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WorksheetsLOCALIZE THAT LESION!!! (you can do it!)
Total questions: 36
Worksheet time: 36mins
Name
Class
Date
1.
5y MN Miniature Dachshund
Mentation: Normal
Gait/Posture: Ambulatory mild paraparesis and proprioceptive ataxia of the pelvic limbs; Kyphotic
Postural reactions: delayed placing/hopping of both PLs, normal FLs
Spinal reflexes: normal withdrawals x4, normal patellars and perineal reflexes, cutaneous trunci cut off cranial lumbar bilaterally
Muscle mass/tone: slight increased tone in PLs, otherwise normal
Cranial nerves: all within normal limits
Palpation: pain at TL junction
LOCALIZE THAT LESION!!!
Mentation: Normal
Gait/Posture: Ambulatory mild paraparesis and proprioceptive ataxia of the pelvic limbs; Kyphotic
Postural reactions: delayed placing/hopping of both PLs, normal FLs
Spinal reflexes: normal withdrawals x4, normal patellars and perineal reflexes, cutaneous trunci cut off cranial lumbar bilaterally
Muscle mass/tone: slight increased tone in PLs, otherwise normal
Cranial nerves: all within normal limits
Palpation: pain at TL junction
LOCALIZE THAT LESION!!!
a)
C1-C5
b)
C6-T2
c)
T3-L3
d)
L4-S1
2.
13y M Miniature Pinscher
Mentation: Normal
Posture: Laterally recumbent
Gait: Severe non-ambulatory tetraparesis to tetraplegia
Postural reactions: Absent x4
Reflexes: Intact in PLs, difficult to illicit withdrawals in TLs
Muscle mass/tone: Increased extensor tone x4
Cranial nerves: Intact
Palpation: Severe cervical pain
LOCALIZE THAT LESION!!!
Mentation: Normal
Posture: Laterally recumbent
Gait: Severe non-ambulatory tetraparesis to tetraplegia
Postural reactions: Absent x4
Reflexes: Intact in PLs, difficult to illicit withdrawals in TLs
Muscle mass/tone: Increased extensor tone x4
Cranial nerves: Intact
Palpation: Severe cervical pain
LOCALIZE THAT LESION!!!
a)
C1-C5
b)
C6-T2
c)
Diffuse neuromuscular
d)
Diffuse brainstem
3.
8y MN Pembroke Welsh Corgi
Mentation: Normal
Posture: Moderate kyphosis
Gait: Ambulatory paraparesis with a moderate proprioceptive ataxia Postural reactions: Decreased hopping/replacement in the RPL, absent hopping and decreased replacement LPL
Reflexes: Intact withdrawal x4, patellar x2, intact cutaneous trunci
Muscle mass/tone: Normal x4 Palpation: Mild hyperesthesia around thoracolumbar junction
Cranial nerves: Intact
LOCALIZE THAT LESION!!!
Mentation: Normal
Posture: Moderate kyphosis
Gait: Ambulatory paraparesis with a moderate proprioceptive ataxia Postural reactions: Decreased hopping/replacement in the RPL, absent hopping and decreased replacement LPL
Reflexes: Intact withdrawal x4, patellar x2, intact cutaneous trunci
Muscle mass/tone: Normal x4 Palpation: Mild hyperesthesia around thoracolumbar junction
Cranial nerves: Intact
LOCALIZE THAT LESION!!!
a)
C1-C5
b)
C6-T2
c)
T3-L3
d)
L4-S1
4.
MRI revealed no spinal abnormalities and CSF tap was unremarkable. What is the top differential? Is there an ante-mortem test for this?
a)
IVDD; yes
b)
FCEM; kind of
c)
Degenerative myelopathy; kind of
d)
Discospondylitis; yes
5.
5y FS Pekingese
Mentation: Normal
Posture: normal
Gait: Ambulatory with normal gait
Postural reactions: normal hopping and placing in all four limbs
Reflexes: Intact withdrawal x4, patellar x2, intact cutaneous trunci
Muscle mass/tone: Normal x4 Palpation: Unremarkable.
Cranial nerves: Mydriatic pupil OD with no PLR in either eye when light shone in OD, normal pupil OS with both eyes constricting when light shone in OS, absent menace OD, normal menace OS. Rest of cranial nerve exam unremarkable.
LOCALIZE THAT LESION!!!
Mentation: Normal
Posture: normal
Gait: Ambulatory with normal gait
Postural reactions: normal hopping and placing in all four limbs
Reflexes: Intact withdrawal x4, patellar x2, intact cutaneous trunci
Muscle mass/tone: Normal x4 Palpation: Unremarkable.
Cranial nerves: Mydriatic pupil OD with no PLR in either eye when light shone in OD, normal pupil OS with both eyes constricting when light shone in OS, absent menace OD, normal menace OS. Rest of cranial nerve exam unremarkable.
LOCALIZE THAT LESION!!!
a)
left prosencephalon
b)
right oculomotor nerve (CN III)
c)
right optic nerve (CN II) or retina
d)
bilateral optic tract
6.
