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Regional > Neuropathways (josh's take) > Flashcards

Neuropathways (josh's take) Flashcards

Josh's guide to straight badassery of any and all neuropathways!!!!!

1
Q

what are the layers of a nerve form outer to inner

A

Epineurium perineurium endoneurium

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2
Q

Lable this

A
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3
Q

Efferant pain signals travel where? and what does it control?

A

to extremities

motor and autonomic

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4
Q

Afferent pain singnals travel where? and what does it control

A

to the core (body)

pain and sensations

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5
Q

If you see these small dots what are you seeing?

A

individual fasicles

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6
Q

What fibers encompass the Afferent fibers?

A

A, B, & C

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7
Q

With afferent nerve fibers:

which nerve fibers are mylinated?

A

A and B

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8
Q

With afferent nerve fibers:

A nerve fibers are further defines as what subunits?

A

Alpha

Beta

Gamma

Delta

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9
Q

With afferent nerve fibers:

Which A fibers are fast, sharp well localized sensation?

A

delta!!!

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10
Q

With afferent nerve fibers:

so what are the characteristics of A-delta fibers again????

A

fast

sharp

well-localized sensation

(just making sure your getting it an dnot just going through the cards)

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11
Q

With afferent nerve fibers:

what nerve fiber is nonmylinated

A

C-fibers

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12
Q

With afferent nerve fibers:

which nerve fiber is slow and poorly localized?

A

C-fibers

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13
Q

With afferent nerve fibers:

what are the characteristics of C-fibers

A

slow, poorly localized

(just double checking again)

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14
Q

With afferent nerve fibers:

which 2 neve fibers are most discussed with regional? then quickly differentiate the 2!

A

A-fast, shape well localized

C- long, annoying lingering pain

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15
Q

With afferent nerve fibers:

the classification of the nerves (A B C) are based on what 2 things?

A
  1. Diameter
  2. Velocity
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16
Q

Must know this next chart forward and backwards!!! don’t memorize conduction speed just know which ones are faster and slower! for example if he askes which is faster A or B know it. After looking at the chart questions will follow!!

A
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17
Q

Must know:

4 sub units of type A fibers?

A
  1. alpha
  2. beta
  3. gamma
  4. delta
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18
Q

Must know:

Type A Alpha

  1. Function
  2. Diameter (µm)
  3. Myelin
  4. Conduction velocity (m/s) (for extra credit)
A
  1. proprioception, motor
  2. 15
  3. heavy
  4. 100
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19
Q

Must know:

Type A Beta

  1. Function
  2. Diameter (µm)
  3. Myelin
  4. Conduction velocity (m/s) (for extra credit)
A
  1. touch pressure
  2. 10
  3. heavy
  4. 50
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20
Q

Must know:

Type A Gamma

  1. Function
  2. Diameter (µm)
  3. Myelin
  4. Conduction velocity (m/s) (for extra credit)
A
  1. Muscle spindles
  2. 5
  3. heavy
  4. 25
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21
Q

Must know:

Type A Delta

  1. Function
  2. Diameter (µm)
  3. Myelin
  4. Conduction velocity (m/s) (for extra credit)
A
  1. pain (sharp); temp
  2. <5
  3. heavy
  4. 25
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22
Q

Must know:

Type A (tricks to remember all facts)

  1. list them in order
  2. function gets more basic goiing down list
  3. diameter gets smaller going down list start with 15 then -5
  4. all highly myelinated
  5. conduction speed gets smaller start with 100 half till 25 then keep it there!
A
  1. Alpha/ beta/ gamma/ Delta
  2. Proprioception motor/ touch pressure/ muscle spindles/ pain temp
  3. 15/ 10/ 5 / <5
  4. all mylinated
  5. 100/ 50/ 25/ 25
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23
Q

Must know:

Type B nerve fibers

  1. Function
  2. diameter (µm)
  3. Mylelin
  4. Conduction velocity (bonus)
A
  1. preganglionic autonomic
  2. < 3
  3. light
  4. 10

****how to remmebr*** just like in the type A still getting smaller. diameter is smaller thus less mylelination thus less speed

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24
Q

Must know:

Type C:

2 types?

