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LSU SVM ANESTHESIA EXAM WITH COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS

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LSU SVM ANESTHESIA EXAM WITH
COMPLETE QUESTIONS AND
CORRECT DETAILED ANSWERS
A-delta fibers - Answer-Small lightly myelinated nerve fibers that are fast conducting
and mediate acute, transient sharp/pricking, localized pain

C fibers - Answer-Small non-myelinated nerve fibers with very high thresholds that are
slow conducting and mediate slow, persistent burning or dull pain

A-beta fibers - Answer-Large myelinated nerve fibers with a low threshold that are rapid
conducting and that normally transmit light touch, non-noxious stimuli but with
pathologic pain transmit noxious stimuli

Transmitted - Answer-After nociceptor depolarization the action potential is ____ to the
CNS by the somatic or visceral sensory fibers

Laminae I-V - Answer-Which synaptic laminae in the spinal cord are important in the
transmission of pain

Laminae I - Answer-Synaptic laminae in the spinal cord that is the sensory relay junction
for pain and temperature; nociceptive specific neurons; input from A-delta and C fibers

Laminae III - Answer-Synaptic laminae in the spinal cord that integrates sensory input
with info descending from the brain

Laminae V - Answer-Synaptic laminae in the spinal cord that receive input from A-beta
and sympathetic A-delta and C fibers and synapse with neurons that project to the brain

Modulated - Answer-Impulses coming from A0delta and C fibers are ____ by
interneurons or descending projections ie either amplifies or inhibits the action potential
via neurotransmitters such as glutamate, aspartate, substance P, etc

Physiologic pain: AMPA, KAI, NK
Pathologic pain: mGluR, NMDA
Both: opioid, noradrenergic, serotoninergic, muscarinic - Answer-What are the receptors
involved in modulation of pain

Projection - Answer-Step of pain pathway where bundles of second-order neurons
(tracts) that originate in the spinal horn laminae that convey nociceptive information to
the brain (spinothalamic, spinoreticular, etc)

, Perception - Answer-Step of pain pathway where third-order neurons transport the
signals to cortical and subcortical regions; these centers process sensory information
that elicits fear, anxiety, and aggression and activate efferent pathways that mediate
autonomic, neuroendocrine, and motor responses

Descending inhibitory pathway - Answer-Descending projection neuron will synapse in
the gap between the first-order and second-order neurons releasing neurotransmitters
such as endogenous opioids, serotonin, GABA, etc to alleviate propagation of the pain
impulse (effective for mild pain)

Ascending analgesic pathway/Gate control theory - Answer-Inhibitory interneurons
normally reduce the output of spontaneously active projection neurons, which relay
sensory information to the brain; activation of the low-threshold A-bets fibers, which
normally transmit non-painful stimuli, increases inhibitory interneuron effects on
projection neurons

Peripheral sensitization - Answer-____ ____ is produced by neurochemical alterations
caused by tissue damage and inflammation at the site of injury and leads to
transformation of A-beta fibers, recruitment of more A-delta and C fibers, and an
increase number and frequency of nociceptive impulses transmitted to the dorsal horn;
results in primary hyperalgesia

Central sensitization - Answer-____ ____ is produced by a change in the excitability of
neurons in the spinal cord and/or activation of glial cells; an increased frequency and
intensity of nociceptive impulses reaching the dorsal horn activate AMPA, KAI, and
NMDA (normally dormant) receptors; activation occurs secondary to flooding of the
second-order synapse with excitatory neurotransmitters -> disruption of the
inhibitory/analgesic pathways -> secondary hyperalgesia and allodynia

Secondary hyperalgesia - Answer-Exaggerated and prolonged pain response that
arises from adjacent, but outside, the area of injury

Allodynia - Answer-Pain response to a normally innocuous stimulus, such as light touch
to the skin or gentle pressure

Simple descriptive scale - Answer-A tool used to assess pain by rating its severity (e.g.,
absent, mild, moderate, or severe); 4-5 categories; does not provide descriptors for
each category; not validated; unidimensional

Numerical rating scale - Answer-Unidimensional Pain scale with numerical score for
overall pain intensity from 0 (no pain) to 10 (extreme pain); not validated

Visual analog scale - Answer-a unidimensional pain rating scale using a straight line;
the left end of the line represents no pain, the right end represents the worst pain, and
an observer mark the place on the line that best represents the severity of the patient's
pain; good for following trends

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