Pain Anatomy And Physiology Flashcards
1
Q
How does a nociceptor respond to higher intensity stimulation
A
Increase firing rate
2
Q
Nociceptors have sensitization?
A
Yes
3
Q
Pinch and pinprick is sensed by
A
Mechanonociceptors
4
Q
What is a silent nociceptor
A
Responsive to inflammation
5
Q
Most common nociceptor
A
Mechano-heat - pressure temperature neurochemical mediators like histamine and bradykinin and capsaicin
6
Q
A beta transmits
A
Non noxious stimuli
7
Q
Does myelination increase conduction speed
A
Yes
8
Q
Do larger axons conduct faster?
A
Yes
9
Q
Sharp localized pain is conducted by which nerve fibers
A
A delta
C is diffuse/dull pain
10
Q
Light touch is which fiber type
A
A beta
11
Q
Fastest fibers are
A
A beta
12
Q
Can first order neurons synapse with sympathetically?
A
Yes
13
Q
Is a WDR neuron a second order neuron?
A
Yes
They receive nociceptor email input from A-delta and C but also from non noxious input too
14
Q
Substance P is released from first order neurons and binds to
A
NK-1
15
Q
Glutamate and aspartame bind to
A
NMDA receptors
16
Q
Excitatory or inhibitory?
CGRP
ATP
Ach
Serotonin
NE
A
Excitatory
Excitatory
Inhibitory
Inhibitory
Inhibitory
17
Q
Substance P effects
A
Vasodilation
Mass cell degranulation
Sensitize nociceptors
Serotonin release from platelets
18
Q
GABA A vs B subtypes
A
A is ligand gated ion channel chloride
B is G protein coupled receptor
19
Q
Where are the WDR neurons mostly?
A
Dorsal horn of spinal cord
20
Q
Which type of neuron does wind up
A
WDR
21
Q
When a WDR neuron has wind up, which part of pain signaling is affected
A
Transduction (which will be increased)
22
Q
What is secondary hyperalgesia?
A
Hyperalgesia surrounding the direct area of injury. This is driven by substance P which also causes tissue edema, redness, and sensitization
23
Q
Secondary hyperalgesia is only triggered by what type of stimulation?
A
Mechanical
Primary hyperalgesia is triggered by mechanical and heat stimuli
24
Q
What is parenthesis
A
Abnormal sensation without an apparent stimulation
Tingling or prickling
25
Substance p binds to
G protein coupled receptors
26
How do nsaids help at the spinal cord?
Decrease prostaglandins
(Prostaglandins usually help release aspartate and glutamate which are activators of NMDA receptors)
27
Which prostaglandin activates and sensitizes nociceptors
E2
28
NSAIDs counter primary hyperalgesia by reducing
Prostaglandins and prostacyclin (by inhibiting the cox pathway)
29
Pain projects to which parts of the cortex
Cingulate gyrus
Primary somatosensory cortex
30
Medial and lateral STT differences
Medial (paleospinothalanic) transmits emotional perceptions of pain and goes to the medial thalamus
Lateral (neospinothalamic) transmits location, duration, intensity and goes to VPN of the thalamus
31
Periaqueductal gray does what
Activates inhibitory interneurons in Rexed lamina 2 of the dorsal horn, which release endogenous opioids (such as enkephalin)
32
Endogenous opioids bind to
u opioid receptors on the axons of A-delta and C fibers
This leads to less substance P release
33
Substance P is released from
Primary afferent first order neurons
34
Periaqueductal gray and alpha2
Activates these receptors in the dorsal horn, which decreases pain signaling
35
Spinoreticular tract does what
Thalamus and hypothalamus
Emotional and autonomic aspects of pain
It ascends in the contra lateral spinal cord (just like STT)
36
Spinocervical tract ascends ——- and projects to ——-
Ipsilaterally
Lateral cervical nucleus and then crosses and projects to the contra lateral thalamus
37
Descending pain pathways
PAG
Rostral ventromedial medulla
38
Does STT project to PAG?
