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Specialty Boards Prep > Deck 12 > Flashcards

Deck 12 Flashcards

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1
Q

What were the most common classifications of tumors in dogs? Cats?

A

Dogs — mesenchymal, followed by round cell

Cat — lymphoma (round cell)

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2
Q

What were some distinguishing features between mesenchymal and round cell tumors?

A

Mesenchymal — cortical lysis, altered vertebral shape, centered on soft tissues with a large soft tissue component, and heterogenous CE

Round cell — cortical sparing, preservation of vertebral shape, centered on vertebra, minimal soft tissue component, homogeneous CE

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3
Q

What is this photo demonstrating? What tumor type is associated with this change most often?

A

diffuse STIR hyperintensity of the vertebral bodies — this can be missed without STIR images. This is most common in cases of lymphoma.

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4
Q

Where along the vertebra do chondrosarcomas most often occur? What else do they ‘classically’ do?

A

Dorsal aspect / affecting the spinous process

They often affect the adjacent spinous processes.

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5
Q

What is the typical signalment of a dog with calcinosis circumscripta?

A

Young, large breed dog

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6
Q

What is Alexander’s disease? What are the MRI features? Path features? Breed predilection?

A

It is a fibrinoid leukodystrophy due to dysfunction of GFAP.

This results in accumulation of fibrillar material in astrocytes, which looks eosinophilic — creates what are colloquially referred to as Rosenthal fibers.

MRI shows diffuse T2W hyperintensity / T1W hypointensity w/o CE of white matter throughout the CNS, but more prominent intracranially. Also causes cerebellar enlargement.

Labradors

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7
Q

Explain the mechanism of action of vagal nerve stimulators?

A

They activate the afferent fibers within the vagus nerve, which then transmit signals to the solitary nucleus. Solitary nucleus projections then activate the locus coeruleus and the dorsal raphe nuclei, which release norepinephrine and serotonin (respectively). These excitatory neurotransmitters then stimulate interneurons to release GABA, which increases the seizure threshold.

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8
Q

What were the main findings of this paper?

A

Osteosarcomas had T2W heterogeneity, T1W isointensity with contrast enhancement, osteolysis, neuroparenchymal compression, large soft tissue mass, long zone of transition, and osteosclerosis. Additionally, about 1/3 invaded into adjacent bones.

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9
Q

What is the most common vertebral tumor? What percent of this tumor type affects the axial skeleton? What size dog is more affected by axial versions of this tumor?

A

OSA and 20% and small dogs

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10
Q

What is a skip metastasis, and in what tumor type are they encountered?

A

Frequently associated with OSA, and refers to the presence of discontinuous lesions within one bone (vertebra in our case). Typically considered a poor prognostic.

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11
Q

What were the findings of this paper?

A

Non-invasive VNS improved seizure frequency in 9/14 (majority) of dogs, but this was not statistically significant. Minimal side effects were reported, with hoarseness, limb trembling, behavioral changes aaaaaand increased seizures in 4 dogs.

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12
Q

What is the recommended angle of flexion with flexed radiographs to detect AA instability? How do you measure the angle?

A

51 degree

You draw a line connecting the external occipital protuberance to the caudal aspect of the tympanic bullae, and then another line parallel to the dorsal aspect of the vertebra canal at C2. Their intersection is the angle of interest.

The more flexed, the smaller the angle.

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13
Q

What is the angle that should be measured to assess for AAI in this paper? A value of what or greater is associated with AAI?

A

They measured the AAA — atlas to axis angle, and anything greater than 10 degrees was 90% sensitive / specific for a diagnosis of AAI.

This angle was measured by the intersection of lines drawn at the roof of canal at C1 and C2.

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14
Q

What are the MRI findings in acute canine distemper virus? Chronic?

A

Acute — T2 hyperintensities and loss of grey/white matter distinction typically in brainstem / cerebellum; correlates with areas of demyelination

Chronic — bilaterally symmetric T2 hyperintensities at grey/white matter junction of forebrain, brainstem and cerebellum with atrophy of cerebellum

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15
Q

Which of the three main non-infectious inflammatory encephalitides in dogs does NOT affect the brainstem? Which one preferentially affects it?

