Brainscape's Knowledge GenomeTM

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


See full index

Anesthesia based on Nebuchanedzzer II > Pain > Flashcards

Pain Flashcards

1
Q

Chemical mediators, ______and _____ is released from pancreatic ______ neurons and can lead to visceral cancer pain

A

Substance P and calcitonin gene-related peptide (CGRP)

vagal afferent neurons

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

The pancreas has sensory innervation via ___

A

vagal branches
and
axons from splanchnic nerves and celiac plexus

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

Central alpha-2-receptor agonists cause (analgesia/pain)

A

analgesia

- sympatholysis

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

Lumbar sympathetic block targets the _______, along the anterolateral border of the lumbar vertebrae. _____ muscle is located posteromedial to the ganglia, and is often injected by contrast.

A

lumbar sympathetic ganglia

Psoas major

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

Most common indication for epidural steroid injection is ____

A
  1. Radicular pain caused by herniated disk
  2. Spinal stenosis

*Radicular pain responds favorably to ESI

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

Cauda equina syndrome affects ____ dermatomes

A

S3-S5

- saddle anesthesia

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

(True/False) localized pain is nototoriously difficult to treat

A

True

- TENS, ESI do not have good results

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

Why is treating phantom limb pain so difficult?

A

Lack of RCTs

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

Order from most to least common nerves affected by herpes zoster

A
  1. Thoracic
  2. Opthalmic division of trigeminal n (V1)
  3. Maxillary division of trigem n. (V2)
  4. Cervical spinal roots
  5. Sacral spinal roots
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Patients with trigger point myofascial pain often have _____.

A

Painful limitation of ROM
Spasm
Stiffness
Weakness

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

What pain syndrome is associated with hypermobile muscles and can be made worse with trigger point injections??

A

Fibromyalgia

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

How do TCAs provide analgesia in non-cancer related pain? (4)

A
  1. SSRI
  2. NMDA antagonist
  3. mu-opioid receptor agonist
  4. Na-K channel blocker
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

TCAs are mu-opioid receptor (agonists/antagonists)

A

agonists

*naloxone is a mu-opioid receptor antagonist

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

Lower extremity complex regional pain syndrome (CRPS)
- (autonomic dysfunction, burning pain, cyanotic, edematous, glossy skin ect)
is treated with_______

A

serial lumbar plexus sympathetic block

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

Common side effect of serial lumbar plexus sympathetic block

A

Failure of ejaculation
(not erectile dysfunction)
- sympathetic dependence of ejaculation

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

Why is diarrhea associated with celiac plexus block?

A

(T5-T12): Supplies innervation to all intraabdominal organs and most of bowel

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

_______ is an NMDA antagonist that may be used in the treatment of CRPS

A

Memantine

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

How does NAC work against acetaminophen toxicity?

A

N-acetylcystine: provides cysteine for replenishment of hepatic stores, which enhances elimination pathway

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

(True/False) Epidural steroid injections for lumbar radiculopathy have a direct correlation duration of symptoms. The Longer the disorder, the better it works.

A

False
- inverse

The more acute the symptoms, the higher predictor of success

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

Inhibitory neurotransmitters: inhibit central nociceptor terminals -> reducing excitatory transmitter release

A

Glycine
- acts at spinal levels

GABA
- acts at higher levels

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

Cation channel gating or excitation occurs as a result of ____ stimulation of ______ in peripheral tissues

A

noxious stimulation of the primary afferent neurons (ie. nociceptors)

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

Excitatory neurotransmitters that lead to opening (gating) of cation channels in the presynaptic nociceptor terminals

A

Glutamate,
substance P,
calcitonin gene-related peptide

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

Patients from (higher/lower) socio-economic backgrounds are more sensitive to pain

A

lower

  • worse coping mechanisms
  • worse understanding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

The stellate ganglion is made of the ______ and _____ sympathetic ganglia and lies in close proximity to the carotid artery, internal jugular vein, lung, and brachial plexus

A

Inferior cervical

First thoracic sympathetic ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Side effects of stellate ganglion block

A
  1. Vasovagal reactions
    - need to differentiate form intravascular, epidural, spinal injections
  2. Horner syndrome
    - Ptosis, miosis, anhidrosis, enopthalmos
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

