Exam 3

Question 1

neuromodulators

Answer 1

chemicals that can either enhance or suppress the pain signal and alter perception of pain. Most are neurotransmitters, but not all.

Question 2

neuromodulator location, function and triggering mechanisms

Answer 2

located in the pathways of the nervous system.

Function is to mediate information about painful stimuli

Triggered by tissue injury (via bradykinins and prostaglandins) and inflammation (via lymphokines)

Question 3

excitatory neurotransmitters (function and examples)

Answer 3

sensitize nociceptors by reducing the activation threshold, leading to increased responsiveness of nociceptors.

Examples include Glutamate, aspartate, substance P***, and calcitonin

Question 4

inhibitory neurotransmitters (function and examples)

Answer 4

contribute to pain inhibition

Examples include GABA***, glycine, norepinephrine and serotonin (in medulla and pons), and endogenous opioids

Question 5

endogenous opioids

Answer 5

a family of morphine-like neuropeptides that inhibit transmission of pain impulses in the periphery, spinal cord, and brain by binding specific opioid receptors

Question 6

endorphins

Answer 6

endogenous morphine

Question 7

the most prevalent of the natural opioids. Binds delta receptors and stops transmission of pain up the spinal cord

Answer 7

enkephalin

Question 8

the most potent of the natural opioids. Bind kappa receptors

Answer 8

dynorphin

Question 9

bind with meu receptors and have potent analgesic effects

Answer 9

endomorphin

Question 10

what is acute pain

Answer 10

a protective mechanism serving to alert an individual to a condition or experience that is immediately harmful to the body

Question 11

manifestations of acute pain

Answer 11

fear and anxiety
tachycardia
hypertension
fever
diaphoresis
dilated pupils
outward pain behaviors
elevated blood sugar levels
decreased gastric acid secretion and intestinal motility
general decrease in blood flow

Question 12

two types of acute pain

Answer 12

acute somatic and acute visceral

Question 13

acute somatic pain

Answer 13

superficial; arises form connective tissue, muscle, bone, and skin.
Transmitted via A delta fibers (sharp and well-localized)

Question 14

acute visceral pain

Answer 14

pain in the internal organs and abdomen; poorly localized as a result of the lesser number of nociceptors.
Transmitted via C polymodal fibers.

Question 15

define referred pain and why it occurs

Answer 15

pain that is present in an area removed or distant from its point of origin.
The area of referred pain is supplied by the same spinal segment as the actual site.

Question 16

define chronic pain

Answer 16

pain lasting more than 3 to 6 months and lasting well beyond the normal healing time; varies with type of injury and serves no purpose and causes suffering

Question 17

three common types of chronic pain

Answer 17

myofascial: injury to muscle/fascia (spasm, tenderness, and stiffness)

chronic post-op pain: persistent pain that can occur with disruption or cutting of sensory nerves

cancer: attributed to advance of disease, treatment, or coexisting disease entities

Question 18

neuropathic pain

Answer 18

chronic pain initiated or caused by a primary lesion or dysfunction in the nervous system and leads to long-term changes in pain pathway (neurplasticity) and abnormal processing of sensory information.
Often described as burning, shooting, shock-like or stinging

Question 19

two types of neuropathic pain

Answer 19

peripheral: caused by peripheral nerve lesions and an increase in the sensitivity and excitability of primary sensory neurons and cells in the dorsal root ganglion
central: caused by a lesion or dysfunction in the brain or spinal cord; a progressive repeated stimulation of group C neurons in the dorsal horn leads to increased pain signaling neurons

Question 20

thermoregulation is achieved through:

Answer 20

precise balancing of heat production, heat conservation, and heat loss

Question 21

methods of heat production

Answer 21

chemical reactions of metabolism, muscle contraction, chemical thermogenesis

Question 22

methods of heat conservation

Answer 22

vasoconstriction, voluntary mechanisms, and slower rate of breathing

Question 23

methods of heat loss

Answer 23

radiation, conduction, convection, vasodilation, decreased muscle tone, increased respiration, voluntary mechanisms, and adaptation to warmer climates

Question 24

two populations most sensitive to temperature changes

Answer 24

pediatrics and older adults

Question 25

define fever

Answer 25

a temporary resetting of they hypothalamic thermostat to a higher level in response to exogenous or endogenous pyrogens

Question 26

exogenous pyrogens

Answer 26

endotoxins produced by pathogens

Question 27

endogenous pyrogens

Answer 27

released from phagocytic cells; examples include TNF-alpha, IL-1, IL-6, and interferon

Question 28

fever of unknown origin

Answer 28

body temp of greater than 38.3 C (101 F) for longer than 3 weeks' duration that remains undiagnosed after 3 days of hospital investigation, 3 outpatient visits, or 1 week of ambulatory investigation.

