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Pain Boards > Pain Anatomy And Physiology > Flashcards

Pain Anatomy And Physiology Flashcards

1
Q

How does a nociceptor respond to higher intensity stimulation

A

Increase firing rate

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2
Q

Nociceptors have sensitization?

A

Yes

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3
Q

Pinch and pinprick is sensed by

A

Mechanonociceptors

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4
Q

What is a silent nociceptor

A

Responsive to inflammation

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5
Q

Most common nociceptor

A

Mechano-heat - pressure temperature neurochemical mediators like histamine and bradykinin and capsaicin

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6
Q

A beta transmits

A

Non noxious stimuli

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7
Q

Does myelination increase conduction speed

A

Yes

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8
Q

Do larger axons conduct faster?

A

Yes

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9
Q

Sharp localized pain is conducted by which nerve fibers

A

A delta
C is diffuse/dull pain

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10
Q

Light touch is which fiber type

A

A beta

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11
Q

Fastest fibers are

A

A beta

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12
Q

Can first order neurons synapse with sympathetically?

A

Yes

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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

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14
Q

Substance P is released from first order neurons and binds to

A

NK-1

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15
Q

Glutamate and aspartame bind to

A

NMDA receptors

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16
Q

Excitatory or inhibitory?
CGRP
ATP
Ach
Serotonin
NE

A

Excitatory
Excitatory
Inhibitory
Inhibitory
Inhibitory

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17
Q

Substance P effects

A

Vasodilation
Mass cell degranulation
Sensitize nociceptors
Serotonin release from platelets

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18
Q

GABA A vs B subtypes

A

A is ligand gated ion channel chloride
B is G protein coupled receptor

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19
Q

Where are the WDR neurons mostly?

A

Dorsal horn of spinal cord

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20
Q

Which type of neuron does wind up

A

WDR

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21
Q

When a WDR neuron has wind up, which part of pain signaling is affected

A

Transduction (which will be increased)

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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

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23
Q

Secondary hyperalgesia is only triggered by what type of stimulation?

A

Mechanical

Primary hyperalgesia is triggered by mechanical and heat stimuli

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24
Q

What is parenthesis

A

Abnormal sensation without an apparent stimulation
Tingling or prickling

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25
Q

Substance p binds to

A

G protein coupled receptors

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26
Q

How do nsaids help at the spinal cord?

A

Decrease prostaglandins
(Prostaglandins usually help release aspartate and glutamate which are activators of NMDA receptors)

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27
Q

Which prostaglandin activates and sensitizes nociceptors

A

E2

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28
Q

NSAIDs counter primary hyperalgesia by reducing

A

Prostaglandins and prostacyclin (by inhibiting the cox pathway)

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29
Q

Pain projects to which parts of the cortex

A

Cingulate gyrus
Primary somatosensory cortex

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30
Q

Medial and lateral STT differences

A

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

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31
Q

Periaqueductal gray does what

A

Activates inhibitory interneurons in Rexed lamina 2 of the dorsal horn, which release endogenous opioids (such as enkephalin)

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32
Q

Endogenous opioids bind to

A

u opioid receptors on the axons of A-delta and C fibers

This leads to less substance P release

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33
Q

Substance P is released from

A

Primary afferent first order neurons

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34
Q

Periaqueductal gray and alpha2

A

Activates these receptors in the dorsal horn, which decreases pain signaling

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35
Q

Spinoreticular tract does what

A

Thalamus and hypothalamus
Emotional and autonomic aspects of pain

It ascends in the contra lateral spinal cord (just like STT)

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36
Q

Spinocervical tract ascends ——- and projects to ——-

A

Ipsilaterally
Lateral cervical nucleus and then crosses and projects to the contra lateral thalamus

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37
Q

Descending pain pathways

A

PAG
Rostral ventromedial medulla

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38
Q

Does STT project to PAG?

