RUSVM - SAM I FINAL

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Covers Endocarditis, Pericardial effusion, Hypertension, Heartworm, Neuro exam, Small animal neuology, Cognitive Dysfunction, Compulsive Disorders

What bact is the most common in endocarditis?

Bartonella spp

Septic thromboemboli from endocarditis can lead to what problems?

Renal, neuro, and pneumonia signs

How would you Dx endocarditis?

Take blood samples from multiple areas and culture them to isolate the causative agent

What's the best to to Dx endocarditis?

Encho - can see > 1mm lesions on valves
valves look hyperechoic, thick, and irregular

How would you Tx endocarditis?

Control arrhythmias and heart failure w/ clindamycin and enrofloxacin

What are some causes of pericardial effusion?

K9: Mostly neoplasia and idiopathic causes
Cats: FIP and lymphoma are most common

What happens if fluid accumulates too quickly or is progressive in pericardial effusion?

Rapid: incr volume in right herat -> RCHF
Progressive: elasticity in sac keeps up until stretched to the limit

What's the signalment for endocarditis?

Large breed mid-age males > female
Rare in cats

What's the signalment for pericardial effusion?

GSD w/ hemangiosarcoma
Brachycephalics w/ paraganglioma
Large breed mid-old age w/ idiopathic effusion

What are some physical exam findings w/ pericardial effusion?

Pale membranes, decr CRT, muffled heart sounds, jugular distension

What are some lab Dx for pericardial effusion fluid analysis?

Serosanguinous in neoplastic & idiopathic effusions
if pH > 7 (neoplasia), if < 7 (benign inflammatory)

What would echocardiography show for neoplastic pericardial effusion?

Hemangiosarc on right auricle > atrium > ventricle
Paraganglioma on heart base at aorta

What would the Tx be for pericardial effusion?

Diuretics are contraindicated b/c it will collapse heart chambers and decr blood volume
Do immediate pericardiocentesis
Paracardectomy

How would you Tx constrictive pericarditis?

Pericardectomy

Prolonged hypertension can lead to what problems?

Organ damage and arteriosclerosis

What are some signs seen w/ hypertension?

Eyes - blindness (most common)
Brain - depression, hemorrhage, seizure
Nose - epistaxis
Kidneys - progressive azotemia

What's the drug of choice to Tx in cats for hypertension?

Amlodipine (Ca-channel blocker)

What are some drugs used to Tx hypertension?

Ca-channel blocker (Diltiazem, Amlodipine)
ACE inhibitors (enelapril, captopril)
Alpha blocker (prazosin)
Beta blocker (atenolol, propranolol)
Diuretics (furosemide, hydrochlorothiazide)

What bact come along w/ heartworm infection?

Wolbachia spp

What's the signalment of dogs and cats w/ heartworm?

Dog: Male ≥ 6month, outdoor, large breed
Cat: male >8month, indoor

How many females do you need for the Ag test to pick up the Ag?

At least 3

What are the drugs used in heartworm prophylaxis?

Ivermectin, Milbemycin, Selamectin, Moxidectin

What drug is contraindicated in heartworm therapy?

Aspirin

What's the drugs of choice adulticide for heartworm therapy?

Melarsomine

What's occult heartworm DZ?

When there are adults, but no microfilariae

Describe heartworm post-caval syndrome?

Where heavy infection that goes from pulm artery to caudal vena cava and blocks tricuspid valve

Immunological rxns to microfilariae in lungs can lead to what?

Esosinophilic pneumonitis and pulm eosinophilic granulomatosis

What are the stage that clinical signs arise in feline heartworm?

•When L5 in lungs -> inflammation confused for feline asthma
•When adults die -> thromboemboli

How do you Tx feline heartworm?

Symptomatic and supportive Tx.
Emphasis is put on prophylaxis

How many heartworms does it take to kill a cat

Just 1 is all it takes

What can generally cause peracute or a slow pregressive onset of clinical nuero signs?

Peracute - trauma, disc herniation
Slow - degenerative, neoplastic, metabolic

What's the purpose of the neuro exam?

To localize neuro lesions

UMN lesions lead to what signs?