A

NME typically only affects the cerebrum, while GME preferentially affects the brainstem. NLE can do both.

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16
Q

What is meningioangiomatosis?

A

This is technically a benign lesion characterized by a proliferation of meningothelial cells around small blood vessels.

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17
Q

Where do craniopharyngiomas typically occur?

A

Within the sella turcica, mimicking a pituitary mass

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18
Q

What is shivers?

A

This is an equine disorder characterized by difficulty walking backwards secondary to Purkinje cell axonopathy. The cell bodies are completely normal, but the axons express different genes and proteins that cause them to degenerate.

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19
Q

Are dogs the only definitive host for neospora?

A

No — wolves, coyotes and dingoes can also be definitive hosts

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20
Q

Exposure to neosporosis is more common in ___________ dogs, but infection is more common in __________ dogs.

What is the most common route of exposure in dogs? Significance?

A

Exposure — mixed breed
Infection — pure breeds

Vertical (transplacental) transmission — this means that most cases of clinical neosporosis are due to reactivation of a latent infection acquired in utero.

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21
Q

What other nuclei can be affected with metronidazole toxicity?

A

Red nuclei and vestibular nuclei

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22
Q

What do most publications consider as a positive neospora titer? What is necessary if you are below this value?

A

Anything > 1:800 (although maybe a lower titer could be considered in dogs with a pure neuromuscular form?)

You can still be considered positive if you have a positive IHC or PCR test result.

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23
Q

Administration of what type of drug often preceded development of clinical signs in this paper?

A

Steroids

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24
Q

What were the most common presenting NALs of these dogs?

A

Generalized myopathy and multifocal intracranial disease

any type of NAL could be present though to include focal myelopathy, polyneuropathy, etc…

