Clin Med- The Neuro Exam

kelseyfmeyer's version from 2015-11-30 13:39

the exam

Question Answer
**what are the three kinds of ataxia?proprioceptive, cerebellar, and vestibular
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, attitude, mentation
what is paraparesis and where does it indicate the lesion is?Decreased voluntary movement in the pelvic limbs, Indicates a lesion caudal to T2
what is Paraplegia and 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?Decreased/absent voluntary movement in all limbs, Indicates a lesion cranial to T2
*what kinda walk do you see with a proprioceptive ataxia?scuffing paws, cross over midline, circumduct limbs
*what kinda walk do you see with a cerebellar ataxia?hypermetria (goosestepping) and trunkal sway
*what kinda walk do you see with a vestibular ataxia?drunken sailor
how would you test CN I(not often done) and what should you not do?offer animal sthing smelly like food and see if they respond. DONT use an irritating substance though, because that can irritate the nasal mucosa and CN V will respond to that
what are a few ways you can test CN II?Two big ways are visual tests and the PLR. Some visual tests are- menace response (test one eye at a time), also drop a cotton ball and see if they track it, and you can also make an obstacle course (Photopic (light) and scotopic (dark) ). You can do the dazzle reflex (see if they close their eyes when suddenly exposed to a bright light), and of course PLR (dont forget to start with looking at their pupils without the light to see if even and appropriate for dim light. Then test direct and indirect response for both eyes)
vestibulo-ocular reflexes is aka and aka?aka physiological nystagmus aka occulocephalic reflexes
what is eye drop? who is it normal in and who is it abnormal in, and 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), or eye drop (lift head up, eye drops), and check physiological nystagmus (aka vestibulo-ocular reflex)and 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 and IV
how do you test for CN IV?(responsible for eye position and movement, so..) also check with vestibulo-ocular reflexes (physiological nystagmus) and by looking for strabismus
how do you test for CN V, the opthalmic branch?(responsible for sensation from eye and nose, so...) Evaluated by testing for a response to facial sensation, corneal reflex (take finger or q-tip and touch cornea, globe of eye should retract back into skull a little). Also palpebral reflex (touch M and L canthus of eye and see if animal blinks). also Nasal sensation (cover their eyes, take object and 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 and make sure lip pulls back
how do you test for CN V, the mandibular branch?(responsible for Sensation from the chin and some sensations from the mouth, and Motor to all of the masticatory muscles, so...) Evaluated by observation and palpation-- make sure chewing mm are full and symmetric
how do you test for CN VI?(responsible for eye position and movement, so...) Evaluated with vestibulo-ocular reflexes and by looking for strabismus (and corneal reflex)
how do you test for CN VII?(responsible for Motor to muscles of facial expression, Parasympathetic function as motor to lacrimal gland, and taste in the rostral 2.3 drawing lip, palpebral reflex, and tickle ears-- should flick them in response. and 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, and limbs relative to the head. So...) Evaluated with vestibulo-ocular reflexes and 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 with response to loud noise. However, if the response is iffy, you will need to further evaluate with electrodiagnostics (Brainstem auditory evoked response (BAER) )
how do you test for CN IX?(responsible for motor to pharyngeal mm, parasympathietic function to salivary glands, and taste in caudal 1/3 tongue and rostral pharynx, so...) motor to pharynx eval by gag reflex (in nice dog you trust, stick your hand in the mouth down the throat and see if they gag. in animal you don't trust, grab larynx from outside and they should swallow).
How do you test for CN X?(responsible for Motor to striated muscle of larynx, pharynx, esophagus, Parasympathetic function to cardiac mm and sm mm of eso, lungs, and enteric. also taste in caudal pharynx, and larynx, so...) difficult to test, but mostly test for gag reflex with this one
how do you test for CN XI?Part of nerve is within the skull, part comes from the spinal cord (responsible for Motor to strap muscles in the neck, Motor to the larynx, esophagus) Dysfunction rarely recognized. Usually Evaluated by observation and palpation (basically if the strap mm of the neck and 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, and then usually licks nose-- should be up the middle or on both sides, not just one side