Yes
39
Do WDR neurons have NMDA receptors
Yes
Hence the wind up
40
How does tens/stim reduce pain
Activate A-beta which goes to PAG which then descends to inhibit
41
How does TCA work
Prevent serotonin and NE reputake at the synaptic cleft
This increases monoamine inhibition of ascending pathways
42
Rexed lamina that is opioid responsive
2
43
Where do Adelta and C fibers project
Adelta - I and V
C - I and II
44
Activation of opioid receptors leads to presynaptic inhibition of
The release of excitatory chemical neurotransmitters
Opioid receptor activation also causes post synaptic hyperpolarization
45
Does naloxone antagonize endogenous opioids?
Yes
46
Is hypercoagulability part of the stress response
Yes
47
Thalamus in response to SCI
Decreases perfusion on functional imaging
48
Clinical associations ankylosing spondylitis
Aortic dilation
Aortic insufficiency
Uveitis. Iritis
GI bleed
Low back pain
Pulm fibrosis
Amyloid nephropathy
Prostatis
Osteoporosis
49
Blockade of N type Ca channels results in
Inhibition of release of excitatory neurotransmitters such as substance P and glutamate (which are released from primary afferent neurons)
50
Ziconotide is cleared from CSF by
CSF flow, not metabolism
Ziconotide is a peptide
51
Pre synaptic opioid receptor activation leads to inhibition of
Voltage gated Ca channels, which inhibits release of substance P and CGRP
52
Post synaptic opioid receptor activation leads to inhibition of
Adenyl Cyclase -> K influx-> hyperpolarization
53
GABA B receptors are what type?
G protein coupled receptors
54
Proprioception is transmitted by
A alpha fibers
55
What activates NMDA receptors
Aspartate
Glutamate
56
Activation of this enzyme from uncontrolled glucose levels leads to vasoconstriction and neuronal ischemia, contributing to diabetic peripheral neuropathy
Protein kinase C
57
Calcitonin can be used for
Vertebral compression fracture pain
Phantom limb pain
Cancer related bone pain
Neuropathic pain
58
Buprenorphine mechanism
Partial mu
Antagonist at kappa and delta
It also blocks the same Na channel as local anesthetics
59
Nortriptyline is only approved for
Depression
60
Buproprion and venlafaxine are only approved for
MDD
61
Pregabalin is approved for
PDN
Fibro
62
Paroxysmal hemicrania
2-30 mins
Severe
Autonomic symptoms
Photo and or phonophobia
More common in females
Indomethacin is diagnostic
63
Heroin
LSD
Marijuana
Dea schedule?
All schedule 1
64
Morphine
Fentanyl
Oxycodone
Methadone
Dea schedule?
2
65
Alprazolam
Clonazepam
Diazepam
Dea schedule?
4
66
Tramadol Dea schedule
4
67
Codeine Dea schedule
2
68
Pregabalin Dea schedule
5
69
Acupuncture has best evidence for treating
Chronic migraine
70
Diagnosis of crps requires one symptom in each category
Sudomotor - edema
Vasomotor - temperature or skin color changes
Sensory - hyperesthesia
Motor - weakness, tremor, decreased ROM
71
Outcomes surgical intervention for trigeminal neuralgia
Best 5 yr data is micro vascular decompression with 10% chance hearing loss
Rhizotomy is less good at 5 yes and highest risk of anesthesia Dolorosa
Radiation (gamma) has unclear 5 yr data. Takes about a month for the. Treatment to work. Low risk of anesthesia dolorosa
72
Brachioradialis reflex
C6
73
Biceps reflex
C5
74
Triceps reflex
C7
75
Wrist flexion myotome
C7
76
Disability
Impairment
Handicap
Disability - function relative to ADLs or work due to impairment
Impairment- loss, loss of use, or derangement of a body part/organ (paraplegia due to stroke, unable to write bc of carpal tunnel syndrome)
Handicap. - inability to fulfill a societal role as a result of impairment or disability
77
Causes of a trendelenburg gait
