Taylor Final Material Flashcards by Kelly Whippo

You are presented with an elderly dog. The owner states he has been sleeping more during the day and is increasing active at night. He seems anxious and disoriented… your top ddx? Prognosis?

Cognitive dysfunction; guarded

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If you suspect an elderly dog of cognitive dysfunction, what change would you expect to see on MRI?

decreased interthalamic adhesion thickness

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How does L-deprenyl (Selegiline) help treat cognitive dysfunction?

MAOI–>increases dopamine levels

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If not treating cognitive dysfunction with Selegiline, what are 2 other Tx options?

Nutritional supplementation

SAM-e

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Name 2 ways hydrocephalus can occur

1) obstruction of CSF flow (obstructive hydrocephalus)

2) loss of brain parenchyma (compensatory hydrocephalus)

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You are presented with a puppy that appears to have a domed skull and ventrolaterally positioned globes. He has a history of seizures, and appears to be ataxic and mentally altered. Top ddx? Best way to confirm? Prognosis?

Hydrocephalus

MRI

guarded

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A CKC spaniel presents to you with cerebellar and vestibular dysfunction; you note that she exhibits phantom scratching of the neck; top ddx? What tests would you do to confirm/rule out other diseases? Prognosis?

Chiari-like malformation

MRI & CSF analysis

guarded

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How does a chiari-like malformation cause disease?

it’s when the caudal fossa is too small and you get compression of the contained structures

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A young kitten presents to you for ataxia and tremors; the owner said she just noticed as the kittens just became able to walk a few days ago; the kitten is otherwise normal (mentation)… top ddx?

Cerebellar hypoplasia

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How does cerebellar hypoplasia develop in kittens?

from an in utero parvovirus infection

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How does hypocalcemia alter neuron function?

lowers neuronal threshold–>hyperexcitability (tremors, seizures)

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What neurologic signs are associated with hypothyroidism?

vestibular dysfunction
generalized neuromuscular disease
encephalopathy

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Discuss 3 ways encephalopathy can develop from lack of liver filtering

1) neurotransmitter imbalance
2) gut-toxins reaching brain
3) brain produces false neurotransmitters

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Two differentials for hepatic encephalopathy

1) PSS

2) hepatic microvascular dysplasia

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Neurologic signs of: abnormal behavior, head pressing, and obtunded mentation accompanied by systemic signs of illness (vomiting/diarrhea, anorexia, PU/PD) is usually indicative of what disease?

Hepatic encephalopathy (HE)

can also see seizures and ptyalism in cats

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Describe how Lactulose and Neomycin sulfate work in treating hepatic encephalopathy

Lactulose: lowers pH of colon which traps excess ammonia so it can be excreted

Neomycin sulfate prevents gut flora from producing ammonia

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If seizures are occurring due to HE, what would be the preferred anticonvulsant

Leviteracetam (not metabolized by liver)

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For Meningioma and Glioma:

1) where they arise from
2) intra- or extra-axial

Meningioma–>extra-axial, arises from arachnoid mater

Glioma–> intra-axial; arises from astroglial cells

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Which type of brain tumor are older brachycephalic breeds predisopsed to getting?

Glioma

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The most common brain tumor of CATS and dogs

Meningioma

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Only definitive way to diagnose any neoplasia?

histopathology

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Name the 4 most commone metastatic tumors in the dog

Hemangiosarcoma, lymphoma, metastatic carcinoma, melanoma

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When conservatively treating brain tumors, what are the 2 most common classes of meds use?

1) Steroids

2) anticonvulsants

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Name the 3 different dosing regimens for glucocorticoids

1) Physiologic (0.1-0.2 mg/kg/day)
2) anti-inflammatory (0.5-1 mg/kg/day)
3) immunosuppressive (2-4 mg/kg/day)

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A dog with a tumor treated conservatively will have a longer survival time if the tumor is located where? 1) cerebrum or 2) cerebellum/brainstem

Cerebrum | only 28 days in cerebellum

GME, NME, & NLE are all presumed to be caused by?

an auto-immune disease

Breeds predisposed to: 1) GME 2) NME 3) NLE

1) toy breeds 2) pug, chihuahua, maltese 3) yorkies

Describe which area of the CNS each like to infect and if grey or white matter 1) GME 2) NME 3) NLE

1) white matter of brainstem and spinal cord 2) white and grey matter of forebrain 3) white matter of brainstem and cerebrum

After ruling out infection and confirming GME, NME, or NLE, how does the prednisone dose change?

Changes from anti-inflammatory (0.5-1 mg/kg/day) to immunosuppressive (2-4mg/kg/day)

Type of virus that causes: 1) canine distemper virus 2) FIP

1) paramyxovirus | 2) coronavirus

Best diagnostic test for canine distemper virus?

Distemper PCR on urine (but can give fale + with vaccination)

Name 3 areas of inflammation seen with FIP

choroid plexi, ependyma, meninges

Virus that causes rabies

Lyssaviridae

Which spp. is more likely to be infected with rabies?

cats

Disease associated with acute-onset, rapidly progressing neurological disorder (7-10 days)

Rabies

Gold standard for diagnosing rabies?

