ANS2 Flashcards
Disease associated with Raynaud
scleroderma
Less common causes of Raynaud
Obstructive arterial disease–as might
occur with the thoracic outlet syndrome, vasospasm
because of drugs (ergot, cytotoxic agents, cocaine), previous
cold injury (frostbite), and circulating cryoglobulins
The presence of ____________, visible with an
ophthalmoscope, has been used as a bedside aid to reveal cases of connective tissue disease in pts with Raynaud
distorted and
proliferative capillaries in the nail bed
Pathophysio for Raynaud
arterial constriction or a decrease in the intraluminal
pressure
Drugs that cause vasoconstriction
ergots, sympathomimetics,
clonidine, and serotonin receptor agonists
condition in which the feet and lower extremities
become red and painful on exposure to warm temperatures
for prolonged periods
En;thromelalgia,
Extirpation of _________ relieves
the more severe cases of palmar sweating
T2 and T3 sympathetic ganglia
Tx for hyperhydrosis
Treatment with local injections of botulinum
toxin
T or F
sweating is affected in restricted spinal root
disease because there is much intersegmental mixing of
the preganglionic axons once they enter the sympathetic
chain and there are no preganglionic autonomic fibers in
the roots below L2.
F
where is the lesion?
The bladder is paralyzed for voluntary and
reflex activity and there is no awareness of the state of
fullness;
Complete Destruction of the Cord Below T12
What is this manuever?
lower abdominal compression and
abdominal straining
Crede maneuver, i.e.,
CMG findings of Complete Destruction of the Cord Below T12?
The cystometrogram
shows low pressure and no emptying contractions
causes of primary
sensory bladder paralysis.
fibers affected?
Diabetes and tabes dorsalis
Neuropathies affecting mainly the small
fibers are the ones usually implicated
Such lesions
result in a reflex neurogenic (spastic) bladder
Upper Spinal Cord Lesions, Above T12
_________________is the result
of vesicular p ressure exceeding the opening pressure
of the sphincter in an areflexic bladder
overflow incontinence
CMG of lesions above T12
The cystometrogram
shows uninhibited contractions of the detrusor muscle in
response to small volumes of fluid
Repeated overdistention
of the bladder wall often results in varying degrees of
decompensation of the _______ and permanent
___________, although the evidence for this mechanism
is uncertain
detrusor muscle
atonia or hypotonia
There is a supranuclear
type of hyperactivity of the detrusor that results in precipitant
voiding
Frontal Lobe Incontinence
pontine nucleus for
micturition
Barrington nucleus
In
the case of a flaccid paralysis of the bladder, ______
produces contraction of the detrusor by direct stimulation
of its muscarinic cholinergic receptors
bethanechol (Urecholine)
In spastic
paralysis, the detrusor can be relaxed by ______________ which acts as a muscarinic
antagonist, and by _____________________, which acts directly on the smooth muscle and
also has a muscarinic antagonist action.
propantheline (Pro-Banthine, 15 to 30 mg tid),
oxybutynin (Ditropan, 5 mg bid or tid)
More recently, alpha1 -sympathomimetic-blocking
drugs such as__________________ have
been used to relax the urinary sphincter and facilitate
voiding
terazosin, doxazosin, and tamsulosin
alpha1 -sympathomimetic-blocking drugs’ widest use has been in men with prostatic
hypertrophy, but they may be beneficial in patients with
_____________from neurologic disease.
dyssynergia of the sphincter (failure of the sphincter to
open when the detrusor contracts)
Antibodies vs __________ are associated in DM polyneuropathy
alpha subunit of the ganglionic acetylcholine
receptor
it has been suggested that paradoxical contraction
of the ________ and ________ may be a
cause of severe constipation (anismus)
puborectus and external anal sphincter
mutations in Hirschsprung
mutation of the RET oncogene, endothelin receptor
Neocortical influences referable to sex involve the limbic
system and are transmitted to the ______ and _____
hypothalamus and spinal
centers
Penile erection is effected through sacral
______, ________ and ________
parasympathetic motor neurons (S3 and S4), the nervi
erigentes, and pudendal nerves
There is some evidence
also that a sympathetic outflow from t__________ via the inferior mesenteric
and hypogastric plexuses can mediate psychogenic erections
in patients with complete sacral cord destruction
horacolumbar segments
originating in T12-Ll
excessive sexual desire is associated with lesions of:
diencephalon, septal region,
and temporal lobes;
The most
common cause of erectile dysfunction is a ______
depressive
state
The phosphodiesterase
inhibitors such as __________have proved to
be useful in the treatment of erectile dysfunction in some
patients with sexual dysfunction of neurologic cause.
sildenafil (Viagra)
mechanism of sildenafil
it enhances the effect of local
nitric oxide on the smooth muscle of the corpus cavemosum;
this results in relaxation of the smooth muscle and
inflow of blood
In patients with
poliomyelitis, for example, the occurrence of respiratory
failure was associated with lesions in the ________
ventrolateral
tegmentum of the medulla
Three paired groups of respiratory nuclei:
(1) a _____________extending from the lower to the upper ventral medulla, in the region of the nucleus retroambiguus;
(2) a dorsal medullary respiratory group (DRG), located ; and
(3) two clusters
of cells in the dorsolateral pons in the region of the
___________
ventral respiratory group (referred to as VRG),
dorsal to the obex and immediately ventromedial to the NTS
parabrachial nucleus.
The __________ form a thin column
in the medial parts of the ventral horns, extending from
the third through fifth cervical cord segments. Damage to
these neurons, of course, precludes both voluntary and
automatic breathing.
phrenic motor neurons
____________was the dominant generator of the respiratory rhythm
DRG
One pontine group,
the____________ modulates the response to
hypoxia, hypocapnia, and lung inflation
“pneumotaxic center,”
found in
the lower pons is a group of neurons that prevent unrestrained
activity of the medullary inspiratory neurons
________________
(“apneustic center”).
What is this reflex?
shortened inspiration and decreased tidal volume triggered
by excessive lung expansion.
Hering-Breuer reflex,
Patterns such as episodic tachypnea up
to 100 breaths per minute and loss of voluntary control of
breathing were, in the past, noteworthy features of _________
postencephalitic
parkinsonism
there is an almost continuous epigastric pulsation
and dyspnea in association with rhythmic bursts of
activity in the inspiratory muscles-a respiratory myoclonus
akin to palatal myoclonus
Leeuwenhoek’s disease
what type of breathing:
During the apneic period the patient is less responsive.
The onset of respiration is
heralded by arousal, marked by eye opening and sometimes vocalization.
At the peak of the hyperventilation
phase, the patient is maximally awake. Consciousness
then wanes followed by slowing of the respiratory rate
and finally coma to complete a full cycle
Chey;ne-Stokes breathing,
Another striking aberration of ventilation is a loss
of automatic respiration during sleep, with preserved
voluntary breathing ________
(Ondine’s curse
lesions for Ondine’s curse
ventrolateral descending medullocervical pathways that
subserve automatic breathing
Often neglected i s the dyspnea that patients experience
with orthostatic hypotension ________
(orthostatic dyspnea).
This rare condition
begins in infancy with apneas and sleep disturbances of varying severity or later in childhood with signs of
chronic hypoxia leading to pulmonary hypertension
congenital cen tral hypoventilation syndrome
lesions for hiccups from?
It may occur as a
component of the lateral medullary syndrome
meds associated with hiccups
dexamethasone.
result of powerful contraction of the diaphragm
and intercostal muscles, followed immediately by laryngeal
closure.
hiccup
hiccups inhibited by?
inhibited by therapeutic elevation of arterial carbon
dioxide (C02) tension
drugs for hiccups
baclofen and metoclop
abdominal wall retracts during inspiration, owing to the
failure of the diaphragm to contract, while the intercostal
and accessory muscles create a negative intrathoracic
pressure
paradoxical respiration
a pattern of
diaphragmatic descent only on alternate breaths (this is
more characteristic of airway obstruction). These signs
appear in the acutely ill patient when the vital capacity
has been reduced to approximately 10 percent of normal,
or 500 mL in the average adult.
respiratory alternans
accounts for as many as 40 percent of cases of an
inability to wean a patient from the ventilation
critical illness polyneuropathy
EMG of critical illness polyneuropathy
The EMG demonstrates
widespread denervation with relative sparing of sensory
potentials.
