26
Q

Which of the following is most likely to be associated with an infra-tentorial lesion:

Pathological nystagmus

Seizures

An altered menace response

Altered response to nasal stimulation

A

Pathological nystagmus

27
Q

Hyperthermia has been identified in a SE patient and active cooling methods begun. At what temperature should cooling efforts be stopped?

A

39C

28
Q

What is the Cushing’s response that can be seen in a patient with raised intracranial pressure?

A

Decreased heart rate (bradycardia) and increased blood pressure (hypertension)

29
Q

Which of the following options would be the most suitable choice of AED for a seizure patient that is otherwise healthy, on no other medication and has no previous history of seizures?

A) Levetiracetam

B) Imepitoin

C) Phenobarbitone

D) Potassium Bromide

A

C) Phenobarbitone

30
Q

The cranial vault is a A) containing brain tissue, blood and B) fluid. An C) in the volume of any one of these components necessitates a D) in volume of one of the others or an increase in intracranial pressure (ICP) will ensue. This is described as the Monro-Kellie Doctrine.

A

A) Rigid tructure
B Cerebrospinal
C) Increase
D) Reduction

31
Q

Which of the following blood abnormalities (if found on initial assessment) has been associated with a poorer prognosis in head trauma patients?
A) Hyperkalaemia
B) Hypoglycaemia
C) Hyperglycaemia
D) Hypokalaemia

A

C) Hyperglycaemia

32
Q

Which of the following statements regarding corticosteroid use in small animal head trauma patients is correct?

A) Some evidence exists that corticosteroid use in head trauma patients is detrimental, but they should still be considered because of the potential anti-inflammatory benefits they provide.

B) Strong evidence exists linking corticosteroid administration to increased mortality. Their use in head trauma patients is not recommended.

C) Evidence regarding corticosteroid use in head trauma patients is inconclusive and case by case decisions are appropriate.

D) Early corticosteroid administration is associated with improved prognosis in head trauma patients.

A

B) Strong evidence exists linking corticosteroid administration to increased mortality. Their use in head trauma patients is not recommended.

33
Q

Hypertonic saline (7.5%) is considered the fluid of choice for the treatment of hypovolaemia in patients with TBI. Which of the following dose rates is most appropriate?

A

4ml/kg over 5 minutes

34
Q

Spastic paralysis - U or LMN?

A

UMN

35
Q

Flaccid paralysis - U or LMN?

A

LMN

36
Q

Where is a flaccid tail localised?

A

sacrococcygeal

37
Q

D/Dx in cat:
PARAPARESIS: T3-L3 spinal segments (3)

A

Acute non–compressive nucleus pulposus extrusion (ANNPE)
Ischaemic myelopathy also called fibrocartilaginous embolism
Spinal trauma as a luxation/fracture.

38
Q

D/Dx in cat:
FLACID TAIL: sacrococcygeal (2)

A

Trauma: tail pulling injury
Inflammatory (e.g., neuritis).

39
Q

Boxer with L4-S1 lesion localisation.
D/Dx? (3)

(progressive HL ataxia)

A

Inflammatory (immune vs infectious)
Meningomyelitis/discospondylitis and spinal empyema

Neoplasia
Spinal cord tumour or vertebral tumour

Degenerative
Disc herniation Hansen type II protrusion or Hansen type I extrusion

40
Q

Boxer with L4-S1 lesion:

CSF:
Pleocytosis 650 nucleated cells/uL with a mixed pleocytosis (reference < 5)
Protein 2.5 g/L (ref < 0.45 g/L)

MRI: Diffuse T2W hyperintensity and contrast enhancement of the lumbar spinal cord parenchyma.

What is the most likely diffferential?
(Toxo/neospora -ve)

A

meningomyelitis.

41
Q

Tx options for meningomyelitis in dogs? (3)

A

1 Prednisolone as sole agent or in association with one of the adjunctive immunosuppressive drugs such as +/- Cytarabine injections (100 mg/m2 as a constant rate infusion over a minimum of 8h)

2 Ciclosporine (5 mg/kg BID for one month, then once daily for three months, then every other day for three months)

3 Azathioprine(2 mg/kg once daily for two weeks, then every other day for six months).

42
Q

How to manage inpatient with meningiomyeltitis pain?

A

Gabapentin PO 10-20 mg/kg q8 h for 2-3 weeks

Methadone 0.2-0.3 mg/kg q4 h

Ketamine constant rate infusion for initial 48 h.

43
Q

Explain the possible complications associated with immunosuppressive treatment and high dosage of steroids. (5)

A

PUPD
Polyphagia
Gastro-intestinal signs (vomiting, diarrhoea)
Risks of opportunistic infections (e.g., urinary tract infections)
Risks of myelosuppression

44
Q

A 4-year-old, male Labrador retriever was presented with a history of acute onset of non painful left pelvic limb monoparesis. Which imaging modality is most likely to give you a diagnosis? 

A

MRI

45
Q

You find an intradural extramedullary lesion on a myelogram. Which of the following is the most likely diagnosis 

a) arachnoid diverticulum (subarachnoid cyst) 
b) vertebral body tumour 
c) extruded disc material 
d) Syringomyelia 

A

a) arachnoid diverticulum (subarachnoid cyst) 

46
Q

A 2-year-old female Poodle was presented collapsed with decreased segmental spinal reflexes and reduced muscle tone.  Which test would you perform first? 

a) CSF analysis 
b) MRI 
c) Electromyography 
d) Electrolytes 

A

d) Electrolytes 

47
Q

A 5-year-old Dachsund was presented with an history of paraparesis. The lesion was localised to the T3-L3 spinal cord segments and myelography was performed. A lesion was identified at the level of T13-L1 however the lateralisation of the lesion was not clear on lateral and ventrodorsal radiographs. What is the next appropriate step? 

A

Right ventral left dorsal and left ventral right dorsal oblique views 

48
Q

When should a dog with a T3-L3 lesion be able to urinate voluntarily? 

a) if the bladder is easy to express 
b) if the bladder is difficult to express 
c) if the dog has voluntary movement in the pelvic limbs 
d) if the dog is not in pain 

A

if the dog has voluntary movement in the pelvic limbs 

spinal surgery 1 (10 decks)

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