Proprioceptive Positioning--> what should you do to help the pt, and what do you do with the test, and what is the normal response?support patient in cases of weakness. Flip paw onto dorsum and see how fast it takes to return to normal. Shouldn't take long at all.
what are the two big things that prioprioceptive positioning tests?all along the Ascending conscious proprioception pathways, and 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 reaction more or less specific than proprioceptive positioning?hopping is more specific
postural rxn-->how does how you do the hopping reaction differ in big vs small dogs?for big dog hopping, just pick up one limb and shove them over to the side kinda in a semi-circle. if smaller dog- can pick up whole animal and just test one limb
postural rxn-->when performing the hopping reaction, what is one thing you should make sure you are doing right with 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 Reactions--> wheelbarrowing is a postural reaction which can be used on big dogs. What do you do and how can you make it more specific to just proprioception?lift up back legs and 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 Reactions--> explain visual placing vs tactile placingvisual placing- bring them to a table and they should see it and reach out for it, and no vision but do tactile placing where they feel the table edge with their paw and try to flip up their paw to step on the table
Postural Reactions--> explain hemistanding/hemiwalkingpick up both legs on one side and shove over, and should be replacing both paws. easier to do on big dogs than hopping
Postural Reactions--> explain extensor postural thrustpick up, bring them to the ground, feet should extend in anticipation of hitting the ground, and then you can wheelbarrow them out of it
Postural Reactions--> 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 three muscles in the thoracic limb where you can check myotactic reflexes?Extensor carpi radialis, triceps, biceps
explain how to get a really good myotactic reflex/ how it workswith myotatic reflexes, finds she gets the best reflexes put some tension on those mm-- so for biceps pull arm all the way back and 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 and 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 with 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 and 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 and 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. and cranial tibial reflex.
L4-6 is what and L6-S1 is what?L4-6 is femoral with patellar and L6-S1 is the sciatic via the gastroc and 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 and the sciatic. but primarily sciatic. (light pinch and all joints flex)
(what is the pseudo sciatic reflex she says she tests?) just bang around area of sciatic nn (at ischatic notch behing greater trochanter and in tront of tuber ischii) should have overall jump
how well does the withdrawl reflex test pain?if you pinch their toe and 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 and see an actual pain response from them
Flexor (Withdrawal) Reflex of the pelvic limb tests which two things?Evaluates sciatic nerve and 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 and pinch one 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 and it happens it is abnormal)
Perineal Reflex--> what do you do and what is being assessed?take hemostat/q-tip or sthing. Tickle skin around anus (dont have to touch anus) and anus should wink at you. It Evaluates the pudendal nerves and the S1-3 spinal cord segments
explain how to perform the Cutaneous Trunci (Panniculus) Reflex, and what it tells youeval 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, and 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 two spinal cord segments CRANIAL to where last lack of response was
explain the method for palpating for skull and spinal paincheck for skull pain- squeeze on temporal area- dog shouldnt care at all. then move down and start palpating her neck--> make sure your fingers are like half way down the neck (on the sides-- because loads of mm on top protecting the spine) and find the transverse processes. squeeze with 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 and give that a squeeze, then at thorax support animal and squeeze on the epaxial mm on either side of spinous processes, and do that going all the way down to the tail. for tail do ROM, side to side, and up and down, and at back end do rectal exam normally but lastly turn finger up and palpate spine from the bottom.
when do you see incontinence?only lose voluntary urination when lose motor function so see this along with 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 because their sphincters have increased tone
what does a "LMN bladder" present as? (this is a bladder which accompanies a LMN lesion)Flabby, easy to express, dribbles constantly
with what lesion is fecal incontinence usually seen?Most often seen with a dorsal spinal cord lesion (like subarachnoid cyst or tumor located dorsally)