NAVC Institute 2014
Neurology for Neurophobes
Self-Assessment Exam KEY
1.
In the following T2-weighted transverse MR image of the brain of a dog, the asterix (*)
indicates a hyperintense area in what region of the brain?
a.
b.
c.
d.
e.
2.
Occipital lobe
Thalamus
Fourth ventricle
Midbrain
Temporal lobe
In the followingT2 sagittal MR image of the brain of a dog, the asterix (*) indicates what
structure?
a.
b.
c.
d.
e.
Midbrain
Olfactory bulb
Interthalamic adhesion
Rostral colliculi
Corpus callosum
2
3.
A 4yr German Shepherd dog presents with the following neurological signs:
Tetraparesis
Conscious proprioceptive deficits in all four limbs
Which of the following neuroanatomical localizations is LEAST likely?
a.
b.
c.
d.
e.
4.
A German shepherd dog presents with neurological signs consistent with a T3-L3
myelopathy. There is NO apparent spinal pain on examination. Based on these findings
ALONE, which are the MOST likely differential diagnoses?
a.
b.
c.
d.
e.
5.
Granulomatous meningoencephalomyelitis (GME)
Cryptococcal meningomyelitis
Type I intervertebral disc extrusion
Traumatic fracture/luxation
Fibrocartilagenous embolism (FCE)
A cat with feline infectious peritonitis has 2 lesions affecting the spinal cord. These
lesions are at the level of the C3 and T11 spinal cord segments. Which of the following
combination of clinical signs would be MOST likely to be found on examination?
a.
b.
c.
d.
e.
7.
Type II degenerative disc disease / Neoplasia
Fibrocartilagenous embolism (FCE) / Degenerative myelopathy
Type II degenerative disc disease / Degenerative myelopathy
Bacterial epidural empyema / Type I degenerative disc disease
Granulomatous meningoencephalomyelitis (GME) / Vertebral fracture
A 4-year-old poodle presents with an acute onset of tetraparesis? The clinical signs
appear to be progressive, and the dog appears to have significant pain with manipulation
of the neck. Which of the following is the LEAST likely differential diagnosis?
a.
b.
c.
d.
e.
6.
C1-C5 myelopathy
C6-T2 myelopathy
Polyneuropathy
T3-L3 myelopathy
Diffuse/multifocal myelopathy
Tetraparesis / Decreased thoracic limb reflexes / Normal pelvic limb reflexes
Decreased pelvic limb reflexes / Paraparesis / Panniculus cut off (level of last rib)
Thoracic limb paresis / Normal pelvic limbs / Normal thoracic limb reflexes
Panniculus cut off (level of last rib) / Tetraparesis / Normal thoracic limb reflexes
Decreased thoracic limb reflexes / Decreased pelvic limb reflexes / Spinal pain
Which of the following conditions is LEAST consistent with a neuroanatomical
localization of a C1-C5 myelopathy?
a.
b.
c.
d.
e.
Type I intervertebral disc extrusion
Type II intervertebral disc protrusion
Degenerative myelopathy
Fibrocartilagenous embolism (FCE)
Atlanto-axial instability/luxation
3
8.
Which of the following statements regarding (conventional) central vestibular syndrome
is FALSE?
a.
b.
c.
d.
e.
9.
Which of the following clinical signs is NOT expected in association with right-sided
otitis media interna?
a.
b.
c.
d.
e.
10.
Head tilt and circling are TOWARDS the side of the lesion
Nystagmus can be horizontal, rotary or vertical and may change direction with
different positions of the head
Reduced mentation may be present due to disturbance of the reticular activating
system in the brainstem
Ipsilateral hemiparesis or conscious proprioceptive deficits may be present due to
involvement of upper motor neuron pathways
Horner’s syndrome commonly is associated with central vestibular syndrome
Right facial nerve paresis
Right head tilt
Right masseter and temporalis muscle atrophy
Horizontal nystagmus with fast phase to the left
Right Horner’s syndrome
An 8-year-old female Rottweiler presents to you with following clinical signs:
Head tilt and leaning to the left side
Positional vertical, dysconjugate, nystagmus
Masseter and temporalis muscle atrophy on the right side
Proprioceptive deficits on the right side
What is the correct localization of this lesion?
a.
b.
c.
d.
e.
11.
