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Yr 2 > BB wk 5- Chronic Pain > Flashcards

BB wk 5- Chronic Pain Flashcards

1
Q

what lesion leads to apraxia?

A

lesions to the premotor area - anterior to the primary motor area of cortex. Responsible for higher thinking, planning.

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2
Q

define apraxia

A

a deficit in learned, skilled motor activity in the absence of paralysis ( eg brushing teeth, combing hair, whistling). you have whistling apraxia:)

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3
Q

how does sensory information get to your postcentral gyrus ( sensory home)?

A

sensory info travels up PCML, Spinothalamic tract, trigeminal lemniscus path, trigeminothalamic tract to the thalamus ( the VPL, VPM) then through the internal capsule, finally to post central gyrus.

most of this information crosses so when it reaches the say, right brain, its from the left side.
Spio crosses right away, and all the rest cross at the decussations.

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4
Q

what is tactile agnosia

A

deficit in the ability to combine touch, pressure and proprioceptive input to interpret the significance of sensory info

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5
Q

what do you get with lesions to the somatosensory association area?

A

tactile agnosia, or astrognosis - inability to recognize an object placed in the hand ( like your astrological sign)

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6
Q

what happens with deficits in the primary visual cortex?

A

deficit in vision in the opposite visual field

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7
Q

what does the visual association area do? what happens when we get a lesion?

A

gives meaning to what we see. Lesion here = deficit in ability to recognize objects in the OPPOSITE visual field despite intact vision

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8
Q

what happens with lesion to the primary auditory area

A

decreased perception of sound, primarily in the contralateral ear

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9
Q

what is acoustic verbal agnosia and where does it come from?

A

lesions in the auditory association area lead to AVA = ability to interpret what is heard is compromised ( called word deafness)

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10
Q

what structure in the cortex deals with taste?

A

the insula. first the info has to hit the VPM of the thalamus though

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11
Q

how do you get “ contralateral neglect syndrome?”

A

when you get a lesion in the nondominant posterior parietal hemisphere ( usually your right), then stimuli on the opposite side of the lesion ( left) are neglected. you dont dress the left side of you, shave the left side of you

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12
Q

why dont you get people neglecting the right half of their body? is it possible?

A

you dont neglect the right side because attns to the right side of self ( posterior pareital lobe’s job) is mediated by both the left and right posterior parietal lobes - double safe system.

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13
Q

define agnosia

A

inability to recognize or identify objects or people

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14
Q

where is brocas area, where is wenicke’s area and who connects them?

A

infront of left ear, left hemisphere = brocas
lateral side of postcentral gyrus, left hemisphere = wernicke’s
connected by “ arcuate fasciculus”
- its easy to remember that language is lateral in the brain

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15
Q

aphasia- define. how is this different than dysarthrias?

A

inability to communicate effectively.

Dysarthrias- inability to produce language due to lesion of the muscles of pharynx, larynx, tongue

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16
Q

what is the superior longitudial fasciculus known for connecting?

A

brocas and wenicke’s areas

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17
Q

what is the uncinate fasciculus/ occipitofrontal fasciculus

A

it functions to connects the frontal, remporal and occipital lobes

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18
Q

what is a watershed area?

A

the area where two perfusion territories come together, They are vulnreable when BP drops or hemorrhage in a central vessel occurs

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19
Q

define chronic pain

A

when pain persists longer than the temporal course of natural healing, associated with a particular type of injury or disease process

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20
Q

what are the three types of pain

A

1) superficial pain - A delta and C fibers
2) Deep Visceral pain - C fibers
3) referred pain- c fibers

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21
Q

where in the dorsal horn does the A delta fiber synapse? recall the exact laminae

A

A delta fibers hit the I and V bits of the laminae

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22
Q

which of rexed’s laminae do C fibers synpase onto?

A

II, III - called substantia gelatinosa

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23
Q

what is hyperalgesia -

A

an increaesd respone to a normally painful stimulus

a pinch causes an INSANE amt of pain

24
Q

what is allodynia?

A

a painful response to a normally benign stimulus

- a feather against your skin produces pain

25
Q

what are the two types of pain categories?

A

1) adaptive ( either nociceptive or inflammatory)

2) Maladaptive ( functional, neuropathic)

26
Q

what is an example of functional pain?

A

fibromyalgia - a medically unexplained syndrome with no cure, though to be an issue with connective tissue. It is charactertized by widespread pain and allodynia. idea is functional pain = we dont know whats causing is. sorry.

