Pathophysiology Flashcards by Lis Powelson

What is the pathophysiology of CRPS?

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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What is the activity of mu-2?

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

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What is the activity of Mu-1?

supraspinal analgesia and dependence

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What is the activity of opioids at kappa receptors?

spinal analgesia, miosis, sedation

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What is the activity of opioids at the delta receptors?

euphoria and physical dependence

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EMG finding of radiation brachial plexopathy

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

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EMG finding of radiculopathy

Paraspinal fibrillations
Neurogenic motor units
Normal sensory nerve AP

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EMG finding of myopathy

Small motor units potential

Increased recruitment

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EMG finding of EARLY radiculopathy

Reduced recruitment
Normal motor units potential
Normal sensory nerve AP

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EMG finding of motor neuron disease

Diffuse fasciculation potentials
Scattered fibrillation potentials
Complex motor units

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Units of measurement for Xrays

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

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Absorbed total ionizing dose is measured in…

Rad or Gray. 1 Gray = 100rad

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

mRem (Roentgen equivalent man) or Sievert

1 Roentgen = 1 rad = 1 rem

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Which nerve block diagnoses pain from TMJ capsule

Auriculotemporal nerve

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> 10Gy doses can cause…

dry desquamation, telangiectasia, dermal atrophy

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Radiation dosing comparison

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

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RF of chronic post surgical pain

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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Golfers elbow (medial epicondylitis)

Pain on supination and elbow extension

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Cubital tunnel syndrome

Numb and tingling in ringer and small finger.

Pain and weak grip

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Infant myelination

Occurs at mid gestation and continues for 2 decades

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Modic changes of vertebrae and end plates

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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How much scattered radiation is absorbed by lead apron?

90-95%

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How thick should lead aprons be?

0.5-1mm

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How thick should thyroid shield be?

0.5mm

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What is the oral bioavailability of morphine?

10-45%

Epidural morphine has bi modal distribution resulting in..

another peal analgesia and respiratory depression therefore not used in outpatient

What is the physical finding in medial epicondylitis?

Pain on supination and elbow extension

What is the PE of cubital tunnel?

tingling in ring and small finger when elbow is bent

What is associated with tight tensor fasica lata?

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

Tight quadricep tendon results in...

Pain in patella and distal thigh.

Tight iliopsoas result in ...

Sudden sharpness in hip and pelvis after trauma

Piriformis syndrome result in...

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

Suprascapular nerve innervated...

supraspinatus, infraspinatus

L4 nerve root is...

Weak dorsiflextion, loss of patella reflex

L3 nerve root is...

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

L5 nerve root is...

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

S1 nerve root is...

Weak of plantaflexion, sensory loss of lateral foot

Tarsal tunnel

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

Dural sac ends...

S2-3 in adults | S4 in children

Which NT acts on NMDA receptor?

Aspartate and glutamate

Hemicrania continua diagnostic criteria

1. Pain >3 months 2/4 of below 1. unilateral pain 2. continuous pain 3. autonomic features 4. moderate intensity with severe exacerbations

Context sensitive half time means...

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

Biological half life=Elimination half life means

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

Tic convulsif is..

Trigeminal neuralgia with involuntary contractions of face

Osteoporosis diagnosis on DEXA scan

more than -2.5 - 1 to -2.5 is osteopenia - 1 and above is normal

Chronic compartment syndrome

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

Main opioid receptor for analgesia

mu-1

Where is H reflex found

-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

Reduced active ROM of ABduction of shoulder BUT NORMAL passive ROM

Subacromial bursitis Vs frozen shoulder which will have reduced passive and active ROM

Horners syndrome can be caused by

carotid artery dissection | diagnosed on MRA neck and head

Glossopharyngeal neuralgia is associated with

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

Examples of Stochastic effects of radiation are

Genetic defects and cancer

Compressive lesion findings on needle examination

Starting from earliest: 1. reduced recruitment 2. dev of fibrillation potentials 3. Complex motor unit potential 4. Large motor unit potential

Thoracic outlet syndrom involves which nerve roots?

1. C8-T1 in 90% cases | 2. C5-7 less common

Innervation of annulus fibrosus

- sinovertebral nerves - gray rami communicantes - lumbar sympathetic trunk

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

laminae I and II

Which receptor senses a steady sensation on the skin?

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

What is the cause of patellofemoral pain syndrome?

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

Mechanism of visceral hyperalgesia

viscerosomatic convergence

Wide dynamic range neurons

Include A and C fibers