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NS_BTRAN > Unit2_NTK > Flashcards

Unit2_NTK Flashcards

1
Q

LA: Topical:

A

○ tetracaine, lidocaine, cocaine

○ Superficial anesthesia

○ Disadvantage = considerable absorption into circulation

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2
Q

LA • Infiltration/Injection into tissue:

A

lidocaine, procaine, bupivacaine

○ Superficial anesthesia, function of underlying organ unaffected

○ Disadvantage: significant absorption into circulation

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3
Q

LA • Nerve block:

A

injection of high concentration near peripheral nerve/nerve plexus

○ Lidocaine (2-4 hours), bupivacaine (longer duration)

○ Anesthetize larger body regions

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4
Q

LA • Intravenous regional anesthesia (Bier’s Block):

A

tourniquet applied, inject anesthetic via catheter for limb anesthesia.

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5
Q

LA • Spinal anesthesia:

A

inject into CSF

○ Anesthetize large body areas with low plasma level of drug.

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6
Q

LA • Epidural anesthesia:

A

inject just outside dura-enclosed spinal canal

○ Allows repeated/continuous anesthetic application
Higher plasma level of anesthetic

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7
Q

How are both types of LA excreted?

A

Via kidneys

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8
Q

Which type of LA is Hydrolyzed in plasma by an esterase (pseudocholinesterase), also hydrolyzed in liver?

A

ESTERS:

think PLASMA esterases

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9
Q

Which LA typically has a longer DOA?

A

amides typically have longer duration of action

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10
Q

wrt, Giant cell arthritis, what are the Sx:

A

○ Symptoms: jaw claudication, temporal artery region scalp tenderness, joint pain, constitutional symptoms (fever, malaise, weight loss)

○ Elevated ESR and CRP

○ Must biopsy temporal artery to confirm dx

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11
Q

how do you Tx Giant cell arthritis?

A

TX = steroids

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12
Q

What Diz has the following:

○ Elevated ICP
○ Normal CSF and Neuro Exam except for:
             ○ Papilledema
             ○ 6th Nerve Palsies
○ Normal neuroimaging and no other Etiology.
○ Obese Women
A

Pseudotumor Cerebri

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13
Q

Complete Cord Transection:

A

a. Tracts: all ascending and descending

b. Deficit: sensory + motor levels below lesions, may also have root → Spinal shock, followed by UMN signs

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14
Q

Central Lesions:

A

a. EX) syringomyelia (fluid filled cavity in cord)
b. Tracts: initially involve crossing spinothalamic tract
c. Deficit: pain/temp loss at level of lesion with sparing of position sensation → “Cape-like” distribution if in C-spine

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15
Q

Posterior Column Syndrome

A

a. EX) Tabes dorsalis (neurosyphilis)
b. Tracts: Dorsal (posterior column)
c. Deficit: bilateral loss of position and vibration sensation

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16
Q

Deficit in Posterior Column Syndrome?

A

Deficit: bilateral loss of position and vibration sensation

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17
Q

Tracts of Posterior Column Syndrome?

A

Dorsal (posterior column)

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18
Q

Tracts in Complete Cord Transection?

A

Tracts: all ascending and descending

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19
Q

Tracts in Central Lesions?

A

Tracts: initially involve crossing spinothalamic tract

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20
Q

Deficit in Complete Cord Transection?

A

sensory + motor levels below lesions, may also have root

→ Spinal shock, followed by UMN signs

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21
Q

Deficit in Central Lesions?

A

Deficit: pain/temp loss at level of lesion with sparing of position sensation → “Cape-like” distribution if in C-spine

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22
Q

Combined anterior horn cell-pyramidal tract syndrome:

A

a. EX) ALS
b. Tracts: corticospinal and LMN cells in cord
c. Deficit: loss of bilateral strength. Fasciculations, atrophy, decreased or increased deep-tendon reflexes, normal sensation.

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23
Q

Tracts in Combined anterior horn cell-pyramidal tract syndrome?

A

Tracts: corticospinal and LMN cells in cord

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24
Q

Deficit in Combined anterior horn cell-pyramidal tract syndrome?

