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Pain Medicine Board Lis and Maggie > Pathophysiology > Flashcards

Pathophysiology Flashcards

1
Q

What is the pathophysiology of CRPS?

A

Inflammation - upregulation of inflammatory markers leads to sensitization of nerves eventually leads to central sensitization which makes it harder to treat.

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2
Q

What is the activity of mu-2?

A

associated with respiratory depression, decreased GI motility, miosis, euphoria and physical dependence.

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3
Q

What is the activity of Mu-1?

A

supraspinal analgesia and dependence

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4
Q

What is the activity of opioids at kappa receptors?

A

spinal analgesia, miosis, sedation

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5
Q

What is the activity of opioids at the delta receptors?

A

euphoria and physical dependence

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6
Q

EMG finding of radiation brachial plexopathy

A

Myokomia
Loss of lat/medial antebrachial cutaneous nerves
Neurogenic motor units
Changes in sensory nerve action potential

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7
Q

EMG finding of radiculopathy

A

Paraspinal fibrillations
Neurogenic motor units
Normal sensory nerve AP

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8
Q

EMG finding of myopathy

A

Small motor units potential

Increased recruitment

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9
Q

EMG finding of EARLY radiculopathy

A

Reduced recruitment
Normal motor units potential
Normal sensory nerve AP

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10
Q

EMG finding of motor neuron disease

A

Diffuse fasciculation potentials
Scattered fibrillation potentials
Complex motor units

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11
Q

Units of measurement for Xrays

A

Annual max permissable radiation measures in rem or sievert. 1 Sy=100 rem

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12
Q

Absorbed total ionizing dose is measured in…

A

Rad or Gray. 1 Gray = 100rad

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13
Q

Total effective dose equivalent on a soft tissue mass is calculated in…

A

mRem (Roentgen equivalent man) or Sievert

1 Roentgen = 1 rad = 1 rem

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14
Q

Which nerve block diagnoses pain from TMJ capsule

A

Auriculotemporal nerve

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15
Q

> 10Gy doses can cause…

A

dry desquamation, telangiectasia, dermal atrophy

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16
Q

Radiation dosing comparison

A

Interventional procedures x10 > Angiography 10x > GI fluoroscopy/CT scanning

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17
Q

RF of chronic post surgical pain

A

5x RF

  • preop pain
  • preop pain in another location
  • feeling of inability to cope psychologically with stresses in the last 6 months
  • > 2 symptoms of sleeping d/o, taking sleeping pills, exhaustion, dizziness, tachycardia, feeling misunderstood, trembling hands
  • poor post op pain control
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18
Q

Golfers elbow (medial epicondylitis)

A

Pain on supination and elbow extension

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19
Q

Cubital tunnel syndrome

A

Numb and tingling in ringer and small finger.

Pain and weak grip

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20
Q

Infant myelination

A

Occurs at mid gestation and continues for 2 decades

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21
Q

Modic changes of vertebrae and end plates

A
  • Modic 1: BM inflammation, edema -> MRI T1 low signal, T2 high
  • Modic 2: Normal BM conversion to yellow fatty BM due to BM ischemia -> T1 high signal, T2 iso to high signal
  • Modic 2: Subchondral bony sclerosis -> T1 and T2 Low signal
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22
Q

How much scattered radiation is absorbed by lead apron?

A

90-95%

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23
Q

How thick should lead aprons be?

A

0.5-1mm

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24
Q

How thick should thyroid shield be?

A

0.5mm

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25
Q

What is the oral bioavailability of morphine?

A

10-45%

26
Q

Epidural morphine has bi modal distribution resulting in..

A

another peal analgesia and respiratory depression therefore not used in outpatient

27
Q

What is the physical finding in medial epicondylitis?

A

Pain on supination and elbow extension

28
Q

What is the PE of cubital tunnel?

A

tingling in ring and small finger when elbow is bent

29
Q

What is associated with tight tensor fasica lata?

A

Pain and tightness in outer knee and IT band when walking uphill.

30
Q

Tight quadricep tendon results in…

A

Pain in patella and distal thigh.

