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Unit2_NTK Flashcards

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1
Q

LA: Topical:

A

○ tetracaine, lidocaine, cocaine

○ Superficial anesthesia

○ Disadvantage = considerable absorption into circulation

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2
Q

LA • Infiltration/Injection into tissue:

A

lidocaine, procaine, bupivacaine

○ Superficial anesthesia, function of underlying organ unaffected

○ Disadvantage: significant absorption into circulation

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3
Q

LA • Nerve block:

A

injection of high concentration near peripheral nerve/nerve plexus

○ Lidocaine (2-4 hours), bupivacaine (longer duration)

○ Anesthetize larger body regions

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4
Q

LA • Intravenous regional anesthesia (Bier’s Block):

A

tourniquet applied, inject anesthetic via catheter for limb anesthesia.

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5
Q

LA • Spinal anesthesia:

A

inject into CSF

○ Anesthetize large body areas with low plasma level of drug.

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6
Q

LA • Epidural anesthesia:

A

inject just outside dura-enclosed spinal canal

○ Allows repeated/continuous anesthetic application
Higher plasma level of anesthetic

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7
Q

How are both types of LA excreted?

A

Via kidneys

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8
Q

Which type of LA is Hydrolyzed in plasma by an esterase (pseudocholinesterase), also hydrolyzed in liver?

A

ESTERS:

think PLASMA esterases

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9
Q

Which LA typically has a longer DOA?

A

amides typically have longer duration of action

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10
Q

wrt, Giant cell arthritis, what are the Sx:

A

○ Symptoms: jaw claudication, temporal artery region scalp tenderness, joint pain, constitutional symptoms (fever, malaise, weight loss)

○ Elevated ESR and CRP

○ Must biopsy temporal artery to confirm dx

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11
Q

how do you Tx Giant cell arthritis?

A

TX = steroids

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12
Q

What Diz has the following:

○ Elevated ICP
○ Normal CSF and Neuro Exam except for:
             ○ Papilledema
             ○ 6th Nerve Palsies
○ Normal neuroimaging and no other Etiology.
○ Obese Women
A

Pseudotumor Cerebri

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13
Q

Complete Cord Transection:

A

a. Tracts: all ascending and descending

b. Deficit: sensory + motor levels below lesions, may also have root → Spinal shock, followed by UMN signs

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14
Q

Central Lesions:

A

a. EX) syringomyelia (fluid filled cavity in cord)
b. Tracts: initially involve crossing spinothalamic tract
c. Deficit: pain/temp loss at level of lesion with sparing of position sensation → “Cape-like” distribution if in C-spine

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15
Q

Posterior Column Syndrome

A

a. EX) Tabes dorsalis (neurosyphilis)
b. Tracts: Dorsal (posterior column)
c. Deficit: bilateral loss of position and vibration sensation

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16
Q

Deficit in Posterior Column Syndrome?

A

Deficit: bilateral loss of position and vibration sensation

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17
Q

Tracts of Posterior Column Syndrome?

A

Dorsal (posterior column)

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18
Q

Tracts in Complete Cord Transection?

A

Tracts: all ascending and descending

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19
Q

Tracts in Central Lesions?

A

Tracts: initially involve crossing spinothalamic tract

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20
Q

Deficit in Complete Cord Transection?

A

sensory + motor levels below lesions, may also have root

→ Spinal shock, followed by UMN signs

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21
Q

Deficit in Central Lesions?

A

Deficit: pain/temp loss at level of lesion with sparing of position sensation → “Cape-like” distribution if in C-spine

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22
Q

Combined anterior horn cell-pyramidal tract syndrome:

A

a. EX) ALS
b. Tracts: corticospinal and LMN cells in cord
c. Deficit: loss of bilateral strength. Fasciculations, atrophy, decreased or increased deep-tendon reflexes, normal sensation.

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23
Q

Tracts in Combined anterior horn cell-pyramidal tract syndrome?

A

Tracts: corticospinal and LMN cells in cord

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24
Q

Deficit in Combined anterior horn cell-pyramidal tract syndrome?

A

Deficit: loss of bilateral strength. Fasciculations, atrophy, decreased or increased deep-tendon reflexes, normal sensation.

