Ch. 15 - Pain, Temperature Regulation, Sleep, And Sensory Function

Front 1

1. Endorphins:
a. increase pain sensations
b. decrease pain sensations
c. may increase or decrease pain sensations
d. have no effect on pain sensations

Back 1

b

Front 2

2. Referred pain from upper abdominal diseases involves:
a. the sacral region
b. L2 to L4
c. T8, L1, and L2
d. the gluteal regions, the posterior thighs, and the calves

Back 2

c

Front 3

3. In the gate control theory of pain:
a. a "closed gate" increases pain perception
b. stimulation of large A fibers "closes the gate"
c. both a and b
d. neither a nor b

Back 3

b

Front 4

4. Norepinephrine:
a. inhibits pain in the spinal cord and brain
b. increases excitability of neurons in the dorsal horn of the cord
c. contributes to pain inhibition in the pons and medulla
d. has major inhibitory effects in the spinal cord

Back 4

c

Front 5

5. Interleukin-1:
a. lowers the hypothalamic set point
b. is an exogenous pyrogen
c. is stimulated by exogenous pyrogens
d. none of above

Back 5

c

Front 6

6. Increased serum levels of epinephrine increase body temperature by:
a. increasing vasodilation
b. decreasing muscle tone
c. increasing heat production by causing glycolysis and increasing metabolic rates
d. decreasing basal metabolic rate.

Back 6

c

Front 7

7. In heat stroke:
a. core temperature usually does not exceed 101 F
b. sodium loss follows sweating
c. core temperature increases as the regulatory center fails
d. both b and c are correct

Back 7

c

Front 8

8. Unmyelinated C nociceptors:
a. are responsible for transmission of the diffuse, burning sensations
b. transmit fast pain sensations
c. carry well-localized, sharp pain sensations
d. terminate in the white matter of the dorsal horn

Back 8

a

Front 9

9. In hypothermia:
a. the viscosity of blood is decreased
b. acidosis can develop
c. the hypothalamic center prevents shivering
d. All of the above

Back 9

b

Front 10

10. Although non-REM and REM sleep are defined by electrical recordings, they are characterized by physiologic events. Which of the following occurs?
a. During NREM sleep, muscle tone increases
b. NREM sleep is initiated by the withdrawal of neurotransmitters from the reticular formation
c. During NREM sleep, cerebral blood flow to the cortex is increased
d. During NREM sleep, levels of corticosteroids are increased

Back 10

b

Front 11

11. Sleep apnea:
a. increases blood oxygen saturation
b. results from airway obstruction during sleep
c. is associated with "jet-lag syndrome"
d. produces pulmonary hypotension

Back 11

b

Front 12

12. Endogenous opioids inhibit:
a. substance P
b. TNF
c. prostaglandin E
d. arginine vasopressin

Back 12

a

Front 13

13. Glaucoma is __ and results from __
a. clouding of the lens; increased aqueous humor formation
b. decreased intraocular pressure; decreased aqueous humor formation
c. increased intraocular pressure; decreased aqueous humor drainage
d. clouding of the lens; decreased aqueous humor drainage

Back 13

c

Front 14

14. Keratitis may cause:
a. ulcers of the cornea
b. conjunctival pus
c. a hordeolum
d. neither a, b, nor c

Back 14

a

Front 15

15. Meniere disease:
a. is a complication of chronic middle ear disease
b. affects cochlear function, hence equilibrium
c. decreases endolymphatic pressure within the cochlea
d. is a genetic cause of vertigo

Back 15

b

Front 16

16. Which is neither an activator nor a depolarizer of primary or first-order afferents?
a. Bradykinin
b. Prostaglandins
c. Leukotrienes
d. Substance P

Back 16

d

Front 17

17. Third-order neurons:
a. terminate in the dorsal horn
b. project to the post central gyrus of the parietal lobe
c. project to the thalamus
d. are concerned with reflexes

Back 17

b

Front 18

18. Deafferentiation pain results from:
a. surgical resection of a nerve
b. muscle strain
c. infected nerves
d. decreased levels of endorphins

Back 18

a

Front 19

Match the pain characteristic with the responsible nervous system component
19. Basic sensation of pain
20. Initiation of pain stimulus
21. Discrimination and precision given
a. nociceptive receptors
b. thalamus
c. brainstem
d. A fibers
e. cortex

Back 19

19. b
20. a
21. e

Front 20

Match the circumstance with the sleep disorder
22. Drug or alcohol abuse
23. Obstructive apnea
24. Depressed vigilance
25. Insomnia
a. sleep initiation disorder
b. sleep breathing disorder
c. sleep-wake schedule disorder

Back 20

22. b
23. b
24. c
25. a

Front 21

Nociceptors indicate __ perception, and there's more on the skin than the __ __.

Back 21

pain
internal organs

Front 22

A-delta fibers carry __ pain sensations, and initiate __ reactions to painful stimuli.

Back 22

sharp
rapid

Front 23

Unmyelinated _ __ nociceptors carry __ __ or __ sensations that may follow A-delta fiber __ pain.

Back 23

C polymodal
diffuse burning
aching
sharp.

Front 24

What are the primary afferents?

Back 24

A-delta and C fibers

Front 25

Once the primary afferents enter the spinal cord, they may branch into __ or __ neuronal projections through the dorsolateral tract of __.

Back 25

ascending
descending
Lissauer

Front 26

Where do all of the primary afferents eventually terminate?

Back 26

in the gray matter of the dorsal horn in distinctive layers.

Front 27

What three classes of second-order cell bodies are found in the dorsal horn?

Back 27

1. projection cells - relay info to higher brain areas (cephalad)
2. excitatory interneurons
3. inhibitory interneurons - modulate nociceptive transmission.

Front 28

The synaptic connections between cells of primary and second-order neurons located in the __ __ and other lamina function as the __ __.

Back 28

substantia gelatinosa
pain gate

Front 29

Most nociceptive information travels __ by means of __ columns in the lateral spinothalamic tract.

Back 29

cephalad
ascending

Front 30

Other spinal cord projection systems convey nociceptive information directly or indirectly to the __ formation of the brainstem and the __ __ (PAG) matter of the midbrain.

Back 30

reticular
periaqueductal gray

Front 31

The principal target for nociceptive __ is the __, which is the major relay station of sensory information in general).

Back 31

afferents
thalamus

Front 32

The thalamus is divided into medial and lateral groups by a band of fibers called the internal __ __.

Back 32

medullary lamina

Front 33

Excluding the thalamus, brainstem, and midbrain, the chief areas involved in the processing and interpretation of pain are the __ __, and the __ and __ systems.

Back 33

cerebral cortex
reticular
limbic

Front 34

Functionally there are three types of neurons.
1) __ (afferent, mostly pseudounipolar)
2) __ (interneurons, multipolar)
3) __ (efferent, multipolar)

Back 34

1) sensory
2) associational
3) motor

Front 35

Also known as nerve glue, they support the neurons of the CNS.

Back 35

neuroglia

Front 36

__ make up __ of the total brain and spinal cord volume and are __ to ___ times more numerous than neurons.

Back 36

Neuroglia
half
5 to 10

Front 37

These types of neuroglia fill the spaces between neurons and surround blood vessels in the CNS

Back 37

Astrocytes

Front 38

These types of neuroglia function to deposit myelin within the CNS, and are the CNS counterpart of the __ cells.

Back 38

Oligodendroglia
Schwann

Front 39

__ cells line the CSF-filled cavities of the CNS (type of neuroglia).

Back 39

Ependymal

Front 40

__ remove debris (phagocytosis) in the CNS

Back 40

Microglia

Front 41

When an axon is severed, a typical sequence of events, known as __, occurs distal to the cut.

Back 41

wallerian degeneration

Front 42

In __ degeneration, the following occurs in the portion of the axon distal to the cut:
1) __
2) __
3) myelin sheath __ and disintegrates
4) axon portion disappears
The myelin sheaths reform into __ cells that line up in a column between the cut and effector organ.

Back 42

1) swelling
2) hypertrophy
3) shrinks
Schwann

Front 43

Neurons are not physically continuous with one another. The region between adjacent cells is called a __. The neurons that conduct a nerve impulse are named according to whether they relay impulses toward a __ (pre_ neurons) or away from the synapse (post_ neurons).

Back 43

synapse
presynaptic
postsynaptic

Front 44

Impulses are transmitted across the __ by chemical conduction. The conducting substance is called a __, and it is often formed in the __ knobs of the presynaptic neuron's axon.

Back 44

synapse
neurotransmitter
synaptic

Front 45

This neurotransmitter is excitatory, and is involved in Alzheimer disease due its decrease, myasthenia gravis (muscle weakness) from a reduction in its receptors, as well as memory, wakefulness, sexuality, and thirst

Back 45

Acetylcholine

Front 46

Monoamines
1) brainstem nuclei, nerve tracts to brain/CNS; Excitatory/inhibitory; Cocaine/amphetamines increase release/block reuptake causes overstimulation of postsynaptic neurons
2) 5-hydroxytryptamine (5-HT); generally inhibitory; brainstem nuclei; nerve tracts to brain/CNS; involved with mood, anxiety, and sleep induction; levels elevated in schizophrenia (delusions, hallucinations, withdrawal)
3) Neurons originating in substantia nigra; generally inhibitory; inhibitory in basal ganglia/may be excitatory in other brain parts; Parkinson disease (depression of voluntary muscle control) results from destruction of dopamine-secreting neurons; drugs used to increase production induce vomiting and schizophrenia
4) Hypothalamus, with nerve tracts to brain/CNS; generally inhibitory; arousal from sleep, pituitary hormone secretion, cerebral circulation control, thermoregulation

Back 46

1) Norepinephrine
2) Serotonin
3) Dopamine
4) Histamine

Front 47

Amino Acids
1) produces local effects/majority of postsynaptic inhibition in the brain/some presynaptic inhibition in spinal cord/drugs that increase this neurotransmitter's function have been used to treat epilepsy (excessive discharge of neurons)
2) produces local effects/most postsynaptic inhibition in the spinal cord/these neurotransmitters receptors are inhibited by the poison strychnine (causes powerful muscle contractions and convulsions, can cause respiratory death)
3) Excitatory/widespread in the brain and CNS, especially in nerve tracts that ascend or descend the CNS or in tracts that project from one part of brain to another/drugs that block these might prevent seizures and neural degeneration from overexcitation
4) Excitatory/blocking this may prevent stroke damage/stimulating release of this is used to treat impotence

Back 47

1) GABA (gamma-aminobutyric acid)
2) Glycine
3) Glutamate and aspartate
4) Nitric Oxide

Front 48

Neuropeptides
1) Generally inhibitory/widely distributed in the CNS/PNS; the opiates morphine and heroin bind to these receptors on presynaptic neurons and reduce pain by blocking the release of neurotransmitters such as substance P
2) Spinal cord, brain, sensory neurons associated with pain; generally excitatory; a neurotransmitter in pain transmission pathways; blocking its release by morphine reduces pain

Back 48

1) Endorphins and enkephalins
2) Substance P

Front 49

Neurotransmitters are normally stored on __ side of the synaptic cleft and the receptor sites on the __ side. Therefore chemical synapses and action potentials transmit in __ direction.

Back 49

one
opposite
one

Front 50

The binding of the neurotransmitter at the receptor site changes the permeability of the postsynaptic neuron and, consequently, its membrane potential. Two possible scenarios can then follow:
1) the __ neuron mainly be excited (__; excitatory postsynaptic potentials - EPSPs) or
2) the __ neuron's plasma membrane may be inhibited (__; inhibitory postsynaptic potentials - IPSPs)

Back 50

1) postsynaptic neuron (depolarized)
2) postsynaptic neuron (hyperpolarized)

Front 51

The brain receives __ to __% of total cardiac output. __ __ serves as a primary regulator for blood flow in the CNS by being a potent vaso__.

Back 51

15 to 20%, or 800 to 1000 ml of blood flow per minute
carbon dioxide
vasodilator

Front 52

The brainstem is made up of the __, __ __, and __. It connects the hemispheres of the brain, cerebellum, and spinal cord.

Back 52

midbrain, medullar oblongata, and pons.

Front 53

A collection of nuclei (nerve cell bodies) within the brainstem collectively constitute the __ __. It is essential for maintaining wakefulness and in conjunction with the __ __ is referred to as the reticular activating system.

Back 53

reticular formation
cerebral cortex

Front 54

A basic CNS principle, __, holds that the CNS is capable of change.

Back 54

plasticity

Front 55

What is the largest portion of the brain? What does it contain?

Back 55

cerebrum
cerebral cortex
basal ganglia

Front 56

From the thalamus, brainstem, and midbrain, __-order neurons project to portions of the CNS involved in the processing and interpretation of __, the chief areas being the __ and __ systems and __ cortex.

Back 56

third
reticular
limbic
cerebral

Front 57

What area of the brain is thought to be involved in the discriminative and cognitive aspects of pain; that is, what we think about pain?
Where is it located?

Back 57

sensory homunculus
on the postcentral gyrus of the parietal lobe

Front 58

What part of the brain receives diffuse projections from the medial thalamic nuclei, which are thought to express how your pain appears to an observer?

Back 58

frontal lobe of the cerebral cortex
frontal lobectomies were once used in an effort to treat some cases of intractable pain.

Front 59

These two systems regulate the complex emotional responses to pain; that is, what we feel about pain.

Back 59

limbic system
reticular activating system

Front 60

Stimulating a group of large, fast, heavily myelinated _-__ fibers (which synapse in the dorsal horn along with their nociceptive Ad and C fiber counterparts) can close the pain gates.

Back 60

A-beta fibers