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Clinical Medicine > Phase II Neuro > Flashcards

Phase II Neuro Flashcards

1
Q

what are the 6 components of the neurological examination

A

1) mentation
2) gait and posture
3) CN exam
4) postural reactions
5) spinal reflexes
6) palpation

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2
Q

what 2 tests do we use to assess postural reactions

A

1) proprioceptive tests (ex. knuckling)
2) hopping

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3
Q

what tests do we use to assess spinal reflexes:
- thoracic limb (TL)
- pelvic limb (PL)
- other regions

A

TL: withdrawal, weight-bearing
PL: withdrawal, patellar
Other regions: perianal, cutaneous trunci

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4
Q

what are the functional segments of the spinal cord and which are the enlargements

A
  • C1-C5
  • C6-T2 (TL enlargement)
  • T3-L3
  • L4-S3 (PL and perineum/tail enlargement)
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5
Q

what do the spinal cord enlargements contain

A

LMNs for the limb pairs

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6
Q

what lives in the white vs grey matter of the spinal cord

A

white matter: tracts
grey matter: motor nerve cell bodies

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7
Q

what are the 3(4) sections of the spinal cord white matter

A
  • dorsal funiculus
  • ventral funiculus
  • lateral funiculi (left and right)
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8
Q

in what general area of the white matter are the ASCENDING tracts located

A

dorsolateral

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9
Q

the ascending tracts contain tracts carrying what 3 general categories of information

A
  • conscious proprioception
  • reflex proprioception
  • nociception
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10
Q

what are the 2 conscious proprioceptive ascending tracts and which limbs do they correspond to

A
  • fasciculus cuneatus (TL)
  • fasciculus gracilis (PL)
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11
Q

what are the 2 reflex proprioceptive ascending tracts and what limbs do they correspond to

A
  • rostral spinocerebellar tract (TL)
  • dorsal and ventral spinocerebellar tracts (PL)
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12
Q

what are the 2 nociceptive tracts

A
  • spinothalamic tract
  • fasciculus proprius
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13
Q

what is the proprioceptive pathway

A

sensory receptor -> peripheral sensory neuron -> spinal cord white matter (tract) -> brainstem/cerebellum -> contralateral cortex

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14
Q

what ascending tracts are deepest in the white matter and what does this mean clinically

A

nociceptive (i.e spinothalamic and fasciculus proprius)

means that loss of deep pain is only going to be seen with a severe spinal cord injury (to the dorsolateral spinal cord)

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15
Q

what clinical signs would you expect to see in a patient with a lesion to the dorsolateral spinal cord (i.e. ascending tracts damaged)

A

1) proprioceptive deficits (decreased hopping, knuckling, proprioceptive ataxia)

2) changes in pain perception (hypoesthesia, hyperesthesia, anesthesia)

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16
Q

what are signs of proprioceptive ataxia

A
  • wobble/sway
  • erratic paw placement
  • limbs crossing over
  • abnormal posture
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17
Q

T/F knuckling will always indicate spinal cord dysfunction

A

F (pain, metabolic disease, orthopedic disease, etc.)

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18
Q

Are you more likely to see proprioceptive deficits (ex. knuckling) if there is a peripheral nerve or a tract problem? Why? Are both possible?

A

More likely in the tracts as you would need complete severage or loss of nerve fibers in the entire nerve to see proprioceptive deficits from a peripheral nerve problem. Both are technically possible (ex. severe trauma such as a car accident that severs the brachial plexus)

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19
Q

T/F proprioceptive ataxia is seen in both CNS and PNS lesions

A

F; only CNS

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20
Q

in what general area of the white matter are the DESCENDING tracts located

A

ventrolaterally

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21
Q

what are the 5 descending white matter tracts

A
  • tectospinal
  • rubrospinal
  • vestibulospinal
  • reticulospinal
  • corticospinal
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22
Q

UMN exercises ___________ on LMN

A

descending inhibition (keeps reflexes in check)

