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CPR Midterm > CPR Thoracic Neurology > Flashcards

CPR Thoracic Neurology Flashcards

1
Q

What is the role of the esophagus?

What is it composed of?

A

joins the laryngopharynx to the stomach

2 layer muscle tube (internal circular layer & external longitudinal layer)

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2
Q

Where is the esophagus located in the thorax?

A

between T1 & esophageal hiatus

travels thru posterior mediastinum

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3
Q

Name the constrictors of the esophagus

A

@ cricopharyngeus m (upper esophageal sphincter)

@ aortic arch

@ left bronchus

@ esophageal hiatus of thoracic diaphragm (lower esophageal sphincter)

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4
Q

Which CN is associated w/ thorax?

Where does it enter?

A

vagus N (R & L)

enters thru superior thoracic aperture

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5
Q

What are the branches of the vagus N in the thorax?

A

L recurrent laryngeal N

pulmonary branches

sup/middle/inferior cardiac branches

esophageal branches

anterior vagal trunk

posterior vagal trunk

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6
Q

Anterior v Posterior vagal trunks

A

anterior from L vagus N

posterior from R vagus N

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7
Q

What cervical spinal N is assoc w/ the thorax?

A

phrenic N (anterior rami of C3-5)

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8
Q

Where does the phrenic N travel?

A

thru superior thoracic aperature into space btwn mediastinal parietal pleura & fibrous pericardium

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9
Q

What does the phrenic N innervate?

A

thoracic diaphragm

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10
Q

What do the intercostal Ns innervate?

A

skin, subcutaneous tissue, muscles, and costal & diaphragmatic parietal pleura

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11
Q

What composes the intercostal Ns?

Where do they run?

A

anterior rami of thoracic spinal Ns

along inf edge of superior rib in the intercostal space btwn internal & innermost intercostal ms

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12
Q

What are the typical intercostal Ns?

A

3rd-6th intercostal Ns

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13
Q

Which intercostal Ns supply the breast?

A

lateral cutaneous branches & anterior cutaneous branches of T4-T6

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14
Q

What do the collateral branches of intercostal Ns 3-6 innervate?

Where do the collateral branches travel?

A

innervate intercostal ms

along sup edge of rib inf to intercostal space

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15
Q

What do the muscular branches of intercostal Ns 3-6 innervate?

A

intercostal ms
subcostal m
transversus thoracic m

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16
Q

What are the atypical intercostal Ns?

A

1st & 2nd, 7th-11th

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17
Q

What do the rami communicates of intercostal Ns 3-6 do?

A

connected intercostal N to ipsilateral sympathetic trunk

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18
Q

What makes the 1st intercostal N atypical?

A

no cutaneous branches & majority superior portion joins brachial plexus

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19
Q

What makes the 2nd intercostal N atypical?

A

majority travels in costal groove w/ small part joining w/ brachial plexus

lateral cutaneous branch supplies skin/tissue of axilla (intercostobrachial N)

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20
Q

Where does the intercostobrachial N originate?

A

2nd intercostal N

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21
Q

What makes the 7th-11th intercostal Ns atypical?

A

travel anteriorly & no longer exist btwn ribs

transition over abdomen to become thoracoadominal N

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22
Q

What are the general principles of the autonomic nervous system (ANS)?

A

sympathetic stimulation is catabolic (fight or flight)

parasympathetic stimulation is anabolic (normal function & energy conservation)

parasympathetic is only in head/neck & trunk viscera while sympathetic distributes to every vascular area of body

parasympathetic controls gland secretion (except sweat glands)

sympathetic can indirectly decrease non-sweat gland secretion via vasoconstriction

vasoconstriction is sympathetically stimulation (except of coronary As)

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23
Q

Where does sympathetic division of ANS arise from?

A

presynaptic fibers have cell bodies in lateral horn of spinal cord from T1-L2

24
Q

Presynaptic fibers of sympathetic

A

cells bodies in lateral horn of SC

always travel in anterior root

always travel into anterior ramus

quickly exit anterior ramus & enter paravertebral ganglia

25
Q

What are the 3 synaptic options for sympathetic presynaptic fibers?

A

synapse @ paravertebral ganglion of same SC level

ascend/descend to synapse @ paravertebral ganglion of different SC level

exit paravertebral ganglion w/o synapsing & continue with abdominopelvic splanchnic nerve to a postsynaptic neuron in PREvertebral ganglion

26
Q

Describe the paravertebral ganglia

A

contain postsynaptic cell bodies

linked vertically to form sympathetic trunks

3 ganglia exist in cervical, lumbar & pelvic regions

27
Q

Describe the prevertebral ganglia

A

contain postsynaptic cell bodies

ganglia & corresponding plexuses surrounding the main unpaired branches of abdominal aorta

28
Q

What are the 4 prevertebral ganglia?