Paralysis/paresis
Normal to hyperreflexia
Normal to incr muscle tone
Minimal (disuse) muscle atrophy

LMN lesions lead to what signs?

Paralysis/paresis
Hyporeflexia or areflexia
Decr muscle tone
Severe, rapid (neurogenic) muscle atrophy

Where are the UMNs and LMNs located?

UMN - cell bodies in brainstem and spinal cord
LMN - cell bodies in brainstem (CrN) and ventral horn of spinal cord (peripheral nn)

What are the overall responsibilities of UMNs and LMNs?

UMN - initiation of voluntary movement and maintenance of tone in enxtensor mm for posture

LMN - innervate mm and glands of body, but also controlled by reflexes in spinal cord

What are the different types of sensory neurons and what do they do?

Segmental - synapse w/ LMNs to make reflex arc

Long tract - carry conscious proprioception and pain and touch to contralateral cerebral cortex

What are some abnormal reflexes and other signs of spinal injury?

Hyperreflexia
Crossed-extensor reflex in lateral recumbency
Mass reflex
Spinal shock
Schiff-Sherrington

Hyperreflexia can be caused by what?

Loss of UMN inhibition and also denervation hypersensitivity

What is mass reflex?

Dramatic hyperreflexia seen several months after spinal cord resection
Consists of bilateral limb flexion, tail twitch, incontinence

What is spinal shock?

Spinal cord damage leading to transient areflexia in limbs caudal to lesion

Where are the lesions resulting in Schiff-Sherrington posture?

Damage to spinal segments T3-L3

What is the proper sequence of the neuro exam?

Observation of mental status, posture, and gait
Palpation of muscular and skeletal system
Evaluation of postural rxns
Evaluation of cranial nerves
Evaluation of spinal nerves & reflexes
Evaluation of sensation

Abnormalities in mental status relate to lesions where?

Brainstem or thalamocortex

What are the different types of ataxia?

Sensory (conscious proprioception) - crossing-over of affected limbs and scuffing toes

Cerebellar (unconscious) - limbs positioned peripheral to center of gravity (wide-based gait)

Vestibular - circle, roll, fall, head tilt, nystagmus to affected side

What are the different tests for postural reactions?

Conscious proprioception
Hopping
Wheelbarrowing
Extensor postural thrust
Hemi-walking

What are the cranial nerves to be evaluated in a neuro exam?

I - Olfactory
II - Optic
III - Oculomotor
IV - Trochlear
V - Trigeminal
VI - Abduscens
VII - Facial
VIII - Vestibulocochlear
IX - Glossopharyngeal
X - Vagus
XI - Accessory
XII - Hypoglossal

What spinal reflex tests are the most effective when evaluating the spinal cord in the neuro exam, and what nerves do they evaluate?

Flexor wthdrawal reflex - sciatic and femoral nn
Patellar reflex - femoral n
Cranial tibial reflex - sciatic n
Extensor carpi radialis reflex - radial n

What nerve does the perineal reflex test?

Pudendal nerve

Stimulation in a normal animal of the sciatic, femoral, and radial nerves affect the joints how?

Sciatic - stifle, hock, and toe flexion
Femoral - hip flexion
Radial - extension in forelimb

What's the difference b/t UMN and LMN bladder signs?

UMN - difficult to express manually
LMN - Bladder is atonic and easily expressed manually

How do you Tx UMN and LMN bladder?

UMN - Prazosin (α antagonist) is drug of choice....Phenoxybenzamine (α agonist) can be used too
LMN - Phenylpropranolamine and Bethanecol

What's hyperesthesia?

Painful response seen by vocalization or avoidance behavior

What neuro signs will you see if one of the four spinal cord regions were affected?

C1-C6 - UMN signs in all four limbs
C6-T2 - LMN signs in front, UMN signs in hind
T2-L3 - Normal front legs, UMN signs in back
L3-S3 - Normal front legs, LMN signs in back

What are the five regions of the brain that can have a lesion?

Brainstem, Diencephalon, Cerebellum, Vestibular system, Cerebral cortex

The brainstem consists of what structures, and what cranial nerves do they have?

Midbrain - III-IV
Pons - V
Medulla - VI-XII

Which cranial nerve tests test which cranial nerves?