A

Dorsal horn

sympathetic

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25
Q

Must know:

Type C:

Dorsal

  1. function
  2. Diameter
  3. Myelin
  4. Conduction (bonus)
A
  1. pain (dull) temp
  2. 1
  3. none
  4. 1
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26
Q

Must know:

Type C:

Sympathetic

  1. function
  2. diameter
  3. myelin
  4. conduction
A
  1. postganglionic
  2. 1
  3. none
  4. >1
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27
Q

what is transduction?

A

noxiuos stimuli translated into electrical activity at the sensory endings of nerves

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28
Q

what is TRANSMISSION?

A

propagation of impulses throughout the sensory nervous system (process of signal going up arm to brain

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29
Q

What is modulation?

A

Efferent control of pain (what my body does with the pain)

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30
Q

with the afferent pathway the whole processes is essentially what?

A

Transmission

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31
Q

FIRST ORDER NEURONS:

are neurons _____ _____ the spinal cord?

A

comming into

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32
Q

FIRST ORDER NEURONS:

The majority enter the ______ spinal root.

A

dorsal

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33
Q

FIRST ORDER NEURONS:

the majority of first order neurons enter the dorsal spinal root at each _____, ______, ______ and ______ level?

A

cervical

thoracic

lumbar

sacral

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34
Q

FIRST ORDER NEURONS:

pain fibers originating in the head are carried by the ___1___, ___2___, __3___, and ___4___ nerves.

give name and number

A
  1. trigeminal (V)
  2. facial (VII)
  3. glossopharyngeal (IX)
  4. vagal (X)
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35
Q

FIRST ORDER NEURONS:

each first order nerve have specific ganglion whoch hold cell bodies of these nerves. the first order neurons in the ganglia reach the spinal cord and synapse with the _____________.

A

2nd order neuron

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36
Q

so once the 1st order neuron reached the spinal cord they become what?

A

2nd order neurons

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37
Q

SECOND ORDER NEURONS:

is made up of spinal cord gray matter divided into what

A

10 lamina

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38
Q

SECOND ORDER NEURONS:

what lamina relate to the dorsal horn?

A

I-VI

Afferent

39
Q

SECOND ORDER NEURONS:

what 2 functions do the I-VI lamina of the dorsal horn have

A
  1. receives all afferent neural activity
  2. principle site for modulation of pain
40
Q

******

what does the substantia gelatinosa do?

A

it is where the C-fibers originate????? double check this

  • it’s found in lamina II or III, and it’s the major site of action of opioids (shores said this in class) [this is rudy, btw]
41
Q

what makes up the dorsal horn? laminia of 2nd order neurons? and what type of pathways

A

I-VI

and are afferent pathways

42
Q

Dorsal vs Ventral location!!

real easy don’t fuck this one up!!!!!!!!!

A

dorsal back (like a dophiins fin)

ventral front

43
Q

SECOND ORDER NEURONS:

Lamina I: does what? (or responds to what?)

A

responds to nociceptive stimuli from cutaneous and deep somatic tissue

44
Q

SECOND ORDER NEURONS:

*********

what is located in the Lamina II [& maybe III]?

A

substantia gelatinosa

45
Q

SECOND ORDER NEURONS:

what is the lamina II (III) for (substantia gelatinosa)

A

contains many interneurons responsible for processing and modulating nociceptive input from cutaneous tissue

46
Q

SECOND ORDER NEURONS:

•**************

what is the major site for opioid actions

A

Lamina II (III?)

substantia gelatinosa

(ohhhhh light bulb thats why it is an important are!!)

47
Q

SECOND ORDER NEURONS:

what do lamina I and V contain?

A

visceral afferents

48
Q

SECOND ORDER NEURONS:

What does Lamina V respond to? and receive?

A

both noxious and non-noxious stimuli

recieves both somatic and visceral inputs

49
Q

SECOND ORDER NEURONS:

what cross the midline to the level of origin to the contralateral side of the spinal cord ((doesn;t make sense to me?)

A

spinothalamic tract

50
Q

SECOND ORDER NEURONS:

the spinothalamic tract is divided into what?

A

lateral and medial

51
Q

SECOND ORDER NEURONS:

which spinothalmic tract, projects location, density, duration of pain in the VENTRAL posteriorlateral nucleus of the thalamus?

A

Lateral spinothalmic tract

52
Q

SECOND ORDER NEURONS:

which spinothalmic tract, projects unpleasent emotionalperceptions of pain in the medial thalamus?

