Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

*Anesthesia JB > ITE CA2 Pain > Flashcards

ITE CA2 Pain Flashcards

1
Q

Celiac plexus block
why?
what level?
side effects?

A

Level of L1
Celiac plexus neurolytic blocks are performed for chronic, intractable abdominal pain originating from most of the viscera.
Adverse effects include orthostatic hypotension (most common), diarrhea, hiccups, pleurisy, retroperitoneal bleeding, abdominal aortic dissection, transient motor paralysis, and paraplegia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Lumbar plexus block

A

A LPB reliably blocks the femoral, lateral femoral cutaneous, and obturator nerves. It spares the sciatic nerve, though the commonly-used posterior approach for a LPB allows for easy access to the sciatic nerve for a separate block.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Psoas compartment block

A

AKA lumbar plexus block. The lumbar plexus is formed by the ventral divisions of the first four lumbar nerves (L1-L4) with a small contribution from the subcostal nerve (T12). Branches (and contributing segments) include the iliohypogastric (T12-L1), ilioinguinal (L1), genitofemoral (L1, L2), lateral femoral cutaneous (L2, L3), obturator (L2-L4), and femoral (L2-L4) nerves. There are also several short, direct muscular branches (T12-L4).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Nerves for TAP block

A

A transversus abdominal plane block affects the intercostal, subcostal, ilioinguinal, and iliohypogastric nerves.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Peripheral n block needle stim intensity

A

The ideal intensity for stimulation and successful peripheral nerve blockade is between 0.3 and 0.5 mA. Intensities less than 0.3 mA are associated with increased intraneural injections and intensities greater than 0.5 mA are often too far from the intended nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Epidural steroid injections

A

ESI involves injecting steroid into the epidural space to decrease inflammation and edema of nerve roots. Nerve roots often become compressed as they leave the spinal cord by a herniated disk or spondylosis. Edema of the nerve causes increased compression and more nerve damage. Symptoms of a compressed nerve include radicular pain. Radicular pain is more likely to respond favorably to ESI than other types of back pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Transtracheal injection of local anesthetic will block the ________ nerve.

A

Transtracheal injection of local anesthetic will block the recurrent laryngeal nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The glossopharyngeal nerve innervates ___________

A

The glossopharyngeal nerve innervates the base of the tongue and oropharynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The external branch of the superior laryngeal nerve is a (motor/sensory) nerve

A

The external branch of the superior laryngeal nerve is a motor nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The internal branch of the superior laryngeal nerve provides …

A

The internal branch of the superior laryngeal nerve provides sensory innervation to the glottis above the vocal cords and has no motor function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which block has highest risk of pneumothorax

A

Supraclavicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pain

The first-order neuron

A

The first-order neuron begins with transduction and ends with synapse at the dorsal horn.

This pathway describes the first-order neuron. First-order neurons secrete chemical mediators of pain, including substance P which is secreted both peripherally and in the dorsal horn. Adenosine is another local molecule that modulates dorsal horn pain transmission.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pain

The second-order neuron

A

The second-order neuron begins at the dorsal horn and ends at the thalamus
The second-order neuron begins with the dorsal horn of the spinal cord and decussates to the contralateral spinothalamic tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pain

the third-order neuron

A

the third-order neuron involves the thalamus and its axonal pathway to the postcentral gyrus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

central inhibition of pain

A

Central inhibition occurs via the descending pathways from the periaqueductal gray matter and alpha-2 receptor agonism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

A-delta fibers

A

A-delta fibers are small myelinated fibers that carry signals from peripheral mechanoreceptors and thermoreceptors to the dorsal horn of the spinal cord. This pathway describes the first-order neuron. First-order neurons secrete chemical mediators of pain, including substance P which is secreted both peripherally and in the dorsal horn. Adenosine is another local molecule that modulates dorsal horn pain transmission.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Trace path of sympathetic nervous system in upper extremities
what signaling molecule do they use