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25
Brown-Sequard (hemi-section):
a. EX) Compression by herniated discs, tumor, extramedullary abscess, etc. b. Tracts: crossed spinothalamic, uncrossed dorsal column, crossed corticospinal c. Deficit: Below lesion, loss of: contralateral pain/temp, ipsilateral, position and strength
26
Tracts in Brown-Sequard (hemi-section)?
Tracts: crossed spinothalamic, uncrossed dorsal column, crossed corticospinal.
27
Deficits in Brown-Sequard (hemi-section)?
Deficit: Below lesion, loss of: contralateral pain/temp, ipsilateral, position and strength.
28
Posterolateral column syndrome: ?
a. EX) B12 deficiency b. Tracts: dorsal column, corticospinal tract c Deficit: bilateral loss of position, vibration, strength
29
Tracts in Posterolateral column syndrome?
Tracts: dorsal column, corticospinal tract
30
Deficits in Posterolateral column syndrome?
Deficit: bilateral loss of position, vibration, strength
31
Anterior Horn Cell Syndrome:
a. EX) spinal muscular atrophy, poliovirus b. Tract: none - lower motor neurons only c. Deficit: bilateral loss of strength i. Fasciculations, decreased tone, decreased deep-tendon-reflexes Spares sensory tracts and bladder functions
32
Tracts in Anterior Horn Cell Syndrome?
Tract: none - lower motor neurons only
33
Deficits in Anterior Horn Cell Syndrome?
Deficit: bilateral loss of strength i. Fasciculations, decreased tone, decreased deep-tendon-reflexes Spares sensory tracts and bladder functions
34
Anterior Spinal Artery Occlusion:?
a. EX) Anterior spinal artery occlusion b. Tracts: spinothalamic and corticospinal tract c. Deficit: bilateral loss of strength, pain/temp. Spare position sense
35
Tracts in Anterior Spinal Artery Occlusion?
Tracts: spinothalamic and corticospinal tract
36
Deficits in Anterior Spinal Artery Occlusion?
Deficit: bilateral loss of strength, pain/temp. | Spare position sense
37
Pyramidal Tract Syndrome: ?
a. EX) Primary lateral sclerosis b. Tract: corticospinal tract c. Deficit: bilateral UMN weakness with spastic gait - Increased deep-tendon-reflexes - Complete sparing of all sensory tracts and bladder function.
38
Tracts in Pyramidal Tract Syndrome?
Tract: corticospinal tract
39
Deficits in Pyramidal Tract Syndrome?
Deficit: bilateral UMN weakness with spastic gait - Increased deep-tendon-reflexes - Complete sparing of all sensory tracts and bladder function.
40
Myelopathy with Radiculopathy: ?
a. Tracts: any or all 3 tracts b. Deficit: bilateral UMN syndrome with spastic gait i. Increased DTRs + ipsilateral or contralateral root signs Possible bladder dysfunction
41
Tracts in Myelopathy with Radiculopathy?
Tracts: any or all 3 tracts
42
Deficits in Myelopathy with Radiculopathy?
Deficit: bilateral UMN syndrome with spastic gait i. Increased DTRs + ipsilateral or contralateral root signs Possible bladder dysfunction
43
Detrusor (smooth) muscle: activated by preganglionic parasympathetic outflow from _______
Detrusor (smooth) muscle: activated by preganglionic parasympathetic outflow from S2-S4
44
_________ muscle: activated by preganglionic parasympathetic outflow from S2-S4
Detrusor (smooth) muscle: activated by preganglionic parasympathetic outflow from S2-S4
45
Involuntary (smooth) sphincter: controlled by sympathetic outflow, in _________
Involuntary (smooth) sphincter: controlled by sympathetic outflow, T10-L2
46
____________________ : controlled by sympathetic outflow, T10-L2
Involuntary (smooth) sphincter
47
Involuntary (smooth) sphincter: controlled by _____________ outflow, T10-L2
sympathetic outflow
48
___________ of pelvic floor: innervated by alpha motor neurons, S2-S4
Skeletal muscle
49
Skeletal muscle of pelvic floor: innervated by ______ ______ neurons, S2-S4
Skeletal muscle of pelvic floor: innervated by alpha motor neurons, S2-S4
50
Skeletal muscle of pelvic floor: innervated by alpha motor neurons, __-__?
Skeletal muscle of pelvic floor: innervated by alpha motor neurons, S2-S4
51
• ____________Bladder: bladder does not contract → overflow incontinence. Parasympathetic lower motor neuron injury, axon compression/disruption
Flaccid
52
Flaccid Bladder: ?
bladder does not contract → overflow incontinence | Parasympathetic lower motor neuron injury, axon compression/disruption
53
• Spastic Bladder: "
Spastic Bladder: ○ Descending pathways cut or injured (BILATERALLY) → UMN injury = initial flaccidity of bladder, then spasticity ○ Problems with coordination between sympathetic outflow (inhibited during voiding) and parasympathetic outflow (activated during voiding) ○ Urinary frequency and urgency
54
Injury above S2-S4 (PNS of detrusor m.) --> what Sx?
UMN Sx
55
○ Spurling’s sign: ?
foraminal compression test. Turn head towards a narrowed neural foramen → tight foramen can cause acute pinching of nerve root → pain radiates out with nerve root into arms
56
Lasegue’s sign: ?
○ Lasegue’s sign: straight leg raising test Sciatic nerve test - if sciatic nerve roots are under compression → shooting shock like sensation down legs
57
straight leg raising test = __________ sign?
Lasegue’s sign
58
Sciatic nerve test = _________ sign?
Lasegue’s sign
59
foraminal compression test = ____________ sign?
Spurling’s sign
60
Turn head towards a narrowed neural foramen → is a test for what sign?
Spurling’s sign
