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Questions and Answers
What is the primary function of the ascending reticular activating system (ARAS)?
What is the primary function of the ascending reticular activating system (ARAS)?
Which of the following best describes the condition known as obtundation?
Which of the following best describes the condition known as obtundation?
What might continuous head tilt suggest about a patient's condition?
What might continuous head tilt suggest about a patient's condition?
In assessing mental status, which of the following indicates a positive outcome?
In assessing mental status, which of the following indicates a positive outcome?
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What is a likely effect of the affectation of the ARAS?
What is a likely effect of the affectation of the ARAS?
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Which observation might indicate a central nervous system disorder?
Which observation might indicate a central nervous system disorder?
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What physical observation could be associated with acquired injuries or congenital deformities?
What physical observation could be associated with acquired injuries or congenital deformities?
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Which of the following describes the mental state of a patient in a coma?
Which of the following describes the mental state of a patient in a coma?
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What characterizes tremors in involuntary movements?
What characterizes tremors in involuntary movements?
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Which observation method involves identifying pain and scars?
Which observation method involves identifying pain and scars?
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What is myoclonus characterized by?
What is myoclonus characterized by?
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What is a primary concern when assessing postural reactions?
What is a primary concern when assessing postural reactions?
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Which of the following describes cataplexy?
Which of the following describes cataplexy?
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What does the wheelbarrowing method in postural reactions involve?
What does the wheelbarrowing method in postural reactions involve?
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Which symptom is part of the semiotic approach's observation method?
Which symptom is part of the semiotic approach's observation method?
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What aspect of palpation examines a skeletal system abnormality?
What aspect of palpation examines a skeletal system abnormality?
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What should be emphasized when performing hopping in severely affected patients?
What should be emphasized when performing hopping in severely affected patients?
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What is a normal response for the extensor postural thrust?
What is a normal response for the extensor postural thrust?
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How should the placing reaction be performed?
How should the placing reaction be performed?
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Which statement about normal animal movement is false?
Which statement about normal animal movement is false?
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When conducting postural reactions, what should be done for the pelvic limbs?
When conducting postural reactions, what should be done for the pelvic limbs?
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What is the primary concern when conducting hopping tests in severely affected patients?
What is the primary concern when conducting hopping tests in severely affected patients?
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What should be observed during the placing reaction?
What should be observed during the placing reaction?
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What is indicated by a normal response during hopping?
What is indicated by a normal response during hopping?
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What is the primary function of the facial nerve (VII)?
What is the primary function of the facial nerve (VII)?
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Which cranial nerve is assessed by checking for a gag reflex?
Which cranial nerve is assessed by checking for a gag reflex?
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What does the examination of physiologic nystagmus involve?
What does the examination of physiologic nystagmus involve?
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What condition is indicated by medial strabismus resulting from a lesion?
What condition is indicated by medial strabismus resulting from a lesion?
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Which cranial nerve is responsible for sensory input regarding head position?
Which cranial nerve is responsible for sensory input regarding head position?
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What is assessed when performing the menace response?
What is assessed when performing the menace response?
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What is one indication of dysphagia during a cranial nerve examination?
What is one indication of dysphagia during a cranial nerve examination?
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What is the primary function of the vagus nerve (X)?
What is the primary function of the vagus nerve (X)?
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What primary function does the Oculomotor nerve (III) provide?
What primary function does the Oculomotor nerve (III) provide?
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How is the function of the Trochlear nerve (IV) primarily assessed?
How is the function of the Trochlear nerve (IV) primarily assessed?
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What is the role of the Abducens nerve (VI)?
What is the role of the Abducens nerve (VI)?
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What symptoms would indicate a lesion in the Oculomotor nerve (III)?
What symptoms would indicate a lesion in the Oculomotor nerve (III)?
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Which cranial nerve is primarily responsible for sensory function to the cornea?
Which cranial nerve is primarily responsible for sensory function to the cornea?
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What is a possible test outcome when examining the function of the Trigeminal nerve (V)?
What is a possible test outcome when examining the function of the Trigeminal nerve (V)?
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Which action is NOT associated with the Oculomotor nerve (III)?
Which action is NOT associated with the Oculomotor nerve (III)?
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What function does the Trigeminal nerve (V) NOT serve?
What function does the Trigeminal nerve (V) NOT serve?
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What type of lesions does the spinal reflex assessment indicate when examining nervous symptoms?
What type of lesions does the spinal reflex assessment indicate when examining nervous symptoms?
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Which section of the spine is associated with Upper Motor Neuron (UMN) signs for both thoracic and pelvic limbs?
Which section of the spine is associated with Upper Motor Neuron (UMN) signs for both thoracic and pelvic limbs?
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What is a distinguishing feature of Lower Motor Neuron (LMN) lesions compared to Upper Motor Neuron (UMN) lesions?
What is a distinguishing feature of Lower Motor Neuron (LMN) lesions compared to Upper Motor Neuron (UMN) lesions?
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Which of the following cranial structures is affected by Intracranial lesions?
Which of the following cranial structures is affected by Intracranial lesions?
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What is the role of Cerebrospinal fluid (CSF) in the nervous system?
What is the role of Cerebrospinal fluid (CSF) in the nervous system?
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What diagnostic test involves the collection and examination of CSF?
What diagnostic test involves the collection and examination of CSF?
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Which of the following is NOT a common diagnostic test in neurology?
Which of the following is NOT a common diagnostic test in neurology?
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Which lesions are connected to decreased spinal reflexes?
Which lesions are connected to decreased spinal reflexes?
