Neurology Exam 1

Question 1

Which of the following is INCORRECT.
A. When a patient has peripheral nerve injury, there will be LMN dysfunction of affected muscle.
B. If a patient had a peripheral nerve injury to the thoracic limb, hyperflexia would be seen.
C. A patient comes rushing into your clinic and was just HBC, you should inform the owner that glucocorticoids can be given after patient is stabilized, but if no improvement in 6 mo.- amputate.
D. Peripheral nerve injuries tend to be non-progressive injuries once obtained.

Answer 1

B. These patients will be showing LMN signs- therefore you will observe hyporeflexia and decreased tonicity.

Question 2

Which of the following is INCORRECT.
A. Brachial plexus avulsion of ventral nerve roots between C6-T2 is most commonly seen.
B. Horner’s syndrome is defined as T1- post synaptic avulsion with miosis, ptosis, enophthamos and 3rd eyelid protrusion.
C. Physiotherapy is tx of choice followed by amputation with no improvement post 6 mo.
D. If a dog came in after being HBC and they have loss of deep pain- prognosis is grave.

Answer 2

B- all is correct except it is T1- PREsynaptic avulsion

Question 3

Which of the following is INCORRECT.
A. Nerve root neoplasia is a progressive disease- begins peripherally and spread proximally.
B. Root signs are seen with peripheral root neoplasia- meaning increased sensitivity to normal stimuli.
C. Definitive dx. of peripheral root neoplasia is CT- allows you to assess location and size of tumor to assess prognosis of patient.
D. Surgery is your best option for treatment but patient still has poor prognosis.

Answer 3

C- Def dx is histopath at surgery

Question 4

Which of the following is INCORRECT.
A. FCE’s originate from nucleus pulposus of intervertebral discs and move to cord causing ischemic myelopathy in cord.
B. Classic presenting complaint- dog was running around chasing a toy and came back with acute paresis/paralysis and extremely painful.
C. This is the most common cause of spinal cord injury and is typically seen in large breed dogs. (Irish wolfhounds or mini schnauzer)
D. Dogs with UMN signs typically improve within a week, however if LMN signs are present there is typically a poor prognosis.

Answer 4

B- These patients DO develop acute paresis/paralysis, however- this is a NON-PAINFUL dz

Also know that if this is in cats- NOT ASSOCIATED WITH EXERCISE

Question 5

Which of the following is INCORRECT.
A. Degenerative myelopathy is due to degeneration of axon and myelin sheath in thoracolumbar spinal cord commonly seen in large breed dogs (GSD).
B. Classical signs of degenerative myelopathy is crossing legs when turning, overstepping gait, progressive paresis and ataxia.
C. Patients with early degenerative myelopathy typically has bladder/fecal incontinence and very painful due to the nerve breakdown.
D. Phsiotherapy is primary tx option with eventual euth.

Answer 5

C- these patients in early disease have fecal and urinary continence (late dz they will become incontinent). These patients are NOT PAINFUL.

Question 6

Which of the following is INCORRECT.
A. Lumbosacral degenerative stenosis is commonly seen in working dogs in the L7/S1 area with osteophyte formation.
B. Lumbosacral dorsal laminectomy or dorsolateral foraminotomy are two sx performed on cauda equina syndrome dogs.
C. You will commonly see a lumbosacral step on x-rays at the transitional vertebrae (predisposing site)
D. UMN signs are seen in the sciatic and pudendal nerve, explaining why you see hyperreflexia.

Answer 6

D- LMN signs are seen at the sciatic and pudendal nerve with pseudohypereflexia

Psuedohypereflexia: this is when it looks like the muscle has exaggerated response to the knee tap. However- the femoral nerve is the only nerve intact on the back limb (innervates the quads) and since you no longer have negative force on the quads due to sciatic nerve function loss- you will have what looks like hyperreflexia- but it is PSUEDO!

Question 7

Which of the following is INCORRECT.
A. Grade 4 IVDD dogs will need a dorsal hemilaminectomy + durotomy where as grade 5 patients will need dorsal hemilaminectomy + fenestration.
B. The defDx of IVDD is myelography
C. Chondrodystrophic breeds replace nucleus pulposus with hyaline cartilage around 4 mo. of age.
D. Hansen type I is commonly seen in chondrodystrophic dogs- acute explosive extrusion of the nuclear pulposus into spinal canal.

Answer 7

A- The opposite would be correct

Question 8

Name the drugs for UMN vs. LMN bladder signs.

