Problem solving - neurology

Question 1

Recall problem based clinical reasoning

Answer 1

1. define problem
   2, define system
2. define location
3. define lesion

Question 2

How to define the problem with collapse?

Answer 2

seizures of syncope?

Question 3

Define ‘can’t eat properly’?

Answer 3

inability to prehend or swallow food

Question 4

Define ‘vomits’

Answer 4

vomiting or regurgitation

Question 5

Define ‘wees a lot’

Answer 5

polyuric or pollakiuric

Question 6

What is the 6 finger rule?

Answer 6

1. localisation
2. signalment
3. onset
4. progression
5. symmetry
6. pain

Question 7

Localisation - hydrocephalus

Answer 7

brain

Question 8

Localisation - cerebellar abiotropy

Answer 8

cerebleeulm

Question 9

Localisation - atlanto-axial subluxation

Answer 9

upper cervical spinal cord

Question 10

Localisation - caudal cervical spondylomyelopathy

Answer 10

caudal cervical spinal cor

Question 11

Localisatio - spinal nephroblastoma (uncommon)

Answer 11

spinal cord (thoracic - lumbar?_

Question 12

Localisation - myasthenia gravis (MG)

Answer 12

NMJ

Question 13

Localisation -muscular dystrophy

Answer 13

mm bed

Question 14

Localisation -vincristine neuropathy

Answer 14

peripheral nn

Question 15

Outlien localisation -lesion distribution - 3

Answer 15

• FOCAL: neoplasia, IVDH, congenital malformation
• MULTIFOCAL: inflammatory, infection, multifocal neoplasia: lymphoma
• DIFFUSE: neurodegenerative, metabolic

Question 16

What are the different onsets of (neuro) diseases

Answer 16

• per-acute
• acute
• sub-acute
• chronic
• acute on chronic

Question 17

What are the different classifications of ‘progression’ of (neuro) diseases?

Answer 17

• improving
• static
• deteriorating
• waxing and waning
• episodic
• paroxysmal

Question 18

Are there pain receptors in the spinal cord?

Answer 18

No

Question 19

List the 8 parts to the neuro exam

Answer 19

1. mentation
2. posture
3. gait
4. postural reactions
5. spinal reflexes
6. cranial nerves
7. palpation
8. nociception

Question 20

What should you do if you suspect a focal lesion?

Answer 20

imaging

Question 21

What should you do if you suspect infection/ inflammation?

Answer 21

Minimum database- CBC, biochem, UA

Question 22

What are teh most important aspects of patient hx in neuro cases? 3

Answer 22

• signalment
• onset
• progression

Question 23

What are the most important things to determine on physical and neuro exam?

Answer 23

• localisation
• symmetry
• presence of pain

Then choose diagnostic tests based on remaining ddx (the true rule outs)

Question 24

What is the ddx based on? 6

Answer 24

• localisation
• signalment
• onset
• progression
• symmetry
• pain

Question 25

What is mucopolsaccharidosis (MPS)?

Answer 25

- rare disease - affects young animals - pure bred - progressive - multi-system involvement (can cause lameness)

Question 26

Diagnosis - MPS

Answer 26

- urine MPS spot test: measures GAG | - enzyme activity of leukocytes (EDTA) and activity of arlysulfatase B activity

Question 27

Outcome - MPS

Answer 27

- poor prognosis | - genetic counselling