Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ACE > ACE Review - pain > Flashcards

ACE Review - pain Flashcards

1
Q

What is allodynia

A

It is pain to a non painfuli stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is complex regional pain syndrome

A

It is a pain syndrome that has type 1 And type 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is crps type 1

A

Pain with the following. 1. Inciting event 2. not limited to one peripheral nerve 3. Pain out of proportion to inciting event.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What symptoms are associated with crps type 1.

A

Edema. Changes of skin blood flow. Pseudomotor abnormality. Allodyna or hyperalgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is type 2 crps

A
  1. After a nerve lesion. Constant burning pain, allodynia, hyperpathia. Vasomotor changes and trophic changes.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is neuralgia

A

Pain in the distribution of a nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is hyperalgesia

A

Increased pain to an already painful stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the salient feature that distinguishes crps from neuralgia

A

The presence of sympathetic disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are sympathetic disturbances of crps

A

Sudomotor: sweating, pilomotor: goosebumps, vasomotor: edema or skin color changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What kind of surgery may be associated with ulnar cutaneous nerve crps2 injury

A

Styloid process surgery of ulnar at the wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What kind of nerve injury would have numbness at the webspace at the bottom of the thumb and at the dorsal surface of the wrist?

A

Radial nerve injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are two types of organic pain

A

Nociceptive and neuropathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is nociceptive pain

A

Pain of somatic and visceral organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is neuropathic pain

A

Pain secondary to damages in the neuro pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the medication treatment for nociceptive pain

A

Opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the treatments for neuropathic pain

A

Tca, anticonvulsant, nmda

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is an example of nociceptive pain.

A

Pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is an example of neuropathic pain

A

Diabetic neuropathy, trigeminal neuralgia, multiple sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Neuropathic pain is secondary to efferent or afferent nerve involvement?

A

Afferent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is physiological dependance.

A

When a patient shows signs of withdrawl when a substance is taken away, but has no behavioral problems. ( aka no addiction problems)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is tolerance

A

When a patient requires increasing doses to maintain the same effect, but does not have behavioral problems ( aka no signs of addiction )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is opioid induced hyperalgesia

A

Long term use of opioids causes patients to have increase pain to noxious stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is common in pt with opioid hyperalgesia

A

They usually complain of pain outside the initial site of injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are 5 terms to describe neuropathic pain

A

Allodynia, dysethesia, paresthesia, hyperesthesia, hyperpathia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is hyperesthesia

A

Increases sensitivity to stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is allodynia

A

Pain due to a non noxious stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is hyperpathia

A

No sense of pain to a repetitive stimuli until a threshold is met and an explosive response is met

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is paresthesia

A

An ABNORMAL sensation (spontaneous or evoked) (like tingling)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is dyesthesia

A

An UNPLEASANT sensation (spontaneous or evoked) (like burning)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Patients on chronic opiod used are more prone to what

A

That have an increase experience with pain and increase risk of respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Are chronic opiod users more or less prone to nausea and itching

A

They are less prone to nausea and itching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What history or physical exam finding is a finding to rule out facet arthropaty

A

Pain radiating pass the knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the history or physical exam pathonomonic for facet arthropathy

A

There is none

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What test is pathonomonic for facet arthropathy

A

Medial branch blocks and intraarticular joint injections are not pathonomonic, but relief is strongly indicative of facet arthropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

At what level is the celiac plexus

A

Below diaphragm, behind stomach, anterior to aorta, L1L2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the celiac plexus

A

It is a collection of cell bodies of the post synaptic neurons making the sympathetic chain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Where are the preganglion nerves of the celiac plexus coming from

A

T5 to t12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are 2 transient effects that are seen with celiac plexus block

A

Hypotension (which may require IVf and pressors) and DIARRHEA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Does celiac plexus block cause complete pain relief

A

No. It only does visceral block, no somatic block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is Allodynia

A

It is pain to a non noxious stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

herpes zoster…how long does it last

A

2-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

herpes zoster…what are the 3 goal of antiviral therapy

A

decrease chronic pain, decrease time of shedding, decrease of acute pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

herpes zoster…what are the 3 drugs u can use

A

famocyclovir, valcyclovir, acyclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

herpes zoster…what are the better drugs to use

A

famocyclovir and valcyclovir bc more bioavailable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

herpes zoster…when should u start antiviral drugs

A

within 72 hours of onset of symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

trigeminal neuralgia…how long do episodes last

A

a few minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

trigeminal neuralgia…do patients have pain in between episodes

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

trigeminal neuralgia…where is the distribution of the pain

A

following the facial nerve…57% of the time on the right side of the face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

trigeminal neuralgia…what age group gets this

A

usually after the age of 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

trigeminal neuralgia…people who have it before the age of 30 has what associated disease

A

multiple sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

atypical face pain…how is it different from trigeminal neuralgia

A

there are not periods of pain free…there are no specific triggers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

reflex sympathatic dystrophy of the face…how is it dfferent from trigeminal neuralgia