IFA detection of virus in brain (post-mortem)

Best test for diagnosis of Cryptococcus?

latex agglutination for crypto antigen

This disease, similar to toxoplasma, does not infect cats, but is medically treated the same way and causes similar clinical signs in dogs

Neospora caninum

In this disease cuterebra flies deposit larva on the skin that migrate into the SQ tissue and into the brain via the cribiform plate; area of US most commonly seen?

Larval migrans NE united states

T/F: a soft tissue buck shot can lead to lead poisoning

False | ONLY via GI tract absorption of lead

A young dog presents to you with vomiting and diarrhea; the owners say they own a scarp yard; as you watch the dog over the next few hours, you start to notice mentation changes and the dog develops seizures; top ddx?

Lead toxicity (guarded to grave)

How do organophosphates cause disease?

Acetylcholinesterase inhibitors (build up of ACh @ nicotinic and muscarinic receptors)

Salivation, lacrimation, defication, urination, bradycardia, tremors, weakness, and seizures are all indicative of?

Organophosphate toxicity

Name 2 potential treatment options for organophosphate toxicity

1) 2-PAM (disrupts bonds between O and ACHase) | 2) atropine (for muscarinic signs)

How do Pyrethrins & Permethrins cause disease?

Facilitate Na channel conduction and block GABA

A cat presents to you with tremors, ataxia, salivation, seizures, and dyspnea; the owners reported giving the cat some flea medication early that day...top ddx?

Pyrethrin & Permethrins toxcitity

Medication that can be used for Pyrethrin & Permethrin induced tremors?

Methocarbamol

Describe how Bromethalin causes disease?

blocks the electron transport chain-->energy deprivation-->neuronal edema-->increased ICP

This disease presents acutely with seizures, tremors, and excitation; the chronic form presents as ataxia, obtundation-coma, tremors, extensor rigidity, and seizures

Bromethalin toxicity

How does strychnine cause disease?

glycine anatagonism in spinal cord and brain (glycine= inhibitory NT)

Owners bring you their dog that just ate rat poisoning; his signs include sound-provoked seizures, tremors, opisthotonous, and extensor rigidity; likely toxin involved?

Strychnine

Symptoms of this disease are seizures, tremors, tachycardia, diarrhea/vomiting, and CNS depression (associated with snail poison)

Metaldehyde toxicity

This toxicity presents with acute central vestibular disease, tremors, and rigidity; prognosis?

Metronidazole; good

Toxicity with Metro is associated with what dose and for what length of time?

>60mg/kg/day for >2-3weeks

Cerebral perfusion pressure (CPP) = ?

mean arterial pressure (MAP) - ICP

Describe the Cushing's reflex and how to recognize it

A drop in CPP-->massive catecholamine release-->systemic hypertension-->stimulates baroreceptors-->vagal stimulation-->bradycardia **Hypertension in the face of bradycardia**

Name the 3 components of Modified Glasgow coma scale

Motor activity brainstem reflexes level of consciousness (lower scores=less activity=poorer prognosis)

Describe Mannitol's MOA and 3 indications for its use

osmotic diuretic (moves fluid from extravascular to intravascular compartment) 3 indications: 1) evidence of brainstem dysfunction 2) decline in MGCS score 3) Cushing's reflex

Which drug/treatment is contraindicated in tx of head trauma and why?

Corticosteroids; cause hyperglycemia and lead to poorer outcomes

An acute, lateralized CNS dysfunction from underlying cerebrovascular disease

Stroke (cerebrovascular accident)

Best choice for diagnosis of a cerebrovascular accident?

MRI

What type of lesions are best identified on MRI?

spinal cord parenchymal lesions

If an animal has motor function, it also has?

Perception of sensation

The order in which function is lost as spinal cord injury increases in severity (i.e. first to go-->last to go)

1) prorioception motor superficial nociception deep nociception

Describe intravertebral disc anatomy 1) general setup 2) composition of nucleus 3) how it gets nutrients

1) collegen annulus surrounded gelatinous nucleus pulposus 2) nucleus has glycosaminoglycan, collagen, and water (hydrated) 3) avascular; nutrients via absorption

Disc extrusions are associated with? Breeds commonly affected?

Chondroid degeneration Chondrodystrophic breeds (dachshund, beagle, cocker, pekingnese)

How can bladder function help you localized a disc extrusion:

UMN bladder with T3-L3 | LMN bladder with L4-S2

Most common areas of disc herniation: 1) cervical region 2) Thoracolumbar region

1) C2-C3 (small dogs) C6-C7 (large) 2) T12-L1 (small) L1-L3 (large)

Name 3 indications for choosing medical treatment of disc extrusion/degeneration

1) acute, single episode of pain 2) +/- mild paresis 3) client doesn't want surgery

Name 3 indications for surgical management of disc extrusion/degeneration

1) multiple episode & chronic history of dysfunction 2) significant paresis/non-ambulatory 3) medical management fails

Surgical management of disc extrusion has variable chances of recovery. What is the biggest determining factor?