Left-sided peripheral vestibular disease
Right-sided peripheral vestibular disease
Left-sided central vestibular disease
Bilateral peripheral vestibular disease
Right-sided paradoxical vestibular disease
Which of the following diagnostic procedures is most useful for diagnosis of congenital
deafness?
a.
b.
c.
d.
e.
Brainstem auditory evoked response (BAER) determination
Magnetic resonance imaging (MRI)
Cerebrospinal fluid collection and analysis
Otoscopic examination
Complete blood count and serum biochemistry profile
4
12.
Which of the following statements regarding vestibular disease is true?
a.
b.
c.
d.
e.
13.
Rotary nystagmus can be seen with central vestibular disease
The direction of the fast phase of the nystagmus is towards the side of the lesion
in peripheral disease
Vertical nystagmus indicates that the vestibular signs are central in origin
Both (a) and (c) are correct
All of the above are correct
A Cocker spaniel presents with the following neurological signs:
A non-positional horizontal nystagmus
(fast phase to right)
Left head tilt
Left ventral strabismus
Rolling and falling to the left side
[Note. You must answer this question
without knowledge of the findings
on a physical examination]
Which of the following is the most appropriate differential list?
a.
b.
c.
d.
e.
14.
Otitis media interna/old dog vestibular disease/gentamicin (an aminoglycoside)
toxicity
Old dog vestibular disease/granulomatous meningoencephalitis/metronidazole
toxicity
Meningioma/otitis media interna/aural polyps
Trauma/canine distemper/old dog vestibular disease
Granulomatous meningoencephalitis/hydrocephalus/bacterial encephalitis
Which of the following statements regarding CSF (cerebrospinal fluid) analysis
is FALSE?
a.
b.
c.
d.
e.
A predominantly neutrophilic pleocytosis would be expected in bacterial diseases
and FIP (feline infectious peritonitis)
An increase in mononuclear cells could be seen with viral infections of the CNS
The presence of inflammatory cells in the CSF provides a definitive diagnosis of
GME
Increased numbers of both mononuclear cells and neutrophils often are seen with
active mycotic and protozoal diseases
The presence of antibodies to specific infectious agents, or antigen in the CSF,
may be useful in providing evidence of infection
5
15.
Multifocal CNS signs may occur with intracranial neoplasia. This is known to occur in all
of the following ways EXCEPT:
a.
b.
c.
d.
e.
16.
Idiopathic epilepsy best describes seizures:
a.
b.
c.
d.
e.
17.
Secondary to a brain tumor
That have developed after previous head trauma
That are genetically inherited
Of unknown cause
Post-encephalitis
A 4-year-old female spayed German shepherd dog presents to you four days after the
second of TWO generalized tonic-clonic seizures experienced during the previous 2
weeks. On neurological examination, the dog compulsively circles to the right, and
occasionally gets stuck in corners and bumps into things. All of the following are likely
causes for her seizures EXCEPT:
a.
b.
c.
d.
e.
18.
Large intracranial tumors can cause destruction and compression of surrounding
brain structures
Secondary intracranial tumors may have multiple metastases to the brain causing
clinical signs reflective of the various tumor locations
Edema caused by the neoplasm may compress adjacent structures or an entire
region of the brain
Elevated intracranial pressure, secondary to an expanding neoplasm, may cause
dramatic shifts of brain parenchyma, leading to multifocal signs
Cytokines released from large intracranial neoplasms may cause diffuse CNS
dysfunction.
Right parietal meningioma
Idiopathic epilepsy
Cryptoccal meningoencephalitis
Metastatic hemangiosarcoma
Obstructive hydrocephalus
“Symptomatic” (or secondary) epilepsy would best describe all EXCEPT:
a.
b.
c.
d.
e.
Seizures from a genetic cause
Seizures from a congenital anomaly
Seizures following head trauma
Seizures from hydrocephalus
Seizures from a cerebral oligodendroglioma
6
19.
One of your very good clients is a Labrador breeder. While picking up heartworm
medication for one of her other dogs, she tells you her 3-year-old intact female Labrador,
Lola, had a “grand mal” (generalized) seizure two days ago. She asks for a prescription
for phenobarbital because: “Lola must be an epileptic; seizures tend to run in her line;
and Lola’s uncle had epilepsy”.
All of the following are appropriate actions for you to take, EXCEPT:
a.
b.
c.
d.
e.