A

there are no pain free moments…usually has allodynia…has vasomotor changers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

geniculate neuralgia….how is this pain described

A

pain near the ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

geniculate neuralgia…what nerve is this associated with

A

seventh cranial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

geniculate neuralgia…is the pain constant or paroxysmal

A

paroxysmal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

trigeminal neuralgia…what is the medication treatment

A

carbamazepine…tegretol

57
Q

trigeminal neuralgia…what is a second line adjunct that has been shown to improve pain

A

gabapentin

58
Q

trigeminal neuralgia…what intervention can be done if medicaiton cannot help

A

retrogasserian rhizotomy

59
Q

trigeminal neuralgia…what drug is used in retrogasserian rhizotomy

A

glycerol

60
Q

trigeminal neuralgia…what is the side effect of retrogasserian rhizotomy

A

facial sensory loss

61
Q

trigeminal neuralgia…what other intervention besides retrogasserian rihzotomy can be done

A

stellate ganglion block

62
Q

trigeminal neuralgia…what are the side effects of a stellate ganglion block

A

there will be sympathectomy associated with this block as well as faical sensory loss

63
Q

what is the stellate ganglion block useful for

A

reflex sympathetic dystrophy of the face

64
Q

Mastectomy…what nerve is the pain if there is axillary pain as well as upper inner arm pain

A

Intercostal Brachialis

65
Q

Mastectomy…what nerve makes up the intercostal brachailis

A

T2 and sometimes t3

66
Q

Mastectomy…what kind causes more intercostal nerve damage

A

Implants are associated with 50% chance…30% in no implants and 30% in mastectomy with no reconstruction.

67
Q

Mastectomy…what treatment can increase likelihood of post surgical breast pain.

A

Chemotherapy.

68
Q

Mastectomy…what is the treatment for post surgical Breast pain.

A

Snri and tca

69
Q

Mastectomy…what is a Tca that is useful in treating post surgical breast pain

A

Amytriptyline

70
Q

Mastectomy…what is an snri that is useful for post surgical breast pain

A

Venlafaxine

71
Q

Trochanteric bursitis…where is the pain

A

Directly over the greater trochanter

72
Q

Trochanteric bursitis…what can be done to make sure that it is not a ridiculous thy

A

Check for motor or sensory loss…if there is any…it is more likely L2 radiculopathy

73
Q

Trochanteric bursitis…what physical exam test can be done to make sure it is not a radiculopathy of L2

A

Do flexion and extension of the spine…if pain is not worsened…it is not likely radiculopathy

74
Q

Meralgia peresthetica…what nerve injury is it

A

It is lateral femoral cutaneous nn injury

75
Q

Meralgia peresthetica…where is the pain distribution.

A

Lateral side of the thigh

76
Q

Meralgia paresthetica…where is the pressure point that can illicit the pain.

A

Anterior iliac spine.

77
Q

Meralgia paresthetica…what surgeries are associated with this pain.

A

Inguinal canal surgery, or surgery of the anterior superior iliac spine

78
Q

Avascular necrosis …where is the pain…

A

Groin region

79
Q

Avascular necrosis.. How can you exacerbate the pain.

A

Internal rotation of the hip

80
Q

Avascular necrosis…you have normal radiographs…what other test can u do to check for it

A

MRI

81
Q

Trochanter bursitis…what treatment can you do to diagnose it

A

Local anesthetic injection

82
Q

Trochanteric bursitis…what is a long term treatment for it

A

Steroid injection into the bursa

83
Q

Trochanteric bursitis…what is a treatment for those refractory to steroid injection

A

Iliotibial band release

84
Q

Tolerance. Are chronic opioid users more or less post op nausea and vomit.

A

Less nausea and vomit

85
Q

Tolerance. Are chronic opiod users more or less postoperative respiratory depression.

A

They are more prone to postoperative respiratory depression.

86
Q

Trigeminal neuralgia. What is the nerve is the problem

A

Cranial nerve 5. The trigeminal nerve.

87
Q

Trigeminal neuralgia. Is the facial nerve the problem.

A

No. Facial nerve is cn7.

88
Q

Trigeminal neuralgia. What is the best intervention treatment

A

Percutaneous radiofrequency Rhizotomy of the gasserian ganglion.

89
Q

Facial nerve. Injury to this will cause what

A

Geniculate neuralgia or hemifacial spasm.

90
Q

Facial nerve. What is be geniculate neuralgia presentation

A

Pain in the ear area.

91
Q

Trigeminal neuralgia. What are the landmarks of the gasserian ganglion Rhizotomy procedure

A

Needle is first at the corner of the out and aims toward the foremen ovale near the sphenoid bone.

92
Q

Trigeminal neuralgia. What is a complication of trigeminal neuralgia gasserian ganglion radiofrequency Rhizotomy

A

It can lead to more facial pain even if the ganglion is ablated …called anesthesia dolorosa

93
Q

Pca. What is a basal rate most likely associated with.

A

Respiratory depression.

94
Q

Pca. Is there a decrease in demand does when a basal rate is given.

A

No.

95
Q

Pca. Is there improved pain or sleep with a basal rate

A

No.

96
Q

Codeine. What is special About this drug

A

It is dependent on the liver cyp2d6 for metabolism.