______ is the most common complication of celiac plexus blockade. It is most often used for ____

A 
#1: Orthostatic hypotension
- splanchnic vasodilation by sympatholysis
#2: diarrhea

Pain caused by unresectable pancreatic cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When there is impingement of the spinal CORD itself that results in functional impairment such as weakness, numbness, or abnormal reflexes, the diagnosis is (radiculitis/myelopathy)

A

Myelopathy

*radiculitis indicates inflammation of spinal NERVE ROOT, which may lead to pain in that nerve’s distribution WITHOUT weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When there is impingement of the spinal NERVE ROOT that results in nerve pain with functional impairment such as weakness, numbness, or abnormal reflexes, the diagnosis is (radiculopathy/myelopathy)

A

Radiculopathy

*myelopathy is at the spinal cord, not the spinal nerve root

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Herpes zoster can cause blindness in immunocompromised pts if the ______ nerve is affected

A

trigeminal nerve

30
Q

Meds approved for fibromyalgia

A

Duloxetine - SNRI, additional antinociceptive effect
Milnacipran - SNRI, additional antinociceptive effect
Pregabalin - a-2/delta calcium channel modulator

31
Q

How does neuraxial fentanyl work and why is it so fast?

A

activation of mu receptors in the substantia gelatinosa in the dorsal horn of the spinal cord
- where they inhibit release of excitatory neurotransmitters (substance P and glutamate)

32
Q

What is more concerning, lipophilic fentanyl or hydrophilic morphine/hydromorphone

A

Hydrophilic

  • ascend in CSF to reach resp centers of the brainstem
  • also works at dorsal horn of SC

*lipophilic opioids work at dorsal horn of SC and through systemic absorption

33
Q

Epidural (hydromorphone/fentanyl) has less cephalic spread

A

fentanyl

  • more lipophilic, and absorbed systemically by surrounding fat
  • the more lipophilic, the shorter its duration in the epidural space

*hydromorphone and morphine is hydrophilic

34
Q

First order neurons secrete _____ in the dorsal horn as a chemical mediator of pain signaling.

A

Substance P

35
Q

Wind-up phenomenon

A

exponentially progressive increase in firing of neurons w/ repeated stimulation

36
Q

a ________ is the next step for failed medical management of complex regional pain syndrome

A

one sided diagnostic sympathetic block

- sympathectomy alone w/o analgesia

37
Q

What is complex regional pain syndrome?

A

syndrome that produces spontaneous pain
- Hyperalgesia or allodynia
and is associated with autonomic dysfunction

Type 1: no nerve damage
- trivial injury, sprain, burn

Type 2: nerve damage present (usually to major nerve trunk)
- traumatic injury, gsw, knife wound

38
Q

a ________ is the last resort for treating complex regional pain syndrome and is indicated for refractive neuropathic pain rather than nociceptive pain

A

Spinal cord stimulator

- short electrical bursts to dorsal column of spinal cord

39
Q

Thigh dermatomes

  • L1
  • L2
  • L3
A
  • L1: Along inguinal ligament
  • L2: Medial/lateral upper thigh
  • L3: Medial/lateral lower thigh (does not include knee)
40
Q

Thigh dermatomes

  • L4
  • L5
  • S1
A
  • L4: lateral lower thigh, knee, and 1/2 of big toe
  • L5: Lateral calf and toes 1.5-4
  • S1: 5th toe
41
Q

How does pKa affect local anesthetics?

A

Associated with speed of onset of drug

- sodium bicarb can be added to LA

42
Q

_______ is the best tx for a pt with an acute lumbosacral radiculopathy

A

NSAIDs

43
Q

In pt with an acute lumbosacral radiculopathy, what should be done first, imaging or treatment?

A

Conservative treatment

  • then CT or MRI if needed
  • XR does not pick up soft tissues like herniated disc
44
Q

Neuropathic pain occurs following injury to (afferent/efferent) pathways and involve (central/peripheral) mechnanisms.

A

afferent
-> hyper-excitability

Both central and peripheral components

45
Q

How does gabapentin and pregabalin work?

A

a-2-delta ligands that bind the subunit on VG calcium channels ->
prevent release of nociceptive neurotransmitters

46
Q

For electrical pain signals to pass, the NMDA receptor must be open. What are common NMDA receptor antagonists?

