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Apex Flashcards > ANS A&P > Flashcards

ANS A&P Flashcards

1
Q

how many spinal nerves are there

A

31

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2
Q

A1 and V1 stimulation increases

A

PLC activity (Gq)

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3
Q

B1, 2, and 3 stimulation increases

A

adenylate cyclase activity (Gs)

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4
Q

A2, M2, M4, D2 receptor decreases

A

adenylate cyclase activity (Gi)

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5
Q

heart SNS and PSNS receptors and effects

A

SNS: B1–> positive inotropic, chronotropic, and dromotropic effects
PSNS: M2–> negative inotropic, chronotropic, and dromotropic effects

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6
Q

lung SNS and PSNS receptors and effects

A

SNS: B2–> bronchodilation
PSNS: M3–> bronchoconstriciton, gland secretions

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7
Q

GI tract SNS and PSNS receptors and effects

A

SNS: a1 –> vasoconstriction, sphincter contraction
PSNS: M3 –> increased Gi motility, sphincter relaxation, increased gland secretion

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8
Q

glands SNS and PSNS receptors and effects

A

SNS: a1 –> increased sweating and decreased pancreatic activity
PSNS: M1, M3 –>increased salivation, increased lacrimation, increased pancreatic activity

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9
Q

urinary tract SNS and PSNS receptors and effects

A

SNS: a1, b2 –>bladder sphincter contraction, increased renin secretion
PSNS: M3 –> bladder sphincter relaxation

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10
Q

skin SNS and PSNS receptors and effects

A

SNS: a1 –> vasoconstriction
PSNS: —–

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11
Q

skeletal muscle SNS and PSNS receptors and effects

A

SNS: B2 –> vasodilation
PSNS: ——-

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12
Q

pupils SNS and PSNS receptors and effects

A

SNS: a1–> dilation (mydriasis)
PSNS: M3 –> constriction (miosis)

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13
Q

intrinsic muscles of the eye (smooth muscles) include (3)

A

ciliary muscle, sphincter pupillae, dilator pupillae

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14
Q

A2 stimulation can produce these effects (3)

A

produce anti shivering effect
inhibit insulin release (which creates hyperglycemia)
promotes platelet aggregation

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15
Q

physiologic effect of A2 receptor stimulation for the following organs/effector sites
vasculature
renal tubules
pancreas
platelets
salivary glands
Gi tract

A

vasculature: constricts
renal tubules: inhibit ADH (diuresis)
pancreas: decreases insulin release
platelets: increases aggregation
salivary glands: dry mouth
Gi tract: decreased gut motility

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16
Q

in VSMC, cAMP inhibits ___________ which produces these two effects

A

inhibits myosin light chain kinase
vasodilation and decreased SVR result

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17
Q

PDE3 inhibitors are useful in the following clinical situations (4)

A

BB induced myocardial depression
acute HF
unresponsiveness to IV catecholamines
any time increased inotropy with reduced after load would be desirable.

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18
Q

how many molecules of ATP can be produced from 1 mole of glucose

A

38

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19
Q

rate limiting step in catecholamine synthesis

A

tyrosine hydroxylase

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20
Q

stimulation of which presynaptic adrenergic receptor augments NE release? stops it?

A

augments: B2
stops: A2

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21
Q

catecholamines are removed from synaptic cleft via what 3 mechanisms?

A
  1. reuptake into presynaptic nerve
  2. reuptake into extra neural tissue
  3. diffusion away from synaptic cleft
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22
Q

what 2 enzymes metabolize NE in the liver and kidney

A

MAO and COMT

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23
Q

major metabolite of dopamine

A

homovanillic acid (HVA)

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24
Q

Ach synthesis in presynaptic nerve terminal

A
  1. acetyl coenzyme A is produced in mitochondria and released into the cytoplasm
  2. choline is transported from the blood to the cytoplasm of the nerve terminal
  3. in the presence of choline aminotransferase, choline and acetyl coa are combined to form acetylcholine, which is then packaged into vescicles
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25
Q

byproducts of Ach metabolism

A

choline, which diffuses into circulation
acetate, acetate, which diffuses away from synaptic cleft

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26
Q

what is another name for true cholinesterase

A

acetylcholinesterase (AchE)

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27
Q

compare and contrast SNS and PSNS:
preganglionic fiber length
postganglionic receptor types
target organs