4y MN Boston Terrier
Mentation: Quiet, responsive
Posture: Low head carriage, holding up RTL
Gait: Ambulatory with a mild paraparesis and proprioceptive ataxia, lameness of RTL
Postural reactions: Normal in TLs, mildly decreased hopping RTL > LTL
Reflexes: Decreased RTL withdrawal
Muscle mass/tone: Normal x4
Cranial nerves: Intact
Palpation: Cervical muscle fasciculations on palpation
LOCALIZE THAT LESION!!!
Mentation: Quiet, responsive
Posture: Low head carriage, holding up RTL
Gait: Ambulatory with a mild paraparesis and proprioceptive ataxia, lameness of RTL
Postural reactions: Normal in TLs, mildly decreased hopping RTL > LTL
Reflexes: Decreased RTL withdrawal
Muscle mass/tone: Normal x4
Cranial nerves: Intact
Palpation: Cervical muscle fasciculations on palpation
LOCALIZE THAT LESION!!!
a)
C1-C5 (R>L)
b)
C6-T2 (R>L)
c)
T3-L3 (R>L)
d)
Right peripheral brachial plexus
7.
2yr FS Maltese
Mentation: Dull
Posture: Normal
Gait: Mild proprioceptive ataxia with occasional scuffing of RPL
Postural reactions: Decreased hopping and placing of RTL/RPL
Reflexes: Normal x4
Muscle mass/tone: Normal x4
Cranial nerves: Positional ventrolateral strabismus OD, decreased palpebral and nasal sensation OD, mild facial paresis with commissure drooping right Palpation: Possible mild hyperesthesia of cranial cervical region
LOCALIZE THAT LESION!!!
Mentation: Dull
Posture: Normal
Gait: Mild proprioceptive ataxia with occasional scuffing of RPL
Postural reactions: Decreased hopping and placing of RTL/RPL
Reflexes: Normal x4
Muscle mass/tone: Normal x4
Cranial nerves: Positional ventrolateral strabismus OD, decreased palpebral and nasal sensation OD, mild facial paresis with commissure drooping right Palpation: Possible mild hyperesthesia of cranial cervical region
LOCALIZE THAT LESION!!!
a)
Right brainstem (Pons and medulla) +/- cervical pain
b)
Left prosencephalon
c)
C1-C5
d)
Left brainstem (Pons and medulla) +/- cervical pain
8.
6y FS Pug
Mentation: Normal
Posture: Normal, uncurled tail
Gait: Ambulatory paraparesis with a severe proprioceptive ataxia. Drops stool while walking.
Postural reactions: Absent hopping and placing in PLs
Reflexes: Intact withdrawal x4, patellar x2, cutaneous trunci cut-off at L1-2, normal perineal reflex/anal tone
Muscle mass/tone: Mildly decreased in PLs, normal tone x4
Palpation: Non-painful
Cranial nerves: Intact
LOCALIZE THAT LESION!!!
Mentation: Normal
Posture: Normal, uncurled tail
Gait: Ambulatory paraparesis with a severe proprioceptive ataxia. Drops stool while walking.
Postural reactions: Absent hopping and placing in PLs
Reflexes: Intact withdrawal x4, patellar x2, cutaneous trunci cut-off at L1-2, normal perineal reflex/anal tone
Muscle mass/tone: Mildly decreased in PLs, normal tone x4
Palpation: Non-painful
Cranial nerves: Intact
LOCALIZE THAT LESION!!!
a)
C6-T2
b)
T3-L3
c)
L4-S1
d)
S1-Cd
9.
In our poop-dropping pug, what is the top differential?
a)
IVDD
b)
Hemivertebrae
c)
Subarachnoid Diverticulum
d)
FCEM
10.
9yo M English Bulldog (go dawgs)
Mentation: Obtunded
Posture: Low head carriage
Gait: Ambulatory, paces around room and sometimes becomes stuck in corners, only turns toward right
Postural reactions: Delayed replacement LTL, LPL and RPL with left deficits > right, decreased hopping LPL
Reflexes: Normal x4
Muscle mass/tone: Normal x4
Cranial nerves: Decreased nasal sensation left, absent menace OS Palpation: Mild TL pain
LOCALIZE THAT LESION!!!
Mentation: Obtunded
Posture: Low head carriage
Gait: Ambulatory, paces around room and sometimes becomes stuck in corners, only turns toward right
Postural reactions: Delayed replacement LTL, LPL and RPL with left deficits > right, decreased hopping LPL
Reflexes: Normal x4
Muscle mass/tone: Normal x4
Cranial nerves: Decreased nasal sensation left, absent menace OS Palpation: Mild TL pain
LOCALIZE THAT LESION!!!
a)
C1-C5 +/- TL pain
b)
Left brainstem +/- TL pain
c)
Right prosencephalon +/- TL pain
d)
Left prosencephalon +/- TL pain
11.
