Autonomic Nervous System

Question 1

A 77 y.o. male smoker with chronic cough is seen in clinic because he noticed drooping of hisleft eyelid. Physical exam reveals the patient has miosis of his left pupil; the left side of his
face is slightly flushed, warm and dry.

1. What is your diagnosis?
   a. Frey’s syndrome
   b. Bell’s palsy
   c. Raynaud’s disease
   d. Wallenberg’s syndrome
   e. Horner’s syndrome
2. What might be causing the problems experienced by this patient?
   a. Injury to the geniculate ganglion
   b. Injury to the Edinger-Westphal nucleus
   c. Injury to the superior salivatory nucleus
   d. A tumor in the apical region of the lung
   e. An infection in the region of the parotid gland

Answer 1

1-E

2-D

Question 2

3 functions of the ANS

Answer 2

1. homeostasis
2. emergency response
3. reproduction

Question 3

Norepinephrine is the post-ganglionic neurotransmitter for the symapathetic nervous system, what is the exception?

Answer 3

Sweat glands and vasodilator fibers respond to Ach

Question 4

Which division of the autonomic nervous system has more divergence?

Answer 4

Sympathetic 1:10 vs 1:3

Question 5

Which thoracic levels are for sympatetic outflow

Answer 5

T1-L2

Question 6

Pathway for pupil constriction

Answer 6

EW Nucelus on CN III through ciliary ganglia

Question 7

Pathway for lacrimation, and sublingual and mandibular glands?

Answer 7

Superior Salivatory Nucleus on CN VII through pterygopalatine and submandibular glands

Question 8

Pathway to the parotid gland?

Answer 8

inferior salivary nucleus, CN IX, otic ganglia

Question 9

Pathway to smooth muscle of GI tract and glands?

Answer 9

Dorsal Motor Nucelus via CN X to myenteric and submucosal ganglia

Question 10

What is the explanation for vasovagal syncope?

Answer 10

Peripheral Venous pooling leads to low pressure sensed by mechanoreceptors and withdrawal of sympathetic activity and increased vagal activity leading to inappropriate vasodilation and bradycardia causing hypotension and syncope

Question 11

Where are stretch receptors located?

Answer 11

carotid sinus and aortic arch

Question 12

Which cranial nerves relay pressure sensed by the baroreceptors?

Answer 12

glossopharyngeal (IX) and vagus (X)

Question 13

Where does processing of blood pressure occur?

Answer 13

Nucleus Solitarius

Question 14

4 Characterisitics of Horner’s Syndrome?

Answer 14

Ptosis, Miosis, Anhidrosis, Enopthalmos(sunken eye)- loss of sympathetic innervation of dilator pupillae, superior tarsal m, and facial sweat glands)

Question 15

A patient has inability to articulate speech (dysarthria), can’t swallow correctly (dyphagia), has loss of pain and temperature sensation on the left side, and loss of facial sensation on the right side, and symptoms of Horner’s syndrome…what conditions does the patient have?

Answer 15

Lateral Medullary Syndrom- Wallenberg- on the right side

Question 16

Injury at which spinal cord level leads to sympathetic hyperreflexia?

Answer 16

T5/6 and above

Question 17

What occurs in sympathetic hyperreflexia?

Answer 17

Noxious stimuli like a full bladder leds to sympathetic activation as pain fibers can’t ascend through the damaged spinal cord elvel leading to vasoconstriction and elevated BP as well as HA, bradycardia, piloerection and pallor

Question 18

What plexus innervates the detrusor muscle for contractions?

Answer 18

S2-4, pelvic splanchnic, inferior hypogastric plexus

Question 19

What controls the internal urethral sphincter?

Answer 19

Sympathetic lumbar splanchnic nerves- storage

Question 20

What controls the external urethral sphincter

Answer 20

parasympathetic lumbar splanchnic -pee

Question 21

What is the disease with congenital absence of the myenteric plexus

Answer 21

Hirshprungs disease

Question 22

Which spinal level is involved in orthostatic hypotension?

Answer 22

T6- splanchnic circulation

Question 23

Which spinal level do upper motor bladder/bowel nerves synapse onto? Where are the lower motor neurons?

Answer 23

S1, conus

Question 24

Which has more control over the other PNS or SNS?

Answer 24

PNS modulates SNS especially for bladder and heart

Question 25

Which areas are only innervated by the SNS?

Answer 25

vessels and sweat glands

Question 26

Which is faster reponse PNS or SNS?

Answer 26

PNS 1 sec SNS several seconds.

Question 27

Which areas deal with coordination of a threat, chief external environment operating officer?

Answer 27

PAG

Question 28

What is the 3 neuron pathway to the dilator pupillae

Answer 28

1. Descending hypothalmic fibers to T1/T2 interomediolateral cell column
2. Preganglionic to Superior Cervical Ganglia
3. SCG to dilator pupillae

Question 29

What can lead to Horner’s Syndrom?

Answer 29

Lateral Medullary Syndrome (wallenberg)
pancoast tumor
carotid dissection

Question 30

What areas provide input to PAG about threats?

Answer 30

insula (bean counter), amygdala (urgency) ventro-medial prefrontal cortex
visceral and pain afferents

Question 31

Where is a controllable threat vs non-controllable located in the PAG?

Answer 31

noncontrollable ventral

Question 32

Where can you stimulate for decreased pain

Answer 32

PAG

Question 33

69 year old woman reports diminished sweating over left face with ptosis on the left and anisocoria with left pupil smaller than right. Left pupil doesn’t dilate in dark. Where is the lesion?

A. Left medullary stroke
B Inflammation of left ciliary nerve
C Left internal carotid aneurysm
D Left optic neurtis
E Neoplasm in apex of left lung

Answer 33

E