AP Exam 4 Part III

Question 1

what is toxic psychosis

Answer 1

exposure to toxins –> delirium

Question 2

emergence delirium of circulatory and respiratory origin

Answer 2

1. hypoxemia 2. hypercarbia 3. hypotension

Question 3

functional psychosis type delirium

Answer 3

brief reaction of paranoid and other changes not caused by an organic abnormality

Question 4

what medications are correlated with increased incidence of postoperative delirium

Answer 4

1. anticholinergics 2. antihistamines 3. benzos

Question 5

emergence delirium occurs with greater incidence among whom?

Answer 5

combat veterans

Question 6

______________ & _____________ are the most frequently occuring neurologic phenomena in older adults

Answer 6

postoperative delirium (POD); POCD

Question 7

what is the predominant risk factor for POD and POCD ?

Answer 7

age 65 +

Question 8

_______________ is characterized as a disruption of perception, thinking, memory, psychomotor behavior, sleep wake cycle, consciousness, and attention

Answer 8

postoperative delirium

Question 9

POD has been found to increase the risk of ____________, ____________, and/or ________________

Answer 9

perioperative mortality; institutionalization; dementia

Question 10

risk factors for POD

Answer 10

1. renal insufficiency & metabolic derrangements 2. poorly controlled pain 3. polypharmacy 4. functional impairment 5. urinary retention + urinary catheter

Question 11

management of postoperative delirium must r/o ______________ FIRST

Answer 11

hypoxemia

Question 12

tx of POD

Answer 12

1. r/o hypoxemia first 2. treat potential causes

Question 13

what is the most common cause of delayed awakening

Answer 13

prolonged action of anesthetic medications

Question 14

possible causes of delayed awakening

Answer 14

1. prolonged action of anesthetic agents 2. metabolic causes (hypo/hyperglycemia, electrolyte disturbances, & Hothyroidism) 3. neuro injury (RARE): (CVA, IC hemorrhage, ICP, extreme hyper/hypotension, and/or emboli)

Question 15

mild s/sx of serotonin syndrome

Answer 15

1. mydriasis 2. diaphoresis 3. myoclonus 4. tachycardia 5. anxiety 6. restlessness

Question 16

severe s/sx of serotonin syndrome

Answer 16

1. fever 2. mental status change 3. muscle rigidity 4. multiple organ failure

Question 17

serotonin syndrome is caused by concurrent administration of serotonergic medications: ______________ & _______________

Answer 17

antidepressants; chronic pain meds

Question 18

what is the most important measure in evaluating pain in the PACU

Answer 18

self report (from the patient)

Question 19

physiological indicators of pain in the PACU

Answer 19

vital signs

Question 20

behavioral indicatiors of pain in the PACU

Answer 20

crying and agitation

Question 21

somatic nociceptive pain is most commonly defined in the terms of what four processes?

Answer 21

1. transduction 2. transmission 3. perception 4. modulation

Question 22

transduction (nociceptive pain)

Answer 22

transformation of a noxious stimulus into an action potential

Question 23

transmission (nociceptive pain)

Answer 23

the process by which an action potential is conducted from the periphery to the CNS

Question 24

perception (nociceptive pain)

Answer 24

occurs once the signal is recognized by various areas of the brain (amygdala, somatosensory areas of cortex, hypothalamus, anterior cingulate cortex)

Question 25

modulation (nociceptive pain)

Answer 25

altering neural afferent activity along the pain pathway (suppresses or enhances pain signals)

Question 26

________________ are pain receptors which are free nerve endings, and can be stimulated chemically, mechanically, or thermally

Answer 26

nociceptors

Question 27

where are nociceptors located

Answer 27

skin, bone, joints, viscera

Question 28

afferent neurons, for transduction, are categorized based on

Answer 28

morphology (diameter, myelination, conduction, and velocity)

Question 29

_______________ are large myelinated afferent neurons that elicit fast sharp pain

Answer 29

A delta fibers

Question 30

what stimulates A-delta fibers

Answer 30

mechanical and thermal noxious stimuli

Question 31

what types of fibers are responsible for the reflex withdrawal mechanism

Answer 31

A-delta

Question 32

A beta fibers are stimulated by what noxious stimuli?

Answer 32

touch, pressure, proprioception

Question 33

______________ are small, non-myelinated fibers that elicit slow, dull, poorly localized pain

Answer 33

C -fibers

Question 34

what noxious stimuli can transduce C fibers?

Answer 34

mechanical, thermal, and chemical

Question 35

C fibers are aka ______________ fibers

Answer 35

polymodal

Question 36

when afferent neurons are stimulated due to peripheral tissue stimuli, what inflammatory mediators and NT are released?

Answer 36

1. glutamate** 2. substance P** 3. bradykinin 4. histamine 5. serotonin 6. prostaglandins 7. cytokines 8. calcitonin Gene related peptides

Question 37

what are the different pathways that carry noxious stimuli from periphery to the brain (i.e. transmission)

Answer 37

1. spinothalamic tract 2. spinomesencephalic tract 3. spinoreticular tract 4. spinolimbic tract

Question 38

spinothalamic tract aka _______________

Answer 38

anterolateral system

Question 39

spinothalamic tract carries pain signals from the the _______________ & ___________ to the CNS

Answer 39

trunk; lower extremities

Question 40

transmission through spinothalamic tract occurs via primary afferent first order neurons: ____________ & ____________

Answer 40

A delta; C fibers

Question 41

in the spinothalamic tract, if the first order neuron is carried via A-delta fibers, it synapses with 2nd order neuron at laminae _______ & _________

Answer 41

I; V

Question 42

in the spinothalamic tract if first order neuron is C -fiber it synapses with second order neuron at laminae ___________

Answer 42

II

Question 43

suppression pain modulation occurs through ?

Answer 43

local inhibitory interneurons in the brainstem and descending efferent pathways

Question 44

suppression of pain occurs through what receptors and neutotransmitters

Answer 44

1. endogenous opioids (enkaphalins/dynorphin) 2. GABA** 3. norepi 4. serotonin 5. Ach 6. glycine

Question 45

what is multimodal analgesia

Answer 45

1. use of agents with different MOA --> synergistic or adaptive effects 2. captures effectiveness of individual agents at optimal dosages to maxmize efficacy and minimize s/e

Question 46

what is preventative analgesia?

Answer 46

to suppress central sensitization, analgesia should be maintained throughout the perioperative period

Question 47

preventative analgesia was previously known as?

Answer 47

pre-emptive analgesia

Question 48

medications that can be used as preventative and multimodal analgesia

Answer 48

1. opioids 2. non-opoids (NSAIDs, tylenol) 3. NMDA antagonists (ketamine) 4. Alpha-2 agonists (precedex and clonidine) 5. L.A. 6. magnesium infusion 7. anticonvulsants/membrane stablizers (Gabapentin) 8. glucocorticoids

Question 49

CV consequences of pain

Answer 49

1. increased HR 2. increased BP 3. increased myocardial work

Question 50

pulmonary consequences of pain

Answer 50

1. decreased VC 2. decreased TV 3. decreased TLC