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Neurology - Physiology > ANS > Flashcards

ANS Flashcards

1
Q

synapses between preand
postganglionic cholinergic nerves are not blocked by
atropine _____________whereas the postganglionic impulses are blocked by atropine __________

A

(nicotinic)

(muscarinic) .

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2
Q

axons of the ciliary ganglion cells innervate the

_________ and __________

A

ciliary muscle

pupillary sphincter

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3
Q

The preganglionic fibers of the _____________ enter the facial nerve and, at a point near the
____________, form the greater superficial petrosal
nerve, through which they reach the _____________; postganglionic fibers from the cells of this
ganglion innervate the ____________

A

superior salivatory nucleus

geniculate ganglion

sphenopalatine ganglion

lacrimal gland

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4
Q

Axons of the_____________ enter the glossopharyngeal
nerve and reach the otic ganglion through the___________ and ________________ cells of the
otic ganglion send fibers to the parotid gland.

A

inferior salivatory nerve cells

tympanic plexus

lesser superficial petrosal nerve;

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5
Q

In organs containing smooth muscle that is innervated
by parasympathetic fibers and therefore not under
voluntary control, there is a parallel innervation of adjacent __________by anterior horn cells

A

voluntary striated muscle

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6
Q

that they are somatomotor, innervating the

skeletal muscle of the _________

A

external urethral and anal sphincters

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7
Q

T or F

the neurons
in the Onuf nucleus, in contrast to other somatomotor
neurons in the sacral cord, tend not to be involved in the
degenerative process

A

T

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8
Q

The axons of the
nerve fibers originating in the intermediolateral column
are of small caliber and are myelinated; when grouped,
they form the_______________

A

white comm un icating ram i

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9
Q

Axons of the sympathetic ganglion cells are also of
small caliber but are unmyelinated. Most of the postganglionicfibers pass via _______________to
their adjacent spinal nerves of ___________

A

gray communicating rami

T5 to L2;

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10
Q

The arm receives its postganglionic

innervation from the ___________

A

inferior cervical ganglion and

uppermost thoracic ganglia

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11
Q

The cardiac plexus and other thoracic
sympathetic nerves are derived from the ___________
and the abdominal visceral plexuses, from the _____________

A

stellate ganglion

fifth to the
ninth or tenth thoracic ganglia

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12
Q

In the brainstem, the

main visceral afferent nucleus is the_______

A

nucleus tractus solitarius

NTS

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13
Q

Cardiovascular, respiratory, and gastrointestinal
afferents, carried in cranial nerves X and IX via the
_______ and ________, terminate on specific subnuclei
of the NTS

A

nodose and petrosal ganglia

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14
Q

The supranuclear
regulatory apparatus of the hypothalamus includes three
main cerebral structures: ______, _______ and _______

A

the frontal lobe cortex, the insular

cortex, and the amygdaloid and adjacent nuclei

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15
Q

Stimulation of one ________ lobe may evoke changes in
temperature and sweating in the contralateral arm and
leg;

A

frontal

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16
Q

The insular cortex receives projections from the _______________

A

NTS, the parabrachial nucleus of the pons, and the lateral hypothalamic nuclei

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17
Q

The _______ and ___________
and their associated subcortical structures (substantia
innominata and the amygdaloid, septal, piriform, habenular, and midbrain tegmental nuclei) have been identified as important cerebral autonomic regulatory centers.

They are called _____________

A

cingulate and hippocampal gyri

visceral brain

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18
Q

__________ released from postganglionic fibers that end on pineal cells stimulates several enzymes involved in the
biosynthesis of melatonin.

A

norepinephrine

NE

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19
Q

Sympathetic responses are most readily obtained by
stimulation of the ___________ regions of the
hypothalamus, and parasympathetic responses from
the _________ regions

A

posterior and lateral

anterior

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20
Q

some structures-_________________-receive only
sympathetic postganglionic fibers, and the _______________
as indicated earlier, has only a preganglionic sympathetic
innervation.

A

sweat glands, cutaneous blood vessels, and hair follicles

adrenal gland,

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21
Q

Most of the neuropeptides exert
their postsynaptic effects through the _________, which uses ______________
as an intermediary.

A

G-protein transduction system

adenyl cyclase or phospholipase C

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22
Q

Adrenergic receptors are of two types, alpha and beta. In general, the alpha
receptors mediate __________________;

beta receptors mediate _________

A

vasoconstriction, relaxation of the gut,
and dilatation of the pupil

vasodilatation,
especially in muscles, relaxation of the bronchi,
and an increased rate and contractility of the heart.

