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WorksheetsRegional Anesthesia Pain/Receptors
Total questions: 72
Worksheet time: 36mins
Name
Class
Date
1.
Where do a majority of First order neurons enter?
a)
Dorsal spinal root at level of Lumbar
b)
Spinal thalamic tract
c)
Dorsal spinal root at each specific level of the spine
d)
Visceral spinal tract
2.
True or False: Pain fibers for the face are sensory cranial nerve that enter above the level of the hypothalamus
a)
True
b)
False
3.
The gray matter of the spinal cord is divided into how many rexed lamina? which one has nerves that modulate pain?
a)
10; Lamina 1
b)
12; Lamina 7
c)
10; Lamina 2
d)
8; Lamina 2
4.
What are the two classification for second order neurons?
a)
Nociceptive and regulatory
b)
Nociceptive and wide dynamic range
c)
Wide dynamic range and c-fibers
d)
Spinalreticular nerve plexus; afferent bundle
5.
Which lamina is the major site of action for opioids and is referred to as the substantia gelatinosa
a)
Lamina 1
b)
Lamina 5
c)
Lamina 3
d)
Lamina 2
6.
Which lamina contains Preganglionic sympathetic neurons?
a)
Lamina 2
b)
Lamina 5
c)
Lamina 7
d)
Lamina 10
7.
Billy is an 8 year old boy who fell from his bike and cut his left knee what is the correct pathway of pain sensation to the thalamus?
a)
Nerve sensation in the knee to the dorsal rexed lamina of the spine traveling ipsilateral from lamina 1 to VENTRAL lateral spinothalamic tract to thalamus
b)
Nerve sensation in the knee to the dorsal rexed lamina of the spine traveling contralateral from lamina 1 to lateral spinalthalamic tract to thalamus
c)
Nerve sensation in the knee to the dorsal root ganglia of the spinal traveling ipsilateral from lamina 1 to lateral spinalthalamic tract to thalamus
d)
Nerve sensation in the knee to the dorsal root ganglia of the spinal traveling contralateral from lamina 1 to ventral lateral spinalthalamic tract to thalamus
8.
Which spinothalamic tract project unpleasant emotional perception of pain?
a)
Dorsal Lateral spinalthalamic tract
b)
Medial spinothalamic tract (Paleospinothalamic tract)
c)
Lateral spinalthalamic tract
d)
Pain is only perceived in the limbic system
9.
The general purpose of the spinalreticular tract is to?
a)
Evoke an emotional response to pain
b)
Send descending nerve fibers to modulate pain
c)
mediate arousal and autonomic response to painful stimulus
d)
Increase inter neuron substance P release
10.
Which spinal tract is responsible for transmitting anti-nociceptive pathways from projections in the periductal gray area?
a)
Spinoreticular tract
b)
Spinalmesencephalic tract
c)
Spinohypothalamic tract
d)
Spinotelencephalic tract
11.
Where does discrete localization of pain take place? Where does that pain get transmitted from?
a)
Thalamus; Hypothalamus
b)
Post Central gyrus and sylvian fissure; Medulla
c)
Anterior central gyrus and sylvian fissure; Thalamus
d)
Post central gyrus and sylvian fissure; Thalamus
12.
Which of the following is NOT part of the first order neurons in the face?
a)
Vagus
b)
Trigeminal
c)
Glossopharyngeal
d)
Vestibulocochlear
13.
Where does the Excitatory nociceptive transmitter substance P bind to?
a)
N-methyl-o-aspartate
b)
Neurokinin 1 receptor
c)
AMPA
d)
Calcium Gene Related peptide receptor
14.
Which of the following is NOT a inhibitory neurotransmitter chemical
a)
Enkephalins
b)
GABA
c)
Beta Endrophins
d)
Calcitonin gene-related peptide
15.
Which nerve fiber is not mylinated
a)
A-delta fibers
b)
A-Beta fibers
c)
B fibers
d)
C fibers
16.
Which nerve fiber has a diameter of 15 micrometers and a velocity of 100 m/sec
a)
A-Alpha
b)
A-Beta
c)
A-Gamma
d)
A-Delta
17.
Which nerve fiber has a diameter of less than 3 micrometer and velocity of 15 m/sec
a)
A-Gamma
b)
A-Delta
c)
A-Beta
d)
B
18.