20.
A 5-year-old castrated Australian shepherd dog presents to your emergency clinic in
status epilepticus. The owner says he had never had a seizure before this, and had been
normal up to this point. What is the LEAST likely cause for his seizures?
a.
b.
c.
d.
e.
21.
Idiopathic epilepsy
Strychnine intoxication
Intracranial neoplasia
Hypoglycemia
Congenital anomaly
What is the drug of choice to stop the seizures of the dog suffering from status epilepticus
in Question 20 (above)?
a.
b.
c.
d.
e.
22.
Ask her to bring Lola in for a physical and neurological examination
Write the prescription for KBr for Lola’s epilepsy, as it is less likely to cause liver
problems than Phenobarbital
Counsel her about whether she intends to breed Lola with the suspicion of
inherited seizures
Discuss trying to rule out other causes for seizures with blood work and possibly
MRI and CSF
Ask if Lola has any possible toxin exposure
Intravenous Phenobarbital
Oral KBr
Oral Phenobarbital
Intravenous valium
Intravenous NaBr
A 10-year-old castrated cat presents to you with a history of episodes of
generalized collapse. What is the LEAST likely cause for this cat’s episodes?
a.
b.
c.
d.
e.
Cardiovascular disease
Metabolic disease
Seizures
Idiopathic epilepsy
Generalized neuromuscular disease
7
23.
Which of the following statements is FALSE?
a.
b.
c.
d.
e.
24.
Which of the following is/are most correct regarding an absent palpebral reflex in a dog?
a.
b.
c.
d.
e.
25.
The menace reaction evaluates CN II and CN V
The lip pinch evaluates CN IV and the cerebral cortex
The trigeminofacial reflex evaluates CN IV and CN VII
The palpebral fissure may be wider than normal with facial nerve dysfunction
With acute facial nerve dysfunction, the lip is usually pulled toward the abnormal
side
“Bessie”, a 5 year old female spayed spaniel mix dog, has an acute onset of a droopy ear
and lip on the right side. The dog is unable to close the right eye, and is dropping food
out of the right side of the mouth. The remainder of the neurological examination is
unremarkable. The dog has an otherwise unremarkable history and physical examination.
The most likely diagnosis is:
a.
b.
c.
d.
e.
27.
Reflects an abnormality of CN V or VII
Reflects an abnormality of CN IV or V
Reflects an abnormality of CN III or IV
Reflects an abnormality of CN V or VI
Reflects an abnormality of CN VI or VII
Which of the following is most correct?
a.
b.
c.
d.
e.
26.
Phenobarbital may cause idiosyncratic blood dyscrasias
Chronic valium administration may cause fatal hepatotoxicity in cats
The half-life (T 1/2) of KBr in dogs is about 25 days
KBr may cause asthma in cats
Elevated liver enzymes with phenobarbital administration indicate hepatotoxicity
Trigeminal neuritis
Idiopathic facial nerve paralysis
Neoplasia
Toxicity
Otitis media-interna
Which of the following is the least correct?
a.
b.
c.
d.
e.
The Schirmer tear test may be useful in localization of a facial nerve problem
The facial nerve exits the skull through the stylomastoid foramen
The facial nerve enters the skull with the trigeminal nerve at the internal
acoustic meatus
The chorda tympani nerve innervates the salivary glands
Listeriosis in cattle may cause a central type of facial paralysis
8
28.
Which of the following statements regarding idopathic tremor syndrome (“shaker dogs”)
is TRUE?
a.
b.
c.
d.
e.
29.
Constant tremors in animals are:
a.
b.
c.
d.
e.
30.
Tremors persevere during sleep
Tremors are similar to the tremors of myoclonus
Tremors affect only white dogs of toy breeds
Tremors are generalized and acute in onset
Tremors are asymmetrical and oscillating
associated with diffuse neuromuscular dysfunction
diminished by voluntary movement
more severe during sleep
seen as part of “cerebellar syndrome”
associated with multifocal spinal cord disorders
A 7-year-old dog is presented to you immediately following being hit by a car.
Neurological examination reveals the following clinical signs:
Loss of consciousness
Hyperextension of the neck, trunk, and thoracic limbs (opisthotonus)
Pelvic limbs held in rigid extension
This abnormal posture is most consistent with:
a.
b.
c.
d.
e.
31.
