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87 Cards in this Set

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What is the definition of a seizure?
Paroxysmal disturbance of cerebral function
Which of the following are involved in the inhibitory arm of the CNS?
a) Chloride
b) Potassium
c) Barbiturates
d) AMPA receptors
e) GABA
a) Chloride
c) Barbiturates
e) GABA
(yeah I know that K is important for all nerve function but we're just talking about inhibition here)
Which of the following are involved in the excitatory arm of the CNS?
a) Benzodiazepines
b) NMDA receptors
c) Phenobarbital
d) KBr
e) Calcium
b) NMDA receptors
e) Calcium (Ca channels cause Glutamate release)
(also AMPA receptors, glutamate)
Categorize the following according to their involvement on either the inhibitory or excitatory arms of the CNS.
a) Benzodiazepines
b) NMDA receptors
c) Phenobarbital
d) KBr
e) Glutamate
Benzodiazepines (inhibit)
NMDA receptors (excite)
Phenobarbital (inhibit)
KBr (inhibit)
Glutamate (excite)
What are the main sources or classes of seizures (there are 3 or 4 depending on how you look at it)?
Symptomatic (intracranial)
Reactive (extracranial)
Idiopathic (breed-associated)
Idiopathic (idiopathic cryptogenic)
What are the PHASES of a seizure?
Pre-ictal phase (prodromal)
Ictus
Post-ictal phase
Interictus
Choose the type/class of seizure associated with each of the following:
- looks like syncope
- rigid extension in all 4 limbs
- tremors in face then neck only
- violent jerking of limbs all over
Atonic - looks like syncope
Tonic - rigid extension in all 4 limbs
partial motor (frontal cortex) - tremors in face then neck only
Tonic-clonic - violent jerking of limbs all over
Choose the type/class of seizure associated with each of the following:
- excessive salivation
- focal seizures w/behavior changes
- twitching only in one place
- long-haired twitchy dachshunds
Autonomic - excessive salivation
Psychomotor - focal seizures w/behavior changes
Focal seizure - twitching only in one place
Myoclonic - long-haired twitchy dachshunds
What are some differentials that can be confused with seizure activity?
Syncope
Excessive REM motion
Narcolepsy/Cataplexy
OCD
Acute vestibular syndrome
Tremor syndromes
Hyper/dyskinesia
Which of the following are NOT true of breed-associated epilepsy?
a) dolicocephalic dogs
b) partial seizures
c) 6yo dog
d) normal neuro exam
e) cats
c) 6yo dog
e) cats
Which of the following are NOT true of breed-associated epilepsy?
a) brachycephalic dogs
b) focal seizures
c) 8 month dog
d) normal minimum database
e) normal interictal period
a) brachycephalic dogs
b) focal seizures
Which of the following are NOT good general principles of seizure management?
a) if drug dose doesn't control seizures, increase dose until seizures stop or toxicity occurs
b) start with a single drug
c) never use phenobarbital in cats
d) always perform liver enzyme tests before beginning therapy
c) never use phenobarbital in cats (nope, pretty much drug of choice)
d) always perform liver enzyme tests before beginning therapy (liver FUNCTION tests should be done)
Which of the following are NOT true regarding phenobarbital?
a) prevents Cl efflux
b) inhibits the CNS
c) pretty long half life
d) sedation is common early in treatment
e) therapeutic range is 30 - 50ug/mL
a) prevents Cl efflux (NO, stimulates Cl influx)
e) therapeutic range is 30 - 50ug/mL (NO, its 20-40; hepatotoxic effects increased >45ug/mL)
What are the common side-effects of phenobarbital use?
Sedation
PU/PD
(bone-marrow suppression in dobies)
Choose dogs, cats, or both with regard to phenobarbital administration:
- drug of choice for seizures
- high liver enzymes are bad news
- sedation and PU/PD side effects
- idiosynchratic lymphoproliferation
CATS>dogs - drug of choice for seizures
CATS - high liver enzymes are bad news
DOGS>cats - sedation and PU/PD side effects
BOTH (but rare) - idiosynchratic lymphoproliferation
T or F:
Phenobarbital should NEVER be removed from therapy immediately.
False!
