Ankylosing spondylitis is characterized by
inflammation, stiffness, and fusion of spinal joints.
Myasthenia gravis is an autoimmune disease in which
acetylcholine receptors are destroyed or dysfunctional.
The pain of nonarticular rheumatism (“growing pain”) is worse
during the night.
Following a bone fracture, the most likely event to occur is
development of a blood clot beneath the periosteum.
Prosthetic joint infection is most often because of
hematogenous transfer.
The most common site affected in Paget’s disease is the
lower spine.
Compartment syndrome occurs secondary to
soft-tissue damage.
Pain that waxes and wanes and is exacerbated by physical exertion is likely related to
fibromyalgia syndrome.
The most common symptom of multiple myeloma is
bone pain.
The most common source of osteomyelitis is
an infection that migrates via the bloodstream.
Anticholinesterase inhibitors may be used to manage
myasthenia gravis.
One of the most common causes of acute pain is
headache.
A unique characteristic feature of fibromyalgia is the presence of
tender point pain.
Which disorder usually causes skeletal pain and involves significant bone demineralization from vitamin D deficiency?
Osteomalacia
The earliest manifestation of scleroderma is
Raynaud phenomenon.
Rheumatoid arthritis involves joint inflammation caused by
autoimmune injury.
Paget’s disease is characterized by
excessive bone resorption followed by excessive formation of fragile bone.
It is true that scleroderma involves
inflammation and fibrosis of connective tissue.
The disease that is similar to osteomalacia and occurs in growing children is
rickets.
Healing of a fractured bone with a poor alignment is called
malunion.
What type of seizure usually occurs in children and is characterized by brief staring spells?
Absence
Pain is thought of as
a subjective experience that is difficult to measure objectively.
Manifestations of acute brain ischemia (Cushing reflex) are due primarily to
sympathetic nervous system activation.
It is true that encephalitis is usually
Because of a bacterial infection in the CNS.
fatal
because of a viral infection in brain cells
asymptomatic.
because of a viral infection in brain cells.
The physiologic change most likely to lead to an increase in intracranial pressure is
cerebral vasodilation.
Rupture of a cerebral aneurysm should be suspected if the patient reports
sudden, severe headache.
The most important determinant for prescribing therapy for acute stroke is
ischemic versus hemorrhagic cause.
A patient who experiences early symptoms of muscle twitching, cramping, and stiffness of the hands may be demonstrating signs of
amyotrophic lateral sclerosis.
Which group of clinical findings indicates the poorest neurologic functioning?
A.Spontaneous eye opening, movement to command, oriented to self only
B.Eyes open to light touch on shoulder, pupils briskly reactive to light bilaterally
C.Assumes decorticate posture with light touch, no verbal response
D.No eye opening, responds to painful stimulus by withdrawing
Assumes decorticate posture with light touch, no verbal response
Rickets is characterized by soft, weak bones resulting from a deficiency of
vitamin D.
Seizures that involve both hemispheres at the outset are termed
generalized.
The ________ is the level of painful stimulation required to be perceived.
threshold
An example of inappropriate treatment for head trauma would be
A. head elevation.
B. Free water restriction.
C. hypoventilation.
D. bed rest.
hypoventilation.
Secondary injury after head trauma refers to
brain injury resulting from the body’s response to tissue damage.
Cerebral aneurysm is most frequently the result of
subarachnoid hemorrhage
Clinical manifestations of a stroke within the right cerebral hemisphere include
left-sided muscle weakness and neglect.
Pain with passive stretching of a muscle is indicative of
noncontractile tissue injury.
Before making a diagnosis of Alzheimer disease
other potential causes of dementia must be ruled out
The primary reason that prolonged seizure activity predisposes to ischemic brain damage is that
the lack of airway maintenance can lead to hypoxia.
The first indication of brain compression from increasing intracranial pressure (ICP) may be
sluggish pupil response to light.
A risk factor for osteoporosis is
early menopause
A clinical finding consistent with a diagnosis of rheumatoid arthritis would be
systemic manifestations of inflammation
Bone healing may be impaired by
nicotine use
The most common type of osteomyelitis is
hematogenous
A compound, transverse fracture is best described as a bone that is
broken and protruding through the skin
What type of fracture generally occurs in children?
Greenstick
Gouty arthritis is a complication of
inadequate renal excretion of uric acid.