A
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28
Q

anatomical origin of SNS fibers
(origin, location on SC, where cell bodies arise from)

A

thoracolumbar region, mainly T1-L3
cell bodies arise from interomediolateral horn of SC and axons exit via ventral roots, aka lateral horn/rexeds lamina 7

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29
Q

anatomical origin of PSNS fibers

A

craniosacral
CN 3, 7, 9, 10
S2-S4

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30
Q

SNS ganglia compared to PSNS ganglia location

A

SNS ganglia are near SC (sympathetic chain) while PSNS ganglia are near or inside tissue effector/organ

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31
Q

SNS pre to post ganglionic ratio versus PSNS

A

SNS: 30:1, post synaptic amplification contributes to mass response
PSNS: 1:1 or 3:1, precise control of each effector organ

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32
Q

SNS versus PSNS preganglionic and postganglionic fibers comparison
(short, long? myelinated, unmyelinated?)

A

SNS: short, myelinated preganglionic B* fiber. long, myelinated postganglionic B fiber
PSNS: long, UNmyelinated preganglionic C* fiber. short, UNmyelinated postganglionic C fiber

33
Q

NT and receptor at SNS and PSNS ganglia

A

both NT’s are Ach and both receptors are NnAchR

34
Q

NT from postganglionic fiber: SNS v PSNS

A

SNS: NE (Ach at sweat glands, piloerector muscles, some blood vessels. there are no post ganglionic fibers at adrenal medulla. chromaffin cells release NE and epi directly into systemic circulation
PSNS: Ach

35
Q

receptor at effector organ: SNS v PSNS

A

SNS: adrenergic (a, b, dopa) or muscarinic
PSNS: muscarinic

36
Q

how many paired sympathetic ganglia are in the sympathetic chain

A

22

37
Q

3 paths for preganglionic sympathetic fibers in sympathetic chain

A
  1. synapse at the same level where they enter sympathetic chain
  2. synapse at a different level than where they enter
  3. synapse outside of the sympathetic chain
38
Q

synapse of preganglionic sympathetic fibers in sympathetic chain at same level of where they enter

A

synapse in sympathetic trunk ganglion. nonmyelinated axon (C fiber) rejoins spinal nerve via grey ramus

39
Q

preganglionic sympathetic fibers synapsing at a different level than where they enter the sympathetic chain

A

ascending preganglionic fibers travel to cervical region where they synapse on postganglionic sympathetic fibers in the 3 cervical ganglia (superior, middle, inferior).
-must pass through stellate ganglion

40
Q

preganglionic sympathetic fibers synapsing outside of sympathetic chain

A

pass through paravertebral ganglia (sympathetic chain or trunk) then synapse in unpaired prevertebral ganglia located near abdominal or pelvic visceral targets they elevate
preganglionic c fibers traverse through the sympathetic trunk associate to form splanchnic nerves
postganglionic fibers pass into the plexuses that surround the main branch of the aorta and are distributed with the arterial network

41
Q

horner syndrome is characterized by (6)

A

ipsilateral ptosis, miosis, anhydrosis, flushing of the skin, nasal congestion, enopthalmos

Very Homely PAM vasodilation horner ptosis miosis anhydrosis

42
Q

stellate ganglion (aka cervicothoracic ganglion) provides SNS innervation to

A

ipsilateral head, neck, and upper extremity

43
Q

2 areas of adrenal gland and what they secrete

A

medulla: catecholamines
cortex: glucocorticoids, mineralocorticoids, androgens

44
Q

triad of pheochromocytoma sx

A

HA, diaphoresis, tachycardia

45
Q

anesthetic considerations for pheochromocytoma: anticipate (3)

A

HTN, tachycardia, hyperglycemia

46
Q

if a pheochromocytoma patient experiences HoTN, which vasopressor is the best choice?

A

neo (because it is direct acting)

47
Q

drugs to avoid during pheo surgery (3 categories)

A

histamine releasing agents (succ, atracurium, mivacurium, morphine)
indirect acting sympathomimetic agents: ephedrine
SNS activators: desflurane, ketamine, pancuronium, naloxone

48
Q

describe the sympathetic innervation of the adrenal medulla (where the sympathetic fibers arise from, myelination, receptor ant NT type)

A

preganglionic sympathetic B fibers arise from T5-T9 and directly go to adrenal medulla (where Ach interacts with NnAchR’s

49
Q

why does SNS activation eventually cause a decrease in potassium

A

when epinephrine binds to B2 receptors on skeletal muscles and erythrocytes, it activates Na/K pump and shifts K into cells which decreases serum K concentration

50
Q

factors that cause K shift in/out include

A
51
Q

what 2 molecules are released r/t SNS stimulation of hepatocytes?