5y FS Affenpinscher
Mentation: quiet but appropriate
Posture: collapsed/non-weight bearing on forelimbs, able to stand on PL
Gait: non-ambulatory tetraparesis (weaker TLs) with propriocetive ataxia of PLs
Postural reactions: Decreased hopping and placing of both pelvic limbs (worse right PL), absent placing/hopping of RTL, absent placing and delayed hopping of LTL
Reflexes: weak withdrawal reflexes of both TLs, absent cutaneous trunci on the right, weak cutaneous trunci on the left, otherwise normal WD and patellars of PLs bilaterally
Muscle mass/tone: weak tone of both forelimbs (weaker on the R), normal to increased tone of PLs
Cranial nerves: miosis, enophthalmus, and ptosis OD, otherwise within normal limits
Palpation: no pain on palpation
LOCALIZE THAT LESION!!!
Mentation: quiet but appropriate
Posture: collapsed/non-weight bearing on forelimbs, able to stand on PL
Gait: non-ambulatory tetraparesis (weaker TLs) with propriocetive ataxia of PLs
Postural reactions: Decreased hopping and placing of both pelvic limbs (worse right PL), absent placing/hopping of RTL, absent placing and delayed hopping of LTL
Reflexes: weak withdrawal reflexes of both TLs, absent cutaneous trunci on the right, weak cutaneous trunci on the left, otherwise normal WD and patellars of PLs bilaterally
Muscle mass/tone: weak tone of both forelimbs (weaker on the R), normal to increased tone of PLs
Cranial nerves: miosis, enophthalmus, and ptosis OD, otherwise within normal limits
Palpation: no pain on palpation
LOCALIZE THAT LESION!!!
a)
C1-C5 (R>L)
b)
C6-T2 (R>L)
c)
Bilateral peripheral brachial plexus injury (R>L)
d)
C1-C5 and right tympanic bulla
12.
8y FS Sphynx cat
Mentation: Normal
Posture: Crouched PLs
Gait: Slinking gait with very flexed stifles and paraparesis R > L
Postural reactions: Mild delay in RPL replacement
Reflexes: Normal withdrawal x4, decreased patellar LPL, absent patellar RPL
Muscle mass/tone: Decreased extensor tone PLs
Cranial nerves: Intact
Palpation: No pain noted
LOCALIZE THAT LESION!!!
Mentation: Normal
Posture: Crouched PLs
Gait: Slinking gait with very flexed stifles and paraparesis R > L
Postural reactions: Mild delay in RPL replacement
Reflexes: Normal withdrawal x4, decreased patellar LPL, absent patellar RPL
Muscle mass/tone: Decreased extensor tone PLs
Cranial nerves: Intact
Palpation: No pain noted
LOCALIZE THAT LESION!!!
a)
T3-L3 (R>L)
b)
L4-L6 (or femoral nerves R>L)
c)
L6-S1 (or sciatic nerves R>L)
d)
S1-S3 (or pudendal/pelvic nerves R>L)
13.
12y FS Labrador Retriever
Mentation: Quiet
Posture: Moderate right head tilt
Gait: Moderate ataxia x4 with leaning towards the right
Postural reactions: Delayed hopping/replacement in the LTL, absent LPL
Reflexes: Normal x4
Muscle mass/tone: Normal x4
Cranial nerves: Horizontal nystagmus, fast phase left, positional ventrolateral strabismus OD
Palpation: No pain noted
LOCALIZE THAT LESION!!!
Mentation: Quiet
Posture: Moderate right head tilt
Gait: Moderate ataxia x4 with leaning towards the right
Postural reactions: Delayed hopping/replacement in the LTL, absent LPL
Reflexes: Normal x4
Muscle mass/tone: Normal x4
Cranial nerves: Horizontal nystagmus, fast phase left, positional ventrolateral strabismus OD
Palpation: No pain noted
LOCALIZE THAT LESION!!!
a)
Right peripheral vestibular
b)
Right central vestibular (paradoxical)
c)
Left peripheral vestibular
d)
Left central vestibular (paradoxical)
14.
8y F Irish Setter
Mentation: normal, appropriate
Posture: knuckled non-weight bearing left thoracic limb, otherwise normal
Gait: ambulatory with monoparesis of LTL
Postural reactions: delayed hopping/absent replacement in the LTL, normal all other limbs
Reflexes: weak to absent withdrawal of LTL, weak cutaneous trunci on the left, normal on the right, withdrawals and patellars otherwise normal, normal perineal
Muscle mass/tone: markedly decreased muscle mass and tone of the LTL, otherwise normal
Cranial nerves: miosis, ptosis, and enophthalmus of OS, otherwise within normal limits
Palpation: pain on deep palpation of left axilla
LOCALIZE THAT LESION!!!