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23
Q

where can we localize UPN to

A

spinal cord white matter

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24
Q

in what regions of the spinal cord do we tend to see ONLY UMN problems (and no LMN problems)

A

C1-C5 and T3-L3

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25
Q

LMN are confined to the _____ and localized to the (3)

A

PNS; spinal nerves, nerve roots or spinal cord grey matter

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26
Q

Describe the following for UMN:
- paralysis
- reflexes
- muscle tone
- atrophy
- urinary/GI
- clinical signs

A
  • spastic paresis/paralysis
  • normal to increased reflexes
  • normal to increased muscle tone
  • disuse atrophy (slow)
  • incontinence
  • struggling to hold body up, still have voluntary movement but it is abnormal, normal proprioception
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27
Q

Describe the following for LMN:
- paralysis
- reflexes
- muscle tone
- atrophy
- urinary/GI
- clinical signs

A
  • flaccid paresis/paralysis
  • decreased or absent reflexes
  • decreased or absent muscle tone
  • neurogenic atrophy (early and severe)
  • incontinence
  • cannot hold body up, no reflexes, loss of deep pain sensation
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28
Q

Put the following in order of increasing loss of function (and what order is gain of function)

  • nociception
  • proprioception
  • urinary incontinence
  • paresis to paralysis
A

Loss of function:
1) proprioception
2) paresis to paralysis
3) incontinence
4) nociception

Gain of function occurs in the reverse order:
1) nociception
2) incontinence
3) paresis to paralysis
4) proprioception

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29
Q

Shiff-Sherrington posture indicates a lesion where? What are the clinical signs? Why?

A
  • lesion in the L1-L4 grey matter border cells or their axons
  • opisthotonus and increased thoracic limb extensor tone
  • these neurons help co-ordinate the posture of the neck
30
Q

T/F Shiff-Sherrington posture indicates poor prognosis

A

F: does not indicate prognosis

31
Q

T/F the spinal cord and brain have no nerve endings

A

T

32
Q

what 3 structures are involved in EXTREME spinal pain

A

bones, nerve roots, meninges

33
Q

what do you NOT want to do to assess neck pain if other signs are present

A

vertical/horizontal flexion

34
Q

what is a nerve root signature

A

single limb lameness (pain) due to nerve damage

35
Q

what do you see in addition to spinal pain in a patient with concurrent spinal cord disease

A

paresis and ataxia -> proprioceptive deficits

36
Q

As a lesion moves CRANIALLY in the spinal cord, what happens to proprioceptive ataxia in the thoracic limbs?

A

gets worse

37
Q

what are the 3 meninges from OUTSIDE to INSIDE

A

dura mater, arachnoid mater, pia mater

38
Q

the patellar reflex tests the function of what nerve

A

femoral nn

39
Q

what are the spinal cord segments tested by the femoral nerve and which is the main one

A

L4, L5, L6

L5 is the main one

40
Q

the flexor reflex tests what nerves

A

radial (thoracic) and sciatic (pelvic)

41
Q

what spinal cord segments are tested by the flexor reflex and what is the main one

A

Radial:
C7, C8, T1, T2

Pelvic:
L6, L7, S1, S2
L7 is the main one

42
Q

where does cutaneous trunci synapse

A

C8-T1

43
Q

the absence of cutaneous trunci reflexes on one side only tells us

A

there is an impaired transmission of sensory signals that synapse between C8-T1 on that side

44
Q

which is left and which is right:

OS
OD

A

OS: left
OD: right

45
Q

what are 4 clinical signs of Horner’s syndrome and which is the MINIMAL clinical sign

A
  • miosis (minimal clinical sign)
  • enopthalmos
  • protruding nictitans
  • ptosis
46
Q

what is the pathway of Horner’s syndrome (normal pathway)

A

hypothalamus -> travels in spinal cord to T1/T2/T3 -> enters sympathetic trunk -> synapses in superficial cervical ganglion -> mediates dilation of the eye

47
Q

where are the synapses along the pathway for Horner’s syndrome

A

1) at T1/T2/T3
2) at the superficial cervical ganglion

48
Q

what are the sections of the CNS

A

thalamocortex, brainstem, cerebellum, spinal cord

49
Q

what are the sections of the PNS

A

peripheral nerves, neuromuscular junctions, skeletal muscles

50
Q

what are the 2 types of LMNs

A

those leaving the cervicothoracic and lumbosacral enlargements and the cranial nerve motor neurons/ganglia

51
Q

the perineal reflex tests what nerve? what segments?

