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Case 1 Flashcards

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1
Q

Name the types of pain (x7)

A 
nociceptive
cutaneous 
somatic 
visceral
referred 
neuropathic 
inflammatory
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2
Q

nociceptive pain definition

A

response to tissue injury

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3
Q

cutaneous pain definition

A

originates from skin

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4
Q

somatic pain definition

A

generated from deeper connective tissue and muscles

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5
Q

visceral pain definition

A

from internal organs

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6
Q

referred pain definition

A

perceived in an area away from the organ site

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7
Q

neuropathic pain definition

A

pain from damage / disease in somatosensory nervous system

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8
Q

inflammatory pain definition

A

activation / sensitisation of nocioceptive pain pathway die to IL-1/6 and TNF alpha

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9
Q

describe gate control theory

A

emotions influence pain / perception of it
pressure is also by inhibitory neurone (rubbing decreases pain)
noradrenaline suppresses pain by receptor inhibition

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10
Q

Phases of pain - transduction (1)

A

converting chemical info into electrical info in spinal cord = action potential

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11
Q

Phases of pain - transmission (2)

A

from nociceptive fibres to dorsal horn of spinal cord to brainstem to thalamus and cortex

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12
Q

Phases of pain - perception (3)

A

conscious experience of discomfort when pain threshold is reached

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13
Q

Phases of pain - modulation (4)

A

release of pain inhibiting neurochemicals ANALGESIA

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14
Q

types of pain fibres (x3)

A

A delta fibres
C fibres
B fibres

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15
Q

A delta fibres

A

noxious stimuli + sharp/localised pain
primary afferent neurons
slow / thin as unmyelinated

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16
Q

C fibres

A

noxious stimuli
free nerve endings
slow / thin unmyelinated
dull / throbbing pain

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17
Q

B fibres

A

large / FAST

from mechanoreceptors

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18
Q

Dorsal horn grey matter laminae 1

A

presynaptic terminal of A and C fibres / 2nd order

- thalamus + somatosensory cortex

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19
Q

Dorsal horn grey matter laminae 2

A

presynaptic terminal of C

- inhibiting signals to 1

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20
Q

Dorsal horn grey matter laminae 3/4

A

presynaptic terminal of A and B and dendrites from 5

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21
Q

Dorsal horn grey matter laminae 5

A

presynaptic terminal of A and 2nd order neurones

- hypothalamus and amygdala

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22
Q

Process of pain transmission (steps 1-4)

A

1 nociceptive action potential ( C and A fibres) reaches presynaptic dorsal horn

2 C and A fibres release pro nociceptive (excitatory NT) into synaptic cleft

3 C fibres release GLUTAMATE activating post-synaptic AMPA receptors

4 causing SP then NK1 receptor activation / CGRP pathways

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23
Q

CGRP receptors (x3)

A

ATP
Glutamate
Nitric oxide

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24
Q

Limbic system parts?