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25
What two bloodwork abnormalities were common in these dogs?
ALT elevation (~360) and CK elevation (~3000)
26
True or false — although a number of these dogs presented with myelopathic signs, MRIs in these dogs did not reveal any spinal cord abnormalities. What MRI abnormalities were frequently identified?
True Muscular changes (masticatory most common) and intracranial changes
27
What was the duration of clindamycin treatment in these dogs? Why was it this way?
12-16 weeks OR two months after a plateau in clinical improvement. They did this more prolonged course because they had some early relapses with the 8 week course recommended by Greene.
28
What was the one year mortality rate for these dogs? How many dogs showed complete responses to treatment? Was relapse common or uncommon?
Approximately 50% 30% improved completely, 30% showed partial improvements Relapse was common
29
What were the possible breed predilections in this paper?
Retrievers and sighthounds
30
Which is more sensitive — neospora IFAT or neospora PCR?
IFAT is more sensitive — it is relatively uncommon to get a positive PCR result.
31
What was the complete response rate in this paper? Euthanasia rate?Were relapses common?
Complete response rate was very low, around 5%. Euthanasia rate was 30%. Relapses were very common (also about 30%).
32
What neurotransmitter do mossy fibers release? Climbing fibers? Granule cells? Purkinje cells?
Mossy — ACh Climbing — aspartate Granule cells — glutamate Purkinje cells — GABA
33
Young Alaskan Malamutes get an inherited disorder. What is it and what is the genetic mutation? What unique clinical feature has recently been associated with this disease?
They develop a DEMYELINATING polyneuropathy around 3-19 months of age that causes progressive weakness, inspiratory stridor and muscle atrophy. The mutation is the NDGR-1 gene. Recently, tongue atrophy has been associated with this disease, with biopsies showing angular atrophy (denervation) and changes in the hypoglossal nerve (less myelin, folded myelin, onion bulbs, and axonal degeneration).
34
What is this photo demonstrating?
The chevrons are pointing to atrophic / angular fibers. The arrowheads are pointing to hypertrophic muscle fibers that have centrally located nuclei. (This is a tongue biopsy from the degenerative polyneuropathy of Alaskan Malamutes)
35
What is this structure?
This is a small onion bulb, and is indicative of a demyelinating neuropathy.
36
What were the main findings of this study?
- Most cats are young (10 months) when their signs develop - EDX findings suggested just a purely motor axonopathy - Nerve biopsy supports an immune-mediated process - prognosis is typically good, although relapses can occur - treatment with steroids is unhelpful
37
What are the proposed criteria for diagnosis of feline IMPN? (8)
38
What were the results of this paper?
2/384 dogs (0.5%) developed acute hepatotoxicity. Another one had an asymptomatic ALT elevation. All of these dog developed this within a few weeks of starting the drug. Some of the chronically treated dogs (16) developed asymptomatic ALP / ALT elevations.
39
What tissue layer is preserved in cases of axonotmesis?
Perineurium
40
Which type of nerve injury does NOT result in spontaneous pathologic activity on EMG?
Neuropraxia
41
What were the main causes of sciatic nerve injury in this paper?
Trauma, iatrogenic (various fracture repairs) and boar bites
42
What were prognostic factors in this paper for dogs? Cats?
Dogs — ability to flex / extend the tarsus (more important than sensation), and a CMAP amplitude of 1.45 mV or greater Cats — none
43
What did this paper report in regard to the MRI appearance of hepatic encephalopathy?
Brain atrophy was the most common finding, and included the cerebellum! The atrophy was typically mild. Cerebral white matter and cerebellar nuclei were T2W hyperintense. NO patient had T1W hyperintensity of the lentiform nuclei.
44
What are these arrows pointing to, and what disease process is this?
The black arrows are pointing to the superior longitudinal fasciculus (connects frontal to parietal and occipital lobes), and the white arrows are pointing to the thalamus. This is an example of osmotic myelinolysis.
45
What are these arrows pointing to, and what disease process is this?
The black arrows are pointing to the superior longitudinal fasciculus, and the white arrows are pointing to the thalamus. This is an example of osmotic myelinolysis.
46
What are these anatomic structures and what is this an example of?
Fat arrow — oculomotor nuclei Skinny arrow — cerebellar nodulus Black arrow — caudal colliculi Dashed arrow — vestibular nuclei Thiamin deficiency Cats with this disease have similar MRI appearances… subjectively seems more dramatic.
47
What is a recent difference identified on MRI images between dogs and cats with hypertensive encephalopathy?
Dogs typically only have white matter changes within the parietal and occipital lobes, while cats have extension of the white matter changes into the frontal lobes (image).
48
What are these MRI images attempting to demonstrate? What is the diagnosis?
The white matter is hyper-intense and has become isointense to grey matter. These are examples of gangliosidosis.
49
What other LSD has a similar MRI appearance to gangliosidosis? What structure is prominently affected?
Fucosidosis Corpus callosum
50
What other LSD has a similar MRI appearance to gangliosidosis? What structure is prominently affected?
Fucosidosis Corpus callosum
51
What is the diagnosis and what might you expects to see on DWI?
