Pain (exam 2) Flashcards
What are the 2 types of pain?
Nociceptive
Neuropathic
What is nociceptive pain?
Trigger nociceptors for pain
Somatic- joints, muscle, skin (very specific)
Visceral- organs (tumor/ obstruction) (very broad, referred pain)
What is neuropathic pain?
Brain feels pain
CNS or PNS
Don’t always know the stimulus
What type of pain do small C fibers cause?
Prolonged, dull, achey, persistent pain
Small C fibers are unmyelinated
What type of pain do large A fibers cause? What other sensations?
Immediate, sharp pain
Large A fibers are myelinated
Touch, vibration, thermal
What are natural analgesics?
Endorphins
Enkephalin
Dynorphin
What does Transduction in pain pathway do?
Nociceptors activated, release substance to activate small C fibers
What does Transmission in pain pathway do?
Small C fibers to spinal cord through brain stem to the thalamus to the cerebral cortex
What does Perception in pain pathway do?
Once in cerebral cortex we feel and become aware of pain
What does Modulation in pain pathway do?
How we inhibit or control pain
What is the gate control theory?
Small C fibers open the gate, cause pain
Large A fibers close the pain gate, modulation: touch, thermal, vibration
What is endogenous modulation?
Release analgesics (endorphins, serotonin, Neorepinephrine)
Block pain at the level small C fibers came in
Block at spinal cord even though nociceptors are still firing
What is exogenous modulation?
Large A fibers doing the modulation and closing gate through touch, vibration and thermal
Nociceptors are still firing, but large A are myelinated and beat to spinal cord so we don’t perceive it
How many months of persistent pain till it is classified as chronic pain?
3 months
Intermittent Chronic Pain
Comes and goes
Ex: chronic migraines
Persistent Chronic Pain
Always present
Ex: lumbago (low back pain)
Neuropathic Pain
Brains perception of pain
Characterized by:
Hyperalgesia (over exaggerated pain levels)
Allodynia (feel pain with no present stimulus)
What is perceptual dominance?
Second injury is masked by pain of greater injury
What causes a fever? What does fever mean?
Pyrogens
Mean infection
What is hyperthemia?
High body temp
Overexposure to heat source
What is malignant hyperthermia?
Increased body temp caused by anesthetics
Spontaneously, quick progression of body temp
Increase muscle contraction, increase body temp
Stop by removal of anesthetics
What is hypothermia?
To low body temp
What are the stages of sleep?
REM (dreaming, rapid eye movement)
Non-REM sleep (4 stages, deeper sleep)
What is Hypersomnia and the types?
To sleepy
Primary hypersomnia: always over sleepy
Secondary hypersomnia: something inducing it, usually drugs
What sleep disorders affect breathing?
Obstructive sleep apnea syndrome (usually overweight or obese)
Nocturnal paroxysmal dyspnea (CHF patients, overwork heart laying down, SOB)
What is insomnia?
Inability to fall or stay asleep
What is strabismus?
Deviation from center of eye
Lazy eye
What is nystagmus?
Eye shaking, twitching
What is diplopia? What is it a symptom of?
Double vision
Strabismus symptom
What is myopia?
Nearsightedness
Long eyeball
Focus in front of retina
What is hyperopia?
Farsightedness
Fat eyeball
Focus behind retina
What is astigmatism?
Uneven corneal curvature
No single retinal focus
What is an otitis externa ear infection?
Outside the tympanic membrane
Swimmers ear
What is an otitis media infection? Most common in who?
Eustachian tube infection
Children and infants
What is vestibular nystagmus?
proprioceptive dysfunction
Eyeball movement secondary to overstimulation of semicircular canals
What is vertigo?
Feel like you are spinning
Spinning sensation secondary to inflammation of semicircular canals
What is the primary cause of aphasia?
Stroke
What is anomic/ amnesia aphasia?
Without a name for person, place, thing
What is receptive aphasia?
Damage to wernicke’s area
Difficulty understanding spoken or written language
What is expressive aphasia?
