Exam 2 - Localization Syndromes

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TrueT/F: We use Cyclosporine when patients relapse on reduction of prednisone, should use for 12 months minimumDz: Exercise-Induced CollapseRelatively uncommon disease: used to be big in labs due to mutation in DNM1 gene --> defect in nerve communication during exercise by ages 5 mo-2 years. Has very high rectal temperature. TX is avoidance of trigger activity (ie be a couch potato)Dz: Steroid MyopathySeen in animals on long term GC or Cushing animals. Will see generalized muscle atrophyFalseT/F: You have a dog with Steroid Myopathy. As long as you treat the Cushings with Trilotane that should be enoughDz: Hypothyroid MyopathyYou have an obese dog with stiff gate. He has not been to the vet in years. Lab work shows increased cholesterol and anemiaFalseT/F: Muscle atrophy is easy to notice in Hypothyroid MyopathyDz: Feline Hypokalemic polymyopathyYou have a cat with ventroflexion of the neck and generalized muscle weaknessDz: Feline Hypokalemic polymyopathyYou have a CKD cat that won't get up. BW confirms CKD, as well as low end of normal K. DDX are Thiamine def, feline idiopathic polymyositis, and ____________Dz: Myasthenia GravisA 3 year old dog presents for generalized weakness with exercise. Spinal reflexes are intact. You do rads of the cranial thorax and neck because you are concerned aboutDz: Myasthenia GravisMost commonly is acquired, has antibodies against ACh receptor. DX test would be testing for these antibodies, very reliable testDz: Myasthenia GravisYou have a canine patient that after work up you have diagnosed megaesophagus. He has normal spinal reflexes and weakness after a few steps once getting up, especially in rear limbs. What could be causing these signs?Dz: Myasthenia GravisHas three forms, focal, generalized, and fulminant. Fulminant is a more serious form of generalized, they will have megaesophagus. No form is classified as an emergencyFalseT/F: Fluoroquinolones are a good choice if you have a myopathy dog, even with myasthenia gravis, with an infectionDz: Myasthenia GravisTreatment is with Pyridostigmine bromide, immunosuppression, and +/- thymectomy. Some patients will self resolveFalseT/F: Pyridostigmine bromide can be started at the high end of the dose if you want to improve esophageal motilityTrueT/F: Immunosuppression drugs work for immune mediated myopathies because if eliminate antibody --> eliminate disease/CSDz: Myasthenia GravisDo not give corticosteroids to animals with ____, unless that are pyridostigmine-resistant, because it can worsen weaknessTrueT/F: Neuropathic Syndromes have Neurogenic muscle atrophy, Flaccid paresis/paralysis, Reduced or absent reflexes, Decreased pain response, Proprioceptive deficitsTrueT/F: A way to tell it is neuropathic syndrome vs myopathies or MG would be reduced/absent reflexes and proprioceptive deficitsTrueT/F: In traumatic neuropathies, if the axon is intact or just disrupted, then the nerve can recover. But prepare owner for the fact the limb may need to be amputated (if axon is severed)TrueT/F: Most cases of dog facial nerve paralysis is idiopathicTrueT/F: Most cases of cat facial nerve paralysis is inner ear disease, although this is rare in catsDz: Facial Nerve ParalysisA mononeuropathy, commonly idiopathic in dogs, but can also be due to otitis media, hypothyroidism, trauma. An issue when can cause dry eye. Poor prognosis of recovery, supportive txDz: Traumatic NeuropathyA mononeuropathy, with LMN signs. Variable return of function due to axon injuryDz: Trigeminal NeuritisAn idiopathic, bilateral acute onset of jaw paralysis. Most face nerves are unilateral, but this is bilateral. Unable to drink water/swallowDz: Trigeminal NeuritisYou have a dog presenting for polydipsia. After an exam you put a special muzzle on the dog so the maxilla and mandible almost touch. What was your dx?Dz: Coonhound Paralysis/Idiopathic PolyradiculoneuritisA polyneuropathy, with LMN