Nervous System and Pain Perception
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Questions and Answers

What enzyme is responsible for the breakdown of phospholipids in cell membranes, leading to the formation of arachidonic acid?

  • Phospholipase A (correct)
  • Cyclooxygenase (COX)
  • Bradykinin
  • Histamine

Which type of nerve fibers are responsible for carrying thermal and chemical pain impulses?

  • Myelinated fibers
  • A-delta fibers
  • C-fibers (correct)
  • Bradykinin fibers

What is the role of prostaglandins in the sensation of pain?

  • They inhibit the activity of nociceptors
  • They sensitize nociceptors and lower the pain threshold (correct)
  • They have no effect on nociceptors
  • They increase the pain threshold

Which of the following is NOT a chemical mediator that can alter the membranes of pain receptors and affect the transmission of pain impulses?

<p>Endorphins (A)</p> Signup and view all the answers

What are the characteristics of A-delta fibers in the afferent pathway?

<p>They are myelinated and have a fast conduction velocity with small reception fields (D)</p> Signup and view all the answers

Where does the afferent pathway terminate in the central nervous system?

<p>The dorsal horn of the spinal cord (A)</p> Signup and view all the answers

What is the goal of treatment for cancer pain?

<p>Keep the pain at a tolerable level for the patient (D)</p> Signup and view all the answers

When does chronic pain transition from acute pain according to some experts?

<p>After 12 months since onset (B)</p> Signup and view all the answers

What is a key principle of patient education in pain management?

<p>Having the patient monitor pain levels (A)</p> Signup and view all the answers

Which type of setting may require transitioning from intravenous to oral pain medications before discharge?

<p>Emergency setting (A)</p> Signup and view all the answers

What should be evaluated when selecting an opioid and dose for a patient's pain?

<p>Benefits versus risks (D)</p> Signup and view all the answers

What defines chronic pain?

<p>$Pain that extends beyond the expected period of healing$ (C)</p> Signup and view all the answers

What are some impacts of pain that can occur according to the text?

<p>$Cognitive disorders$, anxiety, stress, depression (A)</p> Signup and view all the answers

What is the purpose of consistently using a common pain scale initially and at each visit?

<p>To establish a baseline for measuring progress (D)</p> Signup and view all the answers

Why is it important to obtain a history about self-treatment and past treatment successes and failures?

<p>To understand the patient's response to various treatments (B)</p> Signup and view all the answers

What information does the State Board of Pharmacy Prescription Drug Monitoring Program (PDMP) report provide?

<p>List of filled controlled substance prescriptions (C)</p> Signup and view all the answers

Which factor is essential when assessing the past medical history of a patient for opioid use?

<p>History of pain-related illnesses relevant to opioids (A)</p> Signup and view all the answers

Why is a social history important in assessing patients for pain management?

<p>To identify behavioral issues that may affect compliance or misuse (C)</p> Signup and view all the answers

Which statement is true regarding validated screening tools used in pain assessment?

<p>They help assess quality of life and functional ability (D)</p> Signup and view all the answers

What is the primary purpose of using screening tools for opioid misuse risk assessment and depression screening?

<p>To identify risk factors before prescribing opioids (C)</p> Signup and view all the answers

Why is it important to use one of the specified tools when considering initial therapy with an opioid?

<p>To evaluate the patient's risk factors for opioid misuse (A)</p> Signup and view all the answers

What action should providers take when evaluating patients who have been previously treated by another provider?

<p>Use appropriate tools based on the patient's current situation (C)</p> Signup and view all the answers

What component of a patient's history is crucial in identifying potential issues with compliance or misuse?

<p>Education and employment history (B)</p> Signup and view all the answers

What type of pain is typically described as feeling tingling, prickling, burning, or shock-like?

<p>Neuropathic pain (A)</p> Signup and view all the answers

Which type of fibers are poorly localized and have slower impulses compared to A-delta fibers?

<p>C-fibers (A)</p> Signup and view all the answers

Which neurotransmitters play a role in modulating sensitivity to pain in efferent pathways?

<p>Norepinephrine and serotonin (D)</p> Signup and view all the answers

Which type of pain is often perceived at a site distant from the actual source?

<p>Referred pain (B)</p> Signup and view all the answers

What produces complaints of sharp, stabbing, or throbbing pain similar to somatic pain arising from tissue damage to hollow organs?

<p>Visceral pain (D)</p> Signup and view all the answers

What is the primary difference between A-delta and C-fibers in terms of response to stimuli?

<p>Localized vs. poorly localized (C)</p> Signup and view all the answers

'Gastric motility and blood flow to the viscera decrease' is a physiological response associated with which type of pain?

<p>Acute pain (D)</p> Signup and view all the answers

'Examples are burns, arthritis, or metastatic bone pain' describes which type of pain?

<p>Somatic pain (B)</p> Signup and view all the answers

'Behavioral signs can range from stoicism and stillness to demonstrative expressions such as grimacing' is associated with the expression of which type of sensation?

<p>Painful sensations (A)</p> Signup and view all the answers

What type of tissues does somatic pain primarily involve?

<p>Skin, joints, muscle (B)</p> Signup and view all the answers

What is the main reason for performing a urine drug test (UDT) when considering the treatment of a pain patient with an opioid?

<p>To confirm if the patient has taken any drugs recently (D)</p> Signup and view all the answers

Which tool consists of three questions, each scored 0 to 10, and is used when a full depression screening cannot be completed?

