Clin Med - Neuro Review

drraythe's version from 2016-03-22 16:02

The Exam

Question Answer
**What are the 3 kinds of ataxia?Proprioceptive
When should you test nociception?Only test if animal is paralyzed-any motor fxn at all, dont have to do this
What can you get from general observation?BH
What is paraparesis & where does it indicate the lesion is?↓ voluntary movement in the pelvic limbs, Indicates a lesion caudal to T2
What is Paraplegia & where does it indicate the lesion is?Complete loss of voluntary movement in the pelvic limbs, Indicates a lesion caudal to T2
What is Tetraparesis/tetraplegia? where does it indicate the lesion is?↓/absent voluntary movement in all limbs, Indicates a lesion cranial to T2
*What kinda walk do you see w/ a proprioceptive ataxia?Scuffing paws
Cross over midline
Circumduct limbs
*What kinda walk do you see w/ a cerebellar ataxia?Hypermetria (goosestepping) & trunkal sway
*What kinda walk do you see w/ a vestibular ataxia?Drunken sailor
How would you test CN I(not often done) & what should you not do?Offer animal something smelly like food & see if they respond. DONT use an irritating substance tho, bc that can irritate the nasal mucosa & CN V will respond to that
What are a few ways you can test CN II?2 big ways are visual tests & the PLR. Some visual tests are-menace response (test 1 eye at a time), also drop a cotton ball & see if they track it & you can also make an obstacle course (Photopic (light) & scotopic (dark) ). You can do the Dazzle Reflex (see if they close their eyes when suddenly exposed to a bright light) & of course PLR (dont forget to start w/ looking at their pupils w/o the light to see if even & appropriate for dim light. Then test direct & indirect response for both eyes)
Vestibulo-ocular reflexes is aka & aka?Aka physiological nystagmus aka occulocephalic reflexes
What is eye drop? who is it normal in & who is it abnormal in & what CN does it test?If you lift their head up, the eye drops down. NORMAL in herbivores but ABNORMAL in carnivores/sm animals. Testing CN III
How do you test for CN III?Can look for strabismus (abnormal position of eye)
Try eye drop (lift head up, eye drops)
Check physiological nystagmus (aka vestibulo-ocular reflex)
Check PLR!
In PHYSIOLOGICAL nystagmus, if you tilt the head to the right, what is the normal response? which nerve does this check?Tilt head to right
Eyes flick to the right
Tests CN III & IV
How do you test for CN IV?(Responsible for eye position & movement, so..) Also check w/ vestibulo-ocular reflexes (physiological nystagmus) & by looking for strabismus
How do you test for CN V, the ophthalmic branch?(Responsible for sensation from eye & nose, so...) Evaluated by testing for a response to facial sensation, corneal reflex (take finger or q-tip & touch cornea, globe of eye should retract back into skull a little). Also palpebral reflex (touch M & L canthus of eye & see if animal blinks). also Nasal sensation (cover their eyes, take object & tickle their nostril, they should respond)
How do you test for CN V, the maxillary branch?(Sensation from the lower eyelid, nose, cheek, so...) Evaluated by testing for a response to facial sensation. So tickle the muzzle, lightly pinch & make sure lip pulls back
How do you test for CN V, the mandibular branch?(Responsible for Sensation from the chin & some sensations from the mouth & Motor to all of the masticatory muscles, so...) Evaluated by observation & palpation-make sure chewing mm are full & symmetric
How do you test for CN VI?(Responsible for eye position & movement, so...) Evaluated w/ vestibulo-ocular reflexes & by looking for strabismus (& corneal reflex)
How do you test for CN VII?(Responsible for Motor to muscles of facial expression, Parasympathetic fxn as motor to lacrimal gland & taste in the rostral 2.3 Drawing lip, palpebral reflex & tickle ears-should flick them in response. & look for drooping or asymmetry in face
How do you test for CN VIII, vestibular portion?(Responsible for SPECIAL proprioception, so Maintains the position of the eyes, neck & limbs relative to the head. So...) Evaluated w/ vestibulo-ocular reflexes & by looking for strabismus (also for head tilt, check for vestibular ataxia)
How do you test for CN VIII, cochlear portion?Sense of hearing-check w/ response to loud noise. However, if the response is iffy, you will need to further evaluate w/ electrodiagnostics (Brainstem auditory evoked response (BAER) )
