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COM CPR E1 > 11. Neurology > Flashcards

11. Neurology Flashcards

1
Q

describe the makeup of the esophagus

A
  • internal circular layer + external longitudinal layer

- upper ⅔ is both smooth and skeletal muscle

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2
Q

what landmarks define the thoracic region of the esophagus

A

T1 → esophageal hiatus

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3
Q

what are the 4 constriction points of the esophagus

A
  • Upper esophageal sphincter (cricopharyngeus muscle)
  • Aortic arch
  • Left bronchus
  • Lower esophageal sphincter (esophageal hiatus of thoracic diaphragm)
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4
Q

describe the course of the vagus nerve and where branch points are

A

superior thoracic aperture (L laryngeal, pulmonary and inferior cardiac branches)
→ posterior mediastinum (esophageal branches)
→ proximal to abdomen (anterior and posterior vagal trunk)

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5
Q

what structures does the L recurrent laryngeal branch loop under to return to the larynx

A

under aortic arch and ligamentum arteriosum

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6
Q

which nerve branch is derived from the L vagus nerve?

R vagus nerve?

A

L: anterior vagal trunk

R: posteRioR vagal trunk

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7
Q

describe the course of the phrenic nerve

A

superior thoracic aperture

→ between mediastinal parietal pleura and fibrous pericardium

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8
Q

what does the phrenic nerve innervate

A
  • diaphragm

- sensory info from central diaphragmatic and mediastinal pleura and pericardium

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9
Q

which intercostal nerves are typical

A

3-6

  • Rami communicantes
  • Collateral branches
  • Lateral cutaneous branches
  • Anterior cutaneous branches
  • Muscular branches (supply intercostal ms, subcostal ms, and transversus thoracis)
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10
Q

rami communicantes connects what

A

intercostal nerve to sympathetic trunk

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11
Q

where are the collateral branches of typical intercostal ns found

A

superior edge of rib inferior to the intercostal space

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12
Q

what do the lateral cutaneous branches of typical intercostal ns become?

innervate?

A

become anterior and posterior branches

supply skin of thoracic wall
T4-6 breast

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13
Q

what do the anterior cutaneous branches of typical intercostal ns supply

A

anterior aspect of thoracic wall

T4-6 breast

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14
Q

what do the muscular branches of typical intercostal ns supply (3)

A
  • intercostal muscles
  • subcostal muscles
  • transversus thoracis muscle
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15
Q

which intercostal nerves are atypical

A

1, 2, 7-11

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16
Q

what is significant about the 1st atypical intercostal nerve

A

1st: no cutaneous branches, majority of superior portion joins brachial plexus

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17
Q

what is significant about the 2nd atypical intercostal nerve

A
  • travels in costal groove as a typical n w/ small part joining brachial plexus,
  • lateral cutaneous branch supplies skin and subcutaneous tissue of axilla (INTERCOSTALBRACHIAL N .)
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18
Q

what is significant about the 7-11th atypical intercostal nerves

A
  • begins as intercostal but as they travel anteriorly

- run out of ribs and transition to THORACOABDOMINAL N.

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19
Q

general principles of ANS

  • sympathetic stimulation is usually ___
  • parasympathetic stimulation is usually ___
A

S: catabolic
PS: anabolic (normal fxn, conserve energy)

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20
Q

general principles of ANS

  • ___ system distributes to all vascular area of the body
  • ___ has a limited distribution (head, neck, and trunk viscera, never ___
A
  • sympathetic

- parasympathetic, never in body wall or extremities

21
Q

general principles of ANS

  • glandular secretion is stimulated by ___; except ___
  • ___ can indirectly decrease non sweat gland glandular secretion through ___
A
  • parasympathetic, except sweat glands

- sympathetic, vasoconstriction

22
Q

vasoconstriction of what arteries is not under sympathetic control

A

coronary a

***PS control via cardiac plexus

23
Q

what region is the sympathetic system found

A

thoracolumbar T1-L2

24
Q

describe presynaptic sympathetic fibers

  • length
  • cell bodies
  • course
A
  • short
  • CBs in lateral horns of spinal cords
  • always travel in anterior root into anterior ramus
  • quickly exit anterior ramus into PARAvertebral ganglion
25
Q

describe post synaptic sympathetic fibers

A
  • long

- CBs in paravertebral or prevertebral ganglia

26
Q

describe paravertebral vs prevertebral ganglia

A

PARA: linked vertically to form sympathetic trunk BL to vertebral column; 3 ganglia also exist in C/L/P regions