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23
Q

Alpha1 receptors are postsynaptic; alpha2 receptors are

situated on the presynaptic membrane and, when stimulated_____________

A

diminish the release of the transmitter

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24
Q

Beta1 receptors
are, for all practical purposes, limited to the heart; their
activation increases ___________

A

the heart rate and contractility

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25
Q

_________ when stimulated, relax the smooth muscle of the bronchi and of most other sites, including the blood vessels of skeletal muscle.

A

Beta2 receptors,

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26
Q

In BP regulation,

Those in the ______________ are sensitive to
reductions in pulse pressure (the difference between systolic and diastolic blood pressure),

while those in the right
heart chambers and pulmonary vessels respond more to
_________

A

carotid sinus and aortic arch

alterations in blood volume

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27
Q

The____________ are rapidly responsive and capable of detecting beatto- beat changes,

in contrast to the ____________ which
have a longer response time and discriminate only the
larger and more prolonged alterations in pressure

A

carotid sinus baroreceptors

aortic arch nerves,

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28
Q

Increased systemic vascular resistance is mediated
concurrently through parallel connections between the
NTS and the medullary pressor areas that project to the
_________

A

intermediolateral cells of the mid thoracic cord

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29
Q

what are the Two slower-acting humoral mechanisms regulate blood volume and complement the control of systemic vascular resistance

A
  1. Pressure-sensitive renal juxtaglomerular
    cells release renin, which stimulates production of
    angiotensin and influences aldosterone production, both
    of which affect an increase of blood volume.
  2. antidiuretic hormone
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30
Q

The detrusor muscle receives motor innervation from

nerve cells in the intermediolateral columns of gray matter, mainly from the ______________

A

third and also from the second and fourth sacral segments of the spinal cord (the “detrusor
center”).

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31
Q

The internal sphincter and base
of the bladder (trigone), consisting of smooth muscle, are
also innervated to some extent by the sympathetic fibers
of the hypogastric nerves; their receptors are mainly of
__________

A

alpha-adrenergic type,

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32
Q

The external urethral and anal sphincters are composed
of ___________ Their innervation, via
the pudendal nerves, is derived from a densely packed
group of ____________ in the
anterolateral horns of sacral segments 2, 3, and 4.

A

striated muscle fibers.

somatomotor neurons (nucleus of Onuf)

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33
Q

where is the lesion:

dyssynergia of the detrusor and external
sphincter muscles

A

supraspinal levels

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34
Q

The storage of urine and the efficient emptying of
the bladder are possible only when the spinal segments,
together with their afferent and efferent nerve fibers,
are connected with the so-called micturition centers in
the _____________

A

pontomesencephalic tegmentum

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35
Q

Increased BF in the ff brain structures during micturition

A

Increased blood flow was detected in the right pontine
tegmentum, periaqueductal region, hypothalamus, and
right inferior frontal cortex

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36
Q

The act of micturition is both reflex and voluntary.
When the normal person desires to void, there is first a
voluntary relaxation of the ___________, followed sequentially by an increased tension of the abdominal wall, a slow contraction of the _________, and an associated opening of the ________; finally, there is a relaxation of the _______

A

perineum

detrusor

internal sphincter

external sphincter

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37
Q

The
coordination of detrusor and external sphincteric function
depends mainly on the descending pathway from the
posited centers in the ______

A

dorsolateral pontine tegmentum.

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38
Q

stimulates smooth muscle and
the latter also regulates mucosal secretion and blood
flow.

A

myenteric (or Auerbach) plexus

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39
Q

changing from the recumbent to the standing

position, a fall of more than _______ systolic and _________diastolic is abnormal

A

30 mm Hg

15 mm Hg

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40
Q

the arm on which the cuff is
placed must be held ________ when standing, so that
the decline in arm pressure will not be obscured by the
added hydrostatic pressure

A

horizontally

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41
Q

Moreover, blood pressure is most informative
if measured immediately after ________ and again at
approximately ________

A

standing

1 and 3 min

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42
Q

The expected response in BP testing is a
momentary and slight ________ in pressure that is usually not detected with a manual blood pressure cuff, followed by a ________________, and then a slow recovery during the ________

A

increase

slight drop within seconds of standing

first minute

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43
Q

The failure of the heart rate to rise in response to the drop in blood pressure with sta nding is the simplest bedside indicator of ________

A

vagal nerve dysfunction

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44
Q

Neurally mediated syncope may
show one of three initial patterns with testing on a tilt
table:

A
  1. paroxysmal vasodepressor response alone,
  2. combined bradycardic and hypotensive response
  3. bradycardia
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45
Q

The ratio of R-R intervals in the electrocardiogram
(ECG), corresponding to the ____________is an even more sensitive measure of the integrity of vagal inhibition of the sinus node.

A ratio in adults under age 60 of less than ________ is
usually abnormal, indicating a loss of vagal tone and the
normal ratio is progressively higher for younger ages

A

thirtieth and fifteenth beats (the 30:15 ratio),

1 .07

46
Q

more accurate test of vagal function is the measurement
of the ratio of the longest R-R interval during forceful slow expiration (standardized as constant blowing
at a pressure of 40 mm Hg for 10 s) to the shortest R-R
interval during inspiration, which allows the derivation
of an __________

A

expiration-inspiration (E:I) ratio.

47
Q

Failure of the heart rate to increase during the positive intrathoracic pressure phase of the Valsalva maneuver points to_________ and failure of the rate to slow during the period of blood pressure overshoot points to a __________

A

sympathetic dysfunction,

parasympathetic disturbance.

48
Q

_____________ referring to the maximum
heart rate generated by the maneuver to the lowest heart
rate within 30 s of that peak, is another often-used measure in comprehensive autonomic testin

A

The Valsalva ratio,

49
Q

Measurement of the _________ is a rough but

useful index of vasomotor function

A

skin temperature

50
Q

Vasomotor paralysis results in __________ and a __________ in skin temperature;

A

vasodilatation of skin vessels

rise

51
Q

Vasoconstrictor tone may also be tested by measuring the
______________ at a distant site before and
after immersing one or both hands in cold water

A

reduction in skin temperature

52
Q

Vasoconstriction induces an elevation of the blood

pressure. This is the basis of the ________

A

cold pressor test.

53
Q

In normal persons, immersing one hand in ice water for 1 to 5 min raises the systolic pressure by _________ and the diastolic pressure by_______

A

15 to 20 mm Hg

10 to 15 mm Hg.

54
Q

sustained isometric contraction of a group of muscles (e.g., those of the forearm in handgrip) for 5 min normally
increases the heart rate and the systolic and diastolic pressures by at least _____

A

15 mm Hg

55
Q

The stress involved in doing__________ in noisy and distracting surroundings will also stimulate a mild but
measurable increase in pulse rate and blood pressure

A

mental arithmetic

56
Q

If the response to the Valsalva maneuver is abnormal
and the response to the cold pressor test is normal, the
lesion is probably in the ___________

A

baroreceptors or their afferent

nerves;

57
Q

A
failure of the heart rate and blood pressure to rise during
mental arithmetic coupled with an abnormal Valsalva
maneuver suggests a defect in the _________

A

central or peripheral

efferent sympathetic pathways.

58
Q

The integrity of ____________ can be

assessed further by tests of sudomotor activity

A

sympathetic efferent pathways

59
Q

The most rudimentary tests involve ________
after it is absorbed by small squares of filter paper.

Also, powdered charcoal dusted on the skin will cling to moist areas and not to dry ones.

A

weighing sweat

60
Q

In the ______________ a set
of electrodes placed on the skin measures the resistance
to the passage of a weak current through the skin; in all
likelihood, the change in electrical potential is the result
of an ionic current within the sweat glands, not simply
an increase in sweating that lowers skin resistance

A

sympathetic or galvanic skin-resistance test,

61
Q

the galvanic skin response is subject
to _________ with repeated stimuli and will show
no response if there is a ________

A

habituation

sensory neuropathy

62
Q

The starch
iodine test or use of a color indicator such as _______
(gray when dry, purple when wet) and the more recently
introduced __________are other acceptable procedures to delineate peripheral nerve or spinal cord lesions based on the loss of sympathetic innervation.

they are termed _______

A

quinizarin

plastic or silicone method

“thermoregulatory sweat testing

63
Q

It is essentially a
test of distal sympathetic axonal integrity utilizing the
local axon reflex.

A

QSART

quantitative sudomotor axon reflex test

64
Q

abnormalities in QSART

A

patterns of absent or delayed sweating that
signify postganglionic sympathetic failure in small-fiber
neuropathies and excessive sweating or reduced latency
in response, as is seen in reflex sympathetic dystrophy

65
Q

Normal for Schirmer test

A

After 5 min, the moistened area extends for a length

of approximately 15 mm in normal persons

66
Q

Bladder function i s best assessed b y the ____________ which measures intravesicular pressure as a function of the volume of saline solution permitted to flow by gravity into the bladder.

A

cystometrogram,

67
Q

Nocturnal penile tumescence is recorded in some
sleep laboratories and may be used as an ancillary test of
____________

A

sacral autonomic (parasympathetic) innervation.

68
Q

the phenomenon
of denervation hypersensitivity, in which an effector
organ, 2 to 3 wk after denervation, becomes hypersensitive
to its particular neurotransmitter substance and
related drugs.

A

“Cannon law,

69
Q

Relatively recently, the weak direct sympathetic agonist
_________ has been used most widely to demonstrate
that miosis is due to sympathetic denervation
of the pupil

A

apraclonidine

70
Q

aproclonidine test results

A

A positive test, reversal of miosis, depends on the
denervation hypersensitivity that develops after several
days or more of the presence of the Horner syndrome.

71
Q

what is the hydroxyamphetamine test for the sympathetic denervation of the pupil?

A

its effect depends on the presence
of existing norepinephrine in the end terminals of the
nerves that innervate the iris. Failure to dilate indicates a
postganglionic lesion.

72
Q

results of cocaine test for sympa denervation

A

A normal response to cocaine consists of
pupillary dilatation. In sympathetic denervation caused
by lesions of the post- or preganglionic fibers, no change
in pupillary size occurs because no transmitter substance

73
Q

the topical application
into the conjunctival sac of a 4 to 10 percent cocaine
solution that potentiates the effects of_________by preventing its reuptake.

A

NE

74
Q

In the cutaneous flare response:

The wheal and the deeply colored red areola are
caused by the _____________
in response to local injury, while the flare depends on
the integrity of the _________

A

direct action of histamine on blood vessels

axon reflex

75
Q

In the cutaneous flare response:

This axon reflex is mediated
by antidromic stimulation of _____________
that results in the release by the same fibers of various
vasoactive substances such as bradykinin and substance
P.

A

small sensory C fibers

76
Q

In patients with familial dysautonomia, the infusion
of NE produces____________, probably
representing an exaggerated response to endogenous NE.

A

erythematous blotching of the skin, like

that which may occur under emotional stress

77
Q

The integrity of autonomic innervation of the heart
can be evaluated by the intramuscular injection of __________________ while the heart rate is
monitored.

A

atropine,

ephedrine, or neostigmine

78
Q

Normally, the intramuscular injection of
0.8 mg of atropine causes ____________ as a result of a
parasympathetic block and a withdrawal of vagal tone

A

tachycardia

79
Q

Normally, when a person changes from a recumbent to a

standing position, the serum NE level rises__________________

A

two- or threefold.

80
Q

The ___________ enzyme is deficient

in patients with a rare form of sympathetic dysautonomia

A

dopamine /3-hydroxylase

81
Q

In acute autonomic paralysis, the sympathetic and parasympathetic parts of the autonomic
nervous system are affected, mainly at the_______ level

A

postganglionic

level.

82
Q

In this syndrome, unlike the common
forms of orthostatic hypotension (see later), the fall in
blood pressure is accompanied by tachycardia

A

sympathotonic orthostatic hypotension

83
Q

Individual cases
of POTS have been associated with mutations or epigenetic
alterations in the __________

A

norepinephrine transporter gene

84
Q

Idiopathic Orthostatic Hypotension; Pure

Auto n o m i c Fa i l u re is caused by:

A
  1. degenerative disease of middle and
    late adult life,
  2. multiple system atrophy
85
Q

In the_____________of autonomic failure,
plasma levels of NE are subnormal while the patient
is recumbent because of failure of the damaged nerve
terminals to synthesize or release catecholarnines

A

postganglionic type

86
Q

In all forms of multiple system atrophy; the autonomic

failure is attributable to degeneration of _________

A

lateral

horn cells of the thoracic cord

87
Q

Treatment of orthostatic hypotension consists of having
the patient sleep with the head of the bed elevated,
administering the peripherally acting alpha agonist, ______________ starting at 2.5 mg q4h, slowly raising the dose to 5 mg q4h, taking the last dose before about 7 P.M . to void supine hypertension while asleep

A

midodrine

88
Q

alternative tx for orthostatic hypotension

A

mineralocorticoid fludrocortisone acetate

(Florinef) 0.1 mg twice daily

89
Q

An additional feature of the acute dysautonomias
is a tendency to develop hyponatremia, presumably
as a result of dysfunction of afferent fibers from venous,
right atrial, and aortic arch volume receptors; this elicits
a release of___________

A

antidiuretic hormone arginine vasopressin

(AVP) .

90
Q

Pathologic features of Fa m i l i a l Auto n o m i c Neuropathy i n I nfa nts a n d C h i l d ren ( R i l ey-Day Synd rome)

A

The main
pathologic feature is a deficiency of neurons in the superior
cervical ganglia and in the lateral horns of the spinal
cord.

91
Q

In ( R i l ey-Day Synd rome), It is now known that this defect is the result of a mutation in the gene ______that codes for a protein________ that is currently considered to be associated with transcription regulation

A

(IKBKAP)

IKAP

92
Q

Autonomic symptoms are also a prominent feature
of the small-fiber neuropathy of_____________________ as a result of the accumulation
of ceramide in hypothalamic and intermediolateral column
neurons

A 
Fabry disease (alphagalactosidase
deficiency)
93
Q

Interruption of postganglionic sympathetic fibers at any
point along the internal carotid arteries or a lesion of the
superior cervical ganglion results in miosis, drooping of
the eyelid, and abolition of sweating over one side of the
face; this constellation is the Homer, or more properly,

A

Bernard-Homer syndrome

94
Q

A lesion of the stellate ganglion, e.g., compression
by a tumor arising from the superior sulcus of the lung
(Pancoast tumor), produces the interesting combination
of a _________ and _______

A

Homer syndrome and paralysis of sympathetic
reflexes in the limb (the hand and arm are dry and
warm)

95
Q

The combination of segmental anhidrosis and an
Adie pupil is sometimes referred to as the ________
it may be abrupt in onset and idiopathic, or it may follow
a viral infection.

A

Ross syndrome;

96
Q

Lesions of the _________ segments of the spinal cord, if
complete, will interrupt suprasegmental control of both
the sympathetic and sacral parasympathetic nervous systems.

A

C4 or C5

97
Q

What is this state called?

The autonomic changes include
hypotension, loss of sweating and piloerection, paralytic
ileus and gastric atony, and paralysis of the bladder. The
flare component of the axon reflex may be lost. Plasma
epinephrine and NE are reduced

A

spinal shock

98
Q

Nt associated with spinal shock

A

catecholarnines, enkephalins, endorphins, substance P, and 5-hydroxytryptarnine

99
Q

_________ mitigates some of the aspects of spinal
shock; this may be, at least in part, the result of release
of preformed endogenous opioids from the distal axons
that are separated from their cells of origin in the periaqueductal
gray region.

A

Naloxone

100
Q

With __________, there is a loss of the sympathetically mediated cardiovascular
changes in response to stimuli reaching the
medulla

A

cervical cord

lesions

101
Q

BP compensation in tetraplegic patients

A

a fall in blood pressure is

not compensated by sympathetic vasoconstriction

102
Q

After a time, the tetraplegic patient may develop a
mass reflex in which flexor spasms of the legs and involuntary
emptying of the bladder are associated with a
marked rise in blood pressure, bradycardia, and sweating
and pilomotor reactions in parts below the cervical
segments___________

A

(autonomic dysreflexia).

103
Q

Several toxic and pharmacologic agents such as _____
and _________ are capable of producing
abrupt overactivity of the sympathetic and parasympathetic nervous systems-severe hypertension and mydriasis coupled with signs of CNS excitation-sometimes including seizures

A

cocaine and phenylpropanolamine

104
Q

_________ in excessive
doses are also known to produce autonomic effects, but in this case cholinergic blockade leads to dryness of the
mouth, flushing, absent sweating, and mydriasis.

A

Tricyclic antidepressants

105
Q

Poisoning with organophosphate
insecticides (e.g., Parathion), which have anticholinesterase
effects, causes a combination of ______ and _____

A

parasympathetic overactivity

and motor paralysis

106
Q

The exaggerated sympathetic state that accompanies
tetanus-manifest by diaphoresis, mydriasis, and labile
or sustained hypertension-has been attributed to circulating

A

catecholarnines

107
Q

Regarding the acute sympathetic reaction, experimental
evidence suggests that nuclei in the caudal ________ can precipitate severe hypertensive
reactions

A

medullary
reticular formation (reticularis gigantocellularis
and parvocellularis)

108
Q

mechanisms of hypersympathetic state in TBI and ICH

A
  1. brainstem-mediated vasopressor reaction
  2. outpouring of adrenal catecholarnines at the time of the ictus
  3. “diencephalic autonomic seizures”
109
Q

A role has also been inferred for the ____________pressor centers in the maintenance of essential hypertension .

A

ventrolateral

medullary

110
Q

Most profound effect of TL Sympathectomy

A

abnormality is an impairment of vasomotor reflexes

111
Q

This disorder, characterized b y episodic, painful blanching
of the fingers and presumably caused by digital
artery spasm,

A

Ray n a u d Syn d ro m e

112
Q

sequence of color change in Raynaud

A

The appearance is of a triphasic sequence of color change
of pallor, cyanosis, and subsequent rubor of the affected
fingers or toes, but about one-third of such patients have
no cyanosis

Neurology - Physiology (44 decks)

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