Damage to Broca’s area
Difficulty in conveying thoughts speech or writing
What is global aphasia?
Damage to wernicke and broca areas
Loss of almost all language function
What is decorticate?
Hands stuck up on chest
Lower on brain stem
Corticospinal damage: opposite side
What is decerebrate?
Hands stuck down
Higher on brainstem
Ipsilateral damage: same side
What happens with both decorticate and decerebrate damage?
Brain damage is to straight are side
What is Brain Stem Death?
Lack of brain function
Vegetative state, living by machines
What is cerebral death?
Death exclusive of brain stem and cerebellum
Brain maintains internal homeostasis
What is a partial seizure?
Part of brain
Focal and unilateral
What is an absence seizure?
Spacing out, zoning out for a couple minutes
What is a tonic clonic seizure?
Convulsions (rigid and relax, repeat)
Grand mal seizures
What is an epileptic?
Chronic tonic clonic seizures
What is hydrocephalaus?
Big head
Excess CSF within cranial vault, subarachnoid space or both
Increased ICP
What is a coup and counter- coup injury?
Coup is injury where hit on brain
Counter-coup is brain bouncing off opposite side of head, secondary injury
Cerebral Concussion
Most common type of traumatic brain injury Chemical injury with loss of ATP Confusion, Amnesia, Fatigue, Dizziness Loss of consciousness not needed No major broken blood vessels
Epidural Hematoma
Blunt force trauma/ motor vehicle accident Between skull and dura mater Increase ICP Arterial bleed, fast bleed Lucid intervals= think you are fine Progressive Don't break blood brain barrier
Subdural Hematoma
Elderly/ alcoholics/ shaken baby syndrome Increase ICP (highest of all) Below dura, above pia Venous bleed, slow bleed Most common, most fatal Brain becomes hypoxic then necrosis Break blood brain barrier Inflammation and macrophage in brain Liquifactic necrosis
Intracerebral Hematoma
Stroke causes Inside brain tissue Small arteries or veins, slow bleed Fastest to produce symptoms Break blood brain barrier Liquifactic necrosis Forms penumbra, walling off area Little to no change in ICP
Quadrapelegia
Complete paralysis
Damage to T1 or above
Paraplegia
Lower half
T2 and below
Hemiplegia
Half the body
Stroke
What is the circle of willis?
Colateral flow
If get a blockage in part, then should still get bloodflow to brain
Hemorrhagic Stroke
Bleeding into brain tissue
Poor oxygenation
Necrosis
Ischemic Stroke
Lack of bloodflow
Hypoxia
Permanent necrosis
Meningitis
Inflammation of the meninges
Bacterial: skull fractures, antibiotics
Aseptic (Viral)
Fungal: Super fatal and rare
Encephalitis
Inflammation of the brain
Senility
Physiologic
Decrease cognitive function due to age
Dementia
Severe short term memory loss
Alzheimer’s Disease
Initial symptom: memory loss Secondary: motor function loss Strong genetic component Tau tangles and Amyloid plaques Severe atrophy of brain
Parkinson’s Disease
Initial symptom: motor function loss
Secondary: Memory loss
Loss of dopamine production/ release
Loss of inhibition of dopamine causes more Ach= muscle tremors
Amyotrophic Lateral Sclerosis (ALS)
Primary symptom: Muscle weakness
Degeneration of somatic motor neurons
Rapidly prgressive
Multiple Sclerosis
Primary Symptom: Muscle weakness
Demyelination of CNS neurons
Autoimmune disease (type 4): cyto T’s attack oligos
Females more prone
Guillan barre
Primary symptom: Muscle weakness
Demyelination of PNS neurons (schwann cells)
From infection
Can recover
Muscular Dystrophy
Primary symptom: muscle weakness Muscle protein (dystrohpin) problem Duchenne MD= most common in kids Myotonic MD= most common in adults
Myasthenia Gravis (MG)
Primary symptom: muscle weakness
Autoimmune disease: Ab to Ach receptors- block/ destroy- low muscle function