Answer 8

UMN (pew pew too): Prazosin, phenoxypenzamine, tamulosin

LMN: PPA and bethanacol

Question 9

Which of the following is INCORRECT.
A. Diskospondylitis is the spread of infection hematogenously causing fever and inflammatory leukogram.
B. Vertebral lysis, spondylosis and sclerosis can always be observed on rads with diskospondylitis.
C. Diskospondylitis typically requires bacteriostatic Ab tx for ~4 mo.
D. Decompression followed by hemilaminectomy are tx options for the damaged disk.

Answer 9

C- Bacteriocidal drugs for ~ 54 wks.

Question 10

Which of the following is INCORRECT.
A. Intradural-extramedullary > Extradural > Intramedullary is the order of most common to least common.
B. Root signs are commonly observed in vertebral/spinal neoplasia (hyperasthesia) and the golf tee sign will be observed with intradural-extramedullary neoplasia
C. CT is the best dx test done to localize vertebral/spinal neoplasia
D. Spinal neoplasia typically have a poor prognosis with no tx.

Answer 10

A- Extradural > intradural-extramedullary > intramedullary

Question 11

Which of the following is INCORRECT.
A. Vertebral fractures are most commonly a result of a dog fight or tail tug.
B. Shiff sherrington and LMN bladder signs are commonly seen with vertebral fractures.
C. Vertebral fractures rarely occurs in the sacroiliac and thoracolumbar areas.
D. MRI/CT are the best tests that can be done to dx vertebral fractures.

Answer 11

C- most common areas for this to occur

Question 12

Which of the following is INCORRECT.
A. Cervical disk disease Hansen Type I is commonly seen in chondrodystrophic breeds and large breed poodles.
B. Cervical disk disease patients have mild neck pain and will continue with normal behavior.
C. Hansen Type II commonly occurs in large breeds at C6/7 (Canine wobblers)
D. If your patient with cervical disc dz has CP deficits and UMN signs- ventral fenestration and ventral decompression sx are best tx options.

Answer 12

B- SEVERE neck pain- neck guarding and will discontinue eating and drinking

Question 13

Which of the following is INCORRECT.
A. Canine wobblers results from one/more than one: congenital stenosis of vertebral canal, Hansen Type II disk protrusion, hypertrophy of ligamentum flavum and boney proliferation of articular processes.
B. Boney proliferation of articular processes typically occurs with dobermans.
C. Radiographic changes can lead to high suspicion of canine wobblers= “tipping”
D. Canine wobblers is a slow progressive disease.

Answer 13

B- this typically occurs with great danes

Question 14

Which of the following is CORRECT.
A. Atlanto-axial subluxation can occur in toy breeds, but is more commonly seen in chondrodystrophic dogs.
B. Absence or hypoplasia of odontoid process/dens is the most common cause of atlanto-axial subluxation.
C. Odontoid fracture at the ossification center between dens and C3 is a predisposing cause to atlanto-axial subluxation.
D. Once you have given your patient a dose of opioids- it is safe to manipulate the neck because he will no longer feel the pain.

Answer 14

B

A- Most commonly seen in toy breeds
C- Dens and C2
D- Don’t manipulate neck- could kill patient

Question 15

T/F: Majority of the inflammatory myopathies can use prednisone as a tx option.

Answer 15

TRUE

Question 16

T/F: CP, sensory function and spinal reflexes tend to be lost with inflammatory myopathies.

Answer 16

FALSE- these are all spared

Neuropathies lose reflexes

Question 17

Name the inflammatory myopathy.

I am a golden retriever with bilateral exophthalmos but have normal masticatory and limb muscles.

Answer 17

Extraocular myositis

Question 18

Name the inflammatory myopathy.
I am the reigning champion of the greyhound racing community- my last race I became extremely sore and rigid two days post race and had elevated CK levels.

Answer 18

Exertional myopathy

Question 19

This is the most common inflammatory myopathy.

Answer 19

Autoimmune (K9 idiopathic) polymyositis

Question 20

This myopathy occurs in large breeds and typically have masticatory muscle atrophy resulting in skull-like appearance.

Answer 20

Masticatory muscle myositis (eosinophilic myositis or atrophic myositis)

Question 21

This myopathy occurs in racing breeds post heavy exercise and can cause markedly increased CK levels.

Answer 21

Exertional myopathy

Question 22

This myopathy is commonly seen in older cats with renal dz and excessive K loss in urine and you will notice prominent ventroflexion of the neck and stiff gait.

Answer 22

Hypokalemic myopathy

Question 23

This can be seen in pointers or labs after their first day in hunting season due to overexcitement and stimulation of the tail muscles.

Answer 23

Limber tail

Question 24

This myopathy can be seen as early as 6 wks. of age, bunny hopping may be noted, kyphosis/lordosis, enlargement of base of tongue and progressive for first 6 mo. of life and this patient typically has a poor prognosis.

