Ch 16- Pain, Temperature Regulation, Sleep, and Sensory Function

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Questions and Answers

Which fibers transmit nerve action potentials generated by nociceptor excitation?

  • B and C fibers
  • A-beta and C fibers
  • A-delta and C fibers (correct)
  • A-delta and A-beta fibers

What type of pain sensation is transmitted rapidly by A-delta fibers?

  • Burning pain
  • Dull, aching pain
  • Sharp, well-localized pain (correct)
  • Poorly localized pain

Which of the following is a characteristic of pain transmitted by unmyelinated C fibers?

  • Rapid transmission
  • Well-localized sensation
  • Short duration
  • Poorly localized sensation (correct)

Which type of stimulus does NOT excite C fibers?

<p>Vibration stimuli (B)</p> Signup and view all the answers

Which fibers are responsible for causing reflex withdrawal from a stimulus before pain is perceived?

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

Which fibers do not directly transmit pain, but modulate pain transmission?

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

What physiological response is associated with increased ventilator rates during hyperthermia?

<p>Normal pulmonary ventilation providing some heat loss. (C)</p> Signup and view all the answers

Which of the following is a voluntary mechanism employed to reduce body temperature?

<p>Stretching out to increase body surface area. (A)</p> Signup and view all the answers

According to the passage, what structure is NOT directly involved in conscious pain perception?

<p>Dorsal horn of the spinal cord (C)</p> Signup and view all the answers

What is the primary cause of heat exhaustion?

<p>Prolonged vasodilation and profuse sweating leading to dehydration. (B)</p> Signup and view all the answers

What aspect of pain is the somatosensory cortex primarily responsible for?

<p>Identification of pain location (B)</p> Signup and view all the answers

What is the recommended immediate action for an individual experiencing heat exhaustion?

<p>Ceasing activity to decrease heat production and lying down (A)</p> Signup and view all the answers

What is an adaptation that occurs when someone moves to a warmer climate?

<p>An adjustment period that takes days to weeks. (A)</p> Signup and view all the answers

What is the typical duration criterion for classifying pain as chronic?

<p>More than 3 to 6 months (C)</p> Signup and view all the answers

Persistent pain may result in physiological adaptation, leading to which of the following?

<p>Normal heart rate and blood pressure (C)</p> Signup and view all the answers

Which of the following is characteristic of neuropathic pain?

<p>Amplification of pain without stimulation by injury or inflammation (D)</p> Signup and view all the answers

What is the hallmark characteristic of heat stroke?

<p>Rectal temperature greater than 41°C (106°F) (B)</p> Signup and view all the answers

Which physiological process is most directly impaired in heat stroke?

<p>Function of the thermoregulatory center (A)</p> Signup and view all the answers

What is allodynia?

<p>Pain caused by normally nonpainful stimuli (D)</p> Signup and view all the answers

Peripheral neuropathic pain can be caused by:

<p>Diabetic neuropathy (B)</p> Signup and view all the answers

Why does rapid cooling of the skin in heat stroke sometimes need to be avoided?

<p>Peripheral vasoconstriction prevents core cooling (C)</p> Signup and view all the answers

Which of the following is a neurological consequence of prolonged heat stroke?

<p>Cerebral edema and degeneration of the CNS (B)</p> Signup and view all the answers

Which of the following conditions is a common cause of central neuropathic pain?

<p>Postherpetic neuralgia (C)</p> Signup and view all the answers

What type of pain syndrome results from lesions interrupting the spinothalamic pathways?

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

What is the primary function of sleep?

<p>To provide restorative bodily functions and promote the creation of memories (B)</p> Signup and view all the answers

Where is the major sleep center located in the body?

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

Hemiagnosia pain is typically associated with what condition?

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

Phantom limb pain is best described as:

<p>Pain in an amputated limb after the stump has completely healed (C)</p> Signup and view all the answers

Approximately what percentage of total sleep time is spent in NREM sleep?

<p>75-80% (A)</p> Signup and view all the answers

A patient describes their neuropathic pain as 'burning, shooting, and shock-like.' Which additional symptom is commonly associated with this type of pain?

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

What is the approximate duration of each sleep cycle (NREM and REM) in minutes?

<p>90 - 100 minutes (C)</p> Signup and view all the answers

Approximately what percentage of total sleep time is spent in N2 sleep stage?

<p>45-55% (C)</p> Signup and view all the answers

Which physiological change is characteristic of N3 sleep?