A

anterior angulate gyrus

right ventral prefrontal cortex

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25
Pain threshold definition
point where sufficient pain transmitting stimuli has reached the brain to trigger action potential
26
pain tolerance definition
amount of pain a person can endure
27
affect of distraction on pain perception
interrupts pain signal lowering pain level perceived
28
reticular system function in pain pathway
warning individual by looking at damage (motor / autonomic response)
29
somatosensory cortex function in pain pathway
perception and interpretation of sensation (intensity / type / location)
30
limbic system function in pain pathway
emotional and behavioural response to the pain
31
mechanism of modulation of pain
descending inhibition - releasing inhibitory NT to either partially / completely block pain impulse ANALGESIA
32
Pain mechanism (COX)
1 ) phospholipids are converted to ARACHIDONIC ACID by phospholipase A2 2 ) COX (cyclooxygenase) combines amino acids and O2 to make PROSTALANDIN G2 3 ) G2 converted to H2 prostaglandin (peroxidase reaction)
33
What functions is COX 1 responsible for?
homeostasis renal blood flow liver function gastric mucosal lining
34
What functions is COX 2 responsible for?
fever inflammation pain
35
PGH1 function
GI tract chronic pain inflammation
36
PGH2 function
reproductive things chronic pain inflammation
37
PGE2 function
sensitises A delta + C neurons to serotonin
38
PGE2 function
``` GI mucosa renal protection (local vasodilation) ```
39
PGD2 function
bronchoconstriction | antiplatelet activity
40
PGF2 function
bronchoconstriction | urterine contraction
41
TXA2 function
platelet aggregation | local vasoconstriction
42
PGI2 function
INHIBITS platelet aggregation local vasoconstriction
43
Name some NSAIDS
``` ibuprofen codeine rofecoxib asprin celecoxib ```
44
What does NSAIDS stand for
Nonsteroidal anti-inflammatory drugs
45
ibuprofen mechanism
non-selective inhibitor of COX1/2 | is a competitive inhibitor of the AA for COX domain involved in prostanoid production
46
Ibuprofen
T = pain / inflammation / fever SE = indigestion / heart burn / vomiting / diarrhoea DT = stomach ulcer / Crohns disease / asthma / liver failure/ hypertension / heart problems/ clotting issues
47
codeine
opioid receptor antagonist T =pain relief SE = constipation / dry . ought / nausea / sweating DT = kidney problems / thyroid or adrenal gland problems / gallstones / inflammatory bowel problems / breathing problems (COPD / asthma )
48
rofecoxib
selective COX 2 inhibitor T = osteoarthritis and pain been withdrawn from market (MI / stroke risk)
49
aspirin
irreversible inhibition of COX1/2 T = fever / pain / aches / excessive clotting (prevention) SE = indigestion / nosebleeds DT = asthma / stomach ulcer / below 16 (REYES DISEASE) / haemophilia / kidney or liver problems / heart failure / thyroid problems
50
celecoxib
selective COX 2 inhibitor T = pain / inflammation / osteoarthritis / rheumatoid arthritis SE = dizzy / diarrhoea / indigestion / hypertension / UTI / peripheral oedema DT = under 18 / asthma / stomach ulcer / hypertension / clotting issues / heart conditions / kidney and liver problems
51
NSAID side effects on GI mucosa
COX 1 - peptic ulcers - GI bleeding
52
NSAID side effects on kidneys
COX 1 / 2 - NA+ and H2O retention - hypertension - acute kidney damage
53
NSAID side effects on cardiovascular
COX 1/2 - stroke - MI
54
inflammation function
eliminates cause of cell injury clears out necrotic cells initiates tissue repair
55
acute inflammation mechanism
initial response to stimuli characterised by increase movement of plasma and leukocytes to injury site by hyperplasia / hypertrophy / atrophy
56
vascular effect of inflammation
1 transient vasoconstriction preventing initial blood loss 2 vasodilation (histamine / NO) increasing vessel permeability (endothelial cells part too) 3 white blood cells enter
57
cellular response
1 damaged tissue releases cytokines / C5a 2 attracts neutrophils into dilated vessels DIAPEDESIS 3 B and T cells migrate towards chemotaxis signals 4 phagocytosis / degranulation occurs 5 histamine / lysosome / prostaglandin synthesis 6 Increase in IP3 7 increase in Ca2+ 8 cell movement
58
chronic inflammation
macrophages (from monocytes) largely present simultaneous destruction / healing of tissue increase in white blood cells (tissue destruction)
59
chronic inflammation cause
persistent infection | autoimmune disorder
60
name the two phases of clotting
primary / secondary haemostasis
61
Primary haemostasis steps (1-7)
1 damage to epithelium exposing collagen 2 von Willebrand (vW) factor binds to collagen 3 platelets (activated by thrombin / ADP ) bind to vW / collagen - SOFT CLOT 4 platelets activate and increase their surface area 5 degranulation of granules increase step 3/4 6 negative phospholipids bind to coagulation factors 7 smooth muscle contraction (decrease blood loss)
62
secondary haemostasis
CLOT STABILISATION coagulation of soft plug fibrin forms mesh that traps platelets / erythrocytes
63
intrinsic secondary haemostasis pathway
Factor XII to XI to IX to VIII to Factor X and V
64
extrinsic secondary haemostasis pathway
Factor III to VII to Factor X and V
65
common pathway secondary haemostasis pathway
prothrombin (Factor X + V) to thrombin | fibrinogen (thrombin) to fibrin
66
Haemophilia types (x3)
A VIII deficiency B IX deficiency C XI deficiency
67
Name steps of clotting cell based model (x3)
initiation amplification propagation
68
initiation (1) clotting cell based mode
Small amounts of thrombin Factor IXA made EXTRINSIC PATHWAY
69
amplification (2) clotting cell based mode
thrombin activated Factor XI / VIII INTRINSIC and factor V COMMON generating factor XA
70
propagation (3) clotting cell based mode
increase in thrombin generated INTRINSIC
71
function of thrombin in clotting cell based mode
increased thrombin converts fibrinogen - fibrin and factor VIII stabilising it
72
definition of 1st intention healing
stitching together of wound and cleaning
73
definition of 2nd intention healing
separated edges increase inflammation / scar tissue
74
laceration definition
tearing of soft body tissue
75
steps of laceration healing (x4)
haemostasis inflammation (macrophages) proliferation maturation
76
haemostasis laceration healing (1)
1 vasoconstriction (adrenaline) in first 10 mins 2 vasodilation (histamines) 3 exposed collagen = platelet activation 4 chemokines activated by platelets 5 inflammatory cells attracted
77
inflammation laceration healing (2)
1 macrophages secrete collagen / elastase causing injured tissue breakdown 2 release of cytokines which release platelet derived growth factor 3 chemotaxis / fibroblast proliferation attracts endothelial cells 4 ANGEOGENESIS
78
proliferation laceration healing (3)
1 epitheliazation / fibroplasia / angiogenesis 2 formation of granulation tissue
79
maturation laceration healing (4)
collagen forms tight cross links increasing the tensile strength of scar tissue
80
Bruising definition
type of haemotoma caused by crushing of connective tissue / ruptured capillaries without broken skin
81
damage capillaries endothelium in bruising function
releases endothelia causing vasoconstriction to reduce bleeding
82
damaged endothelium in bruising function
exposing the the vW factor causing coagulation to being - temporary clot - normal tissue reformed
83
bruise colour sequential degradation steps (not indicative of injury age)
RED BLUE - haemoglobin GREEN - biverdin YELLOW - bilirubin BROWN - hemosiderin
84
graze / abrasion definition
wound caused by superficial damage to skin ( no deeper than epidermis ) with minimal bleeding
85
serous wound definition
produces clear fluid from plasma and mesothelial cells
86
fibrinous wound definition
after serous - increase fibrin / vascular permeability
87
suppurative / purulent wound definition
++ dead tissue / WBS = pus
88
ulcers wound definition
damage through epithelial layers leaving a cavity
89
Grade 1 sprain injury
slight ligament damage / stretching | still able to keep knee joint stable
90
Grade 2 sprain injury
stretches ligament causing it to loosen (partial tear)
91
Grade 3 sprain injury
complete ligament tear = unstable knee joint

Case 1 (1 decks)

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