Systemic disorders include
rheumatoid arthritis
Enteropathic arthritis is associated with
inflammatory bowel disease
To avoid the progression of cutaneous lesions, a patient diagnosed with systemic lupus erythematosus (SLE) should
avoid sun exposure
Risk factors for hemorrhagic stroke include
acute hypertension
It is true that epidural bleeding is
characterized by a lucid interval immediately after injury
The physiologic mechanisms involved in the pain phenomenon are termed
nociception
Muscular dystrophy includes a number of muscle disorders that are
genetically transmitted
Autonomic dysreflexia is characterized by
hypertension and bradycardia
The stroke etiology with the highest morbidity and mortality is
intracranial hemorrhage
Steroids may be used in the management of acute exacerbation of symptoms in patients with multiple sclerosis, because
demyelination is mediated by immune mechanisms.
A severe complication of elevated intracranial pressure is
brain herniation
What effect do demyelinating disorders such as multiple sclerosis have on neurotransmission?
Slower rate of action potential conduction
A college student living in a dormitory reports a stiff neck and headache and is found to have a fever of 102°F. This information is most consistent with
meningitis
Which neurologic disorder is commonly referred to as Lou Gehrig disease?
Amyotrophic lateral sclerosis
Modulation of pain signals is thought to be mediated by the release of
endorphins.
Orthostatic hypotension may be a manifestation of
Parkinson disease
It is useful to conceptualize pain physiology according to the four stages because each stage provides an opportunity for
intervention
What is manifested by disturbances of skeletal motor function, sensation, autonomic visceral function, behavior, or consciousness?
Seizures
What can trigger a seizure?
Stimuli such as flashing lights, fever, and loud noises?
What is due to an alteration in membrane potential that makes certain neurons abnormally hyperactive and hypersensitive to changes in their environment?
Epileptogenic focus
*Part of seizure disorder
In a generalized seizure, the whole brain surface is affected during the seizure, causing involvement of __________ and _______ ________ results in loss of ______________.
In a generalized seizure, the whole brain surface is affected during the seizure, causing involvement of thalamus and RAS system results in loss of consciousness.
What type of seizure:
Occurs in children, staring spells that last only seconds
Absence (petite mall)
What type of seizure:
myoclonic jerk, automatism with the staring spell
Atypical absense
What type of seizure:
Single/ several jerks
Myoclonic
What type of seizure:
Fall down
Atonic (drop attack)
What type of seizure:
Jerking of many muscles
Tonic-clonic (grand mall)
How do we diagnose seizure disorders?
Electroencephalograms
What do electroencephalograms assess?
Electrical patterns of brain regions
What type of seizure:
Continuing series of seizures without a period of recovery between episodes. Can be life threatening.
Status epilepticus
What type of seizure:
Abnormal electrical activity restricted to one brain hemisphere
partial seizures
What type of seizure:
No change in level of consciousness; motor, sensory, and or autonomic symptoms are common.
Simple partial seizure
What type of seizure:
Change in consciousness; motor, sensory and or autonomic symptoms are common.
Complex partial seizure
Treatment used during a seizure (3 of them)
Maintain airway, protect from injury, and document course of seizure.
When anticonvulsant medications are used for seizure disorders how long are the used for?
Until no seizures occur for at least 2 years and then gradually withdraw.
Syndrome associated with many pathologies; characterized by progressive deterioration and continuing decline of memory and other cognitive changes.
Dementia
What are the two types of dementia
Alzheimer (most common)
Vascular
Characterized by degeneration of neuron in temporal and frontal lobes, brain atrophy, amyloid plaques, and neurofibrillary tangles.
Alzheimer disease
Type of dementia that creates behavioral problems that progress from forgetfulness to total inability to self-care
Alzheimer disease
TRUE/FALSE
As dementia disease progresses difficulty with completing ADLS occur
TRUE
Are the following medications used for mild-moderate Alzheimer's or moderate-severe?
-Acetylcholinesterase inhibitors: Tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl)
Mild-moderate alzheimers and vascular dementia
Are the following medications used for mild-moderate Alzheimer's or moderate-severe?
-N-methyl-D-asparate (NMDA) receptor antagonist:: memantine (Namenda)
Moderate- severe Alzheimers
What do these medications do?
-N-methyl-D-asparate (NMDA) receptor antagonist: memantine (Namenda)
Block stimulation by the neuroexcitatory transmitter glutamate
Dopamine deficiency in the basal ganglia (substantia nigra) is associated with motor impairment; Lewy bodies.
Parkinson Disease
In Parkinson's disease, difficulty initiating and _________ movements results in ________, _________ and _________.