This is L2-hydroxyglutaric aciduria, and the one case with DWI revealed restricted diffusion.
52
True or false — dogs with Lafora body disease typically have profound MRI changes. What are they?
False — often the MRI is completely normal, or mild atrophy is present.
53
Complete the chart
54
True or false — ethylene glycol toxicity can cause a similar pattern of restricted diffusion as bromethalin
True
55
Explain the pathophysiology of edema development in HE.
Excessive ammonia builds up in the brain — this gets converted to glutamine — excessive glutamine accumulates in the astrocytes — this leads to astrocyte dysfunction, compromise of BBB and edema formation.
56
Thiamin is an essential __________ in ________ metabolism.
Cofactor, glucose
57
Besides the obvious absence of the internal carotid, what artery is missing from the feline arterial circle?
Rostral communicating artery
58
What were two factors associated with improved outcome? What were factors associated with a worse outcome?
Improved outcomes were seen when definitive therapies were pursued (84 days) versus when they were not (26 days). Seizures also apparently were associated with a longer survival. Irregular tumor margins on MRI, T2W heterogeneity and drop mets.
59
What are two of the most common sphingolipidoses? Are the MRI appearances similar?
Globoid cell leukodystrophy and gangliosidosis. They have very similar MRI appearances with diffuse white matter hyperintensity that makes the grey and white matter isointense.
60
What is the numerical value for threshold potential?
-65 mV
61
Which is positive and which is negative — cathode v anode? What is the convention regarding the direction of an electrical current?
Anode is positive Cathode is negative The direction is related to the flow of positive charges.
62
Explain the convention behind the naming of electrodes for EDX.
This is different than previously taught. The black port contains the “active recording” electrode, AKA the cathode. The red port contains the anode (previously termed the reference). The green port contains the reference (previously referred to as the ground). Then the voltage (difference in electrical potential) between the reference and cathode, and the reference and anode are measured, and subtracted from each other to determine the net voltage difference between the anode and cathode.
63
Potentials recorded during electrodiagnostic testing are _____________ recordings of _____________ events.
Extracellular Intracellular
64
What is this an example of?
Butterfly glioma (in this case, a high grade oligodendroglioma).
65
True or false — there is a decreasing incidence of glioma the further back in the nervous system you go?
True — majority are located within the fronto-olfactory lobes, then the parietal/temporal lobes, then the diencephalon, then infratentorially and then spinal cord
66
What was the most common presenting sign?
Seizures
67
What were the three imaging distinctions between oligos and astrocytomas / undefined tumors found in this paper?
- Oligos had smoother margins - Oligos were more T1 hypointense - Oligos were more likely have ventricular contact
68
What blood test might be a more sensitive screening tool for discospondylitis compared to things like leukocytosis or fever?
C reactive protein
69
For cases of discospondylitis, dogs with a ___________ duration of clinical signs are more likely to have a CRP elevation? Were other clinical variables were associated with a CRP elevation?
Shorter None — things like the number of infected disc spaces, empyema, spinal cord compression, etc…. were not associated with CRP abnormalities.
70
What were the 2 things associated with clinical remission? 2 things associated with lack of clinical remission?
- younger age and concurrent endocrinopathies are associated with improved outcome - higher titer and regurgitation are associated with worse outcome
71
What particular part of the acetylcholine channel is targeted by antibodies in myasthenia?
Alpha subunit
72
Describe the grading of Chiari malformation and of syringomyelia.
CM0 — normal cerebellum CM1 — indented cerebellum CM2 — herniated cerebellum SM0 — no syrinx SM1 — syrinx less than 2mm SM2 — syrinx greater than 2 mm
73
Main findings of this paper?
1. All CKCSs had signs of CM 2. All these dogs did have abnormalities on their BAER tests — waveform V threshold around 40 dB — no waveform IV (normal in a lot of dogs), “bifid” waves 2&3 — generally latencies were longer for CM2 dogs compared to CM1 dogs
74
What is the impact of the number of copies of the FGF4L2 retrogene?
The more copies that you have (0, 1, or 2), the more mineralized discs you have, the more likely you are to have surgery at a younger age, and in the NSTDR, the longer the vertebrae and rounder the vertebral canal.
75
True or false — dogs without any copies of the CFA12 FGF4 retrogene are more likely to have cervical disc herniation than TL herniations compared to dogs with the retrogene.
True —42% of herniated discs in dogs with no FGF4 copies occurred in the neck.
76
What was the only type of hemivertebrae that Pugs had in this study? The significance of this?
The only had ventral hypoplasia, which resulted in them having more kyphosis than the other 2 breeds. In comparison, the other breeds had a wide variety of hemivertebrae morphology.
77
What is the name of the neurologic disease caused by EHV-1? What is a risk factor for developing this compared to other signs of EHV-1?
Equine herpes encephalomyelopathy Older age
78
How do cervical flexion and extension (respectively) alter the disc space width within the caudal cervical spine?