<p>Low-frequency, high-amplitude delta waves (D)</p> Signup and view all the answers

What part of the brain controls REM sleep?

<p>Pontine and reticular formation (A)</p> Signup and view all the answers

During which sleep stage is respiration dependent and controlled by metabolic processes?

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

Which of the following physiological events occurs during REM sleep?

<p>Atonia of antigravity muscles (D)</p> Signup and view all the answers

Which factor is increased during REM sleep?

<p>Cerebral blood flow to both hemispheres (B)</p> Signup and view all the answers

What is the effect of losing REM sleep?

<p>Impaired memory and learning (C)</p> Signup and view all the answers

Which of the following decreases during NREM sleep?

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

A common symptom shared by both keratitis and inflammatory response is:

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

Which organism commonly causes acute bacterial conjunctivitis?

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

What is the primary cause of trachoma?

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

Which of the following is a typical symptom of allergic conjunctivitis?

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

What is the most common cause of bacterial keratitis?

<p>Staphylococcus aureus (B)</p> Signup and view all the answers

A patient presents with conjunctivitis and pharyngitis. Which type of infection is most likely the cause?

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

What strategy does the WHO recommend for trachoma treatment?

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

What is a potential consequence of chronic conjunctivitis if left untreated?

<p>Persistent inflammation (C)</p> Signup and view all the answers

Flashcards

C fibers

Unmyelinated polymodal fibers; transmit dull, aching pain.

A-delta fibers

Lightly myelinated fibers; transmit sharp, localized pain quickly.

Nociceptors

Free nerve endings that respond to pain stimuli.

Pain transmission

Conduction of pain impulses via A-delta and C fibers.

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Pain perception

Conscious awareness of pain occurring in the CNS.

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Sensory-discriminative system

Identifies the presence, character, location, and intensity of pain.

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Polymodal fibers

Fibers that respond to multiple types of stimuli (C fibers).

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Dorsal horn

Part of the spinal cord where pain signals enter the CNS.

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Increased pulmonary ventilation

Exchange of air that results in minimal heat loss, especially faster at higher body temperatures.

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Voluntary heat loss mechanisms

Behavioral actions like stretching out and wearing light clothing to increase heat loss.

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Heat adaptation

Adjustment period of the body transitioning from cooler to warmer climates lasting several days to weeks.

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Heat exhaustion

Common heat injury due to prolonged high temperatures, leading to dehydration and hypotension.

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Management of heat exhaustion

Encouraging rest and warm fluid intake to recover from heat-related symptoms.

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Chronic Pain

Persistent pain lasting beyond normal healing time, often over 3-6 months.

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Neuropathic Pain

Chronic pain caused by nerve dysfunction, leading to abnormal sensory processing.

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Peripheral Neuropathic Pain

Pain caused by trauma or diseases affecting peripheral nerves.

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Central Neuropathic Pain

Pain from lesions or dysfunction in the central nervous system.

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Hyperalgesia

Increased sensitivity to a painful stimulus; normally painful stimuli feel worse.

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Allodynia

Induction of pain by typically non-painful stimuli.

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Phantom Limb Pain

Pain perceived in an amputated limb after healing.

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Deafferentation Pain Syndromes

Pain resulting from lesions that disrupt sensory pathways in the nervous system.

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Chronic Neuropathic Pain

Long-lasting changes in pain processing along somatosensory pathways.

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Hemiagnosia Pain

Central pain associated with stroke, causing hypersensitivity on one body side.

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Acute bacterial conjunctivitis

Highly contagious eye infection often seen in children, resolves spontaneously in 10-14 days.

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Symptoms of acute bacterial conjunctivitis

Mucopurulent drainage from one or both eyes; associated with redness and pain.

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Viral conjunctivitis

Contagious inflammation of the conjunctiva caused by adenovirus; symptoms include watering and redness.

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Symptoms of viral conjunctivitis

Watering, redness, photophobia; milder than bacterial.

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Allergic conjunctivitis

Ocular inflammation due to allergens, causing itching and a gritty feel in the eyes.

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Treatment for allergic conjunctivitis

Includes antihistamines, corticosteroids, and mast cell stabilizers.

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Trachoma

Chlamydial conjunctivitis caused by Chlamydia trachomatis; leads to blindness if untreated.

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Keratitis

Inflammation of the cornea possibly caused by infection; severe cases may require transplantation.

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Heat Stroke

A lethal condition from the breakdown of thermoregulation due to high body temperature.

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Rectal Temperature for Heat Stroke

A critical indicator of heat stroke; greater than 41°C or 106°F.