Which of the following statements regarding nigropallidal encephalomalacia (yellow star
thistle poisoning) of horses is TRUE:
a.
b.
c.
d.
e.
32.
cranial cervical lesion
decerebellation
unilateral cerebral cortical infarction
decerebration
Schiff-Sherrington sign
This disorder affects the basal nuclei, which are not considered part of the
Affected animals may have intention tremors of the lips and tongue
This disorder may occur following a single exposure to yellow star thistle
Affected animals may have difficulty in initiating movement
This disorder affects the specific cortical areas involved with motor function
Cerebellar hypoplasia resulting from feline panleukopenia virus infection
in utero is a disease that:
a.
b.
c.
d.
e.
results in signs of progressively worsening cerebellar dysfunction
affects only the cerebellum, sparing other parts of the brain
results in hypoplasia of the granular cell layer
produces malformations of the cerebellum and spinal cord
destroys the internal germinal layer of the developing cerebellar cortex
9
33.
Which of the following statements regarding intracranial neoplasia is TRUE?
a.
b.
c.
d.
e.
34.
Which of the following statements regarding the medical therapy of brain trauma is
MOST CORRECT?
a.
b.
c.
d.
e.
35.
Hydrocephalus may be associated with in utero toxins
Hydrocephalus rarely affects the lateral ventricles
Hydrocephalus may result in altered mental status, seizures, and blindness
Hydrocephalus may have a progressive clinical course
Both congenital and acquired forms of hydrocephalus may be seen
Which of the following statements regarding brain tumors in cats and dogs is TRUE?
a.
b.
c.
d.
e.
37.
Dexamethazone is an effective specific medical therapy for reduction of increased
intracranial pressure
For a favorable prognosis, a response to hyperosmolar agents should be evident
Progression from hyperventilation to chaotic respiration is a favorable prognostic
Intracranial injury frequently causes shock
Hemorrhage and edema are uncommon sequelae to brain trauma
Hydrocephalus is the pathological accumulation of CSF in the ventricular system of the
brain.
Which of the following statements regarding hydrocephalus is FALSE?
a.
b.
c.
d.
e.
36.
Small tumors in the olfactory process result in severe clinical signs
Clinical signs of a brain tumor may be identical to those of encephalitis
Brain tumors almost always cause a slow and insidious progression of clinical
Focal seizure activity (if present) seldom aids in localizing a brain tumor
Clinical signs of a brain tumor develop independently from tumor location and
Astrocytoma is the most frequently diagnosed tumor type in cats and dogs
Primary brain tumors do not metastasize to the lungs
Primary brain tumors are more common in cats than in dogs
Primary brain tumors may occur in dogs less than 6 months-of-age
Multiple primary brain tumors do not occur in cats and dogs
Which of the following statements regarding granulomatous meningoencephalo-myelitis
(GME) is INCORRECT?
a.
b.
c.
d.
e.
Cerebrospinal fluid in GME has a mixed pleocytosis and elevated protein content
GME is characterized by perivascular cuffing of lymphocytes, macrophages and
Treatment for GME consists of immunosuppressive therapy
GME affects only poodles and terriers
GME is a disease of undetermined cause
10
38.
An animal that generally is unresponsive, except to vigorous and repeated stimuli that
may be painful, is said to be:
a.
b.
c.
d.
e.
39.
Which of the following diagnostic tests is most contraindicated in a patient with severe
brain trauma?
a.
b.
c.
d.
e.
40.
Cerebellar neoplasia
Organophosphate toxicity of dogs
Cerebellar lipofuscinosis (storage disease) of horses
Head trauma of cats
Canine distemper virus infection
Which of the following statements regarding the cerebellum is CORRECT?
a.
b.
c.
d.
e.
43.
Clinical signs develop 3-4 months after birth
Produces cerebellar ataxia , with severe paresis of movement
Feline panleukopenia virus destroys the molecular layer of the cerebellum
Compensation/accommodation may result in some improvement of clinical signs
May affect Brittany spaniels as late in life as 7 to 13 years-of-age
Which of the following disorders is MOST LIKELY to result in a decerebellate posture?
a.
b.
c.
d.
e.
42.
Electrophysiological studies to assess the functional state of the brain and brain
stem
Repeated partial neurological evaluations
Lumbar cerebrospinal fluid (CSF) puncture
A general physical examination
Advanced imaging studies (e.g., CT or MRI)
Which of the following statements regarding cerebellar hypoplasia is TRUE?
a.
b.
c.
d.
e.