31
Q

Tight iliopsoas result in …

A

Sudden sharpness in hip and pelvis after trauma

32
Q

Piriformis syndrome result in…

A

Dull ache in buttock, pain in calf, foot. Pain with walking incline and prolonged sitting

33
Q

Suprascapular nerve innervated…

A

supraspinatus, infraspinatus

34
Q

L4 nerve root is…

A

Weak dorsiflextion, loss of patella reflex

35
Q

L3 nerve root is…

A

Weak of leg extension (quadriceps), sensory loss of medial aspect of femur

36
Q

L5 nerve root is…

A

Weak dorsiflexion of big toe, loss of sensation of dorsum of foot

37
Q

S1 nerve root is…

A

Weak of plantaflexion, sensory loss of lateral foot

38
Q

Tarsal tunnel

A

Tibial sensory and motor due to fracture leading to ischemia of nerve

39
Q

Dural sac ends…

A

S2-3 in adults

S4 in children

40
Q

Which NT acts on NMDA receptor?

A

Aspartate and glutamate

41
Q

Hemicrania continua diagnostic criteria

A
  1. Pain >3 months

2/4 of below

  1. unilateral pain
  2. continuous pain
  3. autonomic features
  4. moderate intensity with severe exacerbations
42
Q

Context sensitive half time means…

A

the amount of time for blood/plasma concentration to decrease by 50% after stopping the constant infusion.

43
Q

Biological half life=Elimination half life means

A

Time for concentration of substance in plasma to lose 50% of the radiological, pharmacological and physiological activity

44
Q

Tic convulsif is..

A

Trigeminal neuralgia with involuntary contractions of face

45
Q

Osteoporosis diagnosis on DEXA scan

A

more than -2.5

  • 1 to -2.5 is osteopenia
  • 1 and above is normal
46
Q

Chronic compartment syndrome

A

Sudden pain with exercise with tingling
Pain subsides at rest
Changes are reversible, muscles can be normal at rest

47
Q

Main opioid receptor for analgesia

A

mu-1

48
Q

Where is H reflex found

A

-Soleus muscles and forearm flexor muscles
-Delayed/absent H reflex can signify S1
radiculopathy

-Disappearance of H reflex is known as anti-dromic collision along motor neurons

49
Q

Reduced active ROM of ABduction of shoulder BUT NORMAL passive ROM

A

Subacromial bursitis

Vs frozen shoulder which will have reduced passive and active ROM

50
Q

Horners syndrome can be caused by

A

carotid artery dissection

diagnosed on MRA neck and head

51
Q

Glossopharyngeal neuralgia is associated with

A

Bradycardia and syncope due to vagal stimulation

  • Diagnosed by application of 10% cocaine over trigger zone with resolution
  • Pain triggered by swallowing and coughing
  • Posterior 1/3 of tongue
  • Symptom arise in throat and felt in ear
52
Q

Examples of Stochastic effects of radiation are

A

Genetic defects and cancer

53
Q

Compressive lesion findings on needle examination

A

Starting from earliest:

  1. reduced recruitment
  2. dev of fibrillation potentials
  3. Complex motor unit potential
  4. Large motor unit potential
54
Q

Thoracic outlet syndrom involves which nerve roots?

A
  1. C8-T1 in 90% cases

2. C5-7 less common

55
Q

Innervation of annulus fibrosus

A
  • sinovertebral nerves
  • gray rami communicantes
  • lumbar sympathetic trunk
56
Q

A delta and C fibers terminate in which laminae of grey matter

A

laminae I and II

57
Q

Which receptor senses a steady sensation on the skin?

A

Merkel’s disk - mechanoreceptors found in basal epidermis and hair follicles

58
Q

What is the cause of patellofemoral pain syndrome?

A

it is thought to be due to overloading the knees extensor mechanism

59
Q

Mechanism of visceral hyperalgesia

A

viscerosomatic convergence

60
Q

Wide dynamic range neurons

A

Include A and C fibers

Pain Medicine Board Lis and Maggie (7 decks)

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