Presence of deep nociception * Absence of deep nociception will reduce the chance of ambulation to 50%* * 90% recover if it's intact*

What percentage of animals may have another disc extrusion event that requires a second surgery?

20%

Animals with no deep nociception are at risk for?

Myelomalacia

Difference between Hansen Type I and Hansen Type II?

Type 1--annulus ruptures, nuclues protrudes through Type 2--nucleus herniates into annulus causing annular hypertrophy

Instability, malformation, canal stenosis, disc herniation, and ligament hypertrophy are all associated causes of?

Lumbosacral disease (compression @ L7-S1)

Older, large breed dogs, especially german shepherds, are more likely to get these 2 diseases

Lumbosacral disease Degenerative myelopathy

This disease presents with slowly progressive, non-painful T3-L3 myelopathy, and over time, signs may progress cranially

Degenerative myelopathy

Degenerative myelopathy is a diagnosis of _______; how can you definitively diagnose it?

Diagnosis of exclusion Histopathology

Name the 2 forms of Cervical Spondylomyelopathy

1) Malformation and malarticulation (static) | 2) Instability & malarticulation (dynamic)

Stenotic vertebral canals with vertebral body tipping compresses the spinal cord as the animal grows; compression is dorsal to dorsolateral

Malformation & malarticulation (YOUNG DANES)

Compression that worses with extension of the neck

Instability & malarticulation (OLD, LARGE DOGS)

This disease causes a slowly progressive, chronic, painful myelopathy; the signs may come and go

Cervical spondylomyelopathy

Concerning Cervical spondylomyelopathy, where do the different forms localize 1) great danes 2) doberman

1) C1-C5 | 2) C6-T2

Best surgical option for 1) disc associated problem 2) bony form

1) ventral slot | 2) dorsal laminectomy

Describe how atlantoaxial subluxation occurs

Malformation of the dens leads to loss of appropriate ligament support (or ligaments can be congenitally absent)

This disease predominantly affects young, toy breed dogs, can be acute or chronic, localizes to C1-C5, and is commonly associated with paraspinal hyperesthesia

Atlantoaxial subluxation

Prognosis for Atlantoaxial subluxation?

guarded to good (70-94%have successful outcome)

This neoplastic disease shares an association with FeLV, and is usually seen in middle aged animals; Where does it localize?

Lymphoma T3-L3; L4-S1

This neoplastic disease commonly causes cranial cervical myelopathy in older, large breed dogs

Meningioma

An older, large dog presents with slowly progressive muscle atrophy and paresis in the right thoracic limb; on the same side, cutaneous trunci is absent and the limb also shows root signature...top ddx?

Neoplasia--Peripheral nerve sheath tumor

With PNST, what factor alone may determine survival time?

Control of pain (degree of painfulness)

The most common primary vertebral tumor in dogs and cats

Osteosarcoma | less common: Chrondrosarcoma, Fibrosarcoma

A 1 year old beagle presents to you for severe neck pain with cervical myelopathy. You suspect SRMA... what CSF results would confirm this?

Significant neutrophilic pleocytosis & increased protein

Since SRMA is a(n) ______ ________, the treatment includes?

autoimmune disease immunosuppressive steroids (2-4mg/kg/day)

Most common organisms involved in Discospondylitis infection?

Staph intermedius Brucella canis Streptococcus spp. E. coli

This disease is typically seen in large breed, older male dogs. It's characterized by paraspinal hyperesthesia, paresis, & ataxia but rarely causes severe impairment; Tx of choice?

Discospondylitis 1st generation cephalosporins (2-3 months)

Areas of the spine most commonly affected by Discospondylitis

TL and LS

In ALL cases of Discospondylitis, what test should you always perform and why?

Brucella slide agglutination | rules out zoonotic cause

How can you determine if a vertebral fracture is stable or unstable

Stable--involves 1 compartment Unstable--2 or more compartments are involved

Which spinal cord segments are usually affected by trauma? Considerations when taking X-rays?

TL and Lumbar Take lateral and horizontal beams views--NOT V/D (can worsen trauma)

Absence of ______ gives the animal a 0% chance of recovery with fracture/luxation

deep nociception | indicates spinal cord laceration

Describe pathogenesis of FCE (fibrocartilaginous embolism)

fibrocartilage from a disc blocks a spinal artery-->ischema | Grey >>>>> white

An adult large breed dog presents to you after exercising for asymmetric/lateralized myelopathy; he shows no signs of paraspinal pain during the first 24 hours...top ddx?

FCE

FCE is a diagnosis of ______; only definitive way to know?

Diagnosis of exclusion; | necropsy/histopath

You are presented with a cat that has been previously diagnosed with HCM; today, she is acutely paralyzed in her hindlimbs, with localization to the L4-S3 region; the limbs are also cold and blue...top ddx?

Feline aortic thromboembolism (ATE)

Prognosis for feline ATE? Why?

Poor Re-embolization if likely if cardiac disease is underlying cause