41.
obtunded
alert
semi-comatose
depressed
comatose
The cerebellum initiates fine movements in the limbs
The cerebellum coordinates motor activity initiated in the cerebrum
The cerebellum is largely “facilitatory” in its functions
The cerebellum controls muscle tone in the limbs via the spinocerebellar tracts
The cerebellum is “inhibitory” to the menace response
Which statement regarding cerebellar abiotrophy is TRUE?
a.
b.
c.
d.
e.
Abiotrophy results from in utero viral infection
Abiotrophies are progressive, diffuse, and symmetrical
Purkinje’s cells are not affected by abiotrophies
Abiotrophy results from an acquired error in metabolism
Abiotrophies are confined to the cerebellum, and do not affect other areas of the
11
44.
Which of the following clinical signs would you NOT EXPECT to see in association with
a mass lesion affecting the left hemisphere of the cerebellum?
a.
b.
c.
d.
e.
45.
Right central vestibular signs
Menace reaction deficit in the right eye
Increased extensor tone in the left limbs
Dysmetria of the left limbs
Assymetrical ataxia, with strength preserved
A 2-year-old cat is presented to you with a history of generalized seizures, and circling to
the left, of two weeks’ duration. The cat also has developed several abnormal behavioral
problems, including urinating indoors. The cat has bilateral loss of the menace reaction,
with normal pupillary light reflexes in each eye.
Which of the following statements is most likely to be TRUE?
a.
b.
c.
d.
e.
46.
Which of the following clinical signs would you be LEAST LIKELY to see in a dog with
a right-sided cerebral cortical brain neoplasm?
a.
b.
c.
d.
e.
47.
Obtundation
Circling towards the side of the lesion
Circling towards the side away from the lesion
Postural reaction deficits in left thoracic and left pelvic limbs
Focal seizures in the left thoracic limb
Which of the following statements regarding fluid therapy for a dog or cat with
intracranial injury is NOT CORRECT?
a.
b.
c.
d.
e.
48.
The cat has a lesion in the basal nuclei
The cat has a right cerebral cortical lesion
The cat has a thalamic lesion affecting the optic chiasm
The cat has multifocal disease with ocular and cerebral involvement
The cat has a cortical blindness
Colloids are of limited benefit in the management of brain swelling
Prevention of hypotension is a major consideration
Isotonic crystalloids are recommended
Hypertonic saline is preferred to mannitol for reduction of intracranial pressure
Overhydration should be avoided
The two major primary sequelae to intracranial injury are:
a.
b.
c.
d.
e.
hemorrhage and brain edema
aspiration pneumonia and concussion
herniation and hypoxia
increased intracranial pressure and contusion
laceration and edema
12
49.
In brain trauma, the most important factor influencing cerebral blood volume (CBV)
secondary to its effects on cerebral blood flow (CBF), is:
a.
b.
c.
d.
e.
50.
The most effective specific medical therapy for reduction of an increased intracranial
pressure (ICP) following brain trauma is:
a.
b.
c.
d.
e.
51.
O2 content
Systemic blood pressure
Cerebral metabolic rate
Anesthetic drugs
PaCO2
Methylprednisolone sodium succinate
DMSO
Furosemide
Mannitol
High-dose barbiturates
A 6-year-old yellow Labrador is presented to you with a three week history of the
following signs:
Obtundation
Circling to the right
Right sided head tilt
Nystagmus that changes direction with changes in head position, and develops a
vertical component when the dog is placed on its’ right side.
What is the most likely location of the dog’s lesion?
a.
b.
c.
d.
e.
52.
Left cerebellomedullary angle
Left middle ear
Right cerebellomedullary angle
Right petrosal bone
Both (a) and (c) above
A well-circumscribed infarct of (secondary to fibrocartilaginous embolism) in a dog
involves the left side of C8, T1 and T2 spinal cord segments.
Which of the following clinical signs would NOT be expected with this lesion?
a.
b.
c.
d.
e.
Loss of cutaneous trunci reflex on left
Horner’s syndrome in left eye
Loss of cutaneous trunci reflex on right
Loss of proprioceptive positioning in left pelvic limb
Increased muscle tone in the left pelvic limb