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BB2 > Anatomy & Physiology of Pain II > Flashcards

Anatomy & Physiology of Pain II Flashcards

1
Q

How can neuropathic pain occur due to C-fibre nociceptor pathway malfunctioning? [1]

A

Interneurons (lamina II) can spontaneously become active & fire pain

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2
Q

Noxious pain terminates where in dorsal root horn? [1]

Non-noxious pain terminates where in dorsal root horn? [1]

A

Noxious pain: early laminas

Non-noxious pain: deep laminas

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3
Q

Specifically, where do axons that transmit pain and form the spinothalamic tract decussate in the spinal cord? [1]

A

Anterior white commissure

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4
Q

Label A

A

White anterior commissure

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5
Q

Transmission (spinothalamic tract)

Anterior spinothalamic tract projects what type of information / pain? [2]
Lateral spinothalamic tract projects what type of information / pain? [3]

A

Anterior spinothalamic: crude touch, tickle, pressure, itch

Lateral spinothalamic : pain & temperature

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6
Q

Which of the folliwng numbers identify where the anterior and lateral spinothalamic tracts run in the spinal cord? [2]

A

5a: lateral spinothalamic tract
5b: anterior spinothalamic tract

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7
Q

Transmission (Anterior Spinothalamic Tract)

Which fibres project within the Anterior STT?

Where does the Anterior STTT project to after travelling up the spinal cord / wheres the third order neurone? [1]

A

Ab, Ad and C fibres

Projects to ventral posterior lateral (VPL) and ventral posterior inferior (VPI) nucleus of the thalamus. (VPL/VPI) on the contralateral anterior STT tract

Third order neurones from VPL/VPI project to the somatosensory cortex (S1 and S2) - Provide exact localisation and physical intensity of noxious stimulus.

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8
Q

Transmission (Lateral Spinothalamic Tract)

Which fibres project within the Lateral STT?

Describe its path

A

Ad and C fibres

Projects contralaterally via LSTT to mediodorsal nucleus of the thalamus (MDvc) and posterior thalamus (VPI and VMpo).

From mediodorsal nucleus of the thalamus (MDvc) innervates anterior cingulate cortex (ACC)

From posterior thalamus (VPI and VMpo) which innervates the rostral insula (unpleasant emotion of pain)

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9
Q

Anterior STT: innervates the [] cortex via []

Lateral STT: innervates the [] & [] via the [] and []

A

Anterior STT
* Innervate the primary and secondary somatosensory cortex via VPL/VPI

Posterior STT:
* Innervates the anterior cingulate cortex and rostral insula via the mediodorsal nucleus of the thalamus (MDvc) and posterior thalamus (VPI and VMpo)

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10
Q

The unpleasantness (painfull) character of pain is mediated via pain to which are the brain? [1]

A

Limbic systems

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11
Q

[] spinothalamic tract controls affective-motivational dimension of pain (i.e. unpleasantness)

[] spinothalamic tract controls sensory-discriminative dimension of pain (i.e. intensity)

A

Lateral spinothalamic tract controls affective-motivational dimension of pain (i.e. unpleasantness)

Anterior spinothalamic tract controls sensory-discriminative dimension of pain (i.e. intensity)

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12
Q

Label A-E and their functions

A
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13
Q

Modulation (descending pathways - brain regions)

Label the brain regions involved in modulation of pain (A-C) and what type of neurones they have [6]

A

A: peri aqueductal grey (PAG): produces analgesia

B: Locus coerulus: contains descending noradrenergic neurons

C: Raphe nucleus contains descending serotoninergic neurons

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14
Q

Explain the mechansim of pain modulation at the dorsal horn via the Noradrenaline and serotonin neurons

A

Noradrenaline and serotonin neurons descend from locus coerulus and raphe nucleus respectively & exhibit excitatory repsonse on lamina II neurons

The lamina II neurons present here are inhibitory - so release GABA and ekephalins onto the INCOMING Aδ neurons, which reduces their activity

