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