A

The sympathetic nervous system of the upper extremity originates from the first four or five thoracic spinal segments. These preganglionic fibers synapse via acetylcholine-mediated nicotinic receptors in the superior cervical, middle cervical, and stellate ganglia. Postganglionic fibers then travel with afferent pain fibers to the head, neck, upper extremity, heart, and lungs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

spinal side effects

A

Spinal anesthesia is associated with an
incidence of PDPH as high as 25%.
Other common complications or side effects include
increased gastrointestinal secretions and mobility (unopposed parasympathetics),
increased ventilatory response to hypercapnia,
hypothermia from peripheral vasodilation, and a
transient decrease in hearing ability.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

increased risk of transient neurologic syndrome after spinal anesthesia

A

The only factors found to be associated with increased risk of TNS are
lidocaine spinal anesthesia,
the lithotomy position, and
ambulatory surgery with early ambulation.

Pooling and maldistribution of hyperbaric local anesthetic encountered with the use of pencil-point spinal needles or spinal microcatheters are suggested to have a causative effect for neurological injury (cauda equina syndrome), but not TNS.

Baricity of local anesthetics is not associated with the development of TNS following spinal anesthesia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

The path of stimulus to terminal recording of a (lower extremity) motor evoked potential

A

The path of stimulus to terminal recording of a (lower extremity) motor evoked potential (MEP) descends along the neuromotor pathway from most superior to most inferior structures: lower limb cortex, internal capsule, brainstem, corticospinal tract, peripheral nerve, and eventually the lower limb muscle (e.g., tibialis anterior) (A).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

path of somatosensory evoked potential

A

peripheral nerve, dorsal root ganglia, posterior spinal cord, brainstem, thalamus, cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Initial workup for headache and focal neuro sx

A

In a patient presenting with headache and focal neurological symptoms, diagnostic imaging should be obtained. MRI is preferred over CT as it is able to diagnose posterior fossa and dural based abnormalities with higher sensitivity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Attacks of paroxysmal hemicrania can be prevented by therapeutic doses of

A

Attacks of paroxysmal hemicrania can be prevented by therapeutic doses of indomethacin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q 
Type A-alpha fiber
function
diameter
myelination
conduction velocity
A

Proprioception, motor
12-20 mcm
Heavy
70-120 m/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q 
Type A-beta fiber
function
diameter
myelination
conduction velocity
A

Touch, pressure
5-12 mcm
heavy
30-70 m/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q 
Type A-gamma fiber
function
diameter
myelination
conduction velocity
A

muscle spindles, tone
3-6 mcm
heavy
15-30 m/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q 
Type A-delta fiber
function
diameter
myelination
conduction velocity
A

Pain, temp, touch
2-5 mcm
heavy
12-30 m/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q 
Type B fiber
function
diameter
myelination
conduction velocity
A

preganglionic autonomic
< 3 mcm
Light
3-15 m/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q 
Type C Dorsal root fiber
function
diameter
myelination
conduction velocity
A

Dull pain, temp, touch
0.4-1.2 mcm
None
0.5-2.3 m/s

30
Q 
Type C Sympathetic fiber
function
diameter
myelination
conduction velocity
A

Postganglionic
0.3-1.3 mcm
None
0.7-2.3 m/s

31
Q

Which 2 fibers are responsible for transmission of nociception

A

A-delta and C

32
Q

CRPS type I

A

CRPS type I, formerly known as reflex sympathetic dystrophy, is associated with dysregulation of the autonomic nervous system and is typically precipitated by a non-nerve related injury or surgery

33
Q

CRPS II
risk factors
signs/symptoms

A

When there is a nerve related injury, as in the scenario above, CRPS II (causalgia) is reserved as the diagnosis.

Risk factors for the development of CRPS include previous trauma, previous surgery, work-related injuries, and female sex.

Signs and symptoms of CRPS include spontaneous pain, hyperalgesia, allodynia, plus trophic, sudomotor, vasomotor abnormalities, and finally active and passive movement disorders

34
Q

Treatment of CRPS type II

A

Treatment of CRPS type II consists of physical therapy, tricyclic antidepressants, gabapentin, sympathetic blocks, somatic blocks, spinal cord stimulators, and intrathecal medications.