How do you test for CN IX?(Responsible for motor to pharyngeal mm, parasympathietic fxn to salivary glands & taste in caudal 1/3 tongue & rostral pharynx, so...) Motor to pharynx eval by gag reflex (in nice dog you trust, stick your hand in the mouth down the throat & see if they gag. in animal you don't trust, grab larynx from outside & they should swallow)
How do you test for CN X?(Responsible for Motor to striated muscle of larynx, pharynx, esophagus, Parasympathetic fxn to cardiac mm & sm mm of eso, lungs & enteric. also taste in caudal pharynx & larynx, so...) Difficult to test, but mostly test for gag reflex w/ this one
How do you test for CN XI?Part of nerve is w/in the skull, part comes from the spinal cord (responsible for Motor to strap muscles in the neck, Motor to the larynx, esophagus) Dysfxn rarely recognized. Usually Evaluated by observation & palpation (basically if the strap mm of the neck & unilterally atrophies, it might be CN XI)
How do you test for CN XII?(Responsible for motor to tongue, so...) Evaluated by observation, palpation of the tongue-usually do gag reflex & then usually licks nose-should be up the middle or on both sides, not just 1 side
Proprioceptive Positioning → what should you do to help the PTx & what do you do w/ the test & what is the normal response?Support PTx in cases of weakness. Flip paw onto dorsum & see how fast it takes to return to normal. Shouldn't take long at all
What are the 2 big things that prioprioceptive positioning tests?All along the Ascending conscious proprioception pathways & then the Descending motor pathways. Doesn't tell you WHERE the problem is, but is very sensitive for telling you if there is a problem.
Is the hopping rxn more or less specific than proprioceptive positioning?Hopping is more specific
Postural rxn → how does how you do the hopping rxn differ in big vs small dogs?For big dog hopping, just pick up 1 limb & shove them over to the side kinda in a semi-circle. if smaller dog-can pick up whole animal & just test 1 limb
Postural rxn → when performing the hopping rxn, what is 1 thing you should make sure you are doing right w/ it? when should they hop?MAKE SURE you are moving them laterally (medially is basically impossible). when shoulder crosses over the paw, that's when they should move their leg
Postural rxns → wheelbarrowing is a postural rxn which can be used on big dogs. What do you do & how can you make it more specific to just proprioception?Lift up back legs & see if they can walk along on their front legs. cover their eyes/lift their head so they cant see ground to make it more about just proprioception
Postural rxns → explain visual placing vs tactile placingVisual placing-bring them to a table & they should see it & reach out for it & no vision but do tactile placing where they feel the table edge w/ their paw & try to flip up their paw to step on the table
Postural rxns → explain hemistanding/hemiwalkingPick up both legs on 1 side & shove over & should be replacing both paws. easier to do on big dogs than hopping
Postural rxns → explain extensor postural thrustPick up, bring them to the ground, feet should extend in anticipation of hitting the ground & then you can wheelbarrow them out of it
Postural rxns → explain rightingIf lying down, can they get up?
If you are going to test limb reflexes, what must you do?Lie the animal down in recumbency
Which limbs have more clinically reliable myotactic reflexes-thoracic or pelvic?Pelvic
What are the 3 muscles in the thoracic limb where you can check myotactic reflexes?Extensor carpi radialis
Explain how to get a really good myotactic reflex/ how it worksW/ myotatic reflexes, finds she gets the best reflexes put some tension on those mm - so for biceps pull arm all the way back & then hit right in the crook of her elbow. reflex is a slight jump forward
When using hammer thing (reflexor) to test reflexes, explain how it's used when testing a tendon versus a muscleIf hitting tendon, use flat end & hit perpendicular, if hitting mm use pointed end
Tone versus strengthWhat she means about mm tone is when you are just feeling the animals leg, is it a floppy bag or does it have normal tone? Or is it sitting out really weird w/ too much tone? What she means by strength - is there any weakness or paralysis?