Mentation: normal, appropriate
Posture: knuckled non-weight bearing left thoracic limb, otherwise normal
Gait: ambulatory with monoparesis of LTL
Postural reactions: delayed hopping/absent replacement in the LTL, normal all other limbs
Reflexes: weak to absent withdrawal of LTL, weak cutaneous trunci on the left, normal on the right, withdrawals and patellars otherwise normal, normal perineal
Muscle mass/tone: markedly decreased muscle mass and tone of the LTL, otherwise normal
Cranial nerves: miosis, ptosis, and enophthalmus of OS, otherwise within normal limits
Palpation: pain on deep palpation of left axilla
LOCALIZE THAT LESION!!!
a)
L C6-T2 spinal cord segments
b)
L C6-T2 peripheral brachial plexus
c)
left C1-C5
d)
left thoracic limb orthopedic injury
15.
1y MN DSH
Mentation: Agitated, vocalizing
Posture: Sternally recumbent
Gait: Paraplegia; gait in TLs appears normal when PLs are supported
Postural reactions: Normal in TLs, did not assess PLs
Reflexes: Normal TLs, Absent patellar/withdrawal PLs, no perineal reflex, easy to express bladder, intact cutaneous trunci
Muscle mass/tone: Flaccid pelvic limb tone and tail tone
Cranial nerves: Intact
Palpation: Hyperesthesia of caudal lumbar vertebral column
Nociception: Absent in PLs, tail and perineal region
LOCALIZE THAT LESION!!!
Mentation: Agitated, vocalizing
Posture: Sternally recumbent
Gait: Paraplegia; gait in TLs appears normal when PLs are supported
Postural reactions: Normal in TLs, did not assess PLs
Reflexes: Normal TLs, Absent patellar/withdrawal PLs, no perineal reflex, easy to express bladder, intact cutaneous trunci
Muscle mass/tone: Flaccid pelvic limb tone and tail tone
Cranial nerves: Intact
Palpation: Hyperesthesia of caudal lumbar vertebral column
Nociception: Absent in PLs, tail and perineal region
LOCALIZE THAT LESION!!!
a)
T3-L3
b)
L4-S1
c)
S1-S3
d)
L4-caudal
16.
14y FS Golden Retriever
Mentation: Normal
Posture: Mildly plantigrade stance
Gait: Ambulatory with mild paraparesis of PLs, appears to throw PLs forward somewhat when taking steps
Postural reactions: Normal x4
Reflexes: Normal TLs, hyperreflexive patellar PLs, decreased hock flexion for withdrawal in PLs, intact cutaneous trunci, intact perineal reflex
Muscle mass/tone: Normal x4
Cranial nerves: Intact
Palpation: No pain noted on paravertebral palpation
LOCALIZE THAT LESION!!!
Mentation: Normal
Posture: Mildly plantigrade stance
Gait: Ambulatory with mild paraparesis of PLs, appears to throw PLs forward somewhat when taking steps
Postural reactions: Normal x4
Reflexes: Normal TLs, hyperreflexive patellar PLs, decreased hock flexion for withdrawal in PLs, intact cutaneous trunci, intact perineal reflex
Muscle mass/tone: Normal x4
Cranial nerves: Intact
Palpation: No pain noted on paravertebral palpation
LOCALIZE THAT LESION!!!
a)
T3-L3
b)
L4-L6 (or femoral nerves)
c)
L6-S1 (or sciatic nerves)
d)
S1-S3 (or pudendal nerves)
17.
4y FS Schnauzer
Mentation: Anxious, alert/responsive
Posture: Down in pelvic limbs
Gait: Paraplegia
Postural reactions: Normal in TLs, did not assess in PLs
Reflexes: Intact x4, normal perineal, large bladder that cannot be easily expressed; cutaneous trunci cut-off at T13 on the left and L2 on the right, normal patellars, weak withdrawals bilaterally, normal perineal reflexes
Muscle mass/tone: Increased extensor tone in TLs, severely decreased tone in PLs
Palpation: Non-painful
Cranial nerves: Intact
Nociception: Absent in PLs and to tail
LOCALIZE THAT LESION!!!
Mentation: Anxious, alert/responsive
Posture: Down in pelvic limbs
Gait: Paraplegia
Postural reactions: Normal in TLs, did not assess in PLs
Reflexes: Intact x4, normal perineal, large bladder that cannot be easily expressed; cutaneous trunci cut-off at T13 on the left and L2 on the right, normal patellars, weak withdrawals bilaterally, normal perineal reflexes
Muscle mass/tone: Increased extensor tone in TLs, severely decreased tone in PLs
Palpation: Non-painful
Cranial nerves: Intact
Nociception: Absent in PLs and to tail
LOCALIZE THAT LESION!!!
a)
L6-S1 (more left sided)
b)
T3-L3 with spinal shock (more left sided)
c)
L4-S1 (more left sided)
d)
T3-L3 and L4-S1 (more left sided)
18.
Our schnauzer friend was reported to be acutely non-ambulatory. What is the top differential in this dog?
a)
IVDD
b)
Discospondylitis
c)
Trauma (subluxation/fracture)
d)
FCEM
19.