A

Deficit: loss of bilateral strength. Fasciculations, atrophy, decreased or increased deep-tendon reflexes, normal sensation.

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25
Q

Brown-Sequard (hemi-section):

A

a. EX) Compression by herniated discs, tumor, extramedullary abscess, etc.
b. Tracts: crossed spinothalamic, uncrossed dorsal column, crossed corticospinal
c. Deficit: Below lesion, loss of: contralateral pain/temp, ipsilateral, position and strength

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26
Q

Tracts in Brown-Sequard (hemi-section)?

A

Tracts: crossed spinothalamic, uncrossed dorsal column, crossed corticospinal.

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27
Q

Deficits in Brown-Sequard (hemi-section)?

A

Deficit: Below lesion, loss of: contralateral pain/temp, ipsilateral, position and strength.

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28
Q

Posterolateral column syndrome: ?

A

a. EX) B12 deficiency
b. Tracts: dorsal column, corticospinal tract

c Deficit: bilateral loss of position, vibration, strength

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29
Q

Tracts in Posterolateral column syndrome?

A

Tracts: dorsal column, corticospinal tract

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30
Q

Deficits in Posterolateral column syndrome?

A

Deficit: bilateral loss of position, vibration, strength

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31
Q

Anterior Horn Cell Syndrome:

A

a. EX) spinal muscular atrophy, poliovirus
b. Tract: none - lower motor neurons only

c. Deficit: bilateral loss of strength
i. Fasciculations, decreased tone, decreased deep-tendon-reflexes
Spares sensory tracts and bladder functions

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32
Q

Tracts in Anterior Horn Cell Syndrome?

A

Tract: none - lower motor neurons only

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33
Q

Deficits in Anterior Horn Cell Syndrome?

A

Deficit: bilateral loss of strength
i. Fasciculations, decreased tone, decreased deep-tendon-reflexes
Spares sensory tracts and bladder functions

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34
Q

Anterior Spinal Artery Occlusion:?

A

a. EX) Anterior spinal artery occlusion
b. Tracts: spinothalamic and corticospinal tract

c. Deficit: bilateral loss of strength, pain/temp.
Spare position sense

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35
Q

Tracts in Anterior Spinal Artery Occlusion?

A

Tracts: spinothalamic and corticospinal tract

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36
Q

Deficits in Anterior Spinal Artery Occlusion?

A

Deficit: bilateral loss of strength, pain/temp.

Spare position sense

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37
Q

Pyramidal Tract Syndrome: ?

A

a. EX) Primary lateral sclerosis
b. Tract: corticospinal tract

c. Deficit: bilateral UMN weakness with spastic gait
- Increased deep-tendon-reflexes
- Complete sparing of all sensory tracts and bladder function.

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38
Q

Tracts in Pyramidal Tract Syndrome?

A

Tract: corticospinal tract

39
Q

Deficits in Pyramidal Tract Syndrome?

A

Deficit: bilateral UMN weakness with spastic gait

- Increased deep-tendon-reflexes
    - Complete sparing of all sensory tracts and bladder function.
40
Q

Myelopathy with Radiculopathy: ?

A

a. Tracts: any or all 3 tracts

b. Deficit: bilateral UMN syndrome with spastic gait
i. Increased DTRs + ipsilateral or contralateral root signs
Possible bladder dysfunction

41
Q

Tracts in Myelopathy with Radiculopathy?

A

Tracts: any or all 3 tracts

42
Q

Deficits in Myelopathy with Radiculopathy?

A

Deficit: bilateral UMN syndrome with spastic gait
i. Increased DTRs + ipsilateral or contralateral root signs
Possible bladder dysfunction

43
Q

Detrusor (smooth) muscle: activated by preganglionic parasympathetic outflow from _______

A

Detrusor (smooth) muscle: activated by preganglionic parasympathetic outflow from S2-S4

44
Q

_________ muscle: activated by preganglionic parasympathetic outflow from S2-S4

A

Detrusor (smooth) muscle: activated by preganglionic parasympathetic outflow from S2-S4

45
Q

Involuntary (smooth) sphincter: controlled by sympathetic outflow, in _________

A

Involuntary (smooth) sphincter: controlled by sympathetic outflow, T10-L2

46
Q

____________________ : controlled by sympathetic outflow, T10-L2

A

Involuntary (smooth) sphincter

47
Q

Involuntary (smooth) sphincter: controlled by _____________ outflow, T10-L2

A

sympathetic outflow

48
Q

___________ of pelvic floor: innervated by alpha motor neurons, S2-S4

A

Skeletal muscle

49
Q

Skeletal muscle of pelvic floor: innervated by ______ ______ neurons, S2-S4

A

Skeletal muscle of pelvic floor: innervated by alpha motor neurons, S2-S4

50
Q

Skeletal muscle of pelvic floor: innervated by alpha motor neurons, __-__?

A

Skeletal muscle of pelvic floor: innervated by alpha motor neurons, S2-S4

51
Q

• ____________Bladder: bladder does not contract → overflow incontinence.
Parasympathetic lower motor neuron injury, axon compression/disruption

52
Q

Flaccid Bladder: ?

A

bladder does not contract → overflow incontinence

Parasympathetic lower motor neuron injury, axon compression/disruption

53
Q

• Spastic Bladder: “

A

Spastic Bladder:

○ Descending pathways cut or injured (BILATERALLY) → UMN injury = initial flaccidity of bladder, then spasticity

○ Problems with coordination between sympathetic outflow (inhibited during voiding) and parasympathetic outflow (activated during voiding)

○ Urinary frequency and urgency

54
Q

Injury above S2-S4 (PNS of detrusor m.) –> what Sx?

55
Q

○ Spurling’s sign: ?

A

foraminal compression test.

Turn head towards a narrowed neural foramen → tight foramen can cause acute pinching of nerve root → pain radiates out with nerve root into arms

56
Q

Lasegue’s sign: ?

A

○ Lasegue’s sign: straight leg raising test

Sciatic nerve test - if sciatic nerve roots are under compression → shooting shock like sensation down legs

57
Q

straight leg raising test = __________ sign?

A

Lasegue’s sign

58
Q

Sciatic nerve test = _________ sign?

A

Lasegue’s sign

59
Q

foraminal compression test = ____________ sign?

A

Spurling’s sign

60
Q

Turn head towards a narrowed neural foramen → is a test for what sign?

A

Spurling’s sign

61
Q

Lhermitte’s symptom: ?

A

pain syndrome arising due to disease of spinal cord

Neck flexion results in “electric shock” sensation down back and/or arms

62
Q

pain syndrome arising due to disease of spinal cord.

Neck flexion results in “electric shock” sensation down back and/or arms

IS CALLED WHAT?

A

Lhermitte’s symptom:

63
Q

Neck flexion results in “electric shock” sensation down back and/or arms is a sign of what syndrome.

A

Lhermitte’s symptom

64
Q

__________ reflex indicates when spinal shock has resolved.

A

Bulbocavernosus reflex

If BC reflex is present and patient still is not moving/no sensation → anatomic transection of fibers

65
Q

What are the UMN signs?

A

Plantar response: normal = flexion of toes
□ Babinski sign = extension of big toe, fanning of other toes → HYPERREFLEXIA

Hoffman’s sign = hyperreflexia in upper extremity.

Crossed adductor response: tapping medial aspect of adductor tendons near knee elicits scissoring of both legs

66
Q

hyperreflexia ~ with _____ motor neuron

A

Upper motor neuron

67
Q

hyperreflexia in upper extremity = ____________sign?

A

Hoffman’s sign = hyperreflexia in upper extremity.

68
Q

tapping medial aspect of adductor tendons near knee elicits scissoring of both legs = _____________ sign.

A

Crossed adductor response: tapping medial aspect of adductor tendons near knee elicits scissoring of both legs

69
Q

C-fibers: ?

A

small, unmyelinated axons, 1 um in diameter, slow conduction velocity. Warm temperature, burning pain, itch, crude touch

70
Q

C-Fiber detect ?

A

warm temperature, burning pain, itch, crude touch

71
Q

Alpha, Alpha → most rapidly conducting, largest diameter.

What is: □ Ia → ____________
□ Ib → ____________

A

Ia → muscle spindle afferent

Ib → tendon organ afferent

72
Q

What is common to all Alpha Fibers?

A

All Alpha FIbers are myelinated.

73
Q

Alpha-Beta → slower and smaller diameter than Aa, but still fast detect what?

A

Mechanoreceptors of skin, secondary muscle spindle afferents

74
Q

Alpha-Delta → slower and smaller diameter than AB.

Detect what?

A

Sharp pain, cool temp, EXTREME hot Temps.

75
Q

___________ System: ascending pathway for pain and temperature information, axons of dorsal horn second order neurons that cross midline and ascend anterolaterally

A

Anterolateral

76
Q

_____________ tract: pain pathway to thalamus

A

Spinothalamic Tract.

□ Projects to nuclei of ventrobasal thalamus (includes VPL)

□ Processes information related to localization of pain

□ Projects to somatosensory cortex

77
Q

___________ tract: pain pathway that leads to forebrain arousal and elicits emotional/behavioral responses

A

Spinoreticular Tract.

Connects to limbic system
Terminates in pons and medulla

78
Q

______________ tract: projects to midbrain periaqueductal gray region (PAG).

A

Spinomesencephalic tract:

descending control of pain.

79
Q

First pain: __ fibers → detect tolerable, localized, “pricking pain”

A

Ad fibers.

Faster conduction velocity than C fibers

Smaller receptive field = better localized spatial discrimination

80
Q

Second pain: __ fibers → intolerable, diffusely localized, “burning” pain

A

C-fibers.

Slower conduction velocity than Ad fibers

Larger receptive field = dull, aching, poorly localized pain

81
Q

First pain: Ad fibers → detect tolerable, localized, “_________ pain”

A

“pricking pain”

82
Q

Second pain: C fibers → intolerable, diffusely localized, “______” pain

83
Q

____?____: decrease threshold for activation of nociceptors

A 
• Sensitizers: decrease threshold for activation of nociceptors
	○ Prostaglandin
	○ Substance P
	○ ATP
	○ Acetylcholine
        ○ Serotonin (5-HT)
84
Q

___?___: lead to direct activation of nociceptors

A

Activators: lead to direct activation of nociceptors
○ Bradykinin → Ad and C fiber activator; Also increases synthesis of prostaglandins (Sensitizer).
○ Potassium
○ Acid
○ Serotonin (5-HT)

85
Q

Burning pain = _fiber?

86
Q
  • __1__ receptor → rapid synaptic response

* __2__ receptor → slower excitatory potential

A
  1. AMPA

2. NMDA

87
Q

Substance P: Released by C fibers in response to Neurokinin 1 receptor (NK-1)repetitive stimulation in CNS at site of first synapse → binds _________ receptor → close K+ channel, depolarization.

A

Neurokinin 1 receptor (NK-1)

88
Q

__________: Released by C fibers in response to repetitive stimulation in CNS at site of first synapse → binds Neurokinin 1 receptor (NK-1) → close K+ channel, depolarization.

A

Substance P (sensitizer)

89
Q

Substance P: Released by __1__ fibers in response to repetitive stimulation in CNS at site of first synapse → binds Neurokinin 1 receptor (NK-1) → __2__ K+ channel, depolarization.

A
  1. C-Fibers

3. closes K+ ch.

90
Q

_____?______ in midbrain → analgesia (pain sensation attenuated) while touch, pressure and temperature sensation persists

A

PAG stimulation

91
Q

PAG stimulation in midbrain → ___?___ (pain sensation attenuated) while touch, pressure and temperature sensation persists

92
Q

What inhibits secondary neurons in the spinal cord to by exciting INTERNEURONS to secrete enkephalin and results in PRE-synaptic Inhibition?

93
Q

Describe mechanisms underlying neuropathic pain.

  • Peripheral mechanism: ?
  • Central Mechanism: ?
A
  • Peripheral mechanism = sodium channels

* Central Mechanism = GABA content and receptors, sprouting and rewiring, glia and immune system

NS_BTRAN (21 decks)

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