Remove it immediately if idiosynchratic lymphoproliferation or extreme anxiety (in GSDs) occur!
Which of the following are NOT true regarding KBr?
a) prevents Cl efflux
b) binds the GABA receptor
c) shorter half life than phenobarbital
d) induces p450 metabolism
e) Not a good idea to use in cats
b) binds the GABA receptor (NO, Br is preferentially excreted, thus sparing Cl)
c) shorter half life than phenobarbital (NO, 24d t1/2)
d) induces p450 metabolism (NO, not metabolized at all)
(note: KBr causes feline asthma so not so good in cats)
T or F:
PU/PD/PP with KBr will not improve over time while, with Phenobarbital, they will improve.
False!
They won't improve with either drug!
How should KBr levels be measured? What units would you expect?
HPLC (ppm units)
Which of the following are NOT true regarding gabapentin?
a) does not bind GABA receptor
b) interacts with Cl channels
c) 100% urinary excretion
d) has a longer t1/2 than pregabalin
e) does not affect levels of GABA
b) interacts with Cl channels (NO, voltage-gated Ca channels)
d) has a longer t1/2 than pregabalin (NO, shorter)
e) does not affect levels of GABA (NO, it INCREASES GABA by increasing GAD, thus reducing Glutamate)
Which drug is indicated for control of seizure clustering?
Levetiracetam (Keppra)
Choose the drug that is associated with each of the following:
- can be used as IV drip in lieu of diazepam
- works on the AMPA receptor
- binds synaptic vesicle preventing release of glutamate
Levetiracetam - can be used as IV drip in lieu of diazepam
Topiramate - works on the AMPA receptor
Levetiracetam - binds synaptic vesicle preventing release of glutamate
Which drugs SHOULD NOT be used in the management of seizures?
Pnenytoin (Dilantin)
Primidone
Diazepam
Lamotrigine (Lamictal)
Which of the following describe status epilepitcus?
a) seizures that can lead to brain damage if left untreated
b) cluster seizures
c) seizure activity >30 min
d) medical emergency
e) most commonly genetic in origin
a) seizures that can lead to brain damage if left untreated
c) seizure activity >30 min
d) medical emergency
(note - most common etiology POISONING OR TOXICITY)
Which of the following are NOT negative sequellae to epileptic seizures?
a) death
b) Cushing's reflex
c) hypothermia
d) self-trauma
e) aspiration pneumonia
f) hypotension
g) hypertension
b) Cushing's reflex
d) self-trauma
(also blindness, tetraparesis, worsened seizures)
What are the 3 goals to treating status epilepticus?
Stop seizures
Restore homeostasis
Perform diagnostic evaluation
How can status epilepticus be stopped!
Diazepam (per rectum if necessary)
Maybe Phenobarb, Lorazepam or
Levetiracetam
What are the 2 mechanisms for brain injury? Which of the two can you actually do something about and what is the timespan?
Mechanical
Ischemic injury (there's a chance if you get to it 24-48 hrs after the injury)
Which of the following are NOT true regarding mechanical brain injury?
a) acute axonal shearing is most common in the occipital lobe
b) shear-force damage to the axonal hillock can cause profound memory loss
c) transient brain herniation can occur
d) epidural and subdural bleeding is the most common hemorrhage in animal brain trauma
a) acute axonal shearing is most common in the occipital lobe (NO IN THE FRONTAL LOBE)
d) epidural and subdural bleeding is the most common hemorrhage in animal brain trauma (NO; subarachnoid and parenchymal)
Which of the following DO NOT occur with excitotoxicity due to ischemic injury?
a) Ca entry into neuronal cells causes glutamate increase
b) DNA fragmentation occurs due to excess glutamate
c) Peroxynitrate causes toxicity
d) Cytotoxic effects are seen from free radicals, COX, phospholipases, etc
e) ATP changes glutamate to glutamine
a) Ca entry into neuronal cells causes glutamate increase (NO; lack of ATP causes this)
b) DNA fragmentation occurs due to excess glutamate (NO; due to excess Ca entry)
e) ATP changes glutamate to glutamine (NO; this is the normal state - hypoxia causes less ATP)
Which of the following will lead to INCREASED cerebral blood flow?