<p>Pain intensity, Enjoyment of life, and General activity (PEG) (C)</p> Signup and view all the answers

Which type of urine drug test is used to identify drugs not included in immunoassay tests?

<p>Gas chromatography mass spectrometry (GC/MS) (B)</p> Signup and view all the answers

What is the pH range for a urine specimen used in a urine drug test?

<p>4.5 to 8.0 (A)</p> Signup and view all the answers

Which factor can impact the results of a urine drug test?

<p>Urine volume (D)</p> Signup and view all the answers

What does a fully negative urine drug test for a patient reported to be taking a pain medication indicate?

<p>Misuse or overuse of medication may be happening (A)</p> Signup and view all the answers

Which tool is primarily completed by the clinician as part of opioid assessment?

<p>DIRE (D)</p> Signup and view all the answers

What is the main purpose of using immunoassay (IA) drug panels in urine drug testing?

<p>To detect substances present or absent based on a cutoff level (D)</p> Signup and view all the answers

What should be done if a UDT result shows drugs not expected based on the patient's history?

<p>Repeat the UDT to confirm the unexpected findings. (B)</p> Signup and view all the answers

What is one of the key considerations before committing to long-term treatment of a chronic pain patient?

<p>Whether the provider has the necessary time, skills, and education to effectively guide the patient. (A)</p> Signup and view all the answers

Which of the following is NOT mentioned as a necessary resource for a provider's practice to manage a chronic pain patient?

<p>A support group for patients to share their experiences with chronic pain. (C)</p> Signup and view all the answers

Which of the following scenarios would suggest that a patient has achieved satisfactory pain relief using a regular opioid dose?

<p>The patient reports that they can manage daily activities without significant pain interference. (B)</p> Signup and view all the answers

Based on the information provided, when should a provider consider offering naloxone to a patient?

<p>When the patient is using high dose opioids (greater than 50 MME/day) or benzodiazepines. (A)</p> Signup and view all the answers

Which of the following statements accurately describes a scenario where a provider should consider continuing long-term opioid treatment for a chronic pain patient?

<p>The patient reports that they can manage daily activities without significant pain interference, and there are no identified misuse issues or failure to comply with the PPA. (C)</p> Signup and view all the answers

Which of the following statements is TRUE regarding the pharmacological response to the same drug in different patients?

<p>Genetic research shows that the same drug can produce a subtly different pharmacological response based on distinct activation profiles of $\mu$ receptor subtypes. (D)</p> Signup and view all the answers

Which type of receptor is primarily responsible for the analgesic (pain-relieving) effects of opioids?

<p>Mu () receptors (D)</p> Signup and view all the answers

What is the primary function of the kappa () opioid receptors?

<p>Sedative effects (B)</p> Signup and view all the answers

What is the role of the periaqueductal gray (PAG) area in the midbrain in pain modulation?

<p>All of the above (D)</p> Signup and view all the answers

What is the function of the raphe magnus in the brainstem regarding pain modulation?

<p>Both a and b (C)</p> Signup and view all the answers

What is the purpose of the dermatomal map in the context of pain localization?

<p>It helps identify sources of neurological pain. (D)</p> Signup and view all the answers

What is the role of the substantia gelatinosa in the spinal cord regarding pain transmission?

<p>It is a key anatomical region with multiple synapses, where pain impulses can be intensified or blocked. (C)</p> Signup and view all the answers

What is the role of glutamate and its binding to NMDA receptors in the context of pain perception?

<p>Glutamate binding to NMDA receptors is thought to produce a pain memory, leading to chronic pain syndromes. (D)</p> Signup and view all the answers

What is the role of the efferent pathways in the modulation of pain sensation?

<p>They connect the reticular formation, midbrain, and substantia gelatinosa in the dorsal horn of the spinal cord to inhibit the transmission of pain signals. (A)</p> Signup and view all the answers

What is the role of the medulla and hypothalamus in the context of pain perception and response?

<p>They activate coping responses, such as the release of catecholamines and corticosteroids, and physical responses, such as increased heart rate and blood pressure. (D)</p> Signup and view all the answers

What is the recommended temperature range for a urine specimen within 4 minutes of voiding?

<p>90F to 100F (A)</p> Signup and view all the answers

According to the passage, what is the recommended pH range for a urine specimen?

<p>4.5 to 8.0 (A)</p> Signup and view all the answers

What is the significance of a creatinine level less than 2 mg/dL in a urine specimen?

<p>It is not consistent with human urine (C)</p> Signup and view all the answers

What is the recommended approach when initiating an opioid medication?

<p>Use immediate-release dosing (C)</p> Signup and view all the answers

According to the passage, what is the recommended maximum opioid dosage?

<p>No more than 90 morphine milligram equivalents (MME) per day (A)</p> Signup and view all the answers

What is the purpose of the physical exam described in the passage?

<p>All of the above (D)</p> Signup and view all the answers

What is the significance of a positive urine drug test (UDT) result?

<p>It demonstrates recent drug use (D)</p> Signup and view all the answers

What is the recommended approach when increasing opioid dosage?

<p>Increase the dose gradually (D)</p> Signup and view all the answers

What is the recommended approach if the opioid medication is not beneficial or greater risk develops?

<p>Optimize other therapies and lower or stop opioid therapy (A)</p> Signup and view all the answers

What is the significance of individual variability in response to analgesics?

<p>It is due to genetic differences (D)</p> Signup and view all the answers

What is the potential impact of combining opioid and benzodiazepine therapies?

<p>It increases the risk of misuse, abuse, and addiction (C)</p> Signup and view all the answers

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