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Neuro specialty boards > Literature > Flashcards

Literature Flashcards

1
Q

According to VetRecord 2017 Quintavalla et al.
How does Sildenefil affect lower esophageal sphincter tone?

A

Endogenous NO induces smooth muscle relaxation through the synth of secondary messenger cGMP. Sildenafil a phosphodiesterase type 5 (PDE-5) inhibitor indirectly potentiates the action of endogenous NO by reducing cGMP degradation.

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2
Q

According to VetRecord 2017 Quintavalla et al. What dose of sildenafil was utilized to reduce lower esophageal tone?

A

1mg/kg PO q12h

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3
Q

According to VetRecord 2017 Quintavalla et al. How was regurgitation and esophageal diameter improved in dogs receiving sildenafil compared to controls?

A

Significant reduction in Regurgitation (half the events) which remained even at day 30 (2 weeks after stopping). There was marked reduction in esophageal diameter at 2 weeks (about 1/4 the size).

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4
Q

According to VetRecord 2017 Quintavalla et al. What are the most common breeds with congenital idiopathic megaesophagus and what is the typical disease progression?

A

Large and giant breeds: Great Dane, Irish Setter, Lab Retriever, Gemern shepherd, Irish Wolfhound, Newfoundland, Bouvier
Autosomal dominant in miniature schnauzers.
Signs at or before 10 weeks old, often slow spontaneous improvement

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5
Q

According to VetRecord 2017 Quintavalla et al. Why are prokinetic drugs like metoclopramide or cisapride potentially contraindicated in dogs with megaesophagus

A

Because there is striated muscle throughout the length of the esophagus (EXCLUDING THE lower esophageal sphincter) so prokinetics are ineffective for esophageal motility and may be contraindicated as they can increase lower esophageal muscle tone reducing esophageal emptying.
Note because sildenafil only reduces smooth muscle tone this should not reducing motility either.

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6
Q

According to pharmacokinetics of compounded vs commercially avail Keppra ER in cats (AJVR 2019); What is the half life of oral Keppra vs Keppra ER in dogs and how does this affect dosing

A

Keppra 3 hours - needs q8h dosing
Keppra ER 4.5-5 hours - can be dosed q12h

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7
Q

According to pharmacokinetics of compounded vs commercially avail Keppra ER in cats (AJVR 2019); What is the minimal serum concentration in humans considered effective

A

5ug/mL

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8
Q

According to pharmacokinetics of compounded vs commercially avail Keppra ER in cats (AJVR 2019); How does the serum concentration compare to CSF concentration and what is the best way to determine Keppra effectiveness

A

CSF concentration was 89% of the serum concentration in cats = closely estimated.
Neither however necessarily correlate with Keppra penetration into the brain interstitium and synapses which are the source of epileptigenesis which would require brain biopsy sampling and not considered ethical.

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9
Q

According to pharmakinetics of compounded vs commercially avail Keppra ER in cats (AJVR 2019);

A
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10
Q

What is the pitch of a screw

A

The distance between two consecutive threads

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11
Q

What type of pins work best to reduce pull out forces? And what type to reduce bending and shear?

A

Cancellous pins - due to larger thread diameter but smaller core diameter
Cortical pins

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12
Q

What size determines the size of the screw

A

The thread diameter (aka major diameter) and determines pull out strength

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13
Q

What determines the size of hole that must be drilled for a screw?

A

Core diameter (aka minor diameter) and determines shear strength and bending strength

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14
Q

What are causes of stripping of the screw thread during insertion

A

poor bone quality, bone mineral density, inappropriate hole preparation, too high torque during insertion

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15
Q

How much does stripping a screw decrease holding strength

A

more than 80%

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16
Q

What is the best type of screw for angle stable constructs (ie ex-pins or pmma/screws)

A

Cortical screws to reduce bending/shear forces.
Also largest screw diameter and longest length that can be safely used should be

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17
Q

What type of screws are used with mesh to cover skull defects following craniotomy

A

self tapping self drilling

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18
Q

What is an adv and a disadv of a locking plate

A

Provide superior holding in poor quality bone
If they fail they do catostrophically by fracturing the bone.