Flexion — decreased width in the ventral part of the disc Extension — decreased width in the dorsal part of the disc
79
What were the findings of this paper?
The use of the stylet-in technique was associated with more cellular debris and took longer than the stylet-out technique.
80
What F wave parameter directly correlated with the grade of thoracolumbar disc herniation? What parameters were unchanged?
F wave duration — so much so that a linear regression formula was created — 6 +2.7*IVDH grade (5 = DPN) The minimum latency and conduction velocities were unaffected.
81
Describe sidewinder gait in horses. What is the outcome of most of these horses?
This refers to a gait where the pelvic limbs/trunk drift to one side. It is most common in older horses, and has a variety of neurologic and orthopedic etiologies. Often EMG can be used to discriminate between these two broad etiologies. The outcome in most of these horses is poor, with a 79% case fatality.
82
How do glucocorticoids impact hippocampal and thalamic blood flow?
Decrease it
83
Which one of these was biomechanically inferior to the rest?
The dorsal clamp. The rest increased rigidity compared to the intact (and severed) ligament models.
84
In an experimental healthy dog model, what was the effect of C5-6 distraction / fusion on the adjacent C6-7 intradiscal pressure?
Essentially no change occurred in the annulus, with a mild increase in NP pressure when at maximum ROM. This could be different in diseased models.
85
What was more sensitive and what was more specific — CSF coccidiodes EIA antigen or antibody
The antigen test was 100% specific, but poorly sensitive (20%). The antibody test was certainly more sensitive (~50%), but not as specific (86%), but followed the general trend of the antigen test.
86
Above what concentration has it been shown that cytarabine is most effective? What is the “transit time” to get drugs delivered into the CNS? Can this concentration be reached with SQ boluses?
- 1 ug/mL - 5 seconds - Yes, but a single bolus dose does not reach a steady state in the blood stream, limiting how much can get in the CNS.
87
What are the 1 year euthanasia rates for dogs with MG? Cats?
Dogs — 40-60% Cats — 15%
88
What did this study show?
They demonstrated that by using a modified insulin pump, they could deliver a SQ CRI of cytarabine and achieve a steady state > 1 ug/mL of cytarabine for over 10 hours. This is equivalent to what we expect with IV CRIs, although they used a higher dose than we use (400 mg/m2).
89
What are the normal dimensions of the canine pituitary gland? Feline?
Canine — 10 x 7 x 5mm (L, W, H) Feline — 5.2 x 3.1 mm (W, H)
90
What vessels are these?
These are the cavernous sinuses, containing the internal carotid arteries within them, just lateral to the pituitary gland.
91
What were the main findings of this paper?
3D PDGs were very accurate in the cadaver models and 3 live dogs. Average of 2 degrees and 0.5 mm off.
92
What are the names of these vessels? Within what structures are they located? What connects them dorsally?
These are interarcuate branches of the venous sinus. They are located within the “cervical fibrous sheath” (which is not periosteum). There is an anastomosis that connects them dorsally, running through the interarcuate ligament.
93
What percent of the total body’s glucose does the brain use?
20%
94
What is this picture demonstrating? What lobes seem particularly sensitive? In cases with good outcomes, improvement within what time frame occurred?
This is showing severe grey matter swelling and edema secondary to a global hypoxic ischemic brain injury; this caused a secondary mass effect leading to herniation. The parietal and occipital lobes are particularly sensitive. Within 72 hours.
95
Approximately what percentage of dogs with Wobblers have the combined form? Does the combined form happen at the same site or separate sites? What was the impact of same site compression of neurologic grade?
~25% In the majority of cases, it happened at the same site. Dogs with same site compressions had worse neurologic grades.
96
For the imaging diagnosis of discospondylitis, which imaging modalities had poor agreement? Which one was more sensitive?
Radiographs and MRI had poor correlation, with MRI being more sensitive.
97
What were some risk factors identified in this study?
Prior cancer, dental disease, spinal surgery, trauma and steroid therapy.
98
Describe the T2W FLAIR mismatch sign. What tumor type does this identify in dogs? People? What did this sign correlate with on histopath?
Something that is hyperintense of T2W sequences that suppresses centrally with a rim of hyperintensity on FLAIR. Interestingly, in dogs it is 100% specific for low grade oligos (often with little contrast enhancement), while in people it’s specific for low grade astrocytomas. Correlated with the presence of microcysts and myxoid lakes.
99
What were the two most common causes of non-traumatic hemorrhagic myelopathy in dogs? Approximately what percentage of cases were idiopathic?
Angiostrongylus and SRMA ~35%
100
List the 7 categories assessed via the neurodisability score in this publication. Was a high or low score associated with worse function? Was this score predictive of anything in this study?
Ambulatory status, cerebral function, cerebellar function, brainstem function, visual function, postural abnormalities and seizures. A high score was consistent with worse clinical signs. This score helped predict who would make it out of the hospital but did not correlate with long-term outcome.

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