35
Q

Complications of stellate ganglion blocks

A

Complications of stellate ganglion blocks include vasovagal reactions, intravascular or spinal injection, and Horner syndrome (miosis, ptosis, anhidrosis, enophthalmos, and hyperemia).

36
Q

miosis vs mydriasis

A

Miosis or myosis is excessive constriction of the pupil. … The opposite condition, mydriasis, is the dilation of the pupil.

37
Q

Nerve to block for tourniquet pain

A

The intercostobrachial nerve is spared with brachial plexus blockade.

38
Q

The “3-in-1” block

A

The “3-in-1” block is used for anesthesia and analgesia of the anterior thigh and knee, it does not cover the upper extremity.

39
Q

when use interscalene

A

Interscalene blocks are performed on the proximal portion of the brachial plexus at the level of the roots/trunks and are best for shoulder and upper arm surgeries. An interscalene block will not reliably cover the forearm and therefore is not the best choice for this surgery.

40
Q

when use supraclav block

A

The supraclavicular block is often referred to as “the spinal of the upper extremity” and is ideal for surgical procedures involving the hand, wrist, or forearm. When done correctly, especially under ultrasound guidance, a supraclavicular block can provide rapid reliable surgical analgesia from the fingertips to the distal humerus

41
Q

mnemonic for order of absorption for local anesthetics

starts with I

A

ICEBaLLS: Intercostal, Caudal, Epidural, Brachial plexus, Lower Limb, Subcutaneous

42
Q

mnemonic for order of absorption for local anesthetics

starts with B

A

BICEPS: Blood, Intercostal, Caudal, Epidural, Plexus (brachial), Sciatic, Subcutaneous

43
Q

First line treatment for postherpetic neuralgia

A

First-line agents for PHN consist of tricyclic antidepressants, opioids, and gabapentin or pregabalin. There is synergy between each class and they should be used in combination if tolerated.

Also includes lidocaine patches, topical capsaicin, and tramadol.

NSAIDS ineffective, sympathetic blocks innefective

44
Q

Retrobulbar blocks
advantages
risks

A

produce a dense block with complete akinesia.

They pose many risks to the patient, however, including
retrobulbar hemorrhage,
optic nerve damage, and
central spread of the local anesthetic.

45
Q

Meds for fibromyalgia

A

Duloxetine, milnacipran, and pregabalin are approved for fibromyalgia.

46
Q

treatment for trigeminal neuralgia

A

Carbamazepine is the drug of choice for trigeminal neuralgia. Imaging studies are generally not needed when history and physical support for the diagnosis.

47
Q

Glutlamate in pain pathway

A

Glutamate is an excitatory molecule that stimulates pain signal transmission peripherally and centrally.

48
Q

Tissue injury results in a release of chemical inflammatory mediators, including

A

Tissue injury results in a release of chemical inflammatory mediators, including prostaglandins, interleukins, glutamate, substance P, bradykinin, and histamine.

49
Q

The wind-up phenomenon

A

The wind-up phenomenon is caused by repeated stimulation of peripheral C fibers resulting in increased action potentials at the dorsal horn causing an amplified response.

50
Q

How does cryotherapy work

A

Cryotherapy treats acute post-operative pain by decreasing the spread of inflammatory factors and by slowing nociceptive nerve conduction.

51
Q

gate theory

A

A-beta nerve fiber stimulation can inhibit C and A-delta nerve signal conduction by what is termed the “gate theory.”

52
Q

C fiber stimulation causes what

A

C fibers are small unmyelinated nociceptive nerve fibers with a low conduction velocity. Stimulation of these nerves causes slow, aching, or burning pain.

53
Q

Arterial injection during interscalene block most likely which artery?

A

The vertebral arteries most commonly originate from the subclavian arteries and are divided into four segments depending on their anatomic location. They traverse the neck anterior to the scalene muscle and enter the vertebral foramina of the sixth cervical vertebra. It can be a site for inadvertent arterial injection when performing an interscalene nerve block.

54
Q

how do spinal cord stimulators work

A

Spinal cord stimulation is based on the “Gate Control Theory” of pain. Stimulation of large nerve fibers within the substantia gelatinosa may increase the inhibitory neurotransmitter γ-aminobutyric acid (GABA), and decrease the excitatory neurotransmitters (glutamate, aspartate).

