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NBDE Part II > Pain > Flashcards

Pain Flashcards

1
Q

What are 3 components of pain?

A

1-Sensory-descriminative2-Cognitive3-Emotional/affective

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2
Q

The physiological process by which information on actual/potential tissue damage is conveyed to the CNS is called?

A

Nociception

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3
Q

Specialized Ion channels on sensory nerve endings that respond to noxious stimuli are called?

A

Nociceptors

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4
Q

Pain resulting from activation of nociceptors as a result of actual or potential tissue damage and processing by the CNS is called?

A

Nociceptive Pain-Somatic/visceral/inflammatory

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5
Q

A pathophysiological process, resulting from abnormal sensory processing which does not signal actual or potential tissue damage, does not promote healing or repair and may be considered a disease is called?

A

Neuropathic/neurogenic pain

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6
Q

Pain associated with musculoskeleton system that is well defined is called?

A

Somatic

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7
Q

Pain associated with internal organs and associated tissues and is dull burning or poorly defined is called?

A

Visceral

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8
Q

The selective reduction of pain perception without affecting other sensory modalities is called?

A

Analgesia

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9
Q

The absence of any sensation due to suppression of CNS is called?

A

Anesthesia*Local and General

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10
Q

What are the 4 main steps of the nociceptive process?

A

TransductionTransmissionModulationPerception

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11
Q

What are the 4 types of ion channels that are on nerve endings?

A

1-Mechanical2-Chemical3-Thermal4-Polymodal

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12
Q

What compound found in spicy foods depletes substance P by activating the TRPV1 polymodal nociceptor?

A

Capsaicin*numbness following pain

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13
Q

Second messengers such as bradykinins are released from chemically activated nociceptor nerve endings and have what effect?

A

Further activate nociceptors by sensitizing them in a positive feedback

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14
Q

Increased perception of pain in response to a painful stimuli is called?

A

Hyperalgesia

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15
Q

Pain evoked by normally non painful stimuli is called?

A

Allodynia

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16
Q

What are two major candidates for sensitization of nerve endings?

A

1-Substance p (SP) (nerve endings)2-Prostaglandins (damaged cells)

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17
Q

What affect to PGs have on nerve endings?

A

Activate Na channels making the cell more excitable

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18
Q

Which protein is a constitutive in many tissues, generates PGs for regulation, is inhibited by classic NSAIDs and is the basis of some adverse effects of NSAIDs?

A

COX-1*Aspirin blocks both COx1 and 2 but is more effective on 1

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19
Q

GI cytoprotection, platelet aggregation, renal electrolyte homeostasis and blood flow, and some pain and fever are mediated by which protein?

A

COX-1

20
Q

Which protein is induced by hormones, growth and inflammatory mediators?

A

COX-2*blocked by classic NSAIDs and selective Cox-2 inhibitors

21
Q

Renal electrolyte homeostasis and blood flow, Cardiovascular protection, pain, fever and inflammation are all mediated by what?

A

COX-2

22
Q

How do NSAIDs work?

A

Inhibiting the synthesis of prostaglandins that are involved in sensitizing the nociceptor nerve ending

23
Q

Which nociceptors are normally activated by mechanical stimulation (i.e. distention) but may be referred to somatic sites as well?

A

Nociceptors in the Viscera

24
Q

Which axons are the largest, myelinated, very fast and transmit touch, and proprioception?

A

A-beta axons

25
Q

Which axons are small, myelinatad, fast conducting and are associated with mechanical thermal nociceptors, transmitting fast or first pain?

A

A-delta axons

26
Q

Which axons are small, un-myelinated, slow conducting and are associated with polymodal nociceptors, transmitting slow or second pain?

A

C axons

27
Q

The plexus of nerves in the tooth are called what?

A

Plexus of Raschkow or Sub-Odontoblastic plexus

28
Q

Where do the nerves in the dentition come from?

A

-Sensory afferents of the trigeminal nerve-Sympathetics from superior cervical ganglion

29
Q

What are the two types of nerve fibers in the tooth?

A

1-A-delta fibers (sharp localized pain when dentin is first exposed)2-C-fibers (dull diffuse pain)

30
Q

Where do nociceptive fibers synapse with projection neurons?

A

Dorsal horn of the spinal chord*AB and Ad fibers synapse close together. mixing touch with pain

31
Q

What are the two important neurotransmitters in pain?

A

1-Glutamate2-Substance P

32
Q

After decussating, projection neurons ascend contra laterally in the spinothalamic tract to where?

A

Thalamus*Major somatosensory relay

33
Q

Where does the trigeminal nucleus input to?

A

Thalamus*Then goes to somatosensory cortex 1 and 2 (sensory) and limbic (emotional)

34
Q

When dorsal horn projection neurons become sensitized and hyper-respond to nociceptive input it is referred to as what?

A

Central sensitization*contributes to hyperalgesia and allodynia. Prostaglandins likely involved

35
Q

What area is the major site of action of analgesic drugs, a secondary mechanism for NSAIDs and a major site for opioids?

A

Dorsal horn of spine

36
Q

Inhibition of pain by touch is referred to as?

A

Gate Control*AB and Ad/C fibers converge

37
Q

When visceral afferent nociceptors converge on the same pain-projection neurons as the afferents from somatic structures causing pain it is called?

A

Referred pain*ie. sinusitis and dental pain

38
Q

What normally terminated nociceptive pain?

A

Healing

39
Q

Enkephalins/endorphins along with 5HT and NE act where to help modulate pain?

A

Mesencephalic Periaqueductal Gray

40
Q

What are the two types of enkephalins that are 5 amino acids long and stimulate u and d receptors?

A

1-Methionine2-Leucine

41
Q

Which molecules are 91 amino acids long and stimulate u and d receptors?

A

B-endorphins

42
Q

Which molecules are 17 amino acids long, stimulate k receptors are are not abused?

A

Dynorphins A and B*block pain but are not pleasant

43
Q

What are 3 features of Neuropathic pain?

A

1-1 or multiple damaged peripheral nerves2-Continuous deep burning, aching and/or periodic shock3-Triggers initiate the pain

44
Q

What two typical pain treatments do not work well for neuropathic pain?

A

1-NSAIDs2-Opioids (inconsistent)

45
Q

What types of drugs help with neuropathic pain?

A

1-Antidepressants (Cymbalta)2-Anticonvulsants (Lyrica, gabapentin)3-Corticosteroids

46
Q

What is an endogenous analgesia elicited by suggestion called?

A

Placebo*most likely causes release of endorphins

NBDE Part II (13 decks)

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