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*ANS > ANS anatomy & physiology > Flashcards

ANS anatomy & physiology Flashcards

1
Q

Two divisions of the Nervous System

A

Central & Peripheral

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2
Q

3 divisions of the Autonomic nervous system

A
  1. SNS
  2. PSNS
  3. Enteric
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3
Q

Which is more integral for survival SNS or PSNS?

A

PSNS - the ability to remove waste and toxins from our body will prob kill us faster than the rare chance we need to run from a bear.

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4
Q

What kind of muscle does NOT receive signals from the autonomic nervous system

A

Skeletal muscle

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5
Q

What makes up the brainstem? (3)

A

Midbrain
Pons
Medulla

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6
Q

The SNS originates from which spinal cord levels?

A

T1-L2 (L3)

“Thoraco-lumbar”
Spinal cord ends ~ L2, so just think that

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7
Q

Sympathetic nervous system efferents have (long/short) preganglionic fibers and (long/short) postganglionic fibers

A

short pre

long post

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8
Q

Blockade of which ganglion produces horner syndrome?

A

Stellate (cervicothoracic)

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9
Q

Preganglionic neurons are made up of what kind of nerve fibers?

A

Lightly myelinated B-fibers

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10
Q

Postganglionic neurons are made up of what kind of nerve fibers?

A

Unmyelinated C-fibers

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11
Q

The PSNS efferents originate from which cranial nerves and spinal cord levels?

A

Cranial nerves: 3, 7, 9, 10
& S2-S4

“Craniosacral” system

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12
Q

What part of the spinal cord does the somatosensory division arise from?

A

The ventral horn

I think you gotta think in terms of the autonomic nervous system
Somatic and visceral innervations
>visceral innervations are plexus’s
>somatic are via spinal nerves that arise from the ventral horn

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13
Q

What part of the spinal cord does the sympathetic division arise from?

A

The lateral horn of the gray matter

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14
Q

What spinal cord levels contain gray rami?

A

All of them

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15
Q

The SNS has a ratio of (pre/post)ganglionic to (pre/post) ganglionic nerve ratio of 30:1

A

post: pre of 30:1

* a lot more postganglionic fibers

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16
Q

The sympathetic trunk divides into what two distribution pathways?

A

Somatic and Visceral

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17
Q

What sympathetic distribution group travels to effectors via spinal nerves vs plexus’s?

A

somatic group travel via spinal nerves

visceral group travel via plexus’s

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18
Q

What is the stellate ganglion a result of?

A

The joining of the inferior cervical ganglion & T1 ganglion

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19
Q

Horners syndrome results from blockade of what?

A

Stellate ganglion

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20
Q

Does a stellate ganglion blockade result in ipsilateral or contralateral symptoms and what are they? (6)

A

Ipsilateral

  1. Ptosis
  2. Miosis
  3. Enophthalmos (sunken in eyeball)
  4. Nasal congestion
  5. Anhydrosis
  6. Flushed Skin (flushing skin but no sweat)

(3 eye effects, 1 nose, 2 skin)
(Skin effects of the same sided upper extremity)

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21
Q

What 3 plexus’s do the thoracic viscera receive SNS efferents from?

A
  1. Cardiac plexus
  2. Pulmonary plexus
  3. Esophageal plexus
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22
Q

SNS efferents to the abdominal and pelvic viscera are delivered by what 4 plexus’s?

A
  1. Celiac plexus
  2. Aortic plexus
  3. Superior hypogastric plexus
  4. Inferior hypogastric plexus
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23
Q

ALL preganglionic sympathetic nerve fibers are what type of fibers (A/B/C) and where do they all arise from?

A

Preganglionic sympathetic nerve fibers = B fibers

Arise from T1-L2

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24
Q

The stellate ganglion provides SNS innervation to what 3 places?

A

Ipsilateral head, neck, and upper extremity

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25
Q

4 things a stellate ganglion block can be used for.

A
  1. Upper extremity sympathetic dystrophy
  2. Complex regional pain syndrome
  3. Increase blood flow to the upper extremity
  4. tx of intractable post-MI pain
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26
Q

A stellate ganglion block is often an unanticipated consequence of what kind of block?

