Autonomic Nervous System Flashcards
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.
- What is your diagnosis?
a. Frey’s syndrome
b. Bell’s palsy
c. Raynaud’s disease
d. Wallenberg’s syndrome
e. Horner’s syndrome - 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
1-E
2-D
3 functions of the ANS
- homeostasis
- emergency response
- reproduction
Norepinephrine is the post-ganglionic neurotransmitter for the symapathetic nervous system, what is the exception?
Sweat glands and vasodilator fibers respond to Ach
Which division of the autonomic nervous system has more divergence?
Sympathetic 1:10 vs 1:3
Which thoracic levels are for sympatetic outflow
T1-L2
Pathway for pupil constriction
EW Nucelus on CN III through ciliary ganglia
Pathway for lacrimation, and sublingual and mandibular glands?
Superior Salivatory Nucleus on CN VII through pterygopalatine and submandibular glands
Pathway to the parotid gland?
inferior salivary nucleus, CN IX, otic ganglia
Pathway to smooth muscle of GI tract and glands?
Dorsal Motor Nucelus via CN X to myenteric and submucosal ganglia
What is the explanation for vasovagal syncope?
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
Where are stretch receptors located?
carotid sinus and aortic arch
Which cranial nerves relay pressure sensed by the baroreceptors?
glossopharyngeal (IX) and vagus (X)
Where does processing of blood pressure occur?
Nucleus Solitarius
4 Characterisitics of Horner’s Syndrome?
Ptosis, Miosis, Anhidrosis, Enopthalmos(sunken eye)- loss of sympathetic innervation of dilator pupillae, superior tarsal m, and facial sweat glands)
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?
Lateral Medullary Syndrom- Wallenberg- on the right side
Injury at which spinal cord level leads to sympathetic hyperreflexia?
T5/6 and above
What occurs in sympathetic hyperreflexia?
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
What plexus innervates the detrusor muscle for contractions?
S2-4, pelvic splanchnic, inferior hypogastric plexus
What controls the internal urethral sphincter?
Sympathetic lumbar splanchnic nerves- storage
What controls the external urethral sphincter
parasympathetic lumbar splanchnic -pee
What is the disease with congenital absence of the myenteric plexus
Hirshprungs disease
Which spinal level is involved in orthostatic hypotension?
T6- splanchnic circulation
Which spinal level do upper motor bladder/bowel nerves synapse onto? Where are the lower motor neurons?
S1, conus
Which has more control over the other PNS or SNS?
PNS modulates SNS especially for bladder and heart
Which areas are only innervated by the SNS?
vessels and sweat glands
Which is faster reponse PNS or SNS?
PNS 1 sec SNS several seconds.
Which areas deal with coordination of a threat, chief external environment operating officer?
PAG
What is the 3 neuron pathway to the dilator pupillae
- Descending hypothalmic fibers to T1/T2 interomediolateral cell column
- Preganglionic to Superior Cervical Ganglia
- SCG to dilator pupillae
What can lead to Horner’s Syndrom?
Lateral Medullary Syndrome (wallenberg)
pancoast tumor
carotid dissection
What areas provide input to PAG about threats?
insula (bean counter), amygdala (urgency) ventro-medial prefrontal cortex
visceral and pain afferents
Where is a controllable threat vs non-controllable located in the PAG?
noncontrollable ventral
Where can you stimulate for decreased pain
PAG
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
E