61
Lhermitte’s symptom: ?
pain syndrome arising due to disease of spinal cord | Neck flexion results in “electric shock” sensation down back and/or arms
62
pain syndrome arising due to disease of spinal cord. Neck flexion results in “electric shock” sensation down back and/or arms IS CALLED WHAT?
Lhermitte’s symptom:
63
Neck flexion results in “electric shock” sensation down back and/or arms is a sign of what syndrome.
Lhermitte’s symptom
64
__________ reflex indicates when spinal shock has resolved.
Bulbocavernosus reflex If BC reflex is present and patient still is not moving/no sensation → anatomic transection of fibers
65
What are the UMN signs?
Plantar response: normal = flexion of toes □ Babinski sign = extension of big toe, fanning of other toes → HYPERREFLEXIA Hoffman’s sign = hyperreflexia in upper extremity. Crossed adductor response: tapping medial aspect of adductor tendons near knee elicits scissoring of both legs
66
hyperreflexia ~ with _____ motor neuron
Upper motor neuron
67
hyperreflexia in upper extremity = ____________sign?
Hoffman’s sign = hyperreflexia in upper extremity.
68
tapping medial aspect of adductor tendons near knee elicits scissoring of both legs = _____________ sign.
Crossed adductor response: tapping medial aspect of adductor tendons near knee elicits scissoring of both legs
69
C-fibers: ?
small, unmyelinated axons, 1 um in diameter, slow conduction velocity. Warm temperature, burning pain, itch, crude touch
70
C-Fiber detect ?
warm temperature, burning pain, itch, crude touch
71
Alpha, Alpha → most rapidly conducting, largest diameter. What is: □ Ia → ____________ □ Ib → ____________
Ia → muscle spindle afferent Ib → tendon organ afferent
72
What is common to all Alpha Fibers?
All Alpha FIbers are myelinated.
73
Alpha-Beta → slower and smaller diameter than Aa, but still fast detect what?
Mechanoreceptors of skin, secondary muscle spindle afferents
74
Alpha-Delta → slower and smaller diameter than AB. | Detect what?
Sharp pain, cool temp, EXTREME hot Temps.
75
___________ System: ascending pathway for pain and temperature information, axons of dorsal horn second order neurons that cross midline and ascend anterolaterally
Anterolateral
76
_____________ tract: pain pathway to thalamus
Spinothalamic Tract. □ Projects to nuclei of ventrobasal thalamus (includes VPL) □ Processes information related to localization of pain □ Projects to somatosensory cortex
77
___________ tract: pain pathway that leads to forebrain arousal and elicits emotional/behavioral responses
Spinoreticular Tract. Connects to limbic system Terminates in pons and medulla
78
______________ tract: projects to midbrain periaqueductal gray region (PAG).
Spinomesencephalic tract: descending control of pain.
79
First pain: __ fibers → detect tolerable, localized, “pricking pain”
Ad fibers. Faster conduction velocity than C fibers Smaller receptive field = better localized spatial discrimination
80
Second pain: __ fibers → intolerable, diffusely localized, “burning” pain
C-fibers. Slower conduction velocity than Ad fibers Larger receptive field = dull, aching, poorly localized pain
81
First pain: Ad fibers → detect tolerable, localized, “_________ pain”
"pricking pain"
82
Second pain: C fibers → intolerable, diffusely localized, “______” pain
burning
83
____?____: decrease threshold for activation of nociceptors
``` • Sensitizers: decrease threshold for activation of nociceptors ○ Prostaglandin ○ Substance P ○ ATP ○ Acetylcholine ○ Serotonin (5-HT) ```
84
___?___: lead to direct activation of nociceptors
Activators: lead to direct activation of nociceptors ○ Bradykinin → Ad and C fiber activator; Also increases synthesis of prostaglandins (Sensitizer). ○ Potassium ○ Acid ○ Serotonin (5-HT)
85
Burning pain = _fiber?
C-Fiber
86
* __1__ receptor → rapid synaptic response | * __2__ receptor → slower excitatory potential
1. AMPA | 2. NMDA
87
Substance P: Released by C fibers in response to Neurokinin 1 receptor (NK-1)repetitive stimulation in CNS at site of first synapse → binds _________ receptor → close K+ channel, depolarization.
Neurokinin 1 receptor (NK-1)
88
__________: Released by C fibers in response to repetitive stimulation in CNS at site of first synapse → binds Neurokinin 1 receptor (NK-1) → close K+ channel, depolarization.
Substance P (sensitizer)
89
Substance P: Released by __1__ fibers in response to repetitive stimulation in CNS at site of first synapse → binds Neurokinin 1 receptor (NK-1) → __2__ K+ channel, depolarization.
1. C-Fibers | 3. closes K+ ch.
90
_____?______ in midbrain → analgesia (pain sensation attenuated) while touch, pressure and temperature sensation persists
PAG stimulation
91
PAG stimulation in midbrain → ___?___ (pain sensation attenuated) while touch, pressure and temperature sensation persists
analgesia
92
What inhibits secondary neurons in the spinal cord to by exciting INTERNEURONS to secrete enkephalin and results in PRE-synaptic Inhibition?
Serotonin
93
Describe mechanisms underlying neuropathic pain. * Peripheral mechanism: ? * Central Mechanism: ?
* Peripheral mechanism = sodium channels | * Central Mechanism = GABA content and receptors, sprouting and rewiring, glia and immune system

NS_BTRAN (21 decks)

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