Answer 24

Dystrophic myopathy

Question 25

This metabolic myopathy can be seen in young dogs post intense work/play and will return to normal in about 5-25 minutes of rest.

Answer 25

Exercise intolerance/collapse of labs

Question 26

This myopathy is due to sustained depolarization of muscle fibers and dimpling of the tongue/hypertrophy of the tongue/jaw can be seen.

Answer 26

Myotonia congenita

Question 27

T/F: Dermatomyositis is an inflammatory disease of capillary walls in skin and is seen around 2 mo. of age and will typically resolve around 1-2 yrs. of age

Answer 27

TRUE

Question 28

This condition is commonly seen in middle aged pure breed cats and the owner will report twitching of skin, excessive grooming, biting the air and exaggerated tail motion.

Answer 28

Feline hyperesthesia syndrome

Question 29

Which of the following is CORRECT.
A. Congenital myasthenia gravis is due to autoantibodies to motor end-plate receptors
B. Myasthenia gravis in cats is commonly associated with thymomas
C. General myasthenia gravis is widespread appendicular muscle weakness with megaesophagus
D. The test of choice for MG is the tensilon test

Answer 29

B

A- This is describing acquired myasthenia gravis
C- Generalized MG doesn’t have megaesophagus (only focal)
D- NO. He says that too many false positives come from this so the test used for MG is an Ab test

Question 30

This end-plate condition can be seen in hunting dogs who ingest an “un-bled” carcass causing CS (hypotonia, hyporeflexia, hind limb paralysis, megaesophagus) within 6 days post-ingestion.

Answer 30

Botulism

This condition is progressive for 2-3 days and improves over 3 weeks

Question 31

This condition can be seen in hunting dogs and owner will report rapid development of paresis, LMN signs and he noted a tick was found.

Answer 31

Tick paralysis

Signs develop after 5 days of attachment and recovery begins 8-12 hrs. post tick removal

Question 32

This condition is typically associated with a contaminated wound and owner will report sardonic grin and abnormal stiff stance in their dog. What is this, what does the dog usually die from and what causes this?

Answer 32

Tetanus- Clostridium tetani

Patient typically dies of hyperthermia

Question 33

This condition is commonly associated with raccoon bites in hunting dogs causing progressive LMN paralysis (tetraplegia eventually) and the patient is still aware of its surroundings, just unable to respond adequately.

Answer 33

Coonhound paralysis/Acute Idiopathic Polyradiculoneuritis

Fun fact this can be caused by the rabies vaccine inoculated form suckling mice brains (infectious dz SAM notes)

Question 34

T/F: Central vestibular disease occurs with lesions in the vestibular portion of CN VIII or the vestibular sensing apparatus in the inner ear.

Answer 34

FALSE- this is the peripheral VD (most common form seen)

Question 35

These findings describe peripheral or central VD.

- No CP deficits/paresis, no depression, facial n. paralysis (Horner’s) and nystagmus.

Answer 35

Peripheral VD

Question 36

These findings describe peripheral or central VD.

- Tetra/hemiparesis, depression, nystagmus (horizontal and vertical)

Answer 36

Central VD

This is when a lesion is in the vestibular nuclei in the medulla oblongata

Question 37

T/F: Peripheral VD occurs with feline idiopathic VD, K9 geriatric VD, congenital and otitis media-interna.

Answer 37

Peripheral VD

Question 38

This condition has a lesion in the cerebellum causing increased extensor muscle tone, head tilt, circling and falling to the opposite side.

Answer 38

Paradoxial Central vestibular syndrome

Question 39

What are the major signs of cerebellar disease?

Answer 39

Wide based stance, truncal ataxia and intention tremor and dysmetria

Question 40

This disease is commonly caused by intrauterine infection with panleukopenia in kittens around 6 mo. of age causing truncal ataxia, tremor, dysmetria

Answer 40

Cerebellar hypoplasia

Question 41

T/F: In patients with cerebellar lesions, they will have increased extensor tone on the side of the lesion due to lack of inhibitory reflexes.

Answer 41

TRUE- dogs walk to the opposite sides of the lesion and CP deficits on side of lesion

Question 42

Animals with this disease will fall towards side of lesion and may be caused by an ear infection.

Answer 42

Central vestibular lesion

Question 43

What is the most common brain neoplasia?

Answer 43

Meningiomas (dogs and cats)

Question 44

T/F: If there is a lesion in the cortex, your patient will be falling to the side of the lesion.

Answer 44

FALSE- if lesion is on the L side they will fall to the R side