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15
Q

Name three types of endogenous opoids and the receptors they can bind to [6]

A

Endogenous opoids:
* endorphins
* enkephalins
* dynorphins

Opoid receptors:
* Mu opioid receptor
* Delta opioid receptor
* Kappa opioid receptor

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16
Q

How does binding of endogenous opiod to opiod receptor inhibit pain? [2]

A

Causes a decrease in Ca2+ release at pre-synaptic terminal

This inhibits release of glutamate and stops pain modulation

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17
Q

How can you modulate pain via Abeta afferents? (e.g. if in pain - rubbing the area might help)

A

Ab afferent from skin also synapse excitably onto lamina II inhibitory cell body, that are used as interneurons from descending pain pathway (from noradrenaline and serotonin)

This causes more inhbitory GABA and enkephalins to be released on INCOMING Aδ neurons, which reduces their activity

18
Q

What is a definition of chronic pain? [1]

A

Chronic pain is pain that last longer than 3 months despite treatment.

19
Q

Chronic pain

What is allodynia and hyperalgesia?

A

Allodynia: a condition where pain is caused by a non-noxious (non-painful) stimulus (e.g. tickle with a feather).

Hyperalgesia: a condition where an abnormal increased pain sensitivity is caused by a noxious (painful) stimulus (e.g. hot water on sunburn).

20
Q

Chronic pain

Explain what causes peripheral sensitisation?

A

During injury (esp. inflammation), chemical mediators (i.e. cytokines, H+) can activate nociceptors and activate intracellular signalling mechanism, which can up regulate ion channels, thus increase membrane potential closer to depolarisation threshold.

This makes the sensory primary afferent fibres more sensitive to activation.

21
Q

Explain what causes central sensitisation

A

Continuous activation of the projection neurones can activate intracellular signalling mechanism, which can up regulate ion channels, thus increase membrane potential closer to depolarisation threshold.

This makes the projection neurones more sensitive to activation.

22
Q

Peripheral sensitisation

Explain what ectopic and ephatic activation of nocifibres are

A

In peripheral sensitisation:

Ectopic activation: spontaneous activation of fibres causing pain

Ephatic: lateral contact causes generation of AP on neighbouring fibre and cause pain

23
Q

Central sensitsation of pain

Explain what Abeta fibres collateral sprouting-induced pain is [1]

A

Abeta fibres (which dont normall cause paincan sprout in dorsal horn - which directly activates projection neurons which causes chronic pain

24
Q

Which of the following would detect a change in pH?

ASICs
TRPM8
Nav1.7
TRPV1

A

Which of the following would detect a change in pH?

ASICs
TRPM8
Nav1.7
TRPV1

25
Q

Which of the following would detect the cooling effect of this sweet?

ASICs
TRPM8
Nav1.7
TRPV1

A

Which of the following would detect the cooling effect of this sweet?

ASICs
TRPM8
Nav1.7
TRPV1

26
Q

Which of the following would detect the heating effect of this food?

ASICs
TRPM8
Nav1.7
TRPV1

A

Which of the following would detect the heating effect of this food?

ASICs
TRPM8
Nav1.7
TRPV1 aka capsaicin receptor

27
Q

Which of the following serve to receive and transmit information primarily relating to acute pain?

Aα
Aγ
Aδ
Aβ
C

A

Which of the following serve to receive and transmit information primarily relating to acute pain?

Aα
Aγ
Aδ
Aβ
C

28
Q

Which of the following serve to receive and transmit information primarily relating to touch?

Aα
Aγ
Aδ
Aβ
C

A

Which of the following serve to receive and transmit information primarily relating to touch?

Aα
Aγ
Aδ
Aβ
C

29
Q

Which of the following serve to transmit information primarily relating to pain, temperature and itch.

Aα
Aγ
Aδ
Aβ
C

A

Which of the following serve to transmit information primarily relating to pain, temperature and itch.