In Parkinson's disease, difficulty initiating and controlling movements results in akinesia, tremor, and rigidity.
T-Tremors
R-Ridgity
A-Akinesia
P-Posture
What disease causes a general lack of movement, loss of facial expression, drooling, propulsive (shuffling) gait, and absent arm swing?
Parkinson's disease
A diverse group of crippling syndromes that appear during childhood and involve permanent nonprogressive damage to motor control areas of the brain.
Cerebral palsy
In cerebral palsy, damage in the ____ ____ neuron that controls ______ and ______ muscle movement.
In cerebral palsy, damage in the upper motor neuron that controls voluntary and involuntary muscle movement.
TRUE or FALSE
In a patient with cerebral palsy, their symptoms remain for life.
TRUE
What are the three important neurological signs and symptoms seen in a patient with cerebral palsy
Spasticity (rigid/contracted)
Ataxia (non coordinated gait)
Dyskinesia
What are the three etiologies of cerebral palsey
Prenatal infections/disease of the mother
Mechanical trauma to the head before/during/after birth
Exposure to nerve-damaging poisons or reduced oxygen supply to the brain
What causes abnormal accumulation of cerebral spinal fluid (CSF) in cerevroventricular system?
-Associated with neural tube deficit
Hydrocephalus
What are the three important triad of symptoms in a patient with hydrocephalus?
Gait instability
Urinary incontence
dementia
What is the most effected treatment in obstruction hydrocephalus?
(2 of them)
Surgery or ventriculoperitoneal shunt.
Ventriculoperitoneal shunt: CSF flows into peritoneal cavity
Chronic demyelinating disease of the CNS that primarily affects young adults.
-autoimmune disorder that results in inflammation and scarring or myelin sheaths covering nerves; slowly progressive
Multiple sclerosis
TRUE or FALSE
In MS demyelination can occur throughout the CNS but often affects the optic and oculomotor nerves and spinal nerve tracts.
TRUE
What exacerbates MS?
heat, infection, trauma, and stress
What are the manifestations of MS?
double/blurred vision, weakness, poor coordination, sensory deficits, memory impairment, and bladder control may be lost.
Developmental anomaly characterized by defective closure of the bony encasement of the spinal cord (neural tube) through which the spinal cord and meninges may or may not protrude.
Spinal Bifida
What is the etiology of spinal bifida?
Environmental factors such as lack of folate and genetics play a role.
What is the treatment for spinal bifida?
Surgery, C-section, folic acid before and during pregnancy
How do we diagnose spinal bifida?
prenatally- ultrasound, and a-fetoprotein testing
Progressive disease affecting both the upper and lower motor neuron, also called Lou Gehrig disease.
ALS- Amyotrophic lateral sclerosis.
In ALS
Weakness and wasting of the _______ extremities usually occur followed by _______ ________, _______ and ____________.
Weakness and wasting of the upper extremities usually occur followed by impaired speech, swallowing and breathing.
The following clinical manifestations are for what type of Sclerosis?
Weakness, atrophy, cramps, stiffness, irregular twitching of muscles, hyperreflexia in weak, atrophied extremity (highly suggestive).
ALS
What is the mechanism of injury in spinal cord injuries?
Hyperflexion, hyperextension, compression
TRUE/FALSE
Spinal cord injuries happen over time and is characterized by temporary loss of reflexes in the level of injury.
FALSE
Spinal cord injuries occur immediately and is characterized by temporary loss of reflexes below the level of injury.
What causes skeletal/autonomic reflexed to be lost in spinal cord injuries.
(such as bladder)
Muscles becoming flaccid
In spinal cord injuries what causes reflexes return and flaccidity replaced by spasticity?
end of spinal shock
TRUE or FALSE
Neurogenic shock may occurs after spinal cord injury due to peripheral vasodilation and causes hypertension.
FALSE
Neurogenic shock may occur after spinal cord injury due to peripheral vasodilation and cause hypotension.
Inflammatory demyelinating disease of the peripheral nervous system or a lower motor neuron disorder.
-Segmental demyelination that is T-cell and B-cell mediated
Guillian-Barre syndrome
Clinical manifestations of Guillian-Barre syndrome:
Muscle ______ that begins in the lower extremities and spreads to the _____ _______ ________.
Progressive ascending _______ or ______, may affect _________ muscles.
Clinical manifestations of Guillian-Barre syndrome:
Muscle weakness that begins in the lower extremities and spreads to the proximal spinal neurons.
Progressive ascending weakness or paralysis may affect respiratory muscles.
