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OTC > Exam 3 - Pathophysiology of CNS Disorders (Long) > Flashcards

Exam 3 - Pathophysiology of CNS Disorders (Long) Flashcards

1
Q

Pain physiology

A
  • pain is subjective
  • unpleasant and linked to emotional experiences
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2
Q

Nociception

A
  • a type of pain
  • process by which information about a noxious (harmful) stimulus is conveyed to the brain
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3
Q

Nociception is the sum of…

A

Neural activity prior to the cognitive processes to identify a sensation as pain (perception)

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4
Q

Neural activity that identify a sensation as pain (perception)

A

Transduction
Transmission & conduction
Descending modulation

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5
Q

Transduction definition

A

Process whereby a noxious stimulus activates sensory receptors to initiate an action potential (electrical impulse)

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6
Q

Explain transduction

A

Noxious stimuli induce the release of chemicals

These bind to increase the excitability of the neuronal cell membrane and lead to generation of propagated action potentials (electrical impulse)

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6
Q

Where does transduction occur

A

At nociceptors

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7
Q

Conduction

A

Nociceptor activation leading to action potentials that continue along afferent fibers to the spinal cord

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8
Q

Transmission: excitation

A

Na+ increases
K+ and Cl- decrease
Depolarization

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8
Q

Define transmission

A

Action potentials (nerve impulses) conducted to the CNS from activation of Na+ channels at synaptic junctions of neurons

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9
Q

Transmission: inhibition

A

Increased influx of K+ and Cl-
Polarization

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10
Q

Perception

A

Process by which a noxious event is recognized as pain

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10
Q

In transmission, where does the nerve impulse go after excitation and inhibition

A

Continues to the thalamus

Impulses are then relayed to multiple areas of the brain (eg somatosensory cortex = the processing center)

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11
Q

Modulation

A

Descending input from the brain that affects nociceptive transmission in the spinal cord

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12
Q

Migraine triggers: Limbic system

A

Affective emotional response to the noxious stimulus

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12
Q

Perception: somatosensory cortex and insular cortex

A

Involved in sensory-discriminative component

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13
Q

Pain physiology types: nociceptive

A

Due to noxious insult or injury of tissues (adaptive pain)

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14
Q

Pain physiology types

A

Nociceptive
Neuropathic
Inflammatory

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15
Q

Pain physiology types: neuropathic

A

Due to lesion or disease in the somatosensory nervous system (maladaptive pain)

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16
Q

Pain physiology types: inflammatory

A

Activation and sensitization of the nociceptive pain pathway by mediators released at a site of tissue inflammation (eg. proinflammatory cytokines)

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17
Q

Headache pathophysiology

A
  • most are either migraine or tension headaches
  • may be preceded by warning signs/symptoms (auras)
  • activation of trigeminal sensory nerves triggers release of proinflammatory neuropeptides (eg. Neurokinin A, substance P —> potent vasodilators) to induce manifestation
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18
Q

Migraine epidemiology

A

Occurs more in women than men

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19
Q

What do vasodilators do and give examples of them

A

Widen (dilate) blood vessels to decrease BP

Examples:
- Neurokinin A
- Estrogen
- Bradykinin
- Substance P
- Histamine
- Prostacyclin (PGI2)
- Prostaglandin E2 (PGE2)

(Never Ever Be Sucking Hairy PP)

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20
Q

What do vasoconstrictors do and give examples of them

A

Narrow (constrict) BP to increase BP

Examples:
Serotonin
Caffeine
Angiotensin II
Neuropeptide Y
Testosterone
Epinephrine/norepinephrine
Cortisol
NSAIDs (non-salicylates)
Vassopressin

(She CANT Even Catch New Vag)

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21
Q

Tension headaches are usually due to

A

Vasoconstriction

21
Q

What is the most commonly reported trigger for tension headaches

A

Stress

22
Q

How do tension headaches differ from migraines

A
  • Not associated w/ visual disturbances or auras
  • Does NOT cause nausea/vomiting
  • Not intensified by physical activity
  • Not throbbing or pulsatile
  • Bilateral pain, on both sides of head
23
Q

Cluster headache

A
  • severe pain (worse than migraine) in the orbital, supraorbital, or temporal region of head
  • unilateral, pulsating pain
  • more common in men
  • associated w/ vasodilation
24
Q

Are cluster headaches primary or secondary

A

Primary

25
Q

What causes exercise headaches

A

Vasodilation

26
Q

Pathophysiology of fever

A
  • elevation of body temp
  • core body temp is controlled by the hypothalamus and regulated by feedback mechanisms
  • the thermostatic set point of the hypothalamus’ thermoregulatory center is set so that the core temperature is regulated within the normal range
27
Q

Medication use headaches occur from

A

Medication overuse

Aka “rebound headaches”

