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 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
What are some signs seen w/ hypertension?
Eyes - blindness (most common)
Brain - depression, hemorrhage, seizure
Nose - epistaxis
Kidneys - progressive azotemia
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's the signalment of dogs and cats w/ heartworm?
Dog: Male ≥ 6month, outdoor, large breed
Cat: male >8month, indoor
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
What can generally cause peracute or a slow pregressive onset of clinical nuero signs?
Peracute - trauma, disc herniation
Slow - degenerative, neoplastic, metabolic
UMN lesions lead to what signs?
Normal to hyperreflexia
Normal to incr muscle tone
Minimal (disuse) muscle atrophy
LMN lesions lead to what signs?
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?
Crossed-extensor reflex in lateral recumbency
What is mass reflex?
Dramatic hyperreflexia seen several months after spinal cord resection
Consists of bilateral limb flexion, tail twitch, incontinence
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
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?
Extensor postural thrust
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
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 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
What dysfunctions would you see w/ lesions in the diencephalon?
Horner's syndrom (ipsilateral eye)
Altered level of consciousness
Visual impairment (contralateral)
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
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?
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 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?
Tail jack test is more specific for lumbosacral issues
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?
Voluntary motor fxn
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
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
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
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)
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 are the different locations for vertebral and spinal neoplasia, and which are the most common?
Extradural (most common)
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 spinal cord tumor in cats, and what other condition is commonly also present?
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
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
What spinal cord lesions b/t C1-T2 result in tetraparesis/plegia?
Cervical disc DZ
Cervical spondylomyelopathy (K9 Wobbler Syndrome)
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 drug has a steroid sparing effect when Tx myopathies?
Azathioprine....it's usu given w/ prednisolone
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?
Tx - anti-inflammatory therapy
What are some metabolic myopathies?
What are some enz deficiencies that cause myopathies?
Glycogen storage DZ
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)
Protozoal polyradiculoneuritis is caused by what pathogens?
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?
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
What are the 1˚ and 2˚ tumors that arise in the cerebellum?
1˚ - medulloblastoma, glioma
2˚ many types
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)
What cause cognitive dysfunction syndrome?
Changes in circulation
Toxic free radicals
What are the 5 categories of Cognitive Dysfunction?
What are some DDx for cognitive dysfunction?
What diet and drugs can be used to help cognitive dysfunction?
Diet - Hill's b/d
Drugs - Selegiline (MAOI)
What are some different types of compulsive behaviors?
Locomotion, Oral, Vocalization, Hallucinatory, Aggressive
What are some risk factors for compulsive disorders?
Stressful, frustrating env
What drugs do you use to Tx compulsive behavior and what are the contraindications?
Rx - Clomipramine, Fluoxetine
Contraindications: don't use w/ amitraz or selegiline or w/ animals that have seizures
Idiopathic epilepsy is seen in dogs at what ages, and what are the reasons?
Ages 1-6 yrs
<1yr - toxic, infectious, congenital
>6yrs - neoplasia, metabolic DZ
What are some possible preciptating factors for seizures?
Meal -> hypoglycemia
High protein meals -> hepatic encephalopathy (shunt)
How do you differentiate b/t 1˚ and 2˚ seizures?
1˚ - abnormal CT/MRI/EEG
2˚ - abnormal neuro exam, normal CT/MRI/EEG
When should you start seizure therapy?
Seizures once every 6-8 wks
Cluster of seizures (several a day)
Prolonged seizures (> 5 mins)
Sudden withdrawal of an anticonvulsant used to Tx seizures can lead to what?
Sudden severe seizures....dose must be tapered down and weaned off over 6-12 months
What are the different anticonvulsants used to Tx seizures?
Phenobarbital (drug of choice)
Diazepam, Midazolam, Lorazepam
What's the mech of action, contraindications, and adverse effect of phenobarbital?
MoA - Enhances GABA to inhibit seizure
Contraindications - liver DZ
Adverse effects - PU/PD/PP, incr ALP and ALT, hyperactivity
If phenobarbital incr ALP and ALT, what tests do you use to determine hepatotoxicity?
Bile acids test
What's the mech of action, adverse effects, and contraindications of KBr when Tx seizures?
MoA - Move thru Cl channels to hyperpolarize membranes and mimics GABA
Adverse - PU/PD/PP, GI irritation, sedation
Contraindications - renal DZ, high salt diet
What are some alternative therapies for seizures if drugs aren't working?
Surgical resection of 1˚ focus
Vagal nerve stimulation via ocular compression
How long does an animal need to be seizure free to start being taken off drugs?
Adults - 1 yr
Juvenile epilepsy - 6 months
What are the adverse effects of diazepam and KBr in cats?
Diazepam - hepatotoxicity
KBr - reversible resp DZ
What is status epilepticus?
Two or more recurring convulsions w/ incomplete recovery of consciousness b/t seizures or when prolonged seizures (>5mins)
Status epilepticus may result from what things?
Intracranial space occupying lesions
Acute metabolic disturbances
Prolonged seizures that last for more than 30 mins can lead to what?
Cerebral ischemia and neuronal damage