A

Ketamine
Nitric oxide
Methadone

47
Q

Sympathetic plexus blocks are ideal interventions for patients with _______ refractive to medical therapy. A good marker of successful sympathetic block is ________.

A

regional neuropathic pain with sympathetic mediation

Increase in limb temp by 2-3 degrees Celsius as blood vessels dilate

48
Q

Most common cause of seizure immediately after LA injection during a stellate ganglion block?

A

Vertebral or carotid artery injection

49
Q

The stellate ganglion is located at the level of _____ transverse process. The stellate ganglion block is often used in the tx of _____

A

C7
- fusion of the inferior cervical and first thoracic ganglions

Complex regional pain syndrome

50
Q

Bupivacaine, d/t its ______ can cause CNS toxicity at lower doses than many other local anesthetics

A

potency and lipid-solubility

51
Q

Local anesthetics belonging to the (ester/amide) class, more commonly result in hypersensitivity reactions d/t their ______

A

Ester

PABA metabolite

52
Q

The nerve supply to the lower extremity is derived from the _____ and ____ plexus

A

Lumbar and sacral

53
Q

The lumbar plexus gives rise to ______ nerves

A

Femoral n
Obturator n
Lateral femoral cutaneous n

54
Q

The sacral plexus gives rise to ______ nerves

A

Posterior cutaneous n of the thigh

Sciatic n

55
Q

A sciatic peripheral nerve block covers _____

A

cutaneous innervation to posterior thigh and all of the leg and foot below the knee,
EXCEPT medial strip supplied by saphenous n.

56
Q

The saphenous nerve supplies sensation to ___

A

skin on the medial side of the leg and foot

57
Q

Second order neurons describe transmission of pain signals from _____ to ____

A

dorsal horn of the spinal cord

contralateral spinothalamic tract to thalamus

58
Q

TENS is a useful treatment of ______ and involves electrical stimulation of _____ to inhibit signaling of ________ fibers.

A

Myofascial pain syndrome
- acute and chronic

Large diameter A-beta cutaneous mechanoreceptors to inhibit signaling of A-delta and C pain fibers

59
Q

Are the analgesic effects of TENS reversible?

A

Yes - with naloxone

- implies mu-receptor agonism, central and peripheral

60
Q

______ involves osteoarthritic degeneration, causing axial back pain that may radiate to ipsilateral buttocks or thigh. Pain worsened with spinal hyperextension and lateral rotation. Achy in nature, not electrical. Not associated with numbness, weakness, or tingling.

A

Facet syndrome / Facet arthropathy

61
Q

Cons of PCA vs On-request Opioid

A

PCA:

  • More pruritus
  • more respiratory depression if PCA + continuous
62
Q

(True/False) application of TENS electrodes on the contralateral limb has shown successful analgesia

A

True

63
Q

THe superior hypogastric plexus is found at ___

A

L5 anterior to the aortic bifurcation

64
Q

The ________ block targets the sympathetic fibers that innervate the pelvic organs and is therefore effective in treating chronic pelvic pain

A

superior hypogastric block

65
Q

in early complex regional pain syndrome (CRPS), _____ block may be indicated

A

Lumbar sympathetic block

-plexus: L2-L5

66
Q

The suprascapular nerve is derived from _____ via the brachial plexus

A

C5-C6

67
Q

Chronic shoulder pain d/t arthritis can be managed with _____ nerve bloc.

A

Suprascapular nerve block

68
Q

Post-stroke pain, paresthesias, and allodynia are likely a result of _____

A

thalamic pain syndrome

- d/t latent brain plasticity after a thalamic injury

69
Q

Inhibitory neurotransmitters

A

Glycine and y-aminobutyric acid (GABA)

70
Q

Nociceptors consists of ___ and ___ fibers with cell bodies located in the trigeminal and dorsal root ganglia

A

A-delta

C fibers

71
Q

Chronic opioid therapy has profound effects on adrenal and gonadal axes leading to which effects on hormones?

A

Increased
1. prolactin

Decreased

  1. testosterone
  2. Estrogen
  3. Cortisol
  4. LH
  5. FSH
72
Q

What is coccydynia?

A

Chronic pain syndrome that occurs from traumatic and nontraumatic causes

  • fractures
  • child birth
  • tumors

Anesthesia based on Nebuchanedzzer II (38 decks)

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