14y MN Egyptian Mau
History: Episodes of salivation and facial twitching at home
Mentation: Anxious, vocalizing constantly
Posture/Gait: Left head/body turn, pacing around room
Postural reactions: Delayed hopping RTL/RPL
Reflexes: Normal x4
Muscle mass/tone: Normal x4
Cranial nerves: Difficult to elicit menace OU, otherwise normal
Palpation: Non-painful
LOCALIZE THAT LESION!!!
History: Episodes of salivation and facial twitching at home
Mentation: Anxious, vocalizing constantly
Posture/Gait: Left head/body turn, pacing around room
Postural reactions: Delayed hopping RTL/RPL
Reflexes: Normal x4
Muscle mass/tone: Normal x4
Cranial nerves: Difficult to elicit menace OU, otherwise normal
Palpation: Non-painful
LOCALIZE THAT LESION!!!
a)
left central vestibular (rostral medulla)
b)
right prosencephalon
c)
left prosencephalon
d)
right central vestibular (paradoxical)
20.
7y MN Dire wolf
Mentation: Normal
Posture: Crouched in PLs (stifles and tarsi appear over-flexed)
Gait: Ambulatory with moderate paraparesis and slightly short steps in PLs
Postural reactions: Normal x4
Reflexes: Normal TLs, decreased patellar/withdrawal in PLs, intact cutaneous trunci, intact perineal reflex
Muscle mass/tone: Decreased in PLs, normal tail tone
Cranial nerves: Intact
Palpation: Mild hyperesthesia of caudal lumbar vertebral column
LOCALIZE THAT LESION!!!
Mentation: Normal
Posture: Crouched in PLs (stifles and tarsi appear over-flexed)
Gait: Ambulatory with moderate paraparesis and slightly short steps in PLs
Postural reactions: Normal x4
Reflexes: Normal TLs, decreased patellar/withdrawal in PLs, intact cutaneous trunci, intact perineal reflex
Muscle mass/tone: Decreased in PLs, normal tail tone
Cranial nerves: Intact
Palpation: Mild hyperesthesia of caudal lumbar vertebral column
LOCALIZE THAT LESION!!!
a)
T3-L3
b)
L4-L6 (or bilateral femoral nerves)
c)
L6-S1 (or bilateral sciatic nerves)
d)
L4-S1 (or bilateral femoral/sciatic nerves)
21.
5y F Chihuahua
History: Generalized seizures for 1 month
Mentation: Dull
Posture/Gait: Mild head tilt/turn to right, circling right with moderate ataxia x4, occasionally knuckles RTL when standing/walking
Postural reactions: Absent replacement RTL, delayed replacement RPL, delayed hopping RTL/RPL
Reflexes: Decreased withdrawals in TLs (R>L)
Muscle mass/tone: Decreased tone in RTL
Cranial nerves: Inducible rotary nystagmus, fast phase left
Palpation: Moderate cervical hyperesthesia
LOCALIZE THAT LESION!!!
History: Generalized seizures for 1 month
Mentation: Dull
Posture/Gait: Mild head tilt/turn to right, circling right with moderate ataxia x4, occasionally knuckles RTL when standing/walking
Postural reactions: Absent replacement RTL, delayed replacement RPL, delayed hopping RTL/RPL
Reflexes: Decreased withdrawals in TLs (R>L)
Muscle mass/tone: Decreased tone in RTL
Cranial nerves: Inducible rotary nystagmus, fast phase left
Palpation: Moderate cervical hyperesthesia
LOCALIZE THAT LESION!!!
a)
Multifocal (prosencephalon, left medulla, R C6-T2)
b)
Multifocal (prosencephalon, right medulla, R C6-T2)
c)
Multifocal (prosencephalon, cerebellum, R C6-T2)
d)
Multifocal (prosencephalon, cerebellum, C1-C5)
22.
8mo MI Norwegian Forest cat
Mentation: Normal
Posture: Mildly wide-based stance in PLs
Gait: Moderate hypermetria x4, which worsens when cat looks upward, falls frequently when initiating movement, titubation (truncal sway) , intention tremors when offered treats
Postural reactions: Normal hopping x4, could not assess replacement
Reflexes: Normal x4
Muscle mass/tone: Normal x4
Cranial nerves: Intact
Palpation: No pain noted
LOCALIZE THAT LESION!!!
Mentation: Normal
Posture: Mildly wide-based stance in PLs
Gait: Moderate hypermetria x4, which worsens when cat looks upward, falls frequently when initiating movement, titubation (truncal sway) , intention tremors when offered treats
Postural reactions: Normal hopping x4, could not assess replacement
Reflexes: Normal x4
Muscle mass/tone: Normal x4
Cranial nerves: Intact
Palpation: No pain noted
LOCALIZE THAT LESION!!!
a)
Prosencephalon
b)
Brainstem (medulla)
c)
Diffuse neuromuscular
d)
Cerebellum
23.
This kitten was born with those signs. What is the top differential?
a)
FIP
b)
FeLV
c)
Toxoplasmosis
d)
Feline Panleukopenia
24.
