Sam Iii Neuro 1

Front 1

What is the definition of a seizure?

Back 1

Paroxysmal disturbance of cerebral function

Front 2

Which of the following are involved in the inhibitory arm of the CNS?
a) Chloride
b) Potassium
c) Barbiturates
d) AMPA receptors
e) GABA

Back 2

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)

Front 3

Which of the following are involved in the excitatory arm of the CNS?
a) Benzodiazepines
b) NMDA receptors
c) Phenobarbital
d) KBr
e) Calcium

Back 3

b) NMDA receptors
e) Calcium (Ca channels cause Glutamate release)
(also AMPA receptors, glutamate)

Front 4

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

Back 4

Benzodiazepines (inhibit)
NMDA receptors (excite)
Phenobarbital (inhibit)
KBr (inhibit)
Glutamate (excite)

Front 5

What are the main sources or classes of seizures (there are 3 or 4 depending on how you look at it)?

Back 5

Symptomatic (intracranial)
Reactive (extracranial)
Idiopathic (breed-associated)
Idiopathic (idiopathic cryptogenic)

Front 6

What are the PHASES of a seizure?

Back 6

Pre-ictal phase (prodromal)
Ictus
Post-ictal phase
Interictus

Front 7

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

Back 7

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

Front 8

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

Back 8

Autonomic - excessive salivation
Psychomotor - focal seizures w/behavior changes
Focal seizure - twitching only in one place
Myoclonic - long-haired twitchy dachshunds

Front 9

What are some differentials that can be confused with seizure activity?

Back 9

Syncope
Excessive REM motion
Narcolepsy/Cataplexy
OCD
Acute vestibular syndrome
Tremor syndromes
Hyper/dyskinesia

Front 10

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

Back 10

c) 6yo dog
e) cats

Front 11

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

Back 11

a) brachycephalic dogs
b) focal seizures

Front 12

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

Back 12

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)

Front 13

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

Back 13

a) prevents Cl efflux (NO, stimulates Cl influx)
e) therapeutic range is 30 - 50ug/mL (NO, its 20-40; hepatotoxic effects increased >45ug/mL)

Front 14

What are the common side-effects of phenobarbital use?

Back 14

Sedation
PU/PD
(bone-marrow suppression in dobies)

Front 15

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

Back 15

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

Front 16

T or F:
Phenobarbital should NEVER be removed from therapy immediately.

Back 16

False!
Remove it immediately if idiosynchratic lymphoproliferation or extreme anxiety (in GSDs) occur!

Front 17

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

Back 17

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)

Front 18

T or F:
PU/PD/PP with KBr will not improve over time while, with Phenobarbital, they will improve.

Back 18

False!
They won't improve with either drug!

Front 19

How should KBr levels be measured? What units would you expect?

Back 19

HPLC (ppm units)

Front 20

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

Back 20

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)

Front 21

Which drug is indicated for control of seizure clustering?

Back 21

Levetiracetam (Keppra)

Front 22

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

Back 22

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

Front 23

Which drugs SHOULD NOT be used in the management of seizures?

Back 23

Pnenytoin (Dilantin)
Primidone
Diazepam
Lamotrigine (Lamictal)

Front 24

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

Back 24

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)

Front 25

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

Back 25

b) Cushing's reflex
d) self-trauma
(also blindness, tetraparesis, worsened seizures)

Front 26

What are the 3 goals to treating status epilepticus?

Back 26

Stop seizures
Restore homeostasis
Perform diagnostic evaluation

Front 27

How can status epilepticus be stopped!

Back 27

Diazepam (per rectum if necessary)
Maybe Phenobarb, Lorazepam or
Levetiracetam

Front 28

What are the 2 mechanisms for brain injury? Which of the two can you actually do something about and what is the timespan?