Menace - II, VII
PLR - II, III
Ocular positioning - III, IV, VI, VIII
Palpebral - V, VII
Facial symmetry - VII
Masticatory tone & muscle mass - V
Gag reflex - IX, X
Tongue tone - XII

The diencephalon contains what brain structures?

Thalamus, Hypothalamus, Rostal RAS, Optic chiasma

What dysfunctions would you see w/ lesions in the diencephalon?

Horner's syndrom (ipsilateral eye)
Altered level of consciousness
Endocrine dysfunction
Visual impairment (contralateral)
Contralateral paresis
Abnormal PLR

Neuropraxia is d/t what and what do you see and how long does it take to recover?

Loss of blood supply
See myelin degeneration, but no axonal degeneration
Takes days to months to recover

What is axonotmesis and how long does it take to recover?

Axonal degeneration, but endoneurium and Schwann cells intact
axonal regeneration is 1mm/day

What's neurotmesis?

Complete nerve degeneration and severence

Brachial plexus avulsions are d/t what?

Trauma that abducts front limb and forces it caudally or cranially -> avulsions of ventral nerve roots C6-T2

What are the signs of brachial plexus avulsion?

C6-7 - denervation of extensors and flexors of shoulder
C8-T1 - denervation of extensors and flexors of elbow and carpus and lateral thoracic nerve
T1 - Horner's syndrome

Where do nerve sheath tumors most occur?

Caudal cervical area assoc w/ brachial plexus.
Start peripherally and spread proximally into spinal cord

What's the most common emboli that leads to spinal cord injury and what type of injury does it cause?

Fibrocartilaginous emboli originating from nucleus pulposus and cause ischemic myelopathy

For dogs w/ fibrocartilaginous emboli in spinal cord, what's the Px for dogs that have UMN or LMN signs?

UMN - improve
LMN - don't improve

Degeneration of axons and myelin sheaths in the thoracolumbar spinal cord leads to what?

Degenerative myelopathy

What are the signs of degenerative myelopathy in thoracolumbar spinal cord?

Gradual loss of voluntary motor fxns, knuckling, dysmetria, muscle atrophy, UMN signs in hindlimbs

What DZ causes osteophytes on articulation facets that compress the spinal cord and sciatic nerve roots

Lumbosacral malarticulation-malformation

Lumbosacral malarticulation-malformation results in what signs?

Pain and LMN signs in sciatic and pudendal nn, but no disc degeneration

What tests are used to differentiate lumbosacral pain from hip pain?

Lordosis test
Tail jack test is more specific for lumbosacral issues

Dogs w/ transitional vertebrae are more likely to develop what DZ?

Cauda equina syndrome

What's the Tx of lumbosacral malarticulation-malformation?

Lumbosacral laminectomy

All vertebrae have discs except which ones?

C1-C2

What is the intervertebral disc made out of?

Outer fibrous ring (annulus fibrosis)
Inner gelatinous mass (nucleus pulposis)

What happens to the intervertebral discs as dogs age?

Nucleus pulposis degenerates and replaced w/ cartilage
Chondrodystrophic breeds. it's replaced w/ hyaline cartilage

What are the two ways displacement of the nucleus pulposis (NP) happens, and which breeds do they happen in?

Hansen type I - explosion of NP into spinal canal (chondrodystrophic)
Hansen type II - slow protrusion of NP thru annulus fibrosis (large breeds)

Why do intervertebral discs never protrude b/t T2-T10?

B/c of intercapital ligament holds it all in place

Spinal cord compression leads to a loss of what things?

Conscious proprioception
Voluntary motor fxn
Superficial pain
Deep pain

What are the different levels of intervertebral disc DZ?

Grade 1 - spinal hyperesthesia w/o neuro signs
Grade 2 - paresis, but ambulatory
Grade 3 - paresis, but non-ambulatory
Grade 4 - paralysis w/ deep pain intact
Grade 5 - paralysis w/ loss of deep pain

How do you Tx Grade 1-3 intervertebral disc DZ?

Cage rest and prednisolone

Why do you not want to give prednisolone and NSAIDs to a dog w/ Hansen type I intervertebral disc DZ?