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Which sections of the spine show normal function in the pelvic limbs?
Which sections of the spine show normal function in the pelvic limbs?
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In the semiotic approach to nervous symptoms, what is essential for localizing the lesion?
In the semiotic approach to nervous symptoms, what is essential for localizing the lesion?
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Study Notes
Semiotic Approach to Nervous Symptoms
- Integrated clinical reasoning—a structured approach to diagnosing and treating nervous system disorders in veterinary patients.
Introduction
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Central Nervous System (CNS):
- Brain
- Brainstem
- Cerebellum
- Spinal cord
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Peripheral Nervous System (PNS):
- Cranial nerves
- Spinal nerves
- Peripheral nerves
- Sensory neurons
- Motor neurons
- Neurologic Exam: Identify and localize neurological dysfunction.
Introduction (Injury Classification)
- Upper Motor Neuron (UMN) (↑): Cerebral cortex, cerebellum, spinal cord
- Lower Motor Neuron (LMN) (↓): Nerves branching out from the spinal cord
Semiotic Approach to Nervous Symptoms
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1. Observation:
- Mental status (e.g., normal, depression/obtundation, stupor, coma)
- Posture (e.g., head tilt, abnormalities of trunk, limb posture, hemi/decerebration/decerebellation postures)
- Gait (e.g., wide-based stance, knuckling, ataxia, tremor, myoclonus, cataplexy)
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2. Palpation:
- Evaluate the condition of the skin, skeletal system and muscular system. Look for areas of pain, scars, masses, abnormal contour, motion, crepitation, size, tone, and strength of the musculoskeletal system.
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3. Postural Reactions:
- Knukling: Assessing limb positioning without visual cues.
- Wheelbarrowing: Elevating pelvic limbs to assess animal balance and coordinated movement.
- Hopping: Carefully assess the animal's ability to hop.
- Extensor Postural Thrust: Assessing limb movements.
- Placing Reaction: Assessing the ability to place a limb onto a surface.
- Hemi-walking: Assessing the movement of one side of the body.
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4. Spinal Reflexes:
- Patellar reflex: Stimulate knee tendon; assess for proper tibia and stifle extension.
- Gastrocnemius reflex: Evaluate L6(7) to S1 spinal nerves and the tibial branch of the sciatic nerve by stimulating the calf muscles.
- Cranial tibial reflex: Evaluates L6-L7 and S1 spinal nerves and peroneal branch of sciatic.
- Triceps reflex: Evaluate C7-T2 spinal nerves; assesses the animal's ability to reflexively extend its elbow.
- Biceps reflex: Evaluate C6 to C8 spinal nerves and, the musculocutaneous nerve.
- Withdrawal reflexes (thoracic and pelvic limbs): Assess the response to pinching and touching the skin on the patient's extremities.
- Cutaneous trunci reflex: Assess for the response of twitching the cutaneous muscle.
- Perineal reflex: Evaluate S1 to S3 spinal nerves; assessing the animal's ability to reflexively contract muscles in the pelvic region.
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5. Cranial Nerves:
- Olfactory (I): Smell testing
- Optic (II): Vision testing (following, obstacles, menace response, pupil response)
- Oculomotor (III): Checking for physiologic nystagmus, rotation of head, and pupil reaction
- Trochlear (IV): Eye movement testing.
- Trigeminal (V): Facial muscle testing (symmetry, palpation, jaw reflex)
- Abducens (VI): Eye movement testing.
- Facial (VII): Facial expression testing, reaction to stimulation of medial pinna, menace response
- Vestibulocochlear (VIII): Hearing and balance testing (e.g., startle response)
- Glossopharyngeal (IX): Gag reflex and assess for swallowing problems.
- Vagus (X): Gag, deglutition reflex, and laryngeal paralysis.
- Accessory (XI): Neck muscle assessment.
- Hypoglossal (XII): Tongue movement and symmetry testing.
- 6. Sensation of Pain Perception: Evaluating deep and superficial pain perception.
Diagnostic Tests in Neurology
- Cerebrospinal fluid (CSF) collection and examination
- Radiography
- Cerebral angiography
- Computerized Axial Tomography (CAT scan)
- Magnetic resonance imaging (MRI)
- Scintigraphy
- Electromyography and electroneurography
Extracranial and Intracranial Lesions
- Extracranial lesions originate outside the skull.
- Intracranial lesions originate within the skull.
- Locations are presented by spinal nerve and muscle segments and brain regions (e.g., brainstem, diencephalon, vestibular system, cerebellum, cerebral hemispheres).
Clinical Features (UMN vs LMN)
- Descriptions of impairments for upper motor neurons (UMN) and lower motor neurons (LMN).
Spinal Lesions
- Location on spinal cord corresponding to thoracic and pelvic limbs—UMN, LMN, Normal.
Semiotic Approach to Sense Organs
- 1. Vision (Sight): Ocular changes (e.g., cataracts, glaucoma), neurological problems (e.g., central or optic nerve), and systemic issues (e.g., diabetes, toxic effects) may result in blindness.
- 2. Audition (Hearing): Ear related issues, congenital hearing loss, ototoxicity, neurologic disorders, and traumatic events can all detriment hearing.
- 3. Olfaction (Smell): Issues/problems can be nose related, infectious and/or neurological, or due to toxic inhalants.
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Description
This quiz explores the semiotic approach to understanding and diagnosing nervous system symptoms in veterinary patients. It covers the structure of the central and peripheral nervous systems, injury classification, and key observations to assess neurological dysfunction. Test your knowledge of clinical reasoning within this specialized veterinary field.