A

Yes

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39
Q

Do WDR neurons have NMDA receptors

A

Yes
Hence the wind up

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40
Q

How does tens/stim reduce pain

A

Activate A-beta which goes to PAG which then descends to inhibit

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41
Q

How does TCA work

A

Prevent serotonin and NE reputake at the synaptic cleft
This increases monoamine inhibition of ascending pathways

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42
Q

Rexed lamina that is opioid responsive

A

2

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43
Q

Where do Adelta and C fibers project

A

Adelta - I and V
C - I and II

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44
Q

Activation of opioid receptors leads to presynaptic inhibition of

A

The release of excitatory chemical neurotransmitters

Opioid receptor activation also causes post synaptic hyperpolarization

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45
Q

Does naloxone antagonize endogenous opioids?

A

Yes

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46
Q

Is hypercoagulability part of the stress response

A

Yes

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47
Q

Thalamus in response to SCI

A

Decreases perfusion on functional imaging

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48
Q

Clinical associations ankylosing spondylitis

A

Aortic dilation
Aortic insufficiency
Uveitis. Iritis
GI bleed
Low back pain
Pulm fibrosis
Amyloid nephropathy
Prostatis
Osteoporosis

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49
Q

Blockade of N type Ca channels results in

A

Inhibition of release of excitatory neurotransmitters such as substance P and glutamate (which are released from primary afferent neurons)

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50
Q

Ziconotide is cleared from CSF by

A

CSF flow, not metabolism

Ziconotide is a peptide

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51
Q

Pre synaptic opioid receptor activation leads to inhibition of

A

Voltage gated Ca channels, which inhibits release of substance P and CGRP

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52
Q

Post synaptic opioid receptor activation leads to inhibition of

A

Adenyl Cyclase -> K influx-> hyperpolarization

53
Q

GABA B receptors are what type?

A

G protein coupled receptors

54
Q

Proprioception is transmitted by

A

A alpha fibers

55
Q

What activates NMDA receptors

A

Aspartate
Glutamate

56
Q

Activation of this enzyme from uncontrolled glucose levels leads to vasoconstriction and neuronal ischemia, contributing to diabetic peripheral neuropathy

A

Protein kinase C

57
Q

Calcitonin can be used for

A

Vertebral compression fracture pain
Phantom limb pain
Cancer related bone pain
Neuropathic pain

58
Q

Buprenorphine mechanism

A

Partial mu
Antagonist at kappa and delta
It also blocks the same Na channel as local anesthetics

59
Q

Nortriptyline is only approved for

A

Depression

60
Q

Buproprion and venlafaxine are only approved for

A

MDD

61
Q

Pregabalin is approved for

A

PDN
Fibro

62
Q

Paroxysmal hemicrania

A

2-30 mins
Severe
Autonomic symptoms
Photo and or phonophobia
More common in females
Indomethacin is diagnostic

63
Q

Heroin
LSD
Marijuana

Dea schedule?

A

All schedule 1

64
Q

Morphine
Fentanyl
Oxycodone
Methadone

Dea schedule?

A

2

65
Q

Alprazolam
Clonazepam
Diazepam

Dea schedule?

A

4

66
Q

Tramadol Dea schedule

A

4

67
Q

Codeine Dea schedule

A

2

68
Q

Pregabalin Dea schedule

A

5

69
Q

Acupuncture has best evidence for treating

A

Chronic migraine

70
Q

Diagnosis of crps requires one symptom in each category

A

Sudomotor - edema
Vasomotor - temperature or skin color changes
Sensory - hyperesthesia
Motor - weakness, tremor, decreased ROM

71
Q

Outcomes surgical intervention for trigeminal neuralgia

A

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
Q

Brachioradialis reflex

A

C6

73
Q

Biceps reflex

A

C5

74
Q

Triceps reflex

A

C7

75
Q

Wrist flexion myotome

A

C7

76
Q

Disability
Impairment
Handicap

A

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
Q

Causes of a trendelenburg gait

A

L5-S1 radiculopathy
Congenital hip dislocation/hip dysplasia
Hip OA
Fractures of greater trochanter
SCFE
Superior gluteal nerve dysfunction

78
Q

Compression of suprascapular nerve at suprascapular notch affects which muscles

A

Supra and infraspinatus

Compression at the spinoglenoid notch only affects infraspinatus

79
Q

What does the median nerve innervate in the hand

A

First and second lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

80
Q

Nerve roots for lateral femoral cutaneous nerve

A

L2-3

81
Q

Advantages of quantitative sensory testing

A

Assess positive (tingling) and negative (numbness) sensory symptoms
Assess large and small fibers
Assess both the central and peripheral nervous system