A

Brachial plexus (interscalene)

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27
Q

Horners syndrome mnemonic

A

Very Horny PAM

Vasodilation
HORNER
Ptosis
Anydrosis
Miosis
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28
Q

Which preganglionic sympathetic nerve fibers transverse the sympathetic trunk and form the Greater Splanchnic Nerves?

A

T5-T10

```
T1-T4 = Cardiac plexus
(T5-T10 = GSN)
(T10-T11 = LSR SN)
(T12 = LST SN)
~~~

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29
Q

Which ganglion provides efferents to the stomach, liver, gallbladder, and pancreas?

A

Celiac

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30
Q

Which ganglion provides efferents to the kidney?

A

Aorticorenal

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31
Q

Which ganglion provides efferents to the small intestine and ascending colon?

A

Superior mesenteric

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32
Q

Which ganglion provides efferents to the transverse, descending, and sigmoid colon + rectum?

A

Inferior mesenteric

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33
Q

What ganglion provides efferents to the urinary bladder and reproductive organs?

A

Pelvic

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34
Q

The intermediolateral nucleus lies within which Rexed’s Lamina?

A

7

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35
Q

Which plexus may be blocked for relief of pain secondary to chronic pancretitis?

A

Celiac plexus block

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36
Q

What plexus lies at L1?

A

Celiac plexus

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37
Q

What 3 skin structures receive sympathetic stimulation from spinal nerves?

A
  1. Cutaneous arterioles
  2. Sweat glands
  3. Piloerector muscles
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38
Q

Which two cranial nerves supply motor innervation to the salivary glands?

A

Glossopharyngeal

& Facial

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39
Q

T/F: The vagus nerve innervates salivary glands

A

False!

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40
Q

Which cranial nerve lies within the CNS?

A

CN2 - Optic nerve

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41
Q

Which cranial nerves provide parasympathetic outflow to target organs/tissues?

A

3, 7, 9, 10

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42
Q

Cranial Nerve I

Sensory/Motor/Both

A

Olfactory

Sensory - Nose

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43
Q

Cranial Nerve 2

Sensory/Motor/Both

A

Optic

Sensory - Eyes

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44
Q

Cranial Nerve 3

Sensory/Motor/Both

A 
Oculomotor
Motor- eyes
-all ocular muscles except:
superior oblique (CN4)
& lateral rectus (CN6)

+sphinchter/ciliary muscles & eyelid muscle

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45
Q

Cranial Nerve 4

Sensory/Motor/Both

A

Trochlear
Motor- eyes
Eye muscle: superior oblique

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46
Q

Cranial Nerve 5

Sensory/Motor/Both

A

Trigeminal

Both

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47
Q

Cranial Nerve 6

Sensory/Motor/Both

A

Abducens
Motor- eyes
Eye muscle: lateral rectus

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48
Q

Cranial Nerve 7

Sensory/Motor/Both

A

Facial

Both

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49
Q

Cranial Nerve 8

Sensory/Motor/Both

A

Vestibulocochlear

Sensory- Ears

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50
Q

Cranial Nerve 9

Sensory/Motor/Both

A

Glossopharyngeal

Both

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51
Q

Cranial Nerve 10

Sensory/Motor/Both

A

Vagus

Both

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52
Q

Cranial Nerve 11

Sensory/Motor/Both

A

Spinal Accessory

Motor - shoulder shrug

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53
Q

Cranial Nerve 12

Sensory/Motor/Both

A

Hypoglossal

Motor- tongue

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54
Q

Mneumonic for cranial nerve names

A

On occasion, our trusty truck acts funny. Very good vehicle anyhow.

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55
Q

Mnemonic for cranial nerve functions

A

Some say marry money, but my brother says bad business to marry money.

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56
Q

Sensory only cranial nerves (3)

A

1, 2, 8

Smell, Sight, Sound

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57
Q

Sensory + Motor cranial nerves (4)

A

5, 7, 9, 10

Paraysympathetic outflow CNs = 3 7 9 10

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58
Q

Which cranial nerve carries parasympathetic innervation to the submandibular, sublingual, and lacrimal glands?

A

CN 7 - Facial

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59
Q

What are the 5 motor branches of the facial nerve?

A

Temporal, Zygomatic, Buccal, Mandibular, Cervical

Two zebras bit my car

60
Q

What is the sensory function of cranial nerve 7?

A

(Facial nerve)

-anterior 2/3 of the tongue - taste

61
Q

Between cranial nerves 7 and 9, which ones are mostly sensory vs mostly motor?

A

7- mostly motor

9- mostly sensory

62
Q

What kind of receptors lie on the carotid bodies?

A

Chemoreceptors

63
Q

What kind of receptors lie on the carotid sinus?

A

Baroreceptors

64
Q

What nervous system regulates the activity of our internal organs?

A

Visceral/Autonomic Nervous system

65
Q

Which nervous system enables us to interact with our environment?

A

Somatic

CNS = brain and SC
Peripheral NS = sensory and motor
Motor further divided into ANS (automatic) and somatic (motor, voluntary)

66
Q

Where do the preganglionic nerve fibers for the oculomotor (cranial nerve 3) originate?

A

Edinger-Westphal nucleus

67
Q

The parasympathetic neurons consist of what cranial nerves and spinal cord segments?

A

CN 3, 7, 9, 10

S2-S4

68
Q

Another name for the parasympathetic division of the ANS?

A

Craniosacral system

69
Q

The parasympathetic efferent pathways consist of (long/short) preganglionic neurons and (long/short) postganglionic neurons

A

Long pre
Short post

(they have a longer route to travel and don’t enter the sympathetic chain)

70
Q

White rami only exist in which spinal nerve segments?

A

T1-L2/3

71
Q

Which cranial nerve is responsible for miosis?

A

Cranial nerve 3 - oculomotor

Parasympathetic response

72
Q

Which cranial nerve is responsible for near vision accommodation?

A

CN 3- oculomotor

via contraction of the ciliary muscle which releases the tension from suspensory ligaments of the lens
thicker lens = near vision accomodation

73
Q

What cranial nerve is responsible for tearing?

A

CN 7 - facial
Stimulation of the lacrimal gland
*Parasympathetic response

74
Q

Visceral afferents from the heart, lungs, and GI tract are sensed by the vagus nerve and travel to which nucleus?

A

The nucleus of the tractus solitarius (NTS)

75
Q

What kind of nerve fibers compose most of the visceral afferent nerves?

A

Non-myelinated C fibers or

lightly myelinated A-delta fibers

76
Q

Which cranial nerve afferents are implicated in the baroreceptor response for the maintenance of blood pressure?

A

CN 9 - Carotid Sinus

& CN 10- Aortic Arch

77
Q

Which cranial nerve afferents are implicated in the chemoreceptor response for the control of ventilation?

A

CN 9 - Carotid Body

& CN 10 - Aortic arch

78
Q

What is known as the parasympathetic neurotransmitter?

A

Acetylcholine

79
Q

What does it mean if a nerve fiber is cholinergic

A

It produces acetylcholine

80
Q

All preganglionic neurons in the ANS (both PSNS & SNS) use what as their primary neurotransmitter across all autonomic ganglia?

A

Acetylcholine

81
Q

What are 2 potent inhibitors of ganglionic a3B4 autonomic cholinergic receptors?

A

Volatile anesthetics & Ketamine

-Signal can’t get across to propagate up to the brain

82
Q

Where does acetylcholine synthesis occur at?

A

In the presynaptic nerve terminal

83
Q

What antagonizes calcium at the presynaptic nerve terminal?

A

Magnesium

(explains why mag can cause muscle weakness or enhance NMB…. no calcium, no acetylcholine released, less stimulation of post-ganglionic fibers to affect muscle contraction)

84
Q

Are nicotinic receptors ionotropic or metabotrophic?

A

ionotropic

85
Q

What differentiates adult from fetal nicotinic ACh receptors?

A

adult has an E subunit

fetal has a y subunit

86
Q

What are the parasympathetic receptors found in the heart?

A

M2 cholinergic receptors

GI- inhibit adenylyl cyclase

87
Q

What receptors mediate bronchoconstriction?

A

M3 cholinergic recetpros

Gq- activate phospholipase C

88
Q

What kind of receptors are located pre-synaptically and work as a negative feedback loop to inhibit the release of further acetylcholine?

A

M2 receptors

89
Q

What enzyme catalyzes the synthesis of Acetylcholine?

A

Choline AcetylTransferase

ChAT

90
Q

What is another name for en passant synapses?

A

Neuroeffector junctions

91
Q

What NT stimulates sweat glands? What receptor does it attach to?

Sympathetic or parasympathetic response?

A

Acetylcholine from post-synaptic sympathetic neurons onto M3 receptors

*This is the only post-ganglionic sympathetic neuron that secretes ACh (instead of NE)

92
Q

GPCR for Alpha 1

A

Gq

93
Q

GPCR for Alpha 2

A

Gi

94
Q

GPCR for Beta 1

A

Gs

95
Q

GPCR for Beta 2

A

Gs

96
Q

Activation by NE of which presynaptic receptor can increase the release of NE/Epi (Positive feedback loop)?

A

Presynaptic Beta 2

97
Q

Activation by NE of which presynaptic receptor can inhibit further release of NE?

A

Presynaptic Alpha 2

98
Q

Activation by ACh of which presynaptic receptor can inhibit further release of ACh?

A

Presynaptic M2

99
Q

Activation by ACh of which presynaptic receptor can increase the release of ACh (positive feedback loop)?

A

Presynaptic nicotinic Nn

100
Q

Which sympathetic post-ganglionic neurons are actually cholinergic, what do they secrete, and what receptors do they bind to?

A

Exocrine sweat glands

-ACh is secreted and binds to M3 muscarinic receptors

101
Q

Contraction of which muscle of the iris causes mydriasis? What NT/Receptor? SNS or PSNS?

A

Dilator Pupillae (Radial) (radical dilator)
NE > Alpha 1
SNS

(T1 > superior cervical ganglion > NE > alpha 1)

102
Q

Contraction of which muscle of the iris causes miosis? What NT/Receptor? SNS or PSNS?

A

Sphincter pupillae (Circular) (circular sphincter)
ACh > M3
PSNS

(CN3 > ACh > M3)

103
Q

What heart tissue shows little to no response from ACh?

A

ventricular muscle (myocytes)

104
Q

Which brain region is most important for the coordination and control of ANS output?

A

Hypothalamus

105
Q

What is the single most important integrator of autonomic and endocrine function?

A

The hypothalamus

106
Q

What is the major lower brain stem command center for visceral control?

A

The nucleus tractus solitarius (NTS)

107
Q

Where is the hypothalamus located?

A

at the base of the brain, above the pituitary gland

108
Q

8 Things the Hypothalmus helps regulate?

A
  1. Autonomic function with eating
  2. Thermoregulation
  3. Circadian rhythms
  4. Water balance
  5. Emotions
  6. Sex drive
  7. Reproduction
  8. Motivation
109
Q

Which lower brainstem structure receives visceral afferents from cranial nerves 7, 9, & 10?

A

The nucleus tractus solitarius

110
Q

Mnemonic for the 6 cardiac reflexes?

A

3 Bees in the CV… Ouch!

  1. Baroreceptor
  2. Bainbridge
  3. Bezold- Jarish
  4. Chemoreceptor
  5. Valsalva
  6. Occulocardiac
111
Q

What is the purpose of the baroreceptor reflex?

A

A quick response to short-term BP regulation

Reflex- quick! let me fix this! –> proceeds to drop BP and HR and make you wanna vomit and pass out

112
Q

What cardiac reflex is responsible for the increase in cardiac output (increased HR and inotropy) as a result of persistent hypoxemia?

A

Chemoreceptor Reflex

113
Q

What are the afferent and efferent limbs of the oculocardiac reflex?

A

afferent limb = cranial nerve 5 (trigeminal)

efferent limb = cranial nerve 10 (vagus)

114
Q

Another name for a feedback loop

A

Reflex arc

115
Q

What 3 key areas receive the bulk of sensory information from the body?

A

Hypothalamus
Spinal Cord
brainstem

116
Q

What is a ganglion?

A

A relay site where the preganglionic nerve synapses with the postganglionic nerve.