A

medial spinothalmic tract

53
Q

SECOND ORDER NEURONS:

recap

what does the lateral spinothalmic tractdo?

A

projects location, density, duration of pain in the ventral posteriorlateral nucleus of the thalmus

54
Q

SECOND ORDER NEURONS:

recap

what does the medial spinothalmic tract do?

A

projects unpleasent emotional perception of pain in the medial thalmus

55
Q

THIRD ORDER NEURONS:

what the hell are they?

A

neurons in the head

56
Q

THIRD ORDER NEURONS:

information is transfered up to where?

A

thalamus then to the somatosensory cortex

57
Q

*****************

know this

what is the modulation of pain???

A
  • impulses arise in the periventricular/periaquaductal gray matter of the brain stem
  • impulses are transmitted through the RAPHE MAGNUS to the SUBSTANTIA GELATINOSA by way of the DORSOLATERAL FUNICULUS

(awesome remember opioiod work of the substantia gelatinosa=====thus blocking pain…. booom bitch instant mind fuck)

58
Q

what is the modulation of pain??? this is extra to know still important but last slide if most important!!!

so well start were we left off

  • impulses arise in the periventricular/periaquaductal gray matter of the brain stem
  • impulses are transmitted through the RAPHE MAGNUS to the SUBSTANTIA GELATINOSA by way of the DORSOLATERAL FUNICULUS
A
  • Action potentials @ the substantia gelantinosa activate ENKEPHALIN INTERNEURONS
  • release of ENKEPHALIN decreases SUBSTANCE P release (reduction of # of pain impulses ascending in the lateral spinothalamic tract)
  • action potentials descending in the DORSOLATERAL FUNICULUS also hyperpolarize cell bodies of the second order neurons in the pain pathway (reduction in the # of sction potentials int he ascending lateral spinothalmic tract the descending dorsolateral modulates pain)
59
Q

Modulation of pain:

IV opioids produce analgesia how?

A
  • inpart by initiating action potentials in the DESCENDING DORSOLATERAL FUNICULUS
  • also act on other sites in the brain (limbic, hypothalamus, and thalamus) produce supraspinal analgesia primarily by mu-1 receptors
60
Q

Modulation of pain:

Spinal analgesia?

A

mediated by mu-2 receptors occurs when the # of pain impulses passing through the SUBSTANTIA GELANTINOSA is decreased

61
Q

Modulation of pain:

what is the difference b/t spinal and opioid analgesia receptors blockade for pain?

A

spinal mu-2

opioid mu-1 (maybe 2 also)

hmm interesting!!!!!!!!

62
Q

Modulation of pain:

what does the spinalreticular pain pathway dresponsible for?

A

arousal and autonomic response to pain

63
Q

Modulation of pain:

what is the spinalmesencephalic pathway for?

A

anti-nociceptive descending pathways b/c of it;s projections in the periductal gray area

64
Q

Spinalanesthesia is what mu recptors?

supraspinal analgesia is what mu receptors

A

spinal- mu-2

supraspinal- mu1 and 2

65
Q

FIBER SPECIFIC AFFERENTS: fast -sharp pain

is what fiber

A

A delta

66
Q

FIBER SPECIFIC AFFERENTS: fast -sharp pain

A-delta fibers enter and leave where

A
  • the tract of lissaeur
67
Q

FIBER SPECIFIC AFFERENTS: fast -sharp pain

A-delta fibers terminate where?

A

rexed’s lamina I, V

68
Q

FIBER SPECIFIC AFFERENTS:

fast -sharp pain

give the whole pathays(3 steps)

A
  1. A-delta fibers enter and leave the TRACT OF LISSAUER
  2. then enter the DORSAL HORN and terminate at the REXED’S LAMINA I, V
  3. 2nd order neurons leaving lamina I or V cross to the CONTRALATERAL LATERAL SPINOTHALMIC TRACT and ascend to the brain
69
Q

FIBER SPECIFIC AFFERENTS: slow pain

what nerve fiber are we discussing?

A

C fibers

70
Q

FIBER SPECIFIC AFFERENTS: slow pain

the C-fibers terminate primarily where?