97
Q

Codeine. How potent is it compared to morphine.

A

It is 300 times less affinity for the mu receptor.

98
Q

Codeine. How much of the oral drug is converted to morphine with normal cyp2d6

A

Only 2-3 percent.

99
Q

Codeine. What can happen to some people who have low levels ofcyp2d6

A

They will not get pain relieve

100
Q

Codeine. What patients can have low cyp2d6

A

Pt who are on fluoxetine because this antidepressant can reduce thecyp2d6 function

101
Q

Codeine. Can it ever cause fatality if it is this non potent.

A

It can cause mortality in some patients who are hypermetabolizers. Some have a genetic mutation of the cyp2d6

102
Q

Codeine. How can u test for a high metabolizer condition.

A

In your dead patient, you can check for high amounts of morphine

103
Q

Codeine. What drug also has similar pharmacodynamics to Codine

A

Hydrocodone

104
Q

methadone. where is the site of action

A

agonist of mu, snri, and nmda antagonist

105
Q

methadone. what is special about nmda antagonism

A

it prevents hyperalgesia…commonly associated with chronic opiod use that does not have nmda antagonism

106
Q

ziconotide. what is this drug

A

n type voltage calcium channel blocker of conus magnus venomous snail used for pain

107
Q

ziconotide. what is the route of administration

A

intrathecal

108
Q

ziconotide. what is the side effect if given iv

A

profound hypotension

109
Q

ziconotide. what is the side effect if given intrathecal

A

nystagmus, confusion, dizzyness

110
Q

ziconotide. what should be attempted first before ziconotide use

A

optomization of nsaid, systemic opiods, adjuncts, and intrathecal morphine

111
Q

intrathecal baclofen. what is it used for

A

spasticity and dystonia

112
Q

crps. what is the long term outcome of most patients

A

resolution of their pain

113
Q

crps. what can happen to their pain on the extremities

A

it may ascend and extend up the extremity

114
Q

crps. what is it called when another limb experiences similar pain to the affected limb

A

mirror pain

115
Q

pain receptors. how do c fibers differ from a-delta fibers

A

c-fibers can exhibit temoporal summation

116
Q

pain receptors. why are c fibers suspects of chronic pain

A

because they can exhibit temporal summation

117
Q

pain receptors. c fibers. what is temporal summation

A

repetiton of a stimuli to the c fiber does not allow the c-fiber to return to base line…and each subsequent stimulation causes an increase response to a given stimuli

118
Q

pain receptors. what kinds of pain are related to temporal summation

A

allodynia or hyperalgesia

119
Q

pain receptors. what drugs are used to prevent temporal summation

A

nmda antagonist

120
Q

Methadone. What are the receptors of interest

A

Mu agonist. Delta agonist. Nmda antagonism.

121
Q

Methadone. Compared to morphine. Which has more affinity for the receptor.

A

Morphine.

122
Q

Methadone. When is the onset of effect.

A

30 mins.

123
Q

Methadone. How long does it last.

A

It can accumulate in the system up to 1 week after discontinuation

124
Q

Methadone. Why is it good for use in chronic pain.

A

Because it activates the delta receptor. This receptor has a role in tolerance. Thus it can help from decreasing effects of tolerance.

125
Q

Methadone. What cardiac risk does it have.

A

It can cause prolong qt and then lead to torsades.

126
Q

pancreatic cyst. what kind of block will work in treating it

A

celiac ganglion block

127
Q

pancreatic cyst. what is an adverse effect of celiac block

A

lysis an sympathetics…increase parasymp tone…diarrhea

128
Q

celiac plexus block. why do u have to block a sympathetic chain for visceral pain

A

because both visceral and sympathetic nerves share the same nerve bundle

129
Q

duloxetine. what kind of pain is it used for

A

diabetic periphereal neuropathy

130
Q

duloxetine. moa

A

snri

131
Q

duloxetine. how would an snri help with diabetic neuropathy

A

the increase in serotonin and norepi help enhance inhibitory neurons that inhibit transmission from nociceptive ascending nerve fibers

132
Q

duloxetine. besides snri. does it do nmda blockade

A

no

133
Q

suboxone. what is it

A

buprenorphine/naloxone

134
Q

suboxone. compared to morphine. which has more mu affinity

A

it has higher mu affinity, but once bound has less activation compared to morphine…thus morphine is the better analgesic

135
Q

suboxone. what does it do to the kappa recepetor

A

antagonist

136
Q

suboxone. if taken before surgery. will the naloxone affect the intraop opiods?

A

no…suboxone is given sublingual…so its systemic absorption is so low, that it does not effect intraop opiods

137
Q

suboxone. so why is naloxone given if it does not prevent abuse of other IV narcotics

A

it is placed in the sublingual pill to prevent abuse of the suboxone itself

138
Q

suboxone. so if the naloxone does not have effect on intraop opiods…are pt on chronic suboxone have any effect with pain meds intraop and post op

A

these pts may be more resistant and have higher tolerance to pain meds bc the buprenorphine may antagonize other IV mu drugs

ACE (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions