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Pelvic Pain

Pain may be categorized as visceral or somatic depending upon the type of afferent nerve fibers involved. Which of the following structures derive pain from nerve afferents of the somatic nervous system?

a. Muscle

b. Parietal peritoneum

c. Subcutaneous tissue and skin

d. All of the above

The illustration below is a dermatome map that describes which of the following?

Adapted with permission from Steege JF, Metzger DA, Levy BS (eds): Chronic Pelvic Pain: an Integrated Approach, Philadelphia: WB Saunders, 1998.

a. Central sensitization

b. Peripheral sensitization

c. Viscerosomatic convergence

d. Areas of skin supplied by single spinal nerves

Afferent nerve fibers of the autonomic nervous system transmit information from the viscera and visceral peritoneum. Visceral pain is characterized as which of the following?

a. Sharp

b. Stabbing

c. Localized

d. Generalized, dull ache

Peripheral somatic and visceral nerves often synapse in the spinal cord at the same dorsal horn neurons. These neurons, in turn, relay sensory information to the brain. The cerebral cortex recognizes the signal as coming from the same dermatome regardless of its visceral or somatic nerve origin. This leads to difficulty distinguishing internal organ pain from abdominal wall or pelvic floor pain. What is this phenomenon termed?

a. Relay delay

b. Cortex blend

c. Dermatome scatter

d. Viscerosomatic convergence

If tissues are injured, inflammation usually follows with vasodilation and increased capillary permeability. Chemical mediators of this process are prostaglandins and cytokines. Cytokines include which of the following?

a. Interferons

b. Interleukins

c. Tissue necrosis factors

d. All of the above


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