Which Nerve fiber has a diameter of 1 micrometer and a velocity of 1 m/sec
a)
A-Delta
b)
A-Gamma
c)
B
d)
C
19.
What is the definition of Allodynia
a)
Perception of an ordinarily non-noxious stimulus as pain
b)
absence of pain perception
c)
absence of all sensation
d)
Pain in an area that lacks sensation
20.
Analgesia is defined as
a)
Pain in an area that lacks sensation
b)
Increased response to mild stimulation
c)
Absence of pain perception
d)
If you get this wrong I will find you
21.
Hypoalgesia is defined as
a)
Diminished response to noxious stimulation
b)
Increased response to noxious stimulation
c)
Pain in the distribution of a nerve or a group of nerves
d)
Functional abnormality of one or more nerve roots
22.
The presence of hyperesthesia, allodynia, and hyperalgesia usually associated with overreaction, and persistence of the sensation after the stimulus is what term?
a)
Hyperalgesia
b)
Hypesthesia
c)
Radiculopathy
d)
Hyperpathia
23.
Which nerve fibers transmissions are: fast, sharp, and well-localized
a)
A-Gamma
b)
A-Delta
c)
C
d)
B
24.
C fibers generally perceive pain as?
a)
Fast, sharp, burning
b)
Well-localized, slow, sharp
c)
Slow, Dull, poor localization
d)
Slow, Sharp, Poorly-localized
25.
Most free nerve endings sense changes in heat, mechanical, and chemical tissue damage (Morgan & Mikhail). Which nerve endings response to pinches and pricks
a)
Silent nociceptors
b)
Polymodal nociceptors
c)
Mechanonociceptors
d)
B fibers
26.
Which nociceptive nerve endings respond to inflammation
a)
Silent nociceptors
b)
Polymodal mechoheat nocicpetors
c)
Mechanonociceptors
d)
Thermonociceptors
27.
Which of the following is an alogen released from damaged tissue that increases pain
a)
Na+
b)
K+
c)
Substance P
d)
Glycine
28.
Deep somatic nociceptors including all of the following EXCEPT:
a)
Subcutaneous
b)
Bone
c)
Tendons
d)
Fascia
29.
Where does the larynx and trachea nocicpetive C fibers travel to?
a)
Pons
b)
Periaqueductal gray
c)
Nucleus solitarius
d)
RVM Rostral Ventricular Medulla
30.
True or False: Substance P sensitizes nociceptors, degranulates histamine from mast cells, and is a potent vasodilator
a)
True
b)
False
31.
Which of the following is not a direct factor causing the arachidonic acid cascade?
a)
Histamine release from mast cells, basophils, and platelets
b)
Factor XII releasing bradykinin
c)
Release of phospholipids from damaged tissue
d)
Glutamate
32.
At what is the role of cyclooxygenase in the arachidonic acid cascade?
a)
Promote conversion of phospholipase A2 to arachidonic acid
b)
Convert bradykinin to thromboxane A1
c)
Facilitate conversion of arachidonic acid to prostacyclin and prostaglandin
d)
inhibit conversion of arachidonic acid to prostacyclin and prostaglandin
33.
What are the three factors of central modulation?
a)
Wind-up, Receptor field expansion, and hyper excitability of flexion reflexes
b)
Central inhibition, Supraspinal inhibition, and segemntal inhibition
c)
Opioids, Ketamine, Spinals
d)
Substance P, CGRP, and Glutamate
34.
What is the role of Glutamate and aspartate have in central modulation?
a)
Promote hyperflexia through GABA activation
b)
Promote wind-up modulation through activation of NMDA and other receptors
c)
Promote reflex modulation through activation of receptors in the nucleus raphe magnus
d)
Promote arachidonic acid and begin the cascade
35.
What descending spinalthalamic tract is responsible for modulating pain
a)
Dorsolateral funiculus
b)
Rosterial reticular tract
c)
Periaquaiductal gray
d)
enkephalin release from the thalamus
36.
What statement about the Gate Theory is False
a)
It utilizes diameter and speed of afferent neurons within the theory
b)
Describes gate opening if painful stimulus is felt and the gate is closed if simultaneous inhibitory impluses are transmitted
c)
Describes opening and closing of NK1 receptor transmission from the dorsal horn
d)
Describes how rubbing a stubbed toe can inhibit a painful response
37.
