Autonomics and Neurogenic Bladder Flashcards

1
Q

The intermediolateral cell column is found at what spinal levels?

A

T1-L2

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2
Q

The rostral ventrolateral medulla is associated with what reflex?

A

Baroreceptor reflex (and maintenance of BP)

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3
Q

What fibers are transmitted through the white rami communicantes?

A

Preganglionic sympathetic fibers

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4
Q

What ganglion is the main distribution center for sympathetic fibers of the head? What level?

A

Superior cervical ganglion (C4)

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5
Q

How do the post-ganglionic sympathetic fibers leave the sympathetic trunk?

A

Via grey rami communicantes => Cephalic arterial ramus => Periarterial plexus on the carotid arteries

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6
Q

What cranial nerves do the parasympathetic outputs travel in?

A

III - oculomotor

VII - Facial

IX - Glossopharyngeal

X - Vagus

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7
Q

What nucleus is involved with accommodation of the pupil? Cranial nerve? Where is it found?

A

Edinger-Westphal (PNS, CN II and III)

Found in the midbrain

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8
Q

What nucleus is involved with activation of lacrimal, submandibular, and sphenopalatine glands? What cranial nerve is it associated with? Where is it found?

A

Superior salivatory nucleus (CN VII)

Pons

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9
Q

What nucleus is involved with innervation of the parotid duct? What cranial nerve? Where is it found?

A

Inferior salivatory nucleus (CN IX)

Medulla

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10
Q

What nucleus is involved with outputs to visceral organs? What nucleus? Where is it found?

A

Dorsal nucleus of vagal nerve (CN X)

Medulla

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11
Q

What happens to the light reflex if CN II is lesioned?

A

No pupillary constriction or consensual response when light shined in affected eye

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12
Q

What happens to the pupillary light reflex if CN III is lesioned?

A

Affected eye has a large, dilated pupil that does not respond to direct light and does not produce a consensual response

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13
Q

Where do fibers from the superior salivatory nucleus synapse?

A

Sphenopalatine ganglion => lacrimal gland

Submandibular ganglion => submandibular and sublingual glands

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14
Q

Where do fibers from the inferior salivatory nucleus synapse?

A

Otic ganglion => parotid gland

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15
Q

Horner syndrome that has been caused by a preganglionic lesion has been damaged where?

A

Sympathetic chain (May have Pancoast tumor at apex of lung)

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16
Q

Horner syndrome that has been caused by a postganglionic lesion has been damaged where?

A

Internal carotid artery dissection (cavernous sinus)

17
Q

Horner syndrome with normal facial swelling, no pupil dilation in response to release of NE, and an exaggerated pupil dilation in response to E has been lesioned where?

A

Post-ganglionic fibers

18
Q

Horner syndrome that has been lesioned in CNS or pre-ganglionic fibers will have what response to epinephrine and norepinephrine?

A

NE - Pupil dilation

E - No pupil dilation

(also no sweating)

19
Q

Where are the baroreceptors mainly found in the body? What do they respond to?

A

Carotid sinus (CN IX) - Increase AND decrease in BP

Aortic arch (CN X) - only increases in BP

20
Q

What is the effect of the nucleus ambiguus on sympathetic motor activity? What is its overall effect on BP?

A

Inhibits sympathetic activity => Vasodilation of blood vessels => Lower BP

21
Q

How is the valsalva maneuver work with baroreceptor reflex?

A

Valsalva => Increased intrathoracic pressure => less venous return to heart => decreased HR => syncope

22
Q

When is carotid massage appropriate?

A

Evaluation of SVTs

Massage baroreceptors can stimulate vagal inhibition of the heart

23
Q

What is the main consequence of baroreflex afferent failure?

A

Fluctuationg hypertension

24
Q

What is the main consequence of baroreflex efferent failure?

A

Orthostatic hypotension

25
Q

What nerve fibers are involved in preventing urinary incontinence? What levels? What is their action on the detrusor M. and Internal urethral sphincter?

A

Lumbar Sympathetics (T12-L2), sacral splanchnic N/hypogastric N.

Relax detrusor

Contract internal urethral

(don’t want to pee during the test)

26
Q

What nerve fibers are involved in voiding the bladder? From what levels? What is their action on the detrusor M. and the internal urethral sphincter?

A

Sacral parasympathetics (S2-4), pelvic splanchnic Ns.

Contract detrusor m.

Relax internal urethral sphincter

27
Q

In the micturition reflex, where are the excitatory and inhibitory signals sent?

A

Excitatory => Sacral parasympathetic nucleus

Inhibitory => Onuf nucleus

28
Q

What cortex is involved in voluntary inhibition of the micturition reflex?

A

Medial frontal cortex

29
Q

Uninhibited neurogenic bladder is caused by a lesion where?

A

Medial frontal cortex => unable to inhibit pontine micturition center

(seen in elderly, w/ parkinson’s, hydrocephalus, dementia, meningioma)

30
Q

Lesion between the pontine micturition center and the sacral spinal cord will cause what type of neurogenic bladder?

A

Spastic bladder - lack of coordination b/w detrusor and sphincter

(occurs in trauma or multiple sclerosis)

31
Q

Spastic bladder has what effect on bladder volume, intravesicular pressure, and retention?

A

Decreased bladder volume

Increased intravesicular pressure => hypertrophy of bladder wall => volume reduction

Urinary retention occurs in late phase

32
Q

Where is the lesion in a flaccid neurogenic bladder?

A

Sacral spinal cord/Cauda equina/Conus medullaris

33
Q

What happens to bladder volume, intravesicular pressure, retention, and anal reflex?

A

Increased bladder volume

Decreased intravesicular pressure

Urinary retention

Absent anal reflex and perianal anesthesia