Flexor withdrawal reflex → what do you do?Light pinch in webbing of toes...flexes all those mm/joints above in response
What does the Flexor (Withdrawal) Reflex evaluate?Evaluates most of the nerves of the thoracic limb & the C6-T2 spinal segments
What is the MOST RELIABLE myotactic reflex?Patellar reflex
Patellar reflex tests which nerve, which correlates to which spinal segments?FEMORAL nerve, which tests L4-6 segments
If you want to test L4-6 segments, what do you do?Test the FEMORAL NERVE by doing the PATELLAR REFLEX
The Gastrocnemius reflex & the Cranial tibial reflex are testing which nerve, which correlates to which spinal segments?Sciatic nerve, L6-S1 segments
If you want to test the L6-S1 segments, what do you do?Assess the sciatic nerve via the gastroc. & cranial tibial reflex.
L4-6 is what & L6-S1 is what?L4-6 is femoral w/ patellar & L6-S1 is the sciatic via the gastroc & cr tibial (which are BELOW the patella-so below is further down the spine!)
Flexor withdrawal reflex tests which nerve in the pelvic limb?BOTH the femoral & the sciatic. but primarily sciatic. (light pinch & all joints flex)
(What is the pseudo sciatic reflex she says she tests?)Just bang around area of sciatic nn (at ischatic notch being greater trochanter & in tront of tuber ischii) should have overall jump
How well does the withdrawl reflex test pain?If you pinch their toe & they just pull back, that is a reflex! IT DOES NOT INDICATE THEY HAVE PAIN. Only tells you L4-S3 are working (if you are talking about the pelvic limb), nothing about pain. gotta give more stimulus & see an actual pain response from them
Flexor (Withdrawal) Reflex of the pelvic limb tests which 2 things?Evaluates sciatic nerve & L6-S1 spinal cord segments (NOT PAIN)
What is the Crossed Extensor Reflex? what should you know about it?If you LAY THE ANIMAL DOWN & pinch 1 leg, the other leg extends. This is an ABNORMAL RESPONSE which indicates a chronic UMN lesion. (this reflex is normal if you are standing, but if you are laying down & it happens it is abnormal)
Perineal Reflex → what do you do & what is being assessed?Take hemostat/q-tip or something. Tickle skin around anus (dont have to touch anus) & anus should wink at you. It evaluates the pudendal nerves & the S1-3 spinal cord segments
Explain how to perform the Cutaneous Trunci (Panniculus) Reflex & what it tells youEvals Lateral Thoracic nerve which comes out of caudal portion of Brachial Plexus. Should show reflex (twitch of cutaneous trunci reflex in response to pinprick or light pinch of skin) until area of lesion, 1-2 spinal cord segments cr to where the lack of response was. If you start on R side, L side should contract as well. should start where wings of the ileim are, just off the dorsal midline & should get the response. if theres a problem, keep moving up until you do get a response
If you finally get a response from a cutaneous trunci reflex, what do you know about lesion location?It is 2 spinal cord segments CRANIAL to where last lack of response was
Explain the method for palpating for skull & spinal painCheck for skull pain-squeeze on temporal area-dog shouldnt care at all. then move down & start palpating her neck → make sure your fingers are like half way down the neck (on the sides-bc loads of mm on top protecting the spine) & find the transverse processes. squeeze w/ firm but gentle pressure. then put neck through range of motion-push nose to chest, all the way up to the sky, should be able to touch either flank. if they resist you, just make note of that, dont have to push it. then get to thoracic inlet & give that a squeeze, then at thorax support animal & squeeze on the epaxial mm on either side of spinous processes & do that going all the way down to the tail. for tail do ROM, side to side & up & down & at back end do rectal exam normally but lastly turn finger up & palpate spine from the bottom.
When do you see incontinence?Only lose voluntary urination when lose motor fxn so see this along w/ the paralyzed animal
What does a "UMN bladder" present as? (This is a bladder which accompanies an UMN lesion)It is taut, difficult to express bc their sphincters have ↑ tone
What does a "LMN bladder" present as? (this is a bladder which accompanies a LMN lesion)Flabby,Easy to express, dribbles constantly
W/ what lesion is fecal incontinence usually seen?Most often seen w/ a dorsal spinal cord lesion (like subarachnoid cyst or tumor located dorsally)