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19
Q

What is the strongest predictor of anesthetic outcome related to pulmonary disease (in people)

A

Albumin <3.5g/dL

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20
Q

How can intracranial disease lead to arrhythmias?

A

an ischemic phenomenon known as brain-heart or cerebro-cardia syndrome

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21
Q

Renal complications assoc with contrast agents

A

Contrast induced nephropathy or worsening of existing disease. Worse if patients are dehydrated prior to anesthesia.

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22
Q

What range of bp are autoregulatory mechanisms able to maintain CBF

A

50-150mmHg

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23
Q

What percent of patients with primary brain neoplasms have primary neoplasms in other areas?

A

23%- despite that brain neoplasia rarely mets

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24
Q

How often are splenic and hepatic nodules incidental in older dogs?

A

57%

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25
Q

Two treatments for Dobermans with von Willebrand’s disease prior to sx? What is the cut off to be considered positive for Von Willebrand dz?

A

DDAVP and Fresh frozen plasma.
<50% positive. >70% negative (no bleeding risk),

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26
Q

What is the relationship between CLM/syringomyelia and cardiac disease in CKCS

A

Dogs with earlier onset of clinical signs associated with COMS and syringomyelia had a later onset of cardiac disease and vice versa (likely due to selective breeding trends)

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27
Q

What is the most common cause of obstructive hydrocephalus?

A

atresia of the mesensephalic aqueduct associated with fusion of the rostral colliculi

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28
Q

What preps should you use for craniotomies and why? betadyne vs chlorhexidine

A

betadyne preferred as chlorhexidine carries a precaution of CNS toxicity especially in trauma/open situations

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29
Q

What is the recommended IV dose of iodinated contrast and what is the concentration of iohexol

A

600mg iodine/kg
240mg/mL

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30
Q

What is T1 relaxation

A

relates to the spins of protons in the patient that are perturbed by a radiofrequency pulse realigning into their normal position parallel to the magnetic field

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31
Q

What is T2 relaxation

A

relates to the dephasing of the protons immediately after being perturbed by the radiofrequency pulse

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32
Q

Difference between MOA of contrast in CT vs MRI

A

CT contrast is iodinated and alters Xray attenuation within the patient and the iodine atoms are directly visualized on the image
MRI contrast media are paramagnetic and function by changing the relaxation rate of protons

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33
Q

What are the trends of Nacetylasparate (NAA), creatine, choline and lactate in canine brain tumors with MRS, how is this different than humans?

A

NAA and Cr were decreased and lactate was increased in brain tumors; But choline showed now significant difference (Different from humans with tumors showing decreased NAA and increased choline leading to a NAA/Cho ratio which could be diagnostic)

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34
Q

What artifact in CT can be mistaken for pathology (ie cause apparent defects in skull bones)

A

partial volume averaging

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35
Q

What artifact with CT makes imaging the caudal fossa difficult?

A

Beam hardening artifact resulting in hyperattenuating streaks which can obscure pathology

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36
Q

While mets to the brain are rare, when they occur what do they look like/where are they?

A

Multiple, small, located at the junction between gray and white matter (watershed zone) and surrounded by marked edema

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37
Q

Is CT better at acute or chronic hemorrhage?

A

Acute hemorrhage evident as increased density dye to attenuation of xrays by the globin in blood

38
Q

When does the attenuation of acute hemorrhage become isodense on CT?

A

1 month after onset

39
Q

When does the periphery of a hematoma enhance on CT and why?

A

6 days to 6 weeks.
Due to revascularization

40
Q

On MRI what suggests a bleeding neoplasm vs a hemorrhagic stroke?

A

Lack of a distinct complex hypointense rim and bleeding of different durations within the lesion

41
Q

What can can T1 hyperintensity?