signs. Only motor issue from neck down, no sensory lost. Onset is about a week after racoon exposure, persists for 3 months> be cautious for respiratory muscle weakness --> check blood gasDz: Coonhound Paralysis/Idiopathic PolyradiculoneuritisYou have a hunting dog presenting for inability to stand. Owner notes E/D/U/D okay and P is still happy. O complains P's bark is weaker and they are whining more. What is a ddx?Dz: Tick ParalysisA neuromuscular junction polyneuropathy. LMN signs cough, dysphagia, respiratory paralysis. Best way to treat is prevention wit isoxazolonesTrueT/F: with Tick Paralysis, if you remove the tick then there will be rapid recoveryDz: Tick ParalysisYou have a canine patient with respiratory paralysis, cough, and dysphagia. The dog has not been to the vet in years. Owner notes they visited family with the dog in Oregon last week. You have an idea and immediately start a through physical exam. What DX are you trying to prove?Dz: BotulismA more rare neuromuscular junction polyneuropathy, it has progressive ascending LMN paralysis. You can also see megaesophagus, dysphagia, or cranial nerve dysfunctionFalseT/F: TX for botulism is supportive as well as an antitoxin for C toxin. Recovery may never happenDz: Infectious polyradiculoneuritisUsually caused by Neospora caninum (protozoal), seen in under 3 month old puppies. Classic sign = Extensor rigidity of pelvic limbsDz: Infectious polyradiculoneuritisYou have a litter of puppies with Extensor rigidity of pelvic limbs. What is your top ddx?FalseT/F: Treatment is recoverable with Infectious polyradiculoneuritis, just give them some clindamycin and ponazurilTrueT/F: Chronic Inflammatory Demyelinating, Polyneuropathy Chronic Relapsing Polyneuropathy, Idiopathic Unclassified Demyelinating Polyneuropathy differ from the other polyneuropathies because there is sensory and motor loss. Spontaneous onset, may be steroid responsive.Dz: TetanusA dog that has surgery last week has been brought in for generalized muscle stiffness, sardonic grin, fever, and laryngeal spasm. What is a top ddx?TrueT/F: C. tetani anti-toxin does not actually get rid of the toxin. We treat with metronidazole, muscle relaxants (ie acepromazine or midazolam), and nutritional support. Time to resolution is about a month or two, if they do not pass awayTrueT/F: Sensory Neuropathies cause proprioceptiveloss, loss of pain perception, self-mutilation, megaesophagusFalseT/F: Tremors (shaker dog syndrome) are characterized by low frequency and high amplitude disease, can cause hypothermia. Common to see in practiceFalseT/F: Myokymia is muscle twitching (high frequency, low amplitude), you see it with canine distemperFalseT/F: Myoclonus (chorea) is rippling motion of the musclesTrueT/F: Benign Essential/Postural Tremor are non-progressive and non-painful, seen when standing stillDz: Lumbosacral syndromeFlaccid weakness/paralysis of pelvic limbs and tail Bladder incontinence (LMN bladder --> easy to express) Proprioceptive deficits in pelvic limbs Decreased or absent reflexesTrueT/F: Only pelvic limbs are affected, has to be a lesion after T3 (thoracic or lumbar)Dz: Thoracolumbar syndromeHyperreflexia (UMN) to rear limbs UMN bladder (hard to express, animal expresses in small spurts) Hindlimb paresis/paralysis Proprioceptive deficits to pelvic limbsTrueT/F: Schiff-Sherrington classic is increased tone and reflexes when lying down after severe spinal trauma. Due to alterations of reflex arcDz: Cervicothoracic syndromeMono-, hemi-, or tetraparesis LMN signs to thoracic limbs UMN signs to pelvic limbs Proprioceptive deficits all limbsDz: Cervical syndromeUMN to thoracic and pelvic limbs Cervical pain and rigidity Proprioceptive deficits all limbs Abnormal postural reactions in all limbsTrueT/F: Sometimes with cervical syndrome we will just see painFalseT/F: Probably cervical or possibly cervicothoracic are insufficient for ddx or diagnostic plansFalseT/F: Pelvic limbs are easier to assess than forelimbs