A

Lamina II (III?) substantia gelatinosa

71
Q

FIBER SPECIFIC AFFERENTS: slow pain

explain the whole pathway for slow pain ( 3 steps)

A
  1. the c-fibers terminate in teh LAMINA II (III?) SUBSTANTIA GELATINOSA
  2. interneurons transmit C-fiber impulses to LAMINA V
  3. Neurons leaving V cross immediattely to the contralateral lateral spinothalmic tract and ascend to the brain.
72
Q

**********

primary NT for A-delta?

A

Glutamate

73
Q

********

primary NT for C-fibers?

A

Supstance P

74
Q

the primary NT for A-delta fibers (glutamate) does what?

A

binds to AMPA receptors on the postsynaptic membrane

75
Q

The primary NT for C-fibers (Substance P) does what?

A

binds to NK-1 and the postsynaptic membrane

76
Q

Tissue specific NT:

What do tissues release?

A
  1. seratonin
  2. histamine
  3. prostaglandins
  4. H+
  5. K+
77
Q

Tissue specific NT:

what NT does plasma release?

A
  1. kinins
  2. histamine
  3. (platelets, basophls, granules of mast cells)
78
Q

Tissue specific NT:

what NT do nerve terminals release

A

Substance P

79
Q

What typ of pain is muscle joint pain?

A

Somatic

80
Q

Describe somatic pain!

A
  • Aching, often constant
  • possibly dull or sharp
  • exacerbated with movement
  • well localized
81
Q

What type of pain is organ or abdominal pain?

A

Visceral

82
Q

Describe visceral pain

A
  • constant crampy
  • aching
  • poorly localized
  • reffered
83
Q

Somatic structures: SKIN

A-delta high threshold mechanoreceptors (HTMs) deal with what type of pain>

A

noxiuos mechanical stimuli

84
Q

Somatic structures: SKIN

A-delta mylelinated mechanothermal nocieptors (MMTNs) deal with what type of pain>?

A

noxious heat and mechanical stimuli

85
Q

Somatic structures: SKIN

C-polymodal nociceptors (CPNs) deal with what pain?

A
  • nocious mechanical, thermal, chemicl stimuli
  • muscle joints, faciae, other deep somatic structures
86
Q

Visceral structures:

C-fibers and A-delta fibers deal with what pains?

A

disease

inflammation

isometric contraction

ischemia

rapid distention

87
Q

**************** one of his favorite slides***********

Muscle-Skeletal/ cardiac muscles

  1. Inervated by what nerves
  2. Characteristics of pain
  3. most intense when?
  4. the nociceptors undergo sensitation in response to what substances?
A
  1. A-delta and C-fibers
  2. Diffuse, poorly localized
  3. contraction and ischemia
  4. allogenic
88
Q

**************** one of his favorite slides***********

Joint pain

  1. inervated by what nerves?
  2. repsnd only to what?
  3. can become sensitized with __________, leading to activation woth normal movement, or developing background discharge
A
  1. A-delta and C-fibers
  2. Extreme movement/pressure
  3. inflammation
89
Q

**************** one of his favorite slides***********

bone pain

  1. what fibers?
  2. the fibers form a plexus around the ________.
  3. The _____ and ______ has no nociceptive fibers has the lowest threshold of deep somatic structures
A
  1. A-delta and C-fibers
  2. periosteum
  3. cortex and marrow
90
Q

**************** one of his favorite slides***********

Visceral tissue

  1. what fibers?
  2. Is it part of ANS
  3. Insensitive to what?
  4. sensitive to what?
A
  1. A-delta and C-fibers
  2. nope
  3. curring, heating, pinching
  4. twisting and distention
91
Q

Each fascical has both efferent and afferent fibers. this is refered to as the what?

A

reflex arch

92
Q

LA SENSITIVITY:

nerve fibers order of sensitivity to LA?

A

Large myelinated > smaller myelinated > unmyelinated

93
Q

LA SENSITIVITY:

Nerve fiber order of block?

A
  1. B
  2. C-& A-delta
  3. A-gamma
  4. A- beta
  5. A-alpha
94
Q

LA SENSITIVITY:

so why is that last slide true??? see the picture

A

order of block

  1. B
  2. C and A-delta
  3. A-gamma
  4. A-beta
  5. A-aplha

Sensitiveity is largest myelinated at the highest

Regional (24 decks)

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