9y MN Greyhound
Mentation: dull, somnolent, inappropriate
Posture: somewhat low head carriage, otherwise normal
Gait: ambulatory with normal gait, circling to either side in room, bumping into inanimate objects
Postural reactions: normal hopping and placing in all four limbs
Reflexes: normal withdrawals in all four limbs, normal patellar x2, normal cut trunci and perineal
Muscle mass/tone: generally decreased muscle mass (mild), normal tone
Cranial nerves: absent physiologic nystagmus, ophthalmoplegia, mydriatic pupils with weak PLR bilaterally, absent menace bilaterally, normal palpebrals, decreased corneal sensation and retraction of the globes bilaterally, ptosis bilaterally, no head tilt, normal gag, slight decreased nasal sensation bilaterally
Palpation: pain when pressure applied to either side of skull over parietal/temporal bones bilaterally
LOCALIZE THAT LESION!!!
Mentation: dull, somnolent, inappropriate
Posture: somewhat low head carriage, otherwise normal
Gait: ambulatory with normal gait, circling to either side in room, bumping into inanimate objects
Postural reactions: normal hopping and placing in all four limbs
Reflexes: normal withdrawals in all four limbs, normal patellar x2, normal cut trunci and perineal
Muscle mass/tone: generally decreased muscle mass (mild), normal tone
Cranial nerves: absent physiologic nystagmus, ophthalmoplegia, mydriatic pupils with weak PLR bilaterally, absent menace bilaterally, normal palpebrals, decreased corneal sensation and retraction of the globes bilaterally, ptosis bilaterally, no head tilt, normal gag, slight decreased nasal sensation bilaterally
Palpation: pain when pressure applied to either side of skull over parietal/temporal bones bilaterally
LOCALIZE THAT LESION!!!
a)
multifocal (pons, medulla)
b)
bilateral retrobulbar/ophthalmic disease
c)
prosencephalon (specifically diencephalon)
d)
Peripheral CN II, III, IV, VI, V
25.
5y F Belted Galloway
Mentation: Normal
Posture: Lateral recumbency
Gait: Non-ambulatory severe tetraparesis
Postural reactions; Cannot assess
Reflexes: Absent withdrawals x4, absent patellar reflexes
Muscle mass/tone: Flaccid tone x4, normal muscle mass
Cranial nerves: Decreased palpebral reflex OU
Palpation: Non-painful
LOCALIZE THAT LESION!!!
Mentation: Normal
Posture: Lateral recumbency
Gait: Non-ambulatory severe tetraparesis
Postural reactions; Cannot assess
Reflexes: Absent withdrawals x4, absent patellar reflexes
Muscle mass/tone: Flaccid tone x4, normal muscle mass
Cranial nerves: Decreased palpebral reflex OU
Palpation: Non-painful
LOCALIZE THAT LESION!!!
a)
Multifocal (medulla and C1-C5)
b)
Multifocal (C6-T2, T3-L3, CN VII)
c)
Multifocal (CN VII, C1-C5)
d)
Diffuse neuromuscular
26.
7y FS Doberman Pinscher
Mentation: Normal (and super sweet!)
Posture: Wide-based stance in PLs, narrow, tip-toed stance in TLs
Gait: Moderate tetraparesis and proprioceptive ataxia in PLs, short, choppy gait in TLs
Postural reactions: Delayed hopping/replacement in PLs (L>R), delayed hopping LTL, normal RTL
Reflexes: Intact in PLs, kicks during TL withdrawals
Muscle mass/tone: Mildly decreased muscle mass over cranial scapulae; tone appears normal
Cranial nerves: Intact
Palpation: Non-painful
LOCALIZE THAT LESION!!!
Mentation: Normal (and super sweet!)
Posture: Wide-based stance in PLs, narrow, tip-toed stance in TLs
Gait: Moderate tetraparesis and proprioceptive ataxia in PLs, short, choppy gait in TLs
Postural reactions: Delayed hopping/replacement in PLs (L>R), delayed hopping LTL, normal RTL
Reflexes: Intact in PLs, kicks during TL withdrawals
Muscle mass/tone: Mildly decreased muscle mass over cranial scapulae; tone appears normal
Cranial nerves: Intact
Palpation: Non-painful
LOCALIZE THAT LESION!!!
a)
C1-C5 (L>R)
b)
C6-T2 (L>R)
c)
C1-C5 and T3-L3
d)
Cerebellum
27.
4y MN Pitbull Terrier
Mentation: Normal
Posture: Wide-based stance x4
Gait: Moderate dysmetria and ataxia x4, truncal sway when standing still, hypermetria noticeable more so in TLs
Postural reactions: Delayed hopping in PLs, R>L
Reflexes: Normal x4
Muscle mass/tone: Normal x4
Cranial nerves: Inconsistent menace OD
Palpation: No pain noted
LOCALIZE THAT LESION!!!
Mentation: Normal
Posture: Wide-based stance x4
Gait: Moderate dysmetria and ataxia x4, truncal sway when standing still, hypermetria noticeable more so in TLs
Postural reactions: Delayed hopping in PLs, R>L
Reflexes: Normal x4
Muscle mass/tone: Normal x4
Cranial nerves: Inconsistent menace OD
Palpation: No pain noted
LOCALIZE THAT LESION!!!
a)
Right cerebellum
b)
C1-C5 (R>L)
c)
Left prosencephalon and C1-C5
d)
Left prosencephalon and C6-T2
28.
Bonus question about our young pitbull terrier (staffordshire terrier): One of his siblings is also affected and both seem to be getting worse over time. What is the top differential? Is there an antemortem test for this?
a)
Neospora or Toxoplasma; yes
b)
Parvovirus; yes
c)
Neuronal ceroid lipofuscinosis (NCL); yes
d)
Lymphoma; yes
29.
8y M African Painted Dog
Mentation: Normal
Posture: Mildly narrow-based in all limbs
Gait: Stiff, choppy gait x4
Postural reactions: Normal when weight supported
Reflexes: Decreased withdrawal x4, normal patellars
Muscle mass/tone: Shakes in all four limbs when standing
Cranial nerves: Normal
Palpation: Non-painful
LOCALIZE THAT LESION!!!
Mentation: Normal
Posture: Mildly narrow-based in all limbs
Gait: Stiff, choppy gait x4
Postural reactions: Normal when weight supported
Reflexes: Decreased withdrawal x4, normal patellars
Muscle mass/tone: Shakes in all four limbs when standing
Cranial nerves: Normal
Palpation: Non-painful
LOCALIZE THAT LESION!!!
a)
C6-T2
b)
C6-T2 and T3-L3
c)
C1-C5 and L4-S1
d)
Diffuse neuromuscular
30.
7y MN Persian Cat
Mentation: Normal
Posture: Severe left head tilt
Gait: Severe ataxia x4 with falling/rolling left
Postural reactions: Normal
Reflexes: Normal x4
Muscle mass/tone: Increased in right limbs
Cranial nerves: Miosis, elevated third eyelid, ptosis and enophthalmos OS, inducible nystagmus rotary fast phase right, absent menace and palpebral OS (only raises third eyelid), decreased sensation to left inner pinna
Palpation: No pain noted
LOCALIZE THAT LESION!!!
Mentation: Normal
Posture: Severe left head tilt
Gait: Severe ataxia x4 with falling/rolling left
Postural reactions: Normal
Reflexes: Normal x4
Muscle mass/tone: Increased in right limbs
Cranial nerves: Miosis, elevated third eyelid, ptosis and enophthalmos OS, inducible nystagmus rotary fast phase right, absent menace and palpebral OS (only raises third eyelid), decreased sensation to left inner pinna
Palpation: No pain noted
LOCALIZE THAT LESION!!!
a)
Left rostral medulla
b)
Left cerebellum
c)
Left CN VIII, CN VII, and sympathetic innervation to the left eye
d)
Left pons, rostral medulla, and sympathetic innervation to the left eye
31.
6y FS Neapolitan Mastiff
History: Generalized seizure at home, no longer drinking water
Mentation: Dull
Posture/Gait: Intermittent circling to either direction, mild proprioceptive ataxia x4
Postural reactions: Delayed x4
Reflexes: Normal x4
Muscle mass/tone: Normal x4
Cranial nerves: Sluggish PLR OU, inconsistent menace OU
Palpation: Non-painful
LOCALIZE THAT LESION!!!
History: Generalized seizure at home, no longer drinking water
Mentation: Dull
Posture/Gait: Intermittent circling to either direction, mild proprioceptive ataxia x4
Postural reactions: Delayed x4
Reflexes: Normal x4
Muscle mass/tone: Normal x4
Cranial nerves: Sluggish PLR OU, inconsistent menace OU
Palpation: Non-painful
LOCALIZE THAT LESION!!!
a)
Bilateral cerebral hemispheres and C1-C5
b)
Bilateral cerebral hemispheres, bilateral CN II, C1-C5
c)
Diencephalon (hypothalamus)
d)
Brainstem (pons and medulla)
32.
10y FS Chinese Crested Dog
History: Three seizures in the last 24 hours
Mentation: Obtunded
Posture: Sternally recumbent/sleeping, but can be roused into normal posture
Gait: Mild hypermetria TLs > PLs, moderate ataxia x4
Postural reactions: Absent replacement and delayed hopping PLs, delayed replacement TLs (L>R)
Reflexes: Normal x4
Muscle mass/tone: Normal
Cranial nerves: Decreased jaw tone, moderate facial paresis left, mild facial paresis right, inducible vertical nystagmus on back, weak gag
LOCALIZE THAT LESION!!!
History: Three seizures in the last 24 hours
Mentation: Obtunded
Posture: Sternally recumbent/sleeping, but can be roused into normal posture
Gait: Mild hypermetria TLs > PLs, moderate ataxia x4
Postural reactions: Absent replacement and delayed hopping PLs, delayed replacement TLs (L>R)
Reflexes: Normal x4
Muscle mass/tone: Normal
Cranial nerves: Decreased jaw tone, moderate facial paresis left, mild facial paresis right, inducible vertical nystagmus on back, weak gag
LOCALIZE THAT LESION!!!
a)
Cerebellum, brainstem, and C1-C5 (L>R)
b)
Cerebellum and rostral medulla (L>R)
c)
Prosencephalon, pons, rostral medulla (L>R)
d)
Prosencephalon, cerebellum, pons, rostral medulla (L>R)
33.
7y MI Bengal Tiger
Mentation: Normal
Posture: Mildly low head carriage, wide-based stance x4, wide head excursions right to left
Gait: Moderate ataxia x4 with truncal sway
Postural reactions: Could not assess, but appears to place limbs normally
Reflexes: Did not assess
Muscle mass/tone: Supports weight normally
Cranial nerves: Absent physiologic nystagmus
Palpation: Did not perform, but not believed to be painful
LOCALIZE THAT LESION!!!
Mentation: Normal
Posture: Mildly low head carriage, wide-based stance x4, wide head excursions right to left
Gait: Moderate ataxia x4 with truncal sway
Postural reactions: Could not assess, but appears to place limbs normally
Reflexes: Did not assess
Muscle mass/tone: Supports weight normally
Cranial nerves: Absent physiologic nystagmus
Palpation: Did not perform, but not believed to be painful
LOCALIZE THAT LESION!!!
a)
Bilateral rostral medulla
b)
Diffuse cerebellum
c)
Diencephalon
d)
Bilateral vestibular dysfunction (likely peripheral)
34.
5y MI Boerboel
Mentation: Dull
Posture: Mild kyphosis, Left head turn
Gait: Moderate paresis and proprioceptive ataxia in PLs
Postural reactions: Delayed hopping/replacement in PLs (L>R)
Reflexes: Normal x4, cutaneous trunci cut-off at L3
Muscle mass/tone: Normal
Cranial nerves: Absent menace OD and decreased nasal sensation on right
Palpation: Cranial lumbar hyperesthesia
LOCALIZE THAT LESION!!!
Mentation: Dull
Posture: Mild kyphosis, Left head turn
Gait: Moderate paresis and proprioceptive ataxia in PLs
Postural reactions: Delayed hopping/replacement in PLs (L>R)
Reflexes: Normal x4, cutaneous trunci cut-off at L3
Muscle mass/tone: Normal
Cranial nerves: Absent menace OD and decreased nasal sensation on right
Palpation: Cranial lumbar hyperesthesia
LOCALIZE THAT LESION!!!
a)
Left brainstem and T3-L3 (more left sided)
b)
Left prosencephalon and T3-L3
c)
Right prosencephalon and right pons, T3-L3
d)
Right prosencephalon and T3-L3
35.
6y MN Puli
Mentation: Normal
Posture: Normal
Gait: Normal
Postural reactions: Normal
Reflexes: Normal x4
Muscle mass/tone: Normal
Cranial nerves: Absent menace and palpebral OU but attempts to retract globes, dropped jaw, decreased facial sensation bilaterally, facial drooping bilaterally, decreased sensation to inner ear pinnae
Palpation: Non-painful
LOCALIZE THAT LESION!!!
Mentation: Normal
Posture: Normal
Gait: Normal
Postural reactions: Normal
Reflexes: Normal x4
Muscle mass/tone: Normal
Cranial nerves: Absent menace and palpebral OU but attempts to retract globes, dropped jaw, decreased facial sensation bilaterally, facial drooping bilaterally, decreased sensation to inner ear pinnae
Palpation: Non-painful
LOCALIZE THAT LESION!!!
a)
Prosencephalon, bilateral peripheral CN VII
b)
Bilateral peripheral CN V, CN VI, and CN VII
c)
Pons and rostral medulla bilaterally
d)
Bilateral peripheral CN V and CN VII
36.
6y F Three-toed Sloth
Mentation: Normal
Posture: left head tilt
Gait: Normal
Postural reactions: Normal
Reflexes: Normal x4
Muscle mass/tone: normal
Cranial nerves: slight left lip droop, weak palpebral reflex OS, left head tilt, positional rotary nystagmus fast phase to the right, positional ventrolateral strabismus OS, atrophy of the left side of the tongue, weak gag reflex, stridor, normal menace OU, normal PLR OU, otherwise normal
Palpation: Non-painful
LOCALIZE THAT LESION!!!
Mentation: Normal
Posture: left head tilt
Gait: Normal
Postural reactions: Normal
Reflexes: Normal x4
Muscle mass/tone: normal
Cranial nerves: slight left lip droop, weak palpebral reflex OS, left head tilt, positional rotary nystagmus fast phase to the right, positional ventrolateral strabismus OS, atrophy of the left side of the tongue, weak gag reflex, stridor, normal menace OU, normal PLR OU, otherwise normal
Palpation: Non-painful
LOCALIZE THAT LESION!!!
a)
CN VII-XII (left sided, medulla)
b)
CN VII-XII (left sided, peripheral)
c)
Right prosencephalon and medulla
d)
Right prosencephalon and left tympanic bulla/inner ear
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