A

hemorrhage (acute), melanin, high protein, flow artifacts, paramagnetic effects (due to manganese)

42
Q

For hyperacute brain hemorrhage, what is the TIME, type of hemoglobin, intra vs extracellular, T1 and T2 appearance

A

<1 day,
Oxyhemoglobin
intracellular
T1 isointense/hyperintense
T2 hyperintense

43
Q

For acute brain hemorrhage, what is the TIME, type of hemoglobin, intra vs extracellular, T1 and T2 appearance

A

1-3 days,
deoxyhemoglobin,
intracellular
TI isointense/hypointense
T2 hypointense

44
Q

For early subacute brain hemorrhage, what is the TIME, type of hemoglobin, intra vs extracellular, T1 and T2 appearance

A

3-7 days,
methemoglobin,
intracellular
T1 hyperintense
T2 hypointense

45
Q

For late subacute brain hemorrhage, what is the TIME, type of hemoglobin, intra vs extracellular, T1 and T2 appearance

A

7-14 days,
methemoglobin
extracellular
T1 hyperintense
T2 hyperintense

46
Q

For chronic brain hemorrhage, what is the TIME, type of hemoglobin, intra vs extracellular, T1 and T2 appearance

A

> 14 days
ferritin, hemosiderin,
extracellular
T1 hypointense
T2 hypointense

47
Q

Where do lacunar infarcts occur

A

deep gray matter structures - thalamus, caudate nucleus

48
Q

Where to territorial infarcts occur, what is different about sight hounds

A

large artery disease (rectangular or wedge shaped), most common in the cerebellum, in sight hounds may see middle or rostral cerebral arteries affected.

49
Q

How old can an infarct be to appear hyperintense on DWI

A

Usually <9 days, after 7-9 days the DWI pseudonormalizes

50
Q

How does hydrocephalus differ with most congenital cases vs 2ndary?

A

Congenital - usually only dilation of lateral and 3rd ventricles.
Dilation of mesencephalic aqueduct and 4th ventricle often indicates obstruction of CSF flow at the lateral apertures or foramen magnum

51
Q

How often can inflammatory CNS disease be associated with a normal MRI?

A

6 out of 25 dogs in one study (24%)

52
Q

How much CSF can you safely remove from a patient

A

1mL/5kg body weight

53
Q

What is the platelet count threshold for spontaneous bleeding? For surgical bleeding?

A

30,000 (spont), 50,000 (sx)

54
Q

Metastatic carcinomas (from what organs?) like to met to the thoracic/lumbar vertebrae

A

mammary gland, prostate, urinary bladder, AGASACA

55
Q

How much contrast can you inject during myelogram?

A

0-3-0.45mL/kg’
With a max of 8mL for cervical injection in large breed dogs due to intracranial risks.

56
Q

What is the incidence of seizures after myelography

A

3-21%

57
Q

For CT what is the window width and window level for a soft tissue setting?

A

width = 300, level = 100

58
Q

For CT what is the window width and window level for a bone setting?

A

width = 1000, level = 500

59
Q

For the evaluation of spinal cord disease what is the sensitivity of myelography, CT, CT myelography?

A

79% (myel),
66% (CT only),
97% (CT myelogram)

60
Q

Sensitivity of noncontrast CT for disk disease? Vs for all types of SC lesions?

A

IVDH 81-97%
All lesions 66%

61
Q

What is the CT sensitivity for lesions other than mineralized disk ruptures?

A

40%

62
Q

Why are dogs with chronic IVDH more likely to be detected on noncontrast CT?

A

The disk material is more likely to be mineralized.
Chronic disk = 745+/- 288HU
Acute disk 219+/-95HU

63
Q

How many dogs have a dural sac that ends cranial to the sacrum?

A

20%

64
Q

What are the most common causes of nerve root compression related to LS degeneration?

A

epidural fibrosis, hypertrophy of the ligamentum flavum, herniated disk material, subluxation, OS of the articular processes

65
Q

T2 hyperintensity within the spinal cord with normal signal on T1 images associated with disk disease may be due to…

A

mild loss of nerve cells, gliosis edema, wallerian degeneration and demyelination

66
Q

What is T2 hyperintense signal in the cord with T1 hypointense signal associated with?

A

severe changes including necrosis and myelomalacia

67
Q

What is the sensitivity for bone lysis of vertebral tumors on CT compared to plain films

A

CT 0.5% change, plain films >10% lysis before being evident.

68
Q

Where is CSF contained within?