28
Q

Core body temp is controlled by the _______ and regulated by ________

A

Hypothalamus
Feedback mechanisms

29
Q

What is a pyrogen

A

Any substance that causes fever

30
Q

Where do most exogenous pyrogens come from

A

Microbes

31
Q

Lipopolysaccharide endotoxin (LPS) is a pyrogen and is _______ bacteria

A

Gram-negatice

32
Q

What does LPS initiate

A

Macrophage secretion of endogenous pyrogens (ie. Cytokines, prostaglandins, leukotrienes, thromboxane)

33
Q

________ also produce pyrogens that activate macrophages

A

Gram-positive bacteria

34
Q

Gram-positive bacteria

A

Some strains of S aureus and S pyogenes also release superantigen

35
Q

Fever occurs in _______, caused by S aureus and S pyogenes

A

Toxic shock syndrome

36
Q

Fever pathogenesis

A

Pyrogens induce prostaglandin E2 (PGE2) formation, which increases the thermostatic set point in the hypothalamus

Induces vasoconstriction, shivering, and increased metabolism can increase body temp

37
Q

Pathogenesis of musculoskeletal pain: what is included in the musculoskeletal system

A

Muscles
Tendons
Ligaments
Cartilage
Bones

38
Q

Pathogenesis of musculoskeletal pain: Somatic pain

A

Musculoskeletal, skin
Due to noxious stimuli

39
Q

Pathogenesis of musculoskeletal pain: What is tendonitis?

A

Tendon inflammation due to acute injury or from repetitive movements

39
Q

Pathogenesis of musculoskeletal pain: Stains

A

Muscle or tendon injury due to hyperextension causing them to tear

40
Q

Pathogenesis of musculoskeletal pain: Myalgia

A

Muscle pain
Instigated by a variety of noxious stimuli

41
Q

Pathogenesis of musculoskeletal pain: What are the types of tendonitis

A

Carpal tunnel syndrome
Sports-related tendonitis
Medication-related tendonitis

42
Q

Carpal tunnel syndrome

A

Tingling or numbness of the first digits of the hand

42
Q

Sports related tendonitis

A

Overuse of elbow, shoulder, or knee

43
Q

Medication related tendonitis

A

Drugs that weaken tendons

eg. Fluoroquinolones like cipro, levaquin

43
Q

Pathogenesis of musculoskeletal pain: Bursitis

A

Inflammation of the fluid-filled pads (bursae)

44
Q

Pathogenesis of musculoskeletal pain: Sprains

A

Most common problem with ligaments

45
Q

Pathogenesis of musculoskeletal pain: Low back pain

A

May arise due to:
- nerve compression (eg pinched nerve)
- trauma related and degenerative disorders

46
Q

Pathogenesis of musculoskeletal pain: Osteoarthritis

A
  • degenerative joint disease
  • results in gradual softening and destruction of the cartilage between bones, leading to loss of space between joints
  • joint deformities
47
Q

John is considering two types of local analgesics for sports related tendonitis. Both are numbing agents that block Na+ channels in rapid-firing neurons. What are the two analgesics?

A. Camphor
B. Lidocaine
C. Hydrocortisone
D. Capsaicin
E. Diphenhydramine

A

Lidocaine and diphenhydramine

48
Q

What physiological effects does aspirin have on the body? SATA

A. Increases TXA2 synthesis
B. Causes vasodilation
C. Increases gastric acid secretion
D. Increases the thermostatic set point
E. Decreases PGI2 synthesis

A

Increases gastric acid secretion
Decreases PGI2 synthesis

49
Q

Which cytokine is primarily responsible for increasing the set point of hypothalamic thermoregulatory center to induce fever?

A. PGI2
B. PGE2
C. TXA2
D. Arachidonic acid

A

PGE2

50
Q

Which toxicity and medication is mismatched?

Statin - myalgia
Fluoroquinolone - tendonitis
Tylenol - antithrombotic
Advil - GI bleeding
Bayer - gastric ulcer

A

Tylenol - antithrombotic

50
Q

Tension type headaches are the result of cerebral vasoconstriction. Which two endogenous chemicals would be involved in the pathology of these headache types?

A. Serotonin
B. Substance P
C. Neurokinin
D. Norepinephrine
E. Bradykinin
F. Prostacyclin

A

Serotonin
Norepinephrine

51
Q

Which statements below are FALSE?

A. Migraines are induced by vasodilators

B. Cluster headaches are more common in females

C. Auras are common w/ tension headaches

D. Epinephrine is a vasoconstrictor

A

B and C

B is wrong because cluster headaches are more common in men

C is wrong because auras only occur with migraines

52
Q

Which statement below is true?

A. Nerve excitation is caused by polarization

B. Nerve excitation is caused by increased potassium permeability

C. Nerve excitation is caused by increased sodium permeability

D. Nerve excitation is caused by increased chloride permeability

A

C. Nerve excitation is caused by increased sodium permeability

53
Q

What bacterial species is implicated in toxic shock syndrome?

A. Escherichia coli
B. Enterococcus faecalis
C. Streptococcus pyogenes
D. Salmonella typhi
E. Pseudomonas aeruginosa

A

Streptococcus pyogenes

OTC (31 decks)

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