A

celiac ganglion
superior mesenteric ganglion
aorticorenal ganglion
inferior mesenteric ganglion

29
Q

Describe the sympathetic presence in the thorax

A

thoracic sympathetic trunk
cardiopulmonary splanchnic Ns
abdominopelvic splanchnic Ns

30
Q

What is the thoracic sympathetic trunk?

A

paravertebral sympathetic ganglia

location of short presynaptic sympathetic fibers synapses w/ long postsynaptic cell bodies

31
Q

Where are the presynaptic cell bodies of the cardiac splanchnic Ns?

where do these Ns synapse & send info?

A

pre cell bodies are in lateral horn of SC @ T1-T5/6

synapse @ postsynaptic cell bodies in cervical & thoracic sympathetic trunks (sending fibers to superficial & deep cardiac plexuses)

32
Q

Where are the presynaptic cell bodies of the pulmonary splanchnic Ns?

where do they synapse & send info?

A

pre cell bodies in lateral horn of SC @ T2-3

synapse on postsynaptic cell bodies in thoracic sympathetic trunk (sending fibers to pulmonary plexus)

33
Q

What are the 3 divisions of abdominopelvic splanchnic Ns?

A

Greater Splanchnic N
Lesser Splanchnic N
Least Splanchnic N

34
Q

Greater Splanchnic N

A

T5-T9/10

send fibers to esophageal plexus & celiac ganglion in abdomen

feeds into celiac plexus

35
Q

Lesser Splanchnic N

A

T10 & T11

send fibers to celiac & superior mesenteric ganglion in abdomen

feeds into superior mesenteric plexus

36
Q

Least Splanchnic N

A

T12

sends fibers to aorticorenal ganglion in abdomen

37
Q

What nerves make up the parasympathetic nervous system?

A

cranial components exit as CN III, VII, IX, X

sacral components exit spinal levels as pelvic splanchnic Ns (S2-4)

38
Q

Where are the nuclei of parasympathetic NS?

A

nuclei in brainstem & sacral spinal levels

39
Q

Where are the postsynaptic nuclei of the parasympathetic NS?

A

4 cranial ganglia or in wall of target organ (intrinsic parasympathetic ganglia)

40
Q

What are the 4 cranial ganglia receiving parasympathetic stimulation?

A 
Ciliary ganglion (CN III)
Pterygopalatine ganglion (CN VII)
Submandibular Ganglion (CN VII)
Otic Ganglion (CN IX)
41
Q

Parasympathetic present in thorax

A

vagus N

42
Q

What does the vagus N provide innervation to in the thorax?

A

presynaptic innervation of lungs, bronchi, pleurae, heart & pericardium

43
Q

What forms the cardiac plexus?

A

superior, middle & inferior cardiac branches of vaus N (paraysympathetic)

travel w/ cardiac splanchnic Ns (sympathetic)

44
Q

What forms the pulmonary plexus?

A

pulmonary branches of vagus N (parasympathetic) traveling w/ pulmonary splanchnic Ns (sympathetic)

45
Q

What forms the esophageal plexus?

A

parasympathetic from esophageal branches of vagus N (covers inf 2/3 of esophagus)

sympathetic from greater splanchnic N & aortic plexus

46
Q

What are the thoracic autonomic plexuses?

A

Pulmonary plexus
Cardiac plexus
Aortic plexus
Esophageal plexus

47
Q

What are the sympathetic functions of the pulmonary plexus?

A

dilate bronchi & bronchioles
inhibits glands of bronchi & bronchioles
constricts pulmonary vessels
visceral sensory from lungs/bronchi/pleurae

48
Q

What are the parasympathetic functions of the pulmonary plexus?

A

constrict bronchi & bronchioles
increases gland secretion of bronchi & bronchioles
dilator of pulmonary vessels
sensory from bronchial mucosa (cough reflex)
reflex of interalveolar CT
pressure sensory from pulmonary A
chemoreceptor from pumonary V

49
Q

Where do the postsynaptic fibers of the cardiac plexus terminate?

A

near SA & AV nodes

50
Q

What are the sympathetic functions of the cardiac plexus?

A

increase HR via innervation of nodal tissue
increase force of heart contractions
vasomotor to pericardium

51
Q

What are the parasympathetic functions of the cardiac plexus?

A

decrease HR
reduces force of heart contraction
vasoconstrics coronary arteries

52
Q

Where is the superficial cardiac plexus?

Where is the deep cardiac plexus?

A

covers anterior surface of aorta

anterior to bifurcation of trachea, posterior to aortic arch & superior to bifurcation of pulmonary trunk

53
Q

What is the aortic plexus?

A

continuous superiorly w/ superficial cardiac plexus & continues inferiorly as arotic plexus in abdomen

54
Q

Where does the aortic plexus feed?

A

intermesenteric plexus

55
Q

What are the sympathetic functions of the esophageal plexus?

A

inhibit peristalsis

inhibits esophageal glands

56
Q

What are the parasympathetic functions of the esophageal plexus?

A

stimulates peristalsis

stimulates esophageal glands

CPR Midterm (20 decks)

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