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Symptoms of Heat Stroke

Includes dry skin, confusion, irritability, and loss of consciousness.

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Treatment for Heat Stroke

Immediate cooling, removing from heat, using water or ice packs strategically.

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Children and Heat Stroke

Children are more susceptible due to higher metabolic heat and lower sweating capacity.

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Sleep Phases

Normal sleep consists of cyclic phases: NREM and REM.

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NREM Sleep

Non-REM sleep makes up 75-80% of sleep time with varying depths.

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Major Sleep Center

The hypothalamus regulates the sleep-wake cycle.

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N2 Sleep Stage

A sleep stage characterized by slowed EEG, sleep spindles, and slow eye movements; lasts 30-60 min and comprises 45-55% of sleep time.

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N3 Sleep Stage

Known as slow-wave sleep, it features low-frequency high-amplitude delta waves, no slow eye movements, and accounts for 13-23% of sleep time.

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Sleep Spindles

Bursts of oscillatory brain activity that occur in N2 sleep, associated with memory consolidation.

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Atonia

Muscle relaxation during REM sleep, leading to temporary paralysis of antigravity muscles.

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Effects of REM Sleep Loss

Impairment of memory and learning processes due to the absence of REM sleep.

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Cerebral Blood Flow in Sleep

Changes in cerebral blood flow during different sleep stages impact brain function and metabolic processes.

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Conjunctivitis

Inflammation of the conjunctiva, the mucous membrane covering the eyeball.

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Study Notes

Gate Control Theory of Pain

  • Integrates other theories (specificity, pattern) to explain pain perception and modulation
  • Pain transmission is regulated by a "gate" in the spinal cord's substantia gelatinosa
  • Nociceptive transmission (mechanical, thermal, chemical) opens the gate; perception of pain occurs
  • Non-nociceptive stimulation (touch, rubbing) closes or partially closes the gate, reducing pain perception
  • Larger A-beta fibers are involved in the closure or partial closure of the spinal gates

Nerve Fibers and Pain Transmission

  • Nociceptors (primary order neurons) are free nerve endings in the PNS
  • Respond to chemical, mechanical, and thermal stimuli
  • Lateral spinothalmic spinal tract carries nociceptive information, causing pain
  • Categorized by stimulus type and axon properties
  • Nociception has four phases: transduction, transmission, perception, and modulation

Types of Nerve Fibers

  • A-delta fibers: lightly myelinated, medium-sized
    • Stimulated by severe mechanical or thermal stimuli
    • Transmit "fast" pain sensations
    • Cause rapid reflex withdrawal
  • C fibers: unmyelinated, small
    • Stimulated by mechanical, thermal, and chemical stimuli
    • Transmit "slow" pain sensations, often dull, aching, or burning
    • Poorly localized and longer-lasting

Pain Perception in the CNS

  • Conscious pain awareness occurs in the reticular and limbic systems and the cerebral cortex
  • Interactions of three systems (sensory-discriminative, affective-motivational, cognitive-evaluative) determine pain perception and responses

Clinical Descriptions of Pain

  • Pain threshold: the point at which a stimulus is perceived as painful. Relatively consistent between people and over time, but intense pain in one area can increase the threshold in other areas.

  • Pain tolerance: the duration or intensity of pain an individual will endure before responding. Typically decreases with repeated pain exposure. Can be affected by culture, expectations, physical and mental health, and gender.

  • Acute pain: normal protective mechanism, temporary, lasts seconds to days, or up to 3 months. Stimulated by chemical mediators.

  • Chronic pain: lasts significantly longer than expected normal healing; often out of proportion to any tissue injury; associated with anxiety and depression.

  • Neuropathic pain: caused by damage or dysfunction in the nervous system; characterized by burning, shooting, shock-like pain and hyperalgesia/allodynia

    • Central neuropathic pain: results from lesions or dysfunction in the CNS (e.g., spinal cord injury, stroke)
    • Peripheral neuropathic pain: caused by damage to peripheral nerves (e.g., diabetes, injuries).

Endogenous Opioids

  • Family of morphine-like neuropeptides that inhibit pain transmission
  • Types include enkephalins, endorphins, dynorphins, and endomorphins
  • Act on specific receptors in the CNS, GI system, immune system, and others

Temperature Regulation and Epinephrine

  • Heat production is regulated by the hypothalamus and endocrine system (thyroid stimulating hormone, thyroxine)
  • Epinephrine causes vasoconstriction, increasing metabolic rate and heat production

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