A

pudendal (S1, S2, S3)

52
Q

T/F neuromuscular disease involves lesions of both the UMN and LMN

A

F; it involves the LMN since neuromuscular disease involves the PNS

53
Q

T/F cranial nerves may be impacted by neuromuscular disease

A

T, since they are considered LMNs

54
Q

what is the difference between mononeuropathies and polyneuropathies

A

mononeuropathies: one nerve or a group of adjacent nerves affected

polyneuropathies: simultaneous malfunction of many peripheral nerves

55
Q

how do neuromuscular diseases present (signs on the neurologic exam)

A

Presents like LMN disease
- normal mentation
- CN may be afffected
- paresis/paralysis
- decreased to absent reflexes
- decreased to absent muscle tone
- possible neurogenic atrophy
- possible paresthesia
- expect normal postural reactions unless there is concurrent sensory dysfunction

56
Q

where is the cauda equina located

A

over the lumbosacral junction (with species differences)

57
Q

T/F the cauda equina is part of the spinal cord

A

F, part of the PNS (LMN)

58
Q

what are clinical signs of cauda equina lesions

A
  • NO ataxia
  • may see lumbosacral pain
  • may see abnormal spinal reflexes
59
Q

put the following species in order of shortest to longest spinal cord (i.e which ends before the lumbosacral junction and which extends the furthest past the junction)

  • dog
  • cat
  • horse
  • cow
A

dog, cow, horse, cat

60
Q

what is a telltale sign that a lesion affecting all 4 legs is in the PNS as opposed to the CNS

A

lack of proprioceptive ataxia

61
Q

PNS dysfunctions are characterized by

A

RAT
- reflex deficits
- atrophy (neurogenic)
- tone decreased

62
Q

PNS dysfunctions can be a manifestation of (3)

A

neuropathy, junctionopathy, myopathy

63
Q

T/F ataxia is uncommon with PNS lesions

A

T

64
Q

what 3 “opathies” are clinically indistinguishable

A

polyneuropathies, polymyopathies and junctionopathies

65
Q

describe the expected findings on the neurologic exam for a patient with neuromuscular disease:
- mentation
- cranial nerves
- posture/gait
- postural reactions
- reflexes
- muscle tone
- muscle atrophy
- other comorbidities

A
  • mentation: normal
  • cranial nerves: may be affected
  • posture/gait: paresis/paralysis
  • postural reactions: normal
  • reflexes: reduced to normal
  • muscle tone: decreased to absent
  • muscle atrophy: possible
  • other comorbidities: megaesophagus, aspiration pneumonia, exposure keratitis
66
Q

what are important differential diagnoses for a patient showing signs of neuromuscular disease

A
  • orthopaedic (pain)
  • systemic illness (malaise)
  • lumbosacral disease
67
Q

are presynaptic or postsynaptic neuromuscular diseases associated with SLUDGEM

A

post-synaptic

68
Q

what are examples of myopathies

A

non-inflammatory (acquired, degenerative/inherited, nutritional) and inflammatory (infectious and immune-mediated)

69
Q

what 4 ways can we diagnose myopathies

A
  • CBC/biochem/UA: elevated CK, ALT, AST
  • serum pre and post-exercise lactate
  • electrodiagnostics
  • muscle histopathology
70
Q

how do the clinical signs of hypokalemia differ between cats and dogs and why

A

cats: high shoulders and low head carriage

won’t see low head carriage in dogs as they have a more complete nuchal ligament

Clinical Medicine (10 decks)

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