Question 29

define hyperthermia

Answer 29

elevation in body temperature without an increase in hypothalamic set point

Question 30

reference values for hyperthermia

Answer 30

nerve damage at 41 C (105 F) | Death at 43 C (109 F)

Question 31

Heat cramps/exhaustion/stroke

Answer 31

heat cramps: occur in hot conditions; cramping and prolonged sweating heat exhaustion: higher core body temp; dehydration, hypotension, weakness, dizziness, confusion; may or may not require medical attention heat stroke: body's heat loss mechanisms have failed and body has no way to cool itself down; requires medical attention

Question 32

define hypothermia

Answer 32

core body temp less than 35 C (95 F) Produces CNS/respiratory depression. vasoconstriction, alterations in microcirculation, coagulation, and ischemic tissue damage; can produce crystals in cells of extremities

Question 33

therapeutic hypothermia

Answer 33

used to slow metabolism and preserve ischemic tissue during surgery or limb reimplantation; may lead to ventricular fibrillation and cardiac arrest

Question 34

Define dementia

Answer 34

progressive failure of cerebral functions that is not caused by an impaired level of consciousness; many different types

Question 35

clinical manifestations of dementia

Answer 35

loss of orientation, memory, language, judgment, and decision making. Could be caused by: neuron degeneration, arterialm sclerosis, compression of brain tissue, plaques in cerebral vessels, brain trauma, or genetic predisposition

Question 36

Alzheimer's diagnosis and rates

Answer 36

diagnosis of exclusion; leading cause of severe cognitive dysfunction in older persons. around 6 million people in the US have it.

Question 37

three different types of Alzheimer's

Answer 37

nonhereditary sporadic or late-onset (70 to 90%) early-onset familial early-onset (very rare)

Question 38

Alzheimer's theories

Answer 38

mutation for encoding amyloid precursor protein alteration in apolipoprotein E --> leading to tangles, and loss of neurotransmitter stimulation of choline acetyltransferase

Question 39

brain changes with Alzheimer's

Answer 39

plaques and tangles in the brain and CNS neurons neuritic plaques of amyloid beta protein, intraneuronal neurofibrillary tangles, and degeneration of basal forebrain cholinergic neurons with loss of acetylcholine

Question 40

clinical manifestations of Alzheimer's

Answer 40

forgetfulness, emotional upset, disorientation/confusion, lack of concentration, and decline in abstraction, problem solving, and judgment

Question 41

hemiparesis or hemiplegia

Answer 41

weakness or loss of motor function in upper/lower one side

Question 42

diplegia

Answer 42

loss of motor function in both sides

Question 43

paraparesis or paraplegia

Answer 43

weakness or loss of motor function in lower extremities

Question 44

quadriparesis or quadriplegia

Answer 44

weakness or loss of motor function in all four extremities

Question 45

Huntington Disease - define - incidence/transmission - patient characteristics - s/s

Answer 45

- degenerative hyperkinetic disorder involving basal ganglia and cerebral cortex - hereditary, autosomal dominant disorder on chromosome 4 - onset is typically between ages 25 and 45 - chorea that increases with emotional stress and attempted voluntary movement and decreases with rest/sleep, emotional lability, progressive dysfunction of cognitive processes, restlessness, disinhibition, and irritability

Question 46

Parkinson Disease - define - incidence - patient characteristics - s/s

Answer 46

- a complex motor disorder accompanied by systemic nonmotor and neurologic symptoms - primary: begins after age 40, with increased incidence after age 60; more common in males; majority are sporadic/idiopathic - secondary: caused by head trauma, infection, neoplasm, atherosclerosis, drug intoxication is most common and often reversible - primary is more common in males and begins after age 40 - hypertonia, akinesia, parkinsonism, short/shuffling gait, stooped posture, weakness --> TRAP

Question 47

dytonia

Answer 47

involuntary muscle contraction that causes position to be maintained - postures last 8 seconds - movements can be almost permanent

Question 48

decorticate dystonia

Answer 48

abnormal flexion

Question 49

decerebrate dystonia

Answer 49

abnormal extension

Question 50

define stress

Answer 50

anything perceived as an anticipated threat; perception of stimulus which elicits adaptation and survival-related physiologic responses

Question 51

relationship between stress and immunity

Answer 51

acute/short term stress may enhance immunity | chronic stress suppresses immunity

Question 52

the three components of physiologic stress

Answer 52

- the stressor initiating disturbance - the chemical or physical disturbance produced by the stressor - the body's adaptive response to the disturbance

Question 53

physiologic changes (in response to stressors) identified by Selye

Answer 53

- enlargement of the cortex of the adrenal gland - atrophy of the thymus - development of bleeding ulcers