55
Q

inhibitory neurotransmitters

A

γ-aminobutyric acid (GABA)

56
Q

excitatory neurotransmitters

A

excitatory neurotransmitters (glutamate, aspartate).

57
Q

Bilateral lower extremity CRPS can be treated with ____

complications

A

Bilateral lower extremity CRPS can be treated with serial bilateral lumbar plexus nerve blocks. In addition to intravascular, epidural, and intrathecal injection, bilateral lumbar plexus blocks can be complicated by ejaculatory failure in males.

58
Q

If the disease progresses without treatment, the skin can become glossy, smooth, and hairless

A

CRPS

59
Q

Spinal cord stimulators moa

A

Spinal cord stimulators activate the larger Aα and Aβ fibers to a greater degree than the smaller nociceptive Aδ and C fibers. This closes the “gate” in and impedes conduction of pain sensation past the substantia gelatinosa of the dorsal horn of the spinal cord.

60
Q

Klippel-Feil syndrome

A

Klippel-Feil syndrome is a congenital fusion of the cervical spine. Patients with Klippel-Feil often have low hairlines and limited neck motion.

61
Q

Beckwith-Wiedemann syndrome

A

Beckwith-Wiedemann syndrome is associated with hypoglycemia, macroglossia, and organomegaly in newborns. Organomegaly causes hypoglycemia from increased glucose usage. Patients with Beckwith-Wiedemann syndrome may also have omphalocele.

62
Q

Pierre Robin sequence

A

Micrognathia in the neonate is associated with Pierre Robin sequence. Pierre Robin sequence is associated with micrognathia, macroglossia, and severe upper airway obstruction. There are a few other conditions which are associated with Pierre Robin such as fetal alcohol syndrome, Treacher Collins, and velocardiofacial syndrome.

63
Q

Acute epiglottitis is a form what type of obstruction

A

Acute epiglottitis is a form of variable extrathoracic obstruction, depicted as inspiratory compromise on the pulmonary flow-volume loop.

64
Q

Safe airway management of acute epiglottitis

A

Safe airway management of acute epiglottitis is founded on inhalational induction in the sitting position with maintenance of CPAP during spontaneous ventilation to prevent inspiratory laryngeal airway collapse or irritation

65
Q

Oral dosing of midazolam in pediatric patients

A

Oral dosing of midazolam in pediatric patients is typically 0.5 mg/kg (10 times the intravenous dose) and has an onset of action of 15-30 minutes.

66
Q

Cardiac effects of bupivacaine with epinephrine include

A

Cardiac effects of bupivacaine with epinephrine include an increase in the PR interval, increased duration of the QRS complex, increase in T-wave amplitude, ST-segment changes, sinus bradycardia, and sinus arrest.

Bupivacaine-induced T-wave elevation is a sign of impending cardiac toxicity, especially during fast injection.

67
Q

the nerve fibers from MOST to LEAST sensitive to local anesthetics

A

A-delta, A-gamma > lA-alpha, A-beta > C.

The order of susceptibility to local anesthetics is small myelinated (A-delta, A-gamma) > large myelinated (A-alpha, A-beta) > unmyelinated (C).

sympathetic blockade first, followed by pain/sensory blockade, then motor blockade last.

68
Q

Where anesthetize LFCN

A

The LFCN may be anesthetized by injecting local anesthetic 2-2.5 cm medial and 2-2.5 cm inferior to the ASIS and above and below the fascia lata.

69
Q

Chemical stimuli that mediate the activation of peripheral nociceptors

A 
Chemical stimuli that mediate the activation of peripheral nociceptors include 
prostaglandins, 
substance P, 
calcitonin gene-related peptide, 
glutamate, 
bradykinin, 
protons, 
ATP, and 
proinflammatory cytokines
70
Q

spinal cord inhibition is mediated

A

spinal cord inhibition is mediated by
opioids,
γ-aminobutyric acid (GABA), and/or
glycine.

*Anesthesia JB (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions