Porth's Essentials of Pathophysiology, 4e

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Nervous System

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4. A 21-year-old woman presents to the student health center with complaints of a throbbing pain on the left side of her head, nausea and vomiting, and extreme sensitivity to light, noise, and head movement. She also tells you she had a similar headache 3 months ago that lasted for 2 days, and she thinks she is developing migraine headaches like her mother. She is concerned because she has been unable to attend classes and has exams next week. A. Are this woman’s history and symptoms consistent with migraine headaches? Explain. B. Use the distribution of the trigeminal nerve and the concept of neurogenic inflammation to explain this woman’s symptoms. 5. A 48-year-old man presents with complaints of severe pain in his right foot after a crush injury. He reports that although he had his ankle pinned surgically, it still causes severe pain now, almost 1 year after injury. He states that he cannot stand to have the sheets touch his foot, and even wearing shoes is painful. His physician has diagnosed chronic regional pain syndrome type I. A. Differentiate chronic regional pain syndrome type I from type II. B. Explain the proposed theories of why this pain syndrome develops. 1. Guyton A, Hall JE. Textbook of Medical Physiology . 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:543–592. 2. Kandel ER, Schwartz JH, Jessell TM, et al. Principles of Neural Science . 5th ed. New York, NY: McGraw-Hill; 2013:449–555. 3. Vanderah TW. Pathophysiology of pain. Med Clin North Am . 2007;91:1–12. 4. Polomano RC, Dunwoody CJ, Krenzischek DA, et al. Perspectives on pain management in the 21st century. J Perianesth Nurs. 2008;25(1A):S4–S14. 5. Bonica JJ. History of pain concepts and pain theory. Mt Sinai J Med . 1991;58:191–202. 6. Melzack R, Wall PD. Pain mechanisms: a new theory. Science . 1965;150:971–979. 7. Melzack R. Evolution of the matrix theory of pain. The Prithvi Raz Lecture. Presented at the third World Conference Institute of Pain, Barcelona 2004. Pain Pract. 2005;5(2):85–94. 8. Garland EL. Pain processing in the human nervous system: a selective review of nociceptive and biobehavioral pathways. Prim Care . 2012;39:561–571. 9. Grady K, Severn A, Eldridge P. Key Topics in Pain Medicine . 3rd ed. United Kingdom, UK: Informa Healthcare; 2007. 10. D’Mello R, Dickenson AH. Spinal cord mechanisms of pain. Br J Anesth. 2008;101(1):8–16. 11. Ploner M, Gross J, Timmerman L, et al. Cortical representation of first and second pain sensation in humans. Proc Natl Acad Sci U S A 2002;99:12444–12448. 12. Fields HL, Heinricher MM, Mason P. Neurotransmitters in nociceptive modulatory circuits. Annu Rev Neurosci . 1991;14:219–245. R E F E R E N C E S

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