PRE: ganglia and corresponding plexuses surround the main unpaired branches of abdominal aorta (celiac, superior mesenteric, aorticorenal, inferior mesenteric)

27
Q

what 3 options do presynaptic sympathetic fibers in the thorax have after entering paravertebral ganglia

A
  • synpase on postsynaptic neuron of same level
  • ascend or descend to synapse on postsynaptic neuron of different level
  • exit without synapsing, become an abdominopelvic splanchnic nerve and head to postsynaptic neuron in prevertebral ganglion
28
Q

what are the 3 main sympathetics in the thorax

A
  • thoracic sympathetic trunk
  • cardiopulmonary splanchnic nerves (cardiac and pulmonary branches)
  • abdominopelvic splanchnic nerves
29
Q

what happens in the thoracic sympathetic trunk

A

presynaptic sympathetic nerve fibers synapse on postsynaptic cell bodies

30
Q

where are the CBs of the cardiac splanchnic nerve?

where do they synapse?

where are fibers sent?

A
  • CB at T1-5/6,
  • synapse in cervical and thoracic sympathetic trunks
  • → superficial and deep cardiac plexuses
31
Q

where are the CBs of the pulmonary splanchnic nerve?

where do they synapse?

where are fibers sent?

A
  • CB at T2-3,
  • synapses in thoracic sympathetic trunk
  • → pulmonary plexus
32
Q

describe the course of the abdominopelvic splanchnic nerves

A

thoracic sympathetic trunk → prevertebral ganglia in abdomen

33
Q

where does the greater splanchnic nerve arise from?

where does it send its fibers?

A

T5- 9/10

→ esophageal plexus and celiac ganglion (plexus)

34
Q

where does the lesser splanchnic nerve arise from?

where does it send its fibers?

A

T10/11

→ celiac and superior mesenteric ganglion (plexus)

35
Q

where does the least splanchnic nerve arise from?

where does it send its fibers?

A

T12

→ aorticorenal ganglion

36
Q

what is responsible for parasympathetic innervation to the thorax and what structures are innervated

A
  • vagus nerve

- lungs, bronchi, pleurae, heart, and pericardium

37
Q

what are the branches of the vagus nerve

A
  • superior, middle and inferior cardiac branches
  • pulmonary branches
  • esophageal branches
38
Q

which branches of the vagus nerve originate in the neck and descend through the superior thoracic aperture and join the cardiac splanchnic n. to form the cardiac plexus?

A

neck: superior and middle cardiac branches

39
Q

which branches of the vagus nerve originate in the thorax and what do they form?

A
  • inferior cardiac branch, forms cardiac plexus w/ cardiac splanchnic n.
  • pulmonary branch, forms pulmonary plexus with pulmonary splanchnic n.
40
Q

after producing pulmonary branches, what happens to the vagus nerve?

A

becomes indistinguishable from esophageal plexus that covers inferior 2/3 of esophagus

41
Q

what provides sympathetic stimulation to the pulmonary plexus?

what effect does it have (3)?

A
  • pulmonary splanchnic nerves

- bronchodilator; vasoconstrictor; inhibits glands

42
Q

what provides parasympathetic stimulation to the pulmonary plexus?

what effect does it have (3)?

A
  • pulmonary branches of vagus nerve

- bronchoconstrictor; vasodilator, stimulates glands

43
Q

what provides sympathetic stimulation to the cardiac plexus?

what effect does it have (3)?

A
  • cardiac splanchnic nerves

- increases HR and force of contractions, vasomotor to pericardium

44
Q

what provides parasympathetic stimulation to the cardiac plexus?

what effect does it have (3)?

A
  • superior, middle and inferior cardiac branches of vagus nerve
  • decreases HR and force of contractions, vasoconstrictor to coronary arteries
45
Q

where would you find the superficial and deep cardiac plexuses?

A

superficial: covers anterior surface of aorta
deep: anterior to bifurcation of trachea, posterior to aortic arch and superior to bifurcation of pulmonary trunk

46
Q

the superficial cardiac plexus is continuous with what?

A

aortic plexus

- continues into abdomen feeding into intermesenteric plexus

47
Q

what provides sympathetic stimulation to the pulmonary plexus?

what effect does it have (2)?

A
  • greater splanchnic nerve

- inhibits peristalsis and glands

48
Q

what provides parasympathetic stimulation to the pulmonary plexus?

what effect does it have (2)?

A
  • esophageal branches of vagus nerve

- stimulates peristalsis and glands

COM CPR E1 (20 decks)

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