117
Q

Which cardiac reflex is considered a high-pressure arterial reflex vs a low-pressure cardiopulmonary reflex?

A

High-pressure arterial reflex = BRR

low-pressure CP reflex = Bainbridge

118
Q

Which volatile anesthetic impairs the baroreceptor reflex the least?

A

Isoflurane

Has mild Beta-1 Agonist properties –> BP doesn’t drop as low, reflex not as significant

119
Q

Where is the carotid sinus located?

A

At the origin of the ICA, right below where the ICA and ECA bifurcate

120
Q

What does the nerve of herring innervate?

A

The carotid sinus

> converges with the glossopharyngeal (9) to send afferent impulses to the nucleus tractus solitarius in the medulla

121
Q

What 2 procedures may elicit the baroreceptor reflex?

A
  1. CEA > pressure from manipulating the carotid sinus

2. Mediastinoscopy > pressure on the transverse aortic arch

122
Q

How do volatile anesthetics affect the baroreceptor reflex?

A

Volatile anesthetics decrease the HR response to the baroreceptor reflex in a dose-dependent fashion.

123
Q

T/F Phenylephrine is a catecholamine

A

False

124
Q

What cardiac reflex slows the HR in the setting of profound hypovolemia (decreased preload)

A

Bezold- Jarisch

> heart slows in an attempt to allow the heart to fill

125
Q

What cardiac reflex increases the heart rate in response to venous congestion (increased preload)

A

Bainbridge

> try to promote forward flow

126
Q

What is the chemoreceptor reflex stimulated by?

A

Hypoxia and hypercarbia

127
Q

What does stimulation of the chemoreceptor reflex result in?

A

Increased minute ventilation and increased SNS tone

128
Q

Triad of symptoms that characterizes the Bezold-Jarisch reflex

A
  1. Bradycardia
  2. Hypotension
  3. Coronary artery vasodilation
129
Q

What reflex may be initiated secondary to autotransfusion during childbirth and rapid administration of IVF?

A

Bainbridge

130
Q

What reflex is elicited with profound hypotension, massive hemorrhage, and shoulder arthroscopy + regional anesthetic + sitting position

A

Bezold-Jarisch

131
Q

What is the strongest stimulus at peripheral chemoreceptors?

A

Hypoxia

132
Q

Response to acute hypoxia vs persistent

A

Acute = PSNS -> decreased HR and contractility (attempts to slow down to get more o2 to the heart, heart contracts less to try and preserve what o2 is there)

Persistent hypoxia = SNS activation (oh shit, cant fix this issue, let me speed up and get as much o2 out to the tissues as I can)

133
Q

Two causes of vasovagal reflex/syncope?

A
  1. Psychologic stress

2. Peritoneal stretching/distension

134
Q

Does a retrobulbar block cause or prevent the oculocardiac reflex?

A

both

135
Q

Factors that worsen the severity of the oculocardiac reflex (3)

A

Hypoxia
Hypercarbia
Light anesthesia

136
Q

3 steps in treating oculocardiac reflex

A
  1. ask surgeon to stop
  2. 100% fio2, ensure adequate ventilation, deepen anesthetic
  3. anticholinergic
137
Q

Which brainstem center is known as the vasopressor or vasomotor center?

A

Rostral ventrolateral medulla (RVLM)

138
Q

S/S & cause of Cushing’s triad

A
  1. Bradycardia
  2. HYPERTENSION
  3. Irregular respirations

*in response to increased ICP

139
Q

What is shivering diminished by? (3)

A

NMB, old age, and NM diseases

140
Q

Thermoregulation in newborns and infants occurs how?

A

By nonshivering thermogenesis via norepinephrine

141
Q

Forced expiration against a closed glottis results in what reflex?

A

Valsalva

142
Q

Which receptor mediates dilation of coronary arteries?

A

Beta 2

143
Q

What kind of muscle is smooth muscle (3)

A

blood vessels, GI walls, bladder wall

144
Q

The two somatomotor peripheral motor neuron types

A

A-motor neurons & Y- motor neurons

A-alpha & A-gamma

145
Q

Where do the cell bodies of afferent sympathetic nerve fibers lay?

A

In the dorsal root ganglia

*ANS (4 decks)

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