Drugs
What is the difference between Keppra regular release and Keppra extended release?
Keppra RR - lasts 8 hours, so dosed q8hr
Keppra XR/ER - lasts 12 hours, so dosed q12hr (and cannot split/cut these tablets)
What part of the brain is responsible for generating seizure activity?
1) Cerebellum
2) Brainstem
3) Forebrain
Forebrain
An owner shows you a video of their Boxer playing around in the back yard and then collapsing and seeming unconscious for a period of time. They think this is a seizure. What else should we consider that isn't neuro?
Syncope (heart disease)
What is the inside of the intervertebral disc called?
What does CK (creatine kinase, NOT creatinine the kidney enzyme) measure/tell us?
Muscle injury/inflammation
(We track this in our polymyositis cases)
Phenobarbital is metabolized by what organ?
Liver
1) Absent nasal sensation - LEFT
2) Left back leg proprioception is delayed
3) Generalized proprioceptive ataxia
4) Absent menace - LEFT
Where do you localize? (side and part of brain)
Right forebrain
What are the 3 criteria for owners to seek emergency care for seizures in their pet?
1) More than 2 seizures in 24 hours
2) Seizure that lasts longer than 5 minutes
3) Patient not regaining consciousness following a seizure
An AA luxation is defined as excessive laxity (looseness, instability) between what two vertebrae?
C1 and C2
What is the dosage (mg/kg/hr) that we typically start a midazolam CRI at for seizure control?
Acceptable answers:
0.3-0.5mg/kg/hr
What patient would benefit from amantadine?
A) Patient with cluster seizures
B) Patient with severe neck pain
C) Patient whose bladder is difficult to express
B - Patient with severe neck pain
Amantadine is an NMDA-antagonist, which helps with wind-up pain, usually seen with chronic neck pain
A Frenchie had a hemilaminectomy for a herniated disc and was paraplegic DPN. The day after discharge, the owners call and are excited that when they pinch the dog's toes, he pulls the leg back. You tell them:
1) This is a sign of myelomalacia unfortunately.
2) This is likely just a reflex if he isn't visually reacting to the pinch (ex: looking back, trying to bite, etc)
3) This is a sign of improvement! Can't wait to see him back at his recheck!
2) This is likely just a reflex if he isn't visually reacting to the pinch (ex: looking back, trying to bite, etc)
Match tumor with where it is commonly seen in the brain:
Meningioma, glioma, pituitary tumor
Base of brain, within the brain, surface of brain pressing in
Meningioma - surface of brain pressing in
Glioma - within the brain
Pituitary tumor - base of brain
*Pull up spinal radiograph picture*
What is the name of these abnormally shaped vertebrae that we commonly see in Frenchies? (indicated by yellow arrows)
Hemivertebrae
When we have a first time seizure patient, we always ask if they have had labs because seizures can occur from inside the brain or outside the brain (extracranial, or metabolic) Name two extracranial causes of seizures or neurologic signs that we can catch on labs?
Hypoglycemia
Liver dysfunction (bile acid testing)
Severe anemia
Severe hypocalcemia
We have a patient with cluster seizures who is continuing to have seizures, despite being on a midazolam CRI. Name two different CRIs we can start to help control the seizures?
Acceptable answers:
-Ketamine CRI
-Dexmedetomidine CRI
-Propofol CRI
What are the four segments of spinal cord we can localize to?
C1-C5
C6-T2
T3-L3
L4-S3 (some people say L4-S1)
What is the name of the scale that helps grade severity of head trauma?
MGCS (Modified Glasgow Coma Scale)
We see discospondylitis on MRI. Thinking about the causes of disco, what diagnostics do we want to run? (List 3)
Urine culture
Fungal titers
Blood cultures
Brucella testing
What is the difference between obtunded, stuporous, and comatose?
Obtunded - just dull
Stuporous - responsive only to noxious stimuli
Comatose - not responsive at all, not even to noxious stimuli
Rank the 4 seizure medications in order of how fast it takes the drug to get to therapeutic blood levels in a naive patient (quickest to longest).
KBr
Keppra
Phenobarb
Zonisamide
Keppra (24hr)
Zonisamide (3-5 days)
Phenobarbital (2 weeks)
KBr (3 months)
What is Schiff Sherrington posture (what does it look like in the patient)?
Bonus 100: Where does it localize the problem to?
Lateral recumbency posture
Hyperextended front legs (increased tone) + flaccid back legs
Bonus: T3-L3
Order the following pupil changes in terms of how severe the brain swelling or trauma is (least severe to most severe):
-Bilateral miosis
-Anisocoria
-Bilateral mydriasis
Least severe = anisocoria
Moderate = Bilateral miosis
Most severe and concerning = Bilateral mydriasis
What percentage of spinal fractures can you miss on radiographs? (and therefore need CT or MRI to see)
A) 0; radiographs catch all spinal fractures
B) 10%
C) 25%
D) 50%
C) 25%
Sometimes we use diazepam to help ease bladder expression, in addition to prazosin. What does diazepam help relax?
Acceptable answers:
-External urinary sphincter
-Abdominal body wall