Back 28

Mechanical
Ischemic injury (there's a chance if you get to it 24-48 hrs after the injury)

Front 29

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

Back 29

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)

Front 30

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

Back 30

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)

Front 31

Which of the following will lead to INCREASED cerebral blood flow?
a) increased pCO2
b) decreased pCO2
c) increased pO2
d) decreased pO2

Back 31

a) increased CO2
d) decreased pO2

Front 32

Which of the following will lead to DECREASED cerebral blood flow?
a) increased pCO2
b) decreased pCO2
c) increased pO2
d) decreased pO2

Back 32

b) decreased pCO2
c) increased pO2

Front 33

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

Back 33

a) increased CO2
d) decreased pO2
(increased cerebral blood flow leads to leaky vessels and loss of BBB)

Front 34

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

Back 34

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)

Front 35

What are the 2 major causes of DELAYED brain damage?

Back 35

Brain Edema
Hematoma formation

Front 36

What are the 2 types of cerebral edema? Which occurs more in the white matter?

Back 36

Cytotoxic
Vasogenic (more in white matter)

Front 37

Why doesn't CNS pressure change initially as the brain swells (volume increases) in acute trauma?

Back 37

Compliance of the CSF + blood

Front 38

T or F:
You don't f*ck with the Cushing's Reflex!

Back 38

you know it!

Front 39

What are the components of the Cushing's reflex?

Back 39

Increased systemic blood pressure
Decreased heart rate

Front 40

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

Back 40

c) tachycardia
d) hypotension
(should be bradycardia and hypertension - the Cushing's Reflex)

Front 41

What are the 4 levels of decreased consciousness?

Back 41

Obtundation
Stupor
Semi-coma
Coma

Front 42

What are the 3 main brainstem reflexes?

Back 42

Pupil size and reactivity
Respiration pattern
Motor responses

Front 43

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

Back 43

a) mid position, unresponsive
c) dilated, unresponsive pupils

Front 44

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

Back 44

a) may be a thalamic lesion
c) may be cerebellar lesion
(cerebellar or caudal)

Front 45

Miotic responsive pupils indicates...

Back 45

...global cerebral injury

Front 46

T or F:
The cerebrum stimulates parasympathetic influence to CN III.

Back 46

False!
It INHIBITS parasympathetic influence to CN III.

Front 47

A dog with brain trauma is hyperventilating. What is going on?

Back 47

Central neurogenic hyperventilation! You have 30 sec before the sh*t hits the fan!

Front 48

What are the 3 types of central nervous postures? Which one is the worst?

Back 48

Decerebrate rigidity (WORST)
Decorticate posturing
Decerebellate posturing

Front 49

You see a dog with rigid front and hind legs, normal pupils, and is conscious...what gives?

Back 49

Decorticate posturing (rubrospinal tract is still functional)

Front 50

You see a dog w/rigid limbs, non-responsive pupils, and is unconscious. What gives?

Back 50

Decerebrate rigidity

Front 51

Why does a dog with decerebellate rigidity NOT have rigid back legs?

Back 51

Somatotropic region of the cerebellum associated with the pelvic limbs is not injured (cushioned by fourth ventricle).

Front 52

What are the major steps to treating a brain injury?

Back 52

Maintain patent airway/ventilation
Ensure adequate perfusion and CV function
Provide supportive care
Provide medical care; Sx maybe

Front 53

You see a big-ass extradural hemorrhage on the brain...what do you do?

Back 53

Craniotomy and cut the sucker out!

Front 54

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

Back 54

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)

Front 55

How should Mannitol and Furosemide be administered in brain trauma cases?

Back 55

Mannitol followed by furosemide in 15 min

Front 56

Which of the following may help with medical management of brain trauma?
a) prednisone
b) lazaroids
c) Emapamil
d) Amantadine
e) DMSO

Back 56

b) lazaroids (nonglucocorticoid)
d) Amantadine (NMDA receptor antagonist)
e) DMSO
(Note; Ca channel blockers only work PROPHYLACTICALLY)

Front 57

What is a good way to empirically discern neurological from arthritic problems?

Back 57

Give 'em NSAIDs or other pain meds! If responsive, then it is likely arthritis!

Front 58

T or F:
Most dogs with vertebral/spinal trauma also have cardiopulmonary trauma.