a) increased pCO2
b) decreased pCO2
c) increased pO2
d) decreased pO2
a) increased CO2
d) decreased pO2
Which of the following will lead to DECREASED cerebral blood flow?
a) increased pCO2
b) decreased pCO2
c) increased pO2
d) decreased pO2
b) decreased pCO2
c) increased pO2
Which of the following will lead to loss of the blood/brain barrier?
a) increased pCO2
b) decreased pCO2
c) increased pO2
d) decreased pO2
a) increased CO2
d) decreased pO2
(increased cerebral blood flow leads to leaky vessels and loss of BBB)
Which of the following are NOT true with loss of autoregulation?
a) increased PaCO2 due to hyperventilation causes vasodilation in undamaged areas
b) blood is shunted away from undamaged areas when PaCO2 is high
c) Blood is shunted into damaged areas when PaCO2 is low
d) damaged areas are vasodilated
e) hypoxia is increased when blood is shunted away from damaged areas in the Robin Hood effect
a) increased PaCO2 due to hyperventilation causes vasodilation in undamaged areas (NOT due to hyperventilation)
b) blood is shunted away from undamaged areas when PaCO2 is high (blood is shunted away from DAMAGED areas)
e) hypoxia is increased when blood is shunted away from damaged areas in the Robin Hood effect (NO; this is the steal phenomenon)
What are the 2 major causes of DELAYED brain damage?
Brain Edema
Hematoma formation
What are the 2 types of cerebral edema? Which occurs more in the white matter?
Cytotoxic
Vasogenic (more in white matter)
Why doesn't CNS pressure change initially as the brain swells (volume increases) in acute trauma?
Compliance of the CSF + blood
T or F:
You don't fuck with the Cushing's Reflex!
you know it!
What are the components of the Cushing's reflex?
Increased systemic blood pressure
Decreased heart rate
Which of the following is NOT a sequel to increased intracranial pressure?
a) brain-heart syndrome
b) pulmonary edema
c) tachycardia
d) hypotension
e) skull fracture
c) tachycardia
d) hypotension
(should be bradycardia and hypertension - the Cushing's Reflex)
What are the 4 levels of decreased consciousness?
Obtundation
Stupor
Semi-coma
Coma
What are the 3 main brainstem reflexes?
Pupil size and reactivity
Respiration pattern
Motor responses
Which of the following are indicative of brain herniation?
a) mid position, unresponsive
b) small, unresponsive pupils
c) dilated, unresponsive pupils
d) single dilated, unresponsive pupil
a) mid position, unresponsive
c) dilated, unresponsive pupils
Which of the following are TRUE regarding small pupils that are unresponsive to light?
a) may be a thalamic lesion
b) lesion of the occipital lobe
c) may be cerebellar lesion
d) red nucleus may be involved
e) brain herniation
a) may be a thalamic lesion
c) may be cerebellar lesion
(cerebellar or caudal)
Miotic responsive pupils indicates...
...global cerebral injury
T or F:
The cerebrum stimulates parasympathetic influence to CN III.
False!
It INHIBITS parasympathetic influence to CN III.
A dog with brain trauma is hyperventilating. What is going on?
Central neurogenic hyperventilation! You have 30 sec before the shit hits the fan!
What are the 3 types of central nervous postures? Which one is the worst?
Decerebrate rigidity (WORST)
Decorticate posturing
Decerebellate posturing
You see a dog with rigid front and hind legs, normal pupils, and is conscious...what gives?
Decorticate posturing (rubrospinal tract is still functional)
You see a dog w/rigid limbs, non-responsive pupils, and is unconscious. What gives?
Decerebrate rigidity
Why does a dog with decerebellate rigidity NOT have rigid back legs?
Somatotropic region of the cerebellum associated with the pelvic limbs is not injured (cushioned by fourth ventricle).
What are the major steps to treating a brain injury?
Maintain patent airway/ventilation
Ensure adequate perfusion and CV function
Provide supportive care
Provide medical care; Sx maybe
You see a big-ass extradural hemorrhage on the brain...what do you do?
Craniotomy and cut the sucker out!