Where does opioid mu-2 receptor mostly work
a)
Substantia gelatinosa of the ventral rexed lamina 8
b)
Substantia Gelatinosa of the Rosterial ventral medulla
c)
Substantia gelatinosa of posterior rexed lamina 2
d)
Lamina 2 of the medial spinalthalamic tract
38.
Which is not a neurotransmitter that will inhibit pain response
a)
Enkephalin
b)
Endorphins
c)
Norepinephrine
d)
Glutamate
39.
True or False: Preemptive analgesia allows inhibitory effects prior to surgery through peripheral and central modulation of substantia gelantinosa
a)
True
b)
False
40.
Visceral pain has four subcategories which one is: dull, diffuse, midline and is associated with abnormal sympathetic or parasympathetic activity
a)
True localized visceral
b)
True localized parietal
c)
referred visceral
d)
referred parietal
41.
Which of the following is not a true statement regarding acute pain and the cardiovascular system
a)
Hypertension and tachycardia increase SVR
b)
Increase in CO due to acute pain stimulus
c)
Increase in myocardial oxygen demand
d)
Decrease in CO due to acute pain stimulus
42.
True or False: Acute pain increases minute ventilation, increases work of breathing, Reduces tidal volume and functional residual capacity.
a)
True
b)
False
43.
What happens to the GI and GU system during acute pain?
a)
Increased production of fecal matter and uncontrollable urination
b)
Increased sympathetic tone and sphincter tone leading to increase urinary motility and increased GI motility
c)
Increased sympathetic tone and sphincter tone leading to decreased urinary motility and decreased GI motility
d)
Stomach ulceration and severe diaherra
44.
During an acute pain episode does catabolic hormones: Increase, Decrease, or Stay the same
a)
Increase
b)
Decrease
c)
Stay the same
45.
Which of the following is true about the immune system during acute pain?
a)
People are less likely to have infections
b)
Acute pain produces histamine which predisposes patients to infection
c)
Acute pain produces leukocytosis which predisposes patient to infection
d)
Acute pain increases inflammation which drives leukocytes to the brain causing fever
46.
Chronic pain is defined as:
a)
Pain the persists beyond the usual course of an acute disease or after reasonable healing time
b)
A period of greater than 3 months
c)
It is nociceptive, neuropathic, or a combination of both
d)
All answer choices are correct
47.
Which statement of chronic pain is true
a)
Reorganization of receptors fields in the dorsal horn neurons (i.e. Lamina 1,2)
b)
Peripheral stimulus from hyperexcitable neurons cause chronic pain
c)
TRVP (Transient Potential Vanilloid Receptor) activation cause microneural tear along neuron pathway
d)
a noxious stimulation due to an injury within the last week
48.
Which statement regarding chronic pain peripheral and central mechanical changes is incorrect
a)
Short circuits between pain fibers, following demyelination, activating nociceptors by nonnoxious stimuli
b)
Spontaneous electrical activity in the dorsal horn cells or thalamic nuclei
c)
Loss of descending inhibitory influences that are dependent on normal sensory input
d)
Release of enkephalins to sensory neurons to reduce somatic and viscerapain preception
49.
Put these in the correct order:
1. Spinal Transmission
2. Peripheral Transmission
3. Receptor (transduction)
4. Supraspinal processing
5. Peripheral Stimulus
6. Ascending Tracts
1. Spinal Transmission
2. Peripheral Transmission
3. Receptor (transduction)
4. Supraspinal processing
5. Peripheral Stimulus
6. Ascending Tracts
a)
2,3,4,5,1,6
b)
5,3,2,1,6,4
c)
5,3,2,1,4,6
d)
5,1,2,3,6,4
50.
What are A-Beta fibers peripheral stimulation
a)
Non-noxious, mechanical stimulus
b)
Noxious mechanical stimulus
c)
Noxious heat and chemical stimuli
d)
muscle contraction
51.
What receptor does capsaicin work on?
a)
NK-1
b)
Adenosine A2
c)
TRPV1- Transient Receptor Poential Vanilloid
d)
GABA sub-unit A
52.
Hypesthesia is defined as
a)
Absence of pain
b)
Absence of all sensation
c)
Perception of ordinarily non-noxious stimulus as pain
d)
Reduced cutaneous sensation
53.
Unpleasant or abnormal sensation with or without a stimulus is the definition of what term?
a)
Hypoaglesia
b)
Hyperalgesia
c)
Anesthesia Dolorosa
d)
Dysesthesia
54.
Functional abnormality of one or more nerve roots is what term?
a)
Neuralgia
b)
Paresthesia
c)
Radiculopathy
d)
Hypoesthesia
55.
Pain in the distribution of a nerve or a group of nerves is what term
a)
Paresthesia
b)
Neuralgia
c)
Radiculopathy
d)
Hypesthesia
56.
What nerve fibers exclusively innervate the tooth pulp and cornea
a)
A-delta, and vagus
b)
C fiber and trigeminal
c)
Vagus and trigeminal
d)
A-delta and C fibers
57.
As of January 1, 2017 ARNP's can prescribes what schedule medication without doctors co-signature
a)
Schedule III
b)
Schedule V
c)
Schedule II
d)
Schedule I
58.
Hydromorphone is considered what schedule medication
a)
Schedule 1
b)
Schedule 2
c)
Schedule 3
d)
Schedule 4
59.
What does aspirin, celebrex, and ibuprofen have in common?
a)
They treat cancer
b)
They block only COX1
c)
They block COX1 and/or COX2
d)
They block GABA receptors
60.
Which medication last longer Opana-ER or Exalgo ER
a)
They both have the same half-life
b)
Opana-ER
c)
Exalgo-ER
d)
What are these medications
61.
What is Nucynta (Tapentadol)? Where does it work?
a)
Central acting analgesic; Mu opioid agonist and α2 antagonist
b)
Peripheral acting analgesic; Mu opioid agonist and α2 antagonist
c)
Central acting analgesic; Mu opioid agonist and α2 agonist
d)
Peripheral acting analgesic; Mu opioid agonist and α2 agonist
62.
Which SSRI has the longest half life approximately 160-200 hours
a)
Fluoxetine (Prozac)
b)
Sertaline (Zoloft)
c)
Velanfazine (Effexor)
d)
Citalopram (Celexa)
63.
Based from the pain management article how much Gabapentin should be administered orally prior to a "major" surgery? How many hours before the surgery?
a)
900mg; 30 minutes prior
b)
1200mg; 1 hour prior
c)
1200mg; 2 hours prior
d)
900 mg; 1 hour prior
64.
What medication class inhibits phospholipase A2 from converting phospholipid into arachidonic acid
a)
SSRI's
b)
Opioids
c)
Alpha 2 agonist
d)
Corticosteroids
65.
Julio is a gardener that is having severe back muscle spasm, what medication would be expected to be on his pre op med list
a)
Baclofen- Alpha 2 agonist
b)
Baclofen- GABA agonist
c)
Lyrica- Highly protein bound anticonvulsant
d)
Lyrica- agent that blocks voltage gated calcium or sodium channels
66.
An abnormal sensation perceived without an apparent stimulus is what term
a)
Neuralgia
b)
Hyperpathia
c)
Paresthesia
d)
Anesthesia Dolorosa
67.
Does the antiseizure medication Gabapentin and Pregabalin (Lyrica) have to be dosed appropriately to creatinine clearance?
a)
Yes
b)
No
c)
Don't know
d)
Maybe
68.
True or False: Approximately 25.3 million americans experince chronic pain
a)
True
b)
False
69.
A prescription for controlled substances in schedule 3, 4, and 5 may NOT be filled or refilled more than how many times in a period of 6 months?
a)
3
b)
4
c)
5
d)
6
70.
Which medication inhibits the perception of pain, but does not block pain transmission?
a)
Propofol
b)
Morphine
c)
Hydromorphone
d)
Capsacin
71.
Which is not a pain treatment 3 core element
a)
Rehabilitation
b)
Pain managment
c)
Psychological treatment
d)
Psychosocial treatment
72.
Referred visceral diseases process involving the peritoneum or pleura over central diaphragm is referred to what location
a)
Neck and shoulder
b)
Peritoneum or pleura
c)
Chest or upper abdominal wall
d)
Hands and feet
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