B/c they usually have gastroduodenal ulcers too

How do you Tx grade 4 intervertebral disc DZ?

Prazosin or phenoxybenzamine for UMN bladder
Dorsolateral hemilaminectomy is Sx of choice

How do you Tx Grade 5 intervertebral disc DZ?

Dorsolateral hemilaminectomy and durotomy

What is discospondylitis?

Infection of cartilaginous endplates w/ 2˚ involvement of intervertebral disc

What are some common bact that cause discospondylitis and how do these infection spread?

Staph intermedius, Brucella canis, etc
Spread hematogenously

What's the signalment and most common affected vertebral sites of discospondylitis?

Large breed middle-aged males
common sites: Caudal cervical (C6-7)
Mid toracic (T4-6)
Lumbosacral (L7-S1)

Why would you want to do serology for Brucella when Staphlococcus is the most common pathogen in discopsondylitis?

B/c Brucella is zoonotic

What are the abx used to Tx Staph causing discospondylitis and why?

Cephalexin, Cephazolin, Cloxacillin b/c they penetrate bone and pus

What's the surgical Tx for discospondylitis?

Hemilaminectomy

What are the different locations for vertebral and spinal neoplasia, and which are the most common?

Intramedullary
Metastatic intramedullary
Intradural-extramedullary
Extradural (most common)

What vertebral and spinal tumors are intramedullary?

Astrocytoma, oligodendroglioma, ependymoma

What vertebral and spinal tumors are metastatic intramedullary?

Hemangiosarcoma, Melanoma, Carcinoma

What vertebral and spinal tumors are intradural-extramedullary, and which is the most common?

Meningioma (most common), nephroblastoma, MPNSTs

What vertebral and spinal tumors are extradural?

Osteosarcoma, Chondrosarcoma, Multiple myeloma, Hemangiosarcoma, Fibrosarcoma, Lymphosarcoma

What's the most common 1˚ and 2˚ spinal cord tumor in dogs?

1˚ - Meningioma
2˚ - Hemangiosarcoma

What's the most common spinal cord tumor in cats, and what other condition is commonly also present?

Extradural Lymphosarcoma
Usu appear in FeLV+ cats

Which spinal tumors can be resected and what are the survival times in cats and dogs?

Meningiomas and Neurofibromas
6.5 months (dog), 26 moths (cat)

Vertebral fractures and luxations are usu caused by what and what area is most affected?

From trauma w/ sacroilic and thoracolumbar area most affected

Sacrococcygeal luxations and fractions in cats are most commonly caused by what?

Tail tugs

What's used to Tx edema in vertebral fractures and luxations?

Mannitol

What Sx is indicated for vertebral fractures and luxations?

Dorsal hemilaminectomy

What is hemivertebrae?

Failure of left and right center of ossification to fuse.
Involved vertebra are shortened and misshapen

What's the Tx for hemivertebrae?

Laminectomy if neuro signs present, but the condition is usu asymptomatic

Incomplete segmentation of two or more adjacent vertebrae results in what condition?

Block or fused vertebrae

What conditions usu result in tetraparesis/plegia?

Spinal cord lesions b/t C1-T2
Muscle end-plate conditions
Neuropathies
Brain conditions

What spinal cord lesions b/t C1-T2 result in tetraparesis/plegia?

Cervical disc DZ
Cervical spondylomyelopathy (K9 Wobbler Syndrome)
Atlanto-Axial Subluxation

Cervical disc DZ can be d/t what pathologies, and which is most common and where?

Hansen type I (most common): C2-3
Hansen type II: C5-7

K9 Wobbler syndrome is caused by what things, and what's cause is most common in what breeds?

Hansen type II
Stenosis of vertebral canal (Giant breeds)
Malformation of articular process (large breeds)
Hypertrophy of ligamentum flavum

Atlanto-axial subluxation results from what conditions, and which is the most common?

Abscence of hypoplasia of dens (most common)
Odontoid fracture at ossification center b/t dens and C2
Rupture of ligamentous support

Which ligaments can rupture leading to atlanto-axial subluxation?

Dorsal atlantoaxial lig and/or transverse lig

What breeds are most affected by atlanto-axial subluxation?

Toy and mini and poodle 6-18 months old

What are the 5 Ps of prednisolone?