Which of the following are NOT true regarding the treatment of brain injuries?
a) maintain MAP >60 mm Hg
b) cytotoxic edema occurs when blood pressure is too high
c) Mannitol and furosemide decrease vasogenic edema
d) NEVER use glucocorticoids
e) DMSO may be of some use
b) cytotoxic edema occurs when blood pressure is too high (this describes VASOGENIC edema)
c) Mannitol and furosemide decrease vasogenic edema (No, only mannitol decreases vasogenic edema directly; furosemide provides volume depletion)
How should Mannitol and Furosemide be administered in brain trauma cases?
Mannitol followed by furosemide in 15 min
Which of the following may help with medical management of brain trauma?
a) prednisone
b) lazaroids
c) Emapamil
d) Amantadine
e) DMSO
b) lazaroids (nonglucocorticoid)
d) Amantadine (NMDA receptor antagonist)
e) DMSO
(Note; Ca channel blockers only work PROPHYLACTICALLY)
What is a good way to empirically discern neurological from arthritic problems?
Give 'em NSAIDs or other pain meds! If responsive, then it is likely arthritis!
T or F:
Most dogs with vertebral/spinal trauma also have cardiopulmonary trauma.
False!
However, 33% do so you gotta keep it in mind!
T or F:
Most dogs with lumbar spinal trauma also have pelvic trauma.
False!
However, 20% do so you gotta keep it in mind!
What is the only type of stable vertebral fracture?
facet fracture
What radiographic views should be taken with spinal trauma?
Lateral and oblique; move the BEAM not the dog!
Medical management of which type of vertebral trauma has the best prognosis?
Cervical subluxation
Which of the following are NOT associated with Hansen type I disc extrusion?
a) Intercapital ligament prevents rupture from T1 to T13
b) Most common areas of involvement are T10/11 to L2/3
c) Increased GAG and chondroproteins causing the nucleus pulposus to harden
d) Annulus fibrosus rupture on dorsal aspect
e) chondrodystrophic breeds
a) Intercapital ligament prevents rupture from T1 to T13 (No, between T1/2 and T9/10)
c) Increased GAG and chondroproteins causing the nucleus pulposus to harden (NO, DECREASED GAG, chondroprot, + dehydration causes this)
(Note: the hardened nucleus pulposus herniates through a ruptured annulus fibrosus on the dorsal aspect)
What are the 3 aspects of disc herniation affecting the prognosis and which can be modified?
Initial velocity of impact
Amount of disc in canal (can be modified)
Duration of obstruction (can be modified)
Which of the following is true regarding treatment of disc extrusion?
a) surgical treatment is the only option
b) radiographs often show the lesion sufficient for surgery approach
c) damaged discs will often appear sharp or irregular
d) the site of injury often correlates to the ossified disc
c) damaged discs will often appear sharp or irregular
Which of the following are appropriate for the treatment of severe acute myelopathy due to disc herniation?
a) strict cage rest
b) acupuncture
c) NSAIDs
d) Methylprednisone
e) Polyethylene glycol
a) strict cage rest (IMMOBILIZE)
d) Methylprednisone (controversial)
e) Polyethylene glycol (stabilizes membranes and decreases excitotoxicity)
Which of the following DO NOT describe acute cervical disc extrusion?
a) beagles
b) always bilateral
c) most commonly C1/2 and C2/3
d) not managed well medically
e) hemilaminectomy is best treatment
b) always bilateral (nope; can be lateral)
c) most commonly C1/2 and C2/3 (Nope; C2/3 and C3/4)
e) hemilaminectomy is best treatment (Nope; ventral slot or dorsal laminectomy)
What are the two main differentials for a chondrodystrophoid breed with acute paraparesis?
Acute Hansen type I disc extrusion
Acute cervical disc extrusion
Which of the following are likely true regarding a mini schnauzer with a hyperacute, nonpainful, lateralizing, non-progressive myelopathy?
a) fibrocartilagenous embolism
b) poor prognosis
c) good prognosis
d) treat w/hemilaminectomy
e) white matter affected
a) fibrocartilagenous embolism
c) good prognosis
e) white matter affected
(note: no real treatment)
Which of the following are NOT true regarding fibrocartilagenous emboli?
a) radial artery emboli have a good prognosis
b) radial artery emboli primarily affect white matter
c) vertical artery emboli have a good prognosis
d) vertical artery emboli primarily affect white matter
c) vertical artery emboli have a good prognosis (no, its BAD)
d) vertical artery emboli primarily affect white matter (no, its GRAY)
Choose FCE, high velocity, low volume disc extrusion, or both!