82
Q

Which muscle relaxant causes serotonin syndrome

A

Cyclobenzaprine, it is similar in structure to TCAs

83
Q

Can cause false positive methadone drug screen

A

Verapamil
Diphenhydramine
Doxylamine
Quetiapine

84
Q

What two substances are metabolized to morphine

A

Codeine
Heroin

85
Q

At johns worts activates cyp3a4 and increases metabolism of

A

Amytriptyline
Tacrolimus
Warfarin
Digoxin

86
Q

Ginkgo ginger
Ginseng
Garlic

A

Bleeding

87
Q

ASRA guidelines ginkgo

A

Stop for 1 week before neuraxial

88
Q

Fibrillation potentials

A

Acute or new radiculopathy

89
Q

Neurogenic large motor unit potentials

A

Old radiculopathy

90
Q

Elavil for migraine prophylaxis?

A

Yes

91
Q

Wrist extension myotome

A

C6

92
Q

Wrist flexion myotome

A

C8

93
Q

Superior hypogastric plexus

A

Bladder cervix
Uterus
Genitalia

94
Q

Ganglion impair

A

Rectum and coccyx

95
Q

Brain structure that mediates withdrawal and the associated neurohormonal stress response

A

Amygdala

96
Q

Pleasure when actively intoxicated

A

Basal ganglia

97
Q

Obsession with obtaining more drugs is driven by the

A

Prefrontal cortex

98
Q

Convert oral morphine to IT morphine

A

Divide by 300

99
Q

What procedure prolongs QT

A

Right side stellate

100
Q

T1 hypointensity cervical spinal cord signal

A

Poor prognosis. - necrosis

101
Q

Sensory changes crps

A

Allodynia hyperesthesia

102
Q

Vasomotor crps

A

Temperature change
Skin color changes

103
Q

Sudomotor crps

A

Edema
Sweating changes

104
Q

Trophic changes

A

Hair
Nail
Skin

105
Q

Motor crps

A

ROM
Weakness
Tremor
Dystopia

106
Q

Kidney sympathetic innervation

A

Lumbar plexus

107
Q

Uterus sympathetic innervation

A

Superior hypogastric plexus

108
Q

Pudendal neuralgia is worsened by

A

Sitting and hip flexion

Alleviated with standing or lying down

109
Q

Gastroc innervation

A

Tibial nerve S1-2

110
Q

HIV drugs that cause PN

A

Didanosine
Zalcitabine
Stavudine

111
Q

Biceps innervation and level

A

Musculocutaneous nerve
C5-6

Biceps reflex is C5

112
Q

Wrist extension
Nerve and myotome

A

Radial nerve
C6-7

113
Q

Triceps innervation and reflex

A

Radial nerve (C6-8)
Reflex is C7

114
Q

Finger extension myotome and nerve

A

Radial nerve
C7

115
Q

Wrist flexion
Nerve and level

A

Median nerve and ulnar nerve
C7

116
Q

Finger flexion myotome

A

C8

117
Q

Finger abduction myotome

A

C8-T1

118
Q

Finger adduction myotome

A

C8-T1

119
Q

Biceps
Brachioradialis
Triceps
Reflex levels

A

C5
C6
C7

120
Q

A patient doing anything they can to get more drugs is driven by which brain part?

A

Prefrontal cortex

121
Q

Stress response and withdrawal in addiction patients is driven by

A

Extended amygdala

122
Q

Which brain part does euphorias, binge behavior, etc

A

Basal ganglia (including the nucleus accumbens)

123
Q

Axonotmesis

A

Disruption myelin sheath, spare epineurium
Crush injuries
Wallerian degeneration does occur

Neuropraxia

124
Q

Which cranial nerves innervate the posterior fossa meninges

A

Hypoglossal XII
Vagus X

125
Q

Pacinian corpuscle

A

Vibration

126
Q

Markel disc

A

Pressure and position

127
Q

What is the posterior interosseus nerve

A

Motor branch of the radial nerve

128
Q

Convert oral Hydromorphone to morphine

A

Multiply by 4

129
Q

WDR neurons synapse where

A

Lamina 5

Pain Boards (4 decks)

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