Aα
Aγ
Aδ
Aβ
C

30
Q

Which of the following serve to transmit information primarily relating to proprioception (muscle sense)

Aα
Aγ
Aδ
Aβ
C

A

Which of the following serve to transmit information primarily relating to proprioception (muscle sense)

Aα
Aγ
Aδ
Aβ
C

31
Q

Which of the following serve to transmit information relating to this image?

Aα
Aγ
Aδ
Aβ
C

A

Which of the following serve to transmit information relating to this image?

Aα
Aγ
Aδ
Aβ
C

32
Q

Which of the following serve to transmit information relating to this image?

Aα
Aγ
Aδ
Aβ
C

A

Which of the following serve to transmit information relating to this image?

Aα
Aγ
Aδ
Aβ
C

33
Q

Mutations in which of the following would cause this diease?

ASICs
TRPM8
Nav1.7
TRPV1

A

Mutations in which of the following would cause this diease?

ASICs
TRPM8
Nav1.7 Congenital insensitivity to pain (CIP):
TRPV1

34
Q

Name the gene codes for receptor that allows development of neuron growth factor [1]

A

TRKA gene codes for TrKA receptor: causes NGF to be rpoduced

35
Q

Which of the following is key in modulation of pain and empathy

Anterior cingulate cortex
Prefrontal cortex
Insula
Amygdala

A

Which of the following is key in modulation of pain and empathy

Anterior cingulate cortex
Prefrontal cortex
Insula
Amygdala

36
Q

A 56-year-old right-handed man is brought to the emergency department 90 minutes after acute-onset right arm weakness, difficulty forming words, and sustained dizziness. His past medical history is significant for well-controlled type 2 diabetes and hypertension. A CT head without contrast demonstrates no acute hemorrhage or lesion, but shows an area of hypodensity and associated mild parenchymal swelling deep within the left peri-Sylvian fissure. Which of the following vessels is most likely implicated in the etiology of this patient’s current condition?

A. M1 segment of the middle cerebral artery
B. A2 segment of the anterior cerebral artery
C. A3 segment of the anterior cerebral artery
D. M2 segment of the middle cerebral artery

A

A 56-year-old right-handed man is brought to the emergency department 90 minutes after acute-onset right arm weakness, difficulty forming words, and sustained dizziness. His past medical history is significant for well-controlled type 2 diabetes and hypertension. A CT head without contrast demonstrates no acute hemorrhage or lesion, but shows an area of hypodensity and associated mild parenchymal swelling deep within the left peri-Sylvian fissure. Which of the following vessels is most likely implicated in the etiology of this patient’s current condition?

A. M1 segment of the middle cerebral artery
B. A2 segment of the anterior cerebral artery
C. A3 segment of the anterior cerebral artery
D. M2 segment of the middle cerebral artery insula is supplied by the M2 MCA

37
Q

Which of the following is A

Anterior cingulate cortex
Prefrontal cortex
Insula
Amygdala

A

Which of the following is A

Anterior cingulate cortex
Prefrontal cortex
Insula
Amygdala

38
Q

Which of the following is the amygdala
A
B
C
D
E

A

Which of the following is the amygdala
A
B
C
D
E

39
Q

Which of the following modulates pain by releasing seratonin on descending pathways?

PAG
Locus coeruleus
Raphe nucleus
Amygdala
Reticular formation

A

Which of the following modulates pain by releasing seratonin on descending pathways?

PAG
Locus coeruleus
Raphe nucleus
Amygdala
Reticular formation

40
Q

Which of the following modulates pain by releasing noradrenaline on descending pathways?

PAG
Locus coeruleus
Raphe nucleus
Amygdala
Reticular formation

A

Which of the following modulates pain by releasing noradrenaline on descending pathways?

PAG
Locus coeruleus
Raphe nucleus
Amygdala
Reticular formation

41
Q

Label A-C

A

A: Peri-aqueductal grey (PAG)
B: Locus coeruleus
C: Raphe nucleus

42
Q

Label A & B [2]

A

A: allodynia

B:hyperalgesia

BB2 (65 decks)

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