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Question:

Visc-sens-ENG 11 pain route detailed - heart/lungs

Response:

Via which neural route does a pain stimulus go from the heart (e.g. angina pectoris) or lungs to the spinal cord? Put the structures in the correct order.

Heart ->
cardiac plexus and pulmonary plexus
cardiopulmonary splanchnic nerves
sympathetic trunk at the level of T1-T5
white rami communicantes at the level of T1-T5
intercostal nerves T1-T5
spinal (sensory) ganglia T1-T5
posterior horns spinal cord T1-T5
-> via spinal cord to brain

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Question:

Referred pain-ENG 1

Response:

The figure aims to illustrate the principle of referred pain. You see nerve impulses from splanchnic nerves (the red dotted line) and nerve impulses from (the anterior or posterior ramus of) spinal nerves (the blue dotted line) converge at the same location in the spinal cord. This mechanism underlies referred pain. Which remarks regarding referred pain as depicted by this figure apply? (multiple answers can be correct)

Answers	Your Answer	Correct
This can occur with disease processes in internal organs and structures in the chest, such as the heart, lungs and great vessels.
This can occur with disease processes in upper abdominal organs such as liver, gallbladder and bile ducts, stomach, duodenum.
This can occur with disease processes in mid and lower abdominal organs such as jejunum, ileum, caecum and appendix, and colon to mid-sigmoid.
This can occur with disease processes in the distal part of the sigmoid, rectum, bladder (except for dome or roof of the bladder), cervix of uterus and vagina.
This can occur with disease processes in retroperitoneal organs such as the kidneys, adrenal glands and ureters.
The pain stimulus runs via the splanchnic nerve (the red dotted line).
The pain stimulus passes through the anterior or posterior ramus of the spinal nerve (the blue dotted line).
This can lead to referred pain in the spinal nerve dermatome.
This can lead to referred pain in the organs that are sensory innervated via the splanchnic nerve.
This may be accompanied by allodynia (normally non-painful stimuli, such as stroking the skin, are painful) in the spinal nerve dermatome.
This concerns somato-somatic referred pain.
This concerns viscero-somatic referred pain.
This concerns viscero-visceral referred pain.

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Question:

Referred pain-ENG 3

Response:

The figure aims to illustrate the principle of referred pain with a pain stimulus led through the phrenic nerve. Which comments regarding this referred pain apply? (multiple answers can be correct)

Answers	Your Answer	Correct
This can occur with disease processes in organs and structures in contact with the pericardium.
This can occur with disease processes in the superior lateral lung fields.
This can occur with disease processes in organs and structures in contact with the diaphragm.
This can occur with disease processes in the shoulder and upper extremity.
This can occur with disease processes in the gallbladder and cystic duct.
The pain stimulus passes through the supraclavicular nerves.
This can lead to referred pain in the dermatomes C3-C5.
This can lead to referred pain in the neck, shoulder and upper arm.
This concerns somato-somatic referred pain.
This concerns viscero-somatic referred pain.
This concerns viscero-visceral referred pain.

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Question:

Pain 1

Response:

Herpes zoster (see photo) is a very painful condition. Via what kind of nerve does the pain stimulus travel from the patient in the photo to the spinal cord?

Answers	Your Answer	Correct
A splanchnic nerve at levels T2 - T5
A (anterior ramus or posterior ramus of a) spinal nerve at levels T2-T5
A splanchnic nerve at levels T7 - T9
A (anterior or posterior ramus of a) spinal nerve at levels T7 - T9

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Question:

Pain 2

Response:

Explain why pain from the oesophagus, eg heartburn from reflux, is sometimes difficult to distinguish from pain from the heart.

Answers	Your Answer	Correct
The heart lies directly against the esophagus, irritation of the esophagus also stimulates the heart.
Pain stimuli both from the heart and from the esophagus pass through the n. vagus and enter the brain stem at the same height.
Pain stimuli both from the heart and from the oesophagus pass through the same sympathetic nerves and enter the spinal cord at the same heights.

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Question:

Pain 3

Response:

The image above can help answer this question. Fill in the missing words.

Pain in the (left) arm in cardiac ischemia can be explained by the convergence of sensory information from the heart via cardiopulmonary splanchnic nerves and the sympathetic trunk and from the arm via (anterior rami of) spinal nerves at the same spinal cord level: T1 / Th1. The pain from the heart is then also perceived in the arm: so-called referred pain.