Idiopathic neuropathy of the facial nerve; paralysis of the muscles on one side of the face.
Bell Palsy
Clinical manifestation of Bell Palsy:
Develop rapidly over ___-___ hrs; unilateral facial ________, facial ______ and _______ eye blink, hyperacusis and ________ lacrimation
Develop rapidly over 24-48hrs; unilateral facial weakness, facial droop, and diminished eye blink, hypercusis, and decreased lacrimation.
MS-CNS
Guillian-Barre syndrome- PNS
Just remember that
What stage of pain:
Process of converting painful stimuli to neuronal action potentials at the sensory level.
Nociceptor transduce noxious stimuli into action
Chemical mediator after the membrane potential of the pain receptor.
Transduction
____________prevent prostaglandin production by
inhibiting the
action of cyclooxygenase
(enzyme that normally converts
arachidonic
acid to prostaglandin)
NSAIDS
What stage of pain:
Stimulated nociceptors transmit impulses to the CNS by
means
of specialized sensory fibers
Transmission
In transmission who are the 1st ones to send impulses to the CNS?
Aδ:
(A-delta)
What type of sensory fibers in transmission:
large, myelinated fibers involved in transmission of sharp, stinging, and highly localized pain.
Primary sensory fibers Aδ (A-delta)
What type of sensory fibers in transmission:
small, unmyelinated fibers involved in transmission
of dull,
aching, and poorly localized pain that lingers
C
What type of afferent sensory pain fibers:
Myelinated
Amount: 10%
Source: Thermal, mechanical stimuli
Speed: Fast traveling- 5-10m/sec
Sensory quality of pain mediated: Sharp, stinging, cutting pinching
Aδ fibers
What type of afferent sensory pain fibers:
Unmyelinated
Amount: 90%
Source: Polymodal stimuli (mechanical, thermal, chemical)
Slow traveling (0.6-2m/sec)
Sensory quality of pain mediated: Dull, burning and aching
C fiber
What anterolateral tract?
carries Aδ fiber input, projects to thalamus and then sensory cortex
-Have few synapse (go directly to the brain- fast impulses)
Neospinothalamic tract
What anterolateral tract?
carries C fiber input, projects
diffusely to the reticular
formation, mesencephalon,
and thalamus
-Making a lot of synapse and takes a while to reach brain.
Paleospinothalamic tract
If injured in left finger, in what hemisphere will the cross over be present?
Right hemisphere and vise versa
What may stimulate “wind up” phenomenon that
can lead to chronic pain?
Glutamate
Lower brain centers cause?
conscious perception of pain
What neurotransmitters and neuropeptides are involved
in
synaptic transmission at the spinal cord level?
Substance P, glutamate, GABA, cholecystokinin, and
calcitonin
gene–related peptide and Glutamate
Brain can localize a pain sensation to a particular
part of the
body because?
nociceptor pathways are
kept in specific anatomic order in the
cord
(sensory dermatone) and somatosensory cortex
What stage of pain:
within brain/spinal cord by endogenous opioids
(enkephalins, endorphins)
Modulation
In modulation what are mediators of
presynaptic inhibition?
Opioids such as endorphins and morphine
In modulation: What receives input from the periaqueductal gray
(PAG),
which has a high concentration of endogenous opioids, and
the
rostral pons, which secretes norepinephrine?
Raphe magnus
Opioids have different effects depending on the types of
receptors
they activate, what are the 4 types?
mu, kappa, sigma, and delta
Opioids have different effects depending on the types of
receptors
they activate, which of the 4 types have analgesic
activities?
Mu (brain) and kappa (spinal cord)
In modulation which theory states:
Impulses carried by large myelinated cutaneous fibers (Aβ)
could
“close the gate” on nociceptor impulses; pain signals would
be
blocked in the spinal cord and not allowed to progress to the brain
Gate control theory
In modulation:
Rubbing, pressing, or shaking the painful area may....
Reduce pain
What type of pain?
tissue injury has occurred
Physiologic pain
what type of pain?
occurs after tissue injury, but long-term
changes occur both
within the peripheral and CNS; changes
occur along somatosensory
pathways from the periphery to the
cortex
Pathologic pain
What are the clincal manifestations of acute pain?
elevated heart rate, respiratory
rate, and blood pressure;
pallor, sweating, and nausea
Pacing, grimacing, crying, or moaning
in acute pain short term therapy with nonopioid and opioid medications may...
provide adequate pain relief; may prevent some types
of chronic pain
result from dysfunction of the brainstem areas
involved with
modulation of craniovascular afferent fibers
Migraines
Manifestation of headaches...
unilateral throbbing with nausea,
vomiting, photophobia,
phonophobia, lacrimation
Where does RAF nucleus get its signal from?
PAG area (pre-aqueduct gray area)- endorphins
Rostral Pons
What type of pain lasts longer than the expected healing time, > 6
months
Chronic pain
Clinical manifestations of chronic pain?
generally not associated with
signs and symptoms of sympathetic
activity;
psychological such as loss of job, irritability
Disordered pain mechanisms in the CNS
Characterized by chronic widespread pain affecting all
four
extremities; hyperalgesia; trigger or tender points
Many associated symptoms, such as sleep
disturbance/insomnia,
difficulty concentrating, fatigue, irritable
bowel syndrome, allodynia
Fibromyalgia Syndrome
May result from infiltration of organs,
compression of
structures by an expanding
tumor, or as a result of cancer treatments
Clinical manifestations: mixture of sympathetic
nervous system
activation and behavioral
changes
Cancer-Related Pain
Results from tissue injury in which the nerves
themselves become
damaged or dysfunctional
May result from altered central processing of
nociceptive
input (releasing norepinephrine onto
nociceptors)
Neuropathic Pain
Caused by damage to the large peripheral nerves by
inflammation
and demyelination
Patient education for foot care and glucose control
is
critical toward reducing further complications
Diabetic Neuropathy
is characterized by a burning pain that
follows a dermatomal
pathway and is accompanied by a
blistering rash
Herpes zoster (Postherpetic Neuralgia)
Management aimed at improving blood flow and reducing
tissue
hypoxia; removing clot if needed
associated with atherosclerosis
Ischemic Pain
Perceived in an area other than the site of injury
Examples include pain of myocardial infarction being
felt in
the jaw or left arm; shoulder pain after pelvic
procedures;
diaphragmatic irritation from peritonitis
Referred Pain
Physiologic Responses to Pain
Sympathetic nervous system activation during acute pain
can
lead to?
Increased heart rate, respirations, blood pressure
Dilated pupils
Perspiration
Pallor
Increased circulating blood glucose
Decreased gastrointestinal motility
Hypomotility of the bladder
Pain management interventions can be
directed at three points:
__________ peripheral transmission of
nociception
Modulating pain transmission at the _____ _______ ________.
Altering the perception and integration of
_____________
____________ in the brain
Interrupting
peripheral transmission of
nociception
Modulating pain transmission at the spinal cord
level
Altering the perception and integration of
nociceptive
impulses in the brain
Interrupting Peripheral Transmission of Pain is often the first step in......
controlling pain
What alters blood flow and reduces swelling?
Application of heat or cold
__________ decrease prostaglandins thereby
interrupting
peripheral transmission; many significant side
effects
including gastrointestinal bleeding, decreased
platelet
aggregation, and renal insufficiency
NSAIDS
What activates large sensory fibers
that can block the central
progression of nociceptive
transmission at the interneurons?
Cutaneous stimulation
What are types of cutaneous stimulation?
Transcutaneous electrical nerve stimulation
(TENS)
Massage
Acupuncture
Heat/Cold
Therapeutic touch
Epidural and intrathecal analgesia
Dorsal column stimulators
What medication works at specific receptor sites located throughout
the body
but are highly concentrated in the brain
Opioids
Mild pain managed with....
nonopioid
analgesics such as NSAIDs or
acetaminophen
Moderate pain is controlled with
low-potency opioids
such as codeine
Severe pain requires....
more potent doses of
opioids like morphine and fentanyl
What type of Altering the Perception and Integration of Pain will be less able to integrate the pain experience when other competition is present.
Distraction
What type of Altering the Perception and Integration of Pain will alters perception of painful stimuli in higher brain centers; produces relaxation as well as analgesia
Imagery
What type of Altering the Perception and Integration of Pain will increases endorphins; conditioned response
Biofeedback
What type of Altering the Perception and Integration of Pain will conditioned response; increases blood flow
Relaxation
Complications of Fractures:
Eventual necrosis of the soft tissue, especially
muscles and nerves
Compartment syndrome
What are the causes of IP
Increased Brain volume, Increased cerebrospinal fluid volume, increased blood volume,
Vasogenic edema
Is the same as interstitial edema, because of blood vessels.
- sever hypotension, ischemia, stroke
- often unilateral,
Cytotix edema
...