L5-S1 radiculopathy
Congenital hip dislocation/hip dysplasia
Hip OA
Fractures of greater trochanter
SCFE
Superior gluteal nerve dysfunction
78
Compression of suprascapular nerve at suprascapular notch affects which muscles
Supra and infraspinatus
Compression at the spinoglenoid notch only affects infraspinatus
79
What does the median nerve innervate in the hand
First and second lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
80
Nerve roots for lateral femoral cutaneous nerve
L2-3
81
Advantages of quantitative sensory testing
Assess positive (tingling) and negative (numbness) sensory symptoms
Assess large and small fibers
Assess both the central and peripheral nervous system
82
Which muscle relaxant causes serotonin syndrome
Cyclobenzaprine, it is similar in structure to TCAs
83
Can cause false positive methadone drug screen
Verapamil
Diphenhydramine
Doxylamine
Quetiapine
84
What two substances are metabolized to morphine
Codeine
Heroin
85
At johns worts activates cyp3a4 and increases metabolism of
Amytriptyline
Tacrolimus
Warfarin
Digoxin
86
Ginkgo ginger
Ginseng
Garlic
Bleeding
87
ASRA guidelines ginkgo
Stop for 1 week before neuraxial
88
Fibrillation potentials
Acute or new radiculopathy
89
Neurogenic large motor unit potentials
Old radiculopathy
90
Elavil for migraine prophylaxis?
Yes
91
Wrist extension myotome
C6
92
Wrist flexion myotome
C8
93
Superior hypogastric plexus
Bladder cervix
Uterus
Genitalia
94
Ganglion impair
Rectum and coccyx
95
Brain structure that mediates withdrawal and the associated neurohormonal stress response
Amygdala
96
Pleasure when actively intoxicated
Basal ganglia
97
Obsession with obtaining more drugs is driven by the
Prefrontal cortex
98
Convert oral morphine to IT morphine
Divide by 300
99
What procedure prolongs QT
Right side stellate
100
T1 hypointensity cervical spinal cord signal
Poor prognosis. - necrosis
101
Sensory changes crps
Allodynia hyperesthesia
102
Vasomotor crps
Temperature change
Skin color changes
103
Sudomotor crps
Edema
Sweating changes
104
Trophic changes
Hair
Nail
Skin
105
Motor crps
ROM
Weakness
Tremor
Dystopia
106
Kidney sympathetic innervation
Lumbar plexus
107
Uterus sympathetic innervation
Superior hypogastric plexus
108
Pudendal neuralgia is worsened by
Sitting and hip flexion
Alleviated with standing or lying down
109
Gastroc innervation
Tibial nerve S1-2
110
HIV drugs that cause PN
Didanosine
Zalcitabine
Stavudine
111
Biceps innervation and level
Musculocutaneous nerve
C5-6
Biceps reflex is C5
112
Wrist extension
Nerve and myotome
Radial nerve
C6-7
113
Triceps innervation and reflex
Radial nerve (C6-8)
Reflex is C7
114
Finger extension myotome and nerve
Radial nerve
C7
115
Wrist flexion
Nerve and level
Median nerve and ulnar nerve
C7
116
Finger flexion myotome
C8
117
Finger abduction myotome
C8-T1
118
Finger adduction myotome
C8-T1
119
Biceps
Brachioradialis
Triceps
Reflex levels
C5
C6
C7
120
A patient doing anything they can to get more drugs is driven by which brain part?
Prefrontal cortex
121
Stress response and withdrawal in addiction patients is driven by
Extended amygdala
122
Which brain part does euphorias, binge behavior, etc
Basal ganglia (including the nucleus accumbens)
123
Axonotmesis
Disruption myelin sheath, spare epineurium
Crush injuries
Wallerian degeneration does occur
Neuropraxia
124
Which cranial nerves innervate the posterior fossa meninges
Hypoglossal XII
Vagus X
125
Pacinian corpuscle
Vibration
126
Markel disc
Pressure and position
127
What is the posterior interosseus nerve
Motor branch of the radial nerve
128
Convert oral Hydromorphone to morphine
Multiply by 4
129
WDR neurons synapse where
Lamina 5
