ANS2

Question 1

Disease associated with Raynaud

Answer 1

scleroderma

Question 2

Less common causes of Raynaud

Answer 2

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

Question 3

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

Answer 3

distorted and

proliferative capillaries in the nail bed

Question 4

Pathophysio for Raynaud

Answer 4

arterial constriction or a decrease in the intraluminal

pressure

Question 5

Drugs that cause vasoconstriction

Answer 5

ergots, sympathomimetics,

clonidine, and serotonin receptor agonists

Question 6

condition in which the feet and lower extremities
become red and painful on exposure to warm temperatures
for prolonged periods

Answer 6

En;thromelalgia,

Question 7

Extirpation of _________ relieves

the more severe cases of palmar sweating

Answer 7

T2 and T3 sympathetic ganglia

Question 8

Tx for hyperhydrosis

Answer 8

Treatment with local injections of botulinum

toxin

Question 9

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.

Answer 9

F

Question 10

where is the lesion?
The bladder is paralyzed for voluntary and
reflex activity and there is no awareness of the state of
fullness;

Answer 10

Complete Destruction of the Cord Below T12

Question 11

What is this manuever?

lower abdominal compression and
abdominal straining

Answer 11

Crede maneuver, i.e.,

Question 12

CMG findings of Complete Destruction of the Cord Below T12?

Answer 12

The cystometrogram

shows low pressure and no emptying contractions

Question 13

causes of primary
sensory bladder paralysis.

fibers affected?

Answer 13

Diabetes and tabes dorsalis

Neuropathies affecting mainly the small
fibers are the ones usually implicated

Question 14

Such lesions

result in a reflex neurogenic (spastic) bladder

Answer 14

Upper Spinal Cord Lesions, Above T12

Question 15

_________________is the result
of vesicular p ressure exceeding the opening pressure
of the sphincter in an areflexic bladder

Answer 15

overflow incontinence

Question 16

CMG of lesions above T12

Answer 16

The cystometrogram
shows uninhibited contractions of the detrusor muscle in
response to small volumes of fluid

Question 17

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

Answer 17

detrusor muscle

atonia or hypotonia

Question 18

There is a supranuclear
type of hyperactivity of the detrusor that results in precipitant
voiding

Answer 18

Frontal Lobe Incontinence

Question 19

pontine nucleus for

micturition

Answer 19

Barrington nucleus

Question 20

In
the case of a flaccid paralysis of the bladder, ______
produces contraction of the detrusor by direct stimulation
of its muscarinic cholinergic receptors

Answer 20

bethanechol (Urecholine)

Question 21

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.

Answer 21

propantheline (Pro-Banthine, 15 to 30 mg tid),

oxybutynin (Ditropan, 5 mg bid or tid)

Question 22

More recently, alpha1 -sympathomimetic-blocking
drugs such as__________________ have
been used to relax the urinary sphincter and facilitate
voiding

Answer 22

terazosin, doxazosin, and tamsulosin

Question 23

alpha1 -sympathomimetic-blocking drugs’ widest use has been in men with prostatic
hypertrophy, but they may be beneficial in patients with
_____________from neurologic disease.

Answer 23

dyssynergia of the sphincter (failure of the sphincter to

open when the detrusor contracts)

Question 24

Antibodies vs __________ are associated in DM polyneuropathy

Answer 24

alpha subunit of the ganglionic acetylcholine

receptor

Question 25

it has been suggested that paradoxical contraction of the ________ and ________ may be a cause of severe constipation (anismus)

Answer 25

puborectus and external anal sphincter

Question 26

mutations in Hirschsprung

Answer 26

mutation of the RET oncogene, endothelin receptor

Question 27

Neocortical influences referable to sex involve the limbic | system and are transmitted to the ______ and _____

Answer 27

hypothalamus and spinal | centers

Question 28

Penile erection is effected through sacral | ______, ________ and ________

Answer 28

parasympathetic motor neurons (S3 and S4), the nervi | erigentes, and pudendal nerves

Question 29

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

Answer 29

horacolumbar segments | originating in T12-Ll

Question 30

excessive sexual desire is associated with lesions of:

Answer 30

diencephalon, septal region, | and temporal lobes;

Question 31

The most | common cause of erectile dysfunction is a ______

Answer 31

depressive | state

Question 32

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.

Answer 32

sildenafil (Viagra)

Question 33

mechanism of sildenafil

Answer 33

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

Question 34

In patients with poliomyelitis, for example, the occurrence of respiratory failure was associated with lesions in the ________

Answer 34

ventrolateral | tegmentum of the medulla

Question 35

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 ___________

Answer 35

ventral respiratory group (referred to as VRG), dorsal to the obex and immediately ventromedial to the NTS parabrachial nucleus.

Question 36

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.

Answer 36

phrenic motor neurons

Question 37

____________was the dominant generator of the respiratory rhythm

Answer 37

DRG

Question 38

One pontine group, the____________ modulates the response to hypoxia, hypocapnia, and lung inflation

Answer 38

"pneumotaxic center,"

Question 39

found in the lower pons is a group of neurons that prevent unrestrained activity of the medullary inspiratory neurons ________________

Answer 39

("apneustic center").

Question 40

What is this reflex? shortened inspiration and decreased tidal volume triggered by excessive lung expansion.

Answer 40

Hering-Breuer reflex,

Question 41

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 _________

Answer 41

postencephalitic | parkinsonism

Question 42

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

Answer 42

Leeuwenhoek's disease

Question 43

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

Answer 43

Chey;ne-Stokes breathing,

Question 44

Another striking aberration of ventilation is a loss of automatic respiration during sleep, with preserved voluntary breathing ________

Answer 44

(Ondine's curse

Question 45

lesions for Ondine's curse

Answer 45

ventrolateral descending medullocervical pathways that | subserve automatic breathing

Question 46

Often neglected i s the dyspnea that patients experience | with orthostatic hypotension ________

Answer 46

(orthostatic dyspnea).

Question 47

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

Answer 47

congenital cen tral hypoventilation syndrome

Question 48

lesions for hiccups from?

Answer 48

It may occur as a | component of the lateral medullary syndrome

Question 49

meds associated with hiccups

Answer 49

dexamethasone.

Question 50

result of powerful contraction of the diaphragm and intercostal muscles, followed immediately by laryngeal closure.

Answer 50

hiccup

Question 51

hiccups inhibited by?

Answer 51

inhibited by therapeutic elevation of arterial carbon | dioxide (C02) tension

Question 52

drugs for hiccups

Answer 52

baclofen and metoclop

Question 53

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

Answer 53

paradoxical respiration

Question 54

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.

Answer 54

respiratory alternans

Question 55

accounts for as many as 40 percent of cases of an | inability to wean a patient from the ventilation

Answer 55

critical illness polyneuropathy

Question 56

EMG of critical illness polyneuropathy

Answer 56

The EMG demonstrates widespread denervation with relative sparing of sensory potentials.