A

K/glucose

52
Q

surgical procedures that may elicit the baroreceptor reflex include

A

CEA, mediastonoscopy

53
Q

function of baroreceptor reflex (aka carotid sinus reflex)

A

attempts to preserve CO during acute blood loss and shock. venous return too high

54
Q

6 steps of baroreceptor reflex

A
55
Q

which 2 vascular locations contain high pressure baroreceptors

A

carotid sinus
aortic arch

56
Q

drugs that can likely impair baroreceptor reflex include (7)

A

propofol
sevoflurane
labetalol (B1 blockers)
thiopental
CCB
ACEI
PDE inhibitors

57
Q

function of bezold jerisch reflex

A

slows HR in the setting of profound hypervolemia. venous return too low

58
Q

activation of bezold jerisch reflex manifests as (3)

A

bradycardia
HoTN
coronary artery vasodilation

59
Q

bainbridge reflex pathway
sensor
afferent
control
efferent

A

tachycardia caused by an increase in venous return
sensor: increased firing of low pressure stretch receptors during atrial filling
afferent: vagus
control center: NTS
efferent: SNS/PSNS to SA node

60
Q

bezold jarisch reflex pathway
sensor
afferent
control
efferent

A

sensor: chemo and mechanoreceptors in LV wall
afferent: nonmyelinated C fibers in vagus to NTS
control center: NTS and medullary CV nuclei
efferent: vagus.

61
Q

bradycardia and HoTN during spinal or epidural block are attributed to which reflex?

A

bezold jarisch

62
Q

chemoreceptor reflex explanation (afferent, efferent, effects)

A

hypoxia elicits afferent impulses from carotid/aortic bodies through nerve of hering (branch of CN9) and vagus to NTS.
increased RR and MV ensues.

63
Q

drugs that attenuate chemoreceptor reflex (3)

A

volatile anesthetics at subtherapeutic doses
opioids
NO

64
Q

triggers of vasovagal reflex

A

peritoneal stretching or distention
stress

65
Q

sx of vasovagal reflex

A

profound PSNS activation and cease of any SNS activation

66
Q

afferent and efferent limbs of oculocardiac reflex

A

5 (trigeminal) afferent
10 vagus efferent

67
Q

oculocardiac reflex
sensor
afferent pathway (more detail)
control center
efferent pathway (more detail)
effector and response

A

sensor: mechanoreceptors in ocular tissues
afferent: long and short ciliary nerves–>ciliary ganglion –>ophthalmic division (V1) of CN5 (trigeminal ganglion)
control center: NTS and medullary CV nuclei centers
efferent: CN10
effector and response: decreased activity of SA and AV nodes

68
Q

clinical presentation of oculocardiac reflex (4 rhythm possibilities, 1 other sx)

A

bradycardia
HoTN
junctional rhythm
AVB
asystole

69
Q

factors that worsen severity of oculocardiac reflex (3)

A

hypoxemia
hypercarbia
light anesthesia

70
Q

what kind of heat loss occurs via sweating

A

evaporation

71
Q

sx of cushings triad

A

HTN (SNS mediated increase in BP to restore CPP)
bradycardia (baroreceptor reflex)
irregular respirations (brainstem compression)

72
Q

which component of the SNS forms the white rami?

A

preganglionic neuron
remember, preganglionic fibers exit via ventral nerve roots and enter sympathetic chain (T1-L2) via white rami. theyre white because theyre myelinated.

73
Q

which reflex is associated with child birth?

A

bainbridge

74
Q

which reflex is associated with pneumoperitoneum?

A

celiac. mediated by vagus nerve from traction and causes bradycardia/HoTN

75
Q

which cranial nerves arise from the brain stem

A

vagus, facial, spinal accessory
10, 7, 11

76
Q

which cranial nerves arise from midbrain

A

3, 4

77
Q

which cranial nerves arise from the pons

A

5, 6, 7, 8

78
Q

which cranial nerves arise from the medulla

A

9, 10, 11, 12

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