- only painful in the initial insult
- often exercise related
- tx w/intense rehab & exercise
- pain for up to 24 hrs
FCE - only painful in the initial insult
BOTH - often exercise related
FCE - tx w/intense rehab & exercise
HVLV extrusion - pain for up to 24 hrs
What are your two rule-outs for an animal with rapidly progressing and changing neurological signs?
Extradural hemorrhage
Hemorrhagic myelomalacia
T or F:
Hemorrhagic myelomalacia has a hopeless prognosis.
True!
You see a dog w/spinal trauma that has a fully responsive cutaneous trunci reflex in the morning and by noon there is no response caudal to T9. What gives?
Hemorrhagic myelomalacia
Which signs are NOT associated with hemorrhagic myelomalacia?
a) fever
b) pain caudal to lesion
c) never a primary issue
d) progressive
e) hopeless prognosis
b) pain caudal to lesion (analgesia caudal to lesion)
What are your 3 top differentials for a non-chondrodystrophic dog with chronic progressive or relapsing paraparesis?
Chronic (Type II) Disc Protrusion
Vertebral/Spinal Cord Neoplasia
Degenerative Myelopathy
Choose Hansen Type I or Type II for each of the following:
- non-chondrodystrophic breeds
- nuclear fibroid degeneration
- commonly acute
- nuclear chondroid degeneration
- occurs T10/11 to L2/3
Type II - non-chondrodystrophic breeds
Type II - nuclear fibroid degeneration
Type I - commonly acute
Type I - nuclear chondroid degeneration
Type I - occurs T10/11 to L2/3
Which of the following are NOT indicative of Hansen II chronic disc protrusion?
a) in middle-aged, non-chondrodystrophic breeds
b) gray matter degeneration
c) can be multifocal
d) pain is common
e) never treated with steroids
b) gray matter degeneration (NO, white matter)
e) never treated with steroids (NO, if steroid-responsive, good surgical candidate)
What are the 3 locations of spinal cord tumors? Which has the best/worst prognosis?
Extradural (BAD)
Intramedullary (WORST)
Intradural-extramedullary (BEST)
What are the most common tumor types for the following tumor locations:
Extradural
Intramedullary
Intradural-extramedullary
Extradural (nerve sheath or metastatic tumor)
Intramedullary (glial tumor)
Intradural-extramedullary (meningioma)
T or F:
Meningiomas are highly invasive but easily operable if caught early.
False!
Non-invasive but still easy (relatively) to remove
What is the most common sign of spinal cord neoplasia?
PAIN
Which of the following are NOT characteristic of spinal neoplasia?
a) mononuclear pleiocytosis
b) contrast imaging is usually necessary to determine cord tumor location
c) osteosarcoma and neurofibroma can produce ischemic remodeling
d) cord LSA in cats can only be treated medically
e) hemangioma is lytic to the vertebrae
a) mononuclear pleiocytosis (NO; albumino-cytological dissociation)
c) osteosarcoma and neurofibroma can produce ischemic remodeling (NO; meningioma and neurofibroma)
A "golf tee" sign is indicative of which of the following:
a) vertebral neoplasia
b) extradural neoplasia
c) intradural-extramedullary neoplasia
d) intramedullary neoplasia
e) metastatic neoplasia
c) intradural-extramedullary neoplasia
Which of the following are NOT indicative of degenerative myelopathy?
a) No specific treatment
b) GSDs
c) Immune-mediated inflammatory process
d) axonal degeneration
e) involves mutations of the SOD gene
c) Immune-mediated inflammatory process (NOT immune-mediated OR inflammatory)
Any one of which 4 signs can immediately rule-out degenerative myelopathy?
Pain on palpation
Lesion outside of T2-L3
LMN signs to sciatic nerve and maybe bladder
Improves w/anti-inflammatories
Which chronic disease of the spinal cord is treated with exercise and physiotherapy?
Degererative myelopathy