Back 58

False!
However, 33% do so you gotta keep it in mind!

Front 59

T or F:
Most dogs with lumbar spinal trauma also have pelvic trauma.

Back 59

False!
However, 20% do so you gotta keep it in mind!

Front 60

What is the only type of stable vertebral fracture?

Back 60

facet fracture

Front 61

What radiographic views should be taken with spinal trauma?

Back 61

Lateral and oblique; move the BEAM not the dog!

Front 62

Medical management of which type of vertebral trauma has the best prognosis?

Back 62

Cervical subluxation

Front 63

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

Back 63

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)

Front 64

What are the 3 aspects of disc herniation affecting the prognosis and which can be modified?

Back 64

Initial velocity of impact
Amount of disc in canal (can be modified)
Duration of obstruction (can be modified)

Front 65

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

Back 65

c) damaged discs will often appear sharp or irregular

Front 66

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

Back 66

a) strict cage rest (IMMOBILIZE)
d) Methylprednisone (controversial)
e) Polyethylene glycol (stabilizes membranes and decreases excitotoxicity)

Front 67

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

Back 67

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)

Front 68

What are the two main differentials for a chondrodystrophoid breed with acute paraparesis?

Back 68

Acute Hansen type I disc extrusion
Acute cervical disc extrusion

Front 69

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

Back 69

a) fibrocartilagenous embolism
c) good prognosis
e) white matter affected
(note: no real treatment)

Front 70

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

Back 70

c) vertical artery emboli have a good prognosis (no, its BAD)
d) vertical artery emboli primarily affect white matter (no, its GRAY)

Front 71

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

Back 71

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

Front 72

What are your two rule-outs for an animal with rapidly progressing and changing neurological signs?

Back 72

Extradural hemorrhage
Hemorrhagic myelomalacia

Front 73

T or F:
Hemorrhagic myelomalacia has a hopeless prognosis.

Back 73

True!

Front 74

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?

Back 74

Hemorrhagic myelomalacia

Front 75

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

Back 75

b) pain caudal to lesion (analgesia caudal to lesion)

Front 76

What are your 3 top differentials for a non-chondrodystrophic dog with chronic progressive or relapsing paraparesis?

Back 76

Chronic (Type II) Disc Protrusion
Vertebral/Spinal Cord Neoplasia
Degenerative Myelopathy

Front 77

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

Back 77

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

Front 78

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

Back 78

b) gray matter degeneration (NO, white matter)
e) never treated with steroids (NO, if steroid-responsive, good surgical candidate)

Front 79

What are the 3 locations of spinal cord tumors? Which has the best/worst prognosis?

Back 79

Extradural (BAD)
Intramedullary (WORST)
Intradural-extramedullary (BEST)

Front 80

What are the most common tumor types for the following tumor locations:
Extradural
Intramedullary
Intradural-extramedullary

Back 80

Extradural (nerve sheath or metastatic tumor)
Intramedullary (glial tumor)
Intradural-extramedullary (meningioma)

Front 81

T or F:
Meningiomas are highly invasive but easily operable if caught early.

Back 81

False!
Non-invasive but still easy (relatively) to remove

Front 82

What is the most common sign of spinal cord neoplasia?

Back 82

PAIN

Front 83

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

Back 83

a) mononuclear pleiocytosis (NO; albumino-cytological dissociation)
c) osteosarcoma and neurofibroma can produce ischemic remodeling (NO; meningioma and neurofibroma)

Front 84

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

Back 84

c) intradural-extramedullary neoplasia

Front 85

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

Back 85

c) Immune-mediated inflammatory process (NOT immune-mediated OR inflammatory)

Front 86

Any one of which 4 signs can immediately rule-out degenerative myelopathy?

Back 86

Pain on palpation
Lesion outside of T2-L3
LMN signs to sciatic nerve and maybe bladder
Improves w/anti-inflammatories

Front 87

Which chronic disease of the spinal cord is treated with exercise and physiotherapy?

Back 87

Degererative myelopathy