27
Q

start of quiz questions: a lesion that results in loss of pain and temp on the left side of the body but the right side of the face is most likely located in:

A

right dorsolateral medulla -
right side of medulla lesioned = left side has no P+T
and because the TTT runs up through the spinal nucleus of V ipsilaterally, then the right side of the face doesnt get P+ T

28
Q

the experience of exaggerated pain on suprathreshold stimulation is described as what facny term?

A

hyperalgesia

29
Q

pain due to a stimulus that does not normally provoke pain is defined as:

A

allodynia

30
Q

a patient is able to wrinkle his forehead but when he smiles his right side droops. the most likely site of lesion is the

A

wrinkle forehead = outflow from nucleus of 7 is fine
when smiles, right droops = lower half of his face doesnt move. hes had a UMN lesion of the 7th nucleus
ans: lesion is in the left corticobulbar input to the 7th nucleus

31
Q

what would happen with lesion to the trigeminal motor nucleus in terms of jaw jerk reflex?

A

the reflex would be exaggerated, as its an UMN lesion

32
Q

correct the statement : the spinal nucleus of V receives discriminative and tactile sensory information from the ipisilateral side of the face and sends efferents that synapse in the contralateral thalamas

A

no the spinal trigeminal tract receives pain and temp, not d touch and sensory stuff

33
Q

t/f : the mesencephalic nucleus receives input from the ipsilateral muscle spindles ( stretch info) of the muscles of mastication

A

true

34
Q

The floor of the temporal fossa is formed by the components of four different bones, which meet in the ara called the pterion. which of the following bones does not form the pterion?

A

the pterion = the parietal bone, frontal bone, greater wing of the sphenoid, swuamous part of the temporal bone.
- it does not include the lesser wing of the sphenoid

35
Q

where do unlaminated pain fibers synpase onto the dorsal horn of the spinal cord?

A

they synapse in lamina II

36
Q

cognitive behavioural therapy focuses on which of the following?

A

altering patterns of negative thoughts, dysfunctional attitudes, that interfere with recovery

37
Q

referred pain is best described as

A

pain perceived at a site adjacent to or at a distance from the site of njury’s origin

38
Q

which of the following increases pain on suprathreshold stimulation, which is thought to be mediated by wide dynamic range neurons?

A

secondary hyperalgesia

39
Q

neuropathic pain is characterized by?

A

prolonged sensation after stimuation, allodynia, hyperalgesia, nearly continuous pain. the pain is not limited to the course of an injured nerve

40
Q

what is the pathophys of migraine?

A

we dont really know but we do know the “ cortical spreading depression CSD wave” is a wave of vascular ischemia which progresses anteriorly from the occipital cortex

41
Q

pain med pharmacology - what does desipramine do?

A

increases endogenous inhibitory descending pathway transmission

42
Q

what is a central excitatory NT in the dorsal horn?

A

substance P

43
Q

who supplies what: paramedian area of caudal medulla

A

ASA - anterior spinal artery

44
Q

who supplies what: basal pons

A

basilar artery

45
Q

who supplies what:super cerebellar peduncle

A

superior cerebellar artery

46
Q

who supplies what: dorsolateral area of rostal medulla

A

PICA

47
Q

who supplies what: ventral horn of spinal cord

A

anterior spinal artery

48
Q

who supplies what: cerebral peduncle

A

posterior cerebral artery

49
Q

what does of TCA is needed to control chronic pain, vs dosage amt for depression - which one is more?

A

you give more TCAs for depression, less for chronic pain.

50
Q

what are common SEs of TCAs?

A

postoral hypotension and insane dry mouth - pam was dying

51
Q

what agents are used to treat acute migraine?

A

triptans, opiopds, NSAIDs, ergot derivatives, NOT bblockers

52
Q

in a rearrangement of the grey and white matter form the spinal cord ot the brainstem, which of the following is true?

A

the tract of lissauuer corresponds to the spinal trigeminal tract

53
Q

what happens when you give someone lamotrigine

A

almost 100% of the time they get a skin rash

54
Q

activation of neurtrophils activates the production of the cox-2 isoenzyme which leads to nociceptor hypersensitivty by increasing the production and secretion of what?

A

prostaglandins e2

55
Q

which of the following is not involved in the persistent phase of central sensitization?

A

addition of phosphate groups to ion channels and receptors

Yr 2 (9 decks)

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