A

Subarachnoid space

69
Q

Lateral to medial what are the 3 dorsal paraspinal muscle masses?

A

iliocostalis, longissimus, transversospinalis

70
Q

Where is the ligamentum flavum (interarcuate or yellow ligament)

A

Along the dorsal arch of the vertebrae connecting between vertebrae. What may cause the “pop” as you enter the spinal canal in lumbar punctures

71
Q

Is there an adv of lumbar puncture over cervical with regard to brain herniation risk?

A

No

72
Q

How soon should CSF return to normal after a myelogram, if no CSF was collected at that time?

A

Nucleated cell count normal within 83 hours, protein returned to normal by 8 days post myelogram.

73
Q

For muscle biopsies how does you muscle choice change with acute vs chronic conditions?

A

Acute - choose most severely affected muscle
Chronic - choose less affected muscle since the most affected are likely just going to reflect fibrotic infiltration and not the underlying dz process.

74
Q

How much (%) of diameter of a nerve can you sample for nerve biopsies?

A

30-50% nerve diameter preserves neurological function while being a representative sample.

75
Q

What muscles and nerve are most commonly sampled in the pelvic limb? What about for a distal muscle/nerve?

A

Biceps femoris and gastrocnemius muscles, common peroneal nerve

Distal - cranial tibial muscle and tibial nerve

76
Q

What muscles and nerve are most commonly sampled in the thoracic limb?

A

medial head of the triceps brachii muscle, superficial digital flexors, ulnar nerve.

77
Q

What main vessel supplies blood to the brain in cats?

A

maxillary artery for entire brain

78
Q

What vessel supplies blood to the rostral half of the brain in dogs?

A

internal carotid

79
Q

Most common differential diagnoses for primary skull tumors

A

multilobular osteochondrosarcoma, osteoma, osteosarcoma,
less commonly: chondrosarcoma, SCC, fibrosarcoma.

80
Q

What are evidence of increased intraventricular pressure (with hydrocephalus)

A

periventricular edema, enlargement of the temporal horns, effacement of the sulci

81
Q

What is the rate of infection within 6 months of ventriculoperitoneal shunt placement?

A

8-10%

82
Q

What % of dogs with VPS placement have a good long term outcome?

A

85%

83
Q

What % of dogs require shung revision following VPS placement? and why?

A

15% Due to shunt obstruction, fracture or migration.

84
Q

With dogs with quadrigeminal cistern cysts how much compression (%) of the occipital lobes always caused clinical signs?

A

14%
Or dogs with both rostral and caudal compression.

85
Q

What signalment (breed/age) is most common for quadrigeminal cysts? and what are the most common clinical signs?

A

Shih Tzu, <1yo
Signs: seizures, ataxia, vestibular dysfunction, neck pain. But many can be incidental so need to r/o other causes of signs (meningoencephalitis).

86
Q

What is the most frequent neurologic disease in nursery piglets

A

Meningoencephalitis by streptococcus suis (S suis)

87
Q

What are clinical signs of S suis meningoencephalitis

A

typical acute cases develop motor incoordination, convulsions, lateral recumbency and opisthotonus which may persis up to 3 weeks until death

88
Q

Name one of 3 diseases in young pigs that cause lesions of the entire brain and produce primarily incoordination, tremors, paddling and convulsions

A

Aujeszky disease, salt poisoning, edema disease

89
Q

What piglet disease has exudate concentrated over the cerebellum and occipital poles of the cerebrum and produces motor incoordination and lateral recumbency

A

Glasser disease

90
Q

What infectious disease in pigs predominantly affects the brainstem causing paresis

A

Listeriosis

91
Q

What is the most common signalment and location for spinal nephroblastoma

A

Dogs 6m-2y, over-represented in GSDs and Golden Retrievers. Tumor between T10-L3 with an intradural extramedullary pattern on MR

92
Q

What is the current MST for surgery vs radiation vs palliative care for spinal nephroblastoma

A

Surgery MST few months up to 3 years
Radiation unknown, one dog reported with Sx+ Rt 5 year survival
Palliative care days to weeks (MST 55 days)

Neuro specialty boards (1 decks)

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