PU/PD/PP, Panting, Pot-belly appearance

Atlanto-axial subluxation is best seen in which radiographic view?

VD

Infectious myopathies result from which pathogens?

Toxoplasma or Neospora

What's the most common inflammatory myopathy?

K9 idiopathic polymyositis

What drug has a steroid sparing effect when Tx myopathies?

Azathioprine....it's usu given w/ prednisolone

Which myopathy gives a skull appearance to the head?

Masticatory Muscle Myositis

How do you Tx extraocular myositis?

Oral corticosteroids

What dogs are exertional myopathies most seen in and what happens to them?

Greyhounds and sled dogs
Die of renal failure

Hypo-K myopathy in cats causes what to happen to the muscles?

Incr membrane potential making contractions more difficult -> weakness

When pointers and labs develop a flaccid tail b/c of prolonged cage rest or cold wet weather, what condition do they have and how to Tx?

Limber tail
Tx - anti-inflammatory therapy

What is dystrophin?

Cytoskeletal protein that maintains membrane integrity

What skeletal deformities do you see w/ dystrophinopathies?

Kephosis, lordosis

Dogs w/ dystrophinopathies will die of what condition when they're older?

DCM

What's alpha-2-laminin?

Glycoprotein constituent of basement membrane

What are some metabolic myopathies?

Hypothyroid
Hyperthyroid
Cushings
Enz deficiencies
Exercise-Induced Collapse

What are some enz deficiencies that cause myopathies?

Glycogen storage DZ
Phosphofructokinase deficiency

How do you Tx exercise-induced collapse?

Phenobarbital will reduce excitement

How do you Tx Myotonia congenita and Dermatomyositis?

Myotonia - Procainamide
Dermatomyositis - Pentoxifylline

If a cat has intermittent twitching, excessive grooming, agitation, aggression, and vocalization, it most likely has what condition?

Feline hyperesthesia syndrome

What ticks cause tick paralysis?

Dermacentor andersoni (Rocky Mtn tick)
D. variabils (America dog tick)
Ixodes spp

Protozoal polyradiculoneuritis is caused by what pathogens?

Toxoplasma
Neospora caninum (most common)

What are the differentiating signs of peripheral and central vestibular DZ?

Peripehral: No CP issues, no depression, facial nerve paralysis, horiz nystagmus

Central: Tetra/hemiparesis, depression, other CrNs affected, positional nystagmus

Central vestibular DZ mostly comes from what things?

Neoplasia
Encephalitis (distemper (K9), FIP (cat))

What are the signs seen w/ bilateral vestibular DZ?

Pendulum head swing
No spontaneous nystagmus seen w/ oculocephalic reflex

Most cerebellar conditions have what signs?

Wide-based stance, truncal ataxia, intention tremor, dysmetria

What's the difference b/t decerebrate and decerebellate rigidity?

Decerebrate - opisthotonos w/ extension in all 4 legs

Decerebellata - opsithotonus w/ extension in front legs

Cerebellar hypoplasia in cats is d/t what?

Intrauterine panleukopenia (Parvovirus)

What is an abiotrophy?

Premature death of neuron d/t disruption of metabolic processes

What are the 1˚ and 2˚ tumors that arise in the cerebellum?

1˚ - medulloblastoma, glioma
2˚ many types

Who gets shaker dog DZ and how do you Tx?

Dogs <15kg
Tx w/ glucocorticoid

How do you Tx episodic falling in King Charles dogs?

Clonazepam

How do you Tx narcolepsy?

Amphetamine (methyphenidate) and/or anti-depressants (imipramine)

Feline ischemic encephalopathy is caused by what?

Cuterebra larva migrating from nose to brain

What are the different types of deafness?

Conductive - chronic otitis externa/media prevent sound transmission to inner ear

Central - damage to auditory pathway

Sensorineural - congenital or acquired, assoc w/ pigment, deafness present at birth and permanent

What are the phases of the seizure?

Preictal (aura and prodromal)
Ictal (actual seizure)
Postictal (gradual return to normal)

How long do the tonic and clonic phases last during a seizure?

Tonic - 10-30 sec
Clonic - 1-2 mins

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