Test 2 Info Flashcards
what are the general responsibilities of the cervical plexus?
motor to strap muscles
deeper neck muscles
phrenic n
skin of neck and chest
ANS: how many neurons are required to transmit a nerve impulse from the CNS?
2 (preganglionic and postganglionic)
PNS: how many neurons are required to transmit a nerve impulse from the CNS?
1
where do preganglionic cell bodies arise?
in CNS
where do postganglionic cell bodies arise?
outside CNS
are preganglionic fibers myelinated or unmyelinated?
myelinated
are postganglionic fibers myelinated or unmyelinated?
unmyelinated
what does the sympathetic nervous system innervate?
lungs (bronchodilation) heart (increase HR) BV walls (vasoconstriction- increase blood pressure) erector pilae sweat glands viscera dilator pupillae
also responsible for ejaculation
sympathetic NS: what are the relative lengths of the preganglionic and postganglionic fibers?
short preganglionic fiber, long postganglionic fiber
EXCEPT when passing thru and changing name to splanchnic
what does the parasympathetic NS innervate?
glands in head sphincter pupillae blood vessels heart lungs (bronchoconstriction) digestive tract bladder bowel "rest and digest"
parasympathetic NS: what are the relative lengths of the preganglionic and postganglionic fibers?
long preganglionic fiber and short postganglionic fiber
where do sympathetic cell bodies ORIGINATE?
intermediolateral grey portion of spinal cord (T1-L2)
what is the pathway through the sympathetic NS?
IMLG ventral root spinal nerve ventral rami white rami communicante sympathetic chain
is the white rami communicante preganglionic or postganglionic?
preganglionic
is the grey rami communicate preganglionic or postganglionic?
postganglionic
what are the 3 choices that could be made in the sympathetic NS?
- synapse AT THAT LEVEL in sympathetic chain ganglion and leave via grey rami
- synapse in NEARBY LEVEL in a sympathetic chain ganglion and leave via grey rami
- PASS THRU sympathetic chain (without synapsing) as splanchnic n. and synapse near target organ
is a splanchnic n preganglionic or postganglionic?
preganglionic
what is the ganglion impar and where is it?
where the paired ganglion unite, found at sacral level
sympathetic chains runs from __ to ___, and there are __ pairs of sympathetic ganglia
C1 to S4
22-23 pairs
what is the stellate ganglion?
where T1 ganglion blends with lower C ganglion – someone thought it looked like a star
greater splanchnic nn levels
T5-T9/10
lesser splanchnic nn levels
T10, T11
least splanchnic nn levels
T12
what do the lumbar splanchnic nerves arise from?
lumbar sympathetic ganglia (likely L1/L2)
** do not originate from the chain **
where do parasympathetic cell bodies originate?
cranio-sacral
CN 3, 7, 9, 10 + S2, S3, and S4
what parasympathetics does CN III control?
smooth muscle that constricts pupil and does lens accommodation
what parasympathetics does CN VII control?
secretion of tears and saliva
what parasympathetics does CN IX control?
secretion of saliva
what parasympathetics does CN X control?
heart
lungs (bronchi)
viscera (esophagus, smooth muscle and glands of trachea)
bowel, bladder
movements and glandular secretion of thoracic and proximal half of abdominal viscera
what parasympathetics does S2/S3/S4 control?
distal half of abdominal viscera (via PELVIC splanchnic n. – p for pelvic and parasympathetic)
bowel/ bladder (promote digestion)
erection (vasodilation)
what is acetylcholine (Ach) secreted by?
BOTH systems, preganglionic neurons (cholinergic)
almost all parasympathetic postganglionic fibers
what is noradrenaline secreted by?
almost all sympathetic postganglionic fibers
what controls ANS?
hypothalamus and solitary nucleus (receive afferent input) local reflexes (help with regulation of homeostasis)
what is the carotid sinus?
dilation of proximal part of internal carotid artery (right near bifurcation)
baroreceptor that reacts to changes in bp
what is the carotid sinus innervated by?
CN IX and X
if an increase in NP is sensed by the baroreceptors in the carotid sinus, what is the following process?
this afferent info (increase in BP) would be sent back to hypothalamus, where info would be integrated and then there is a response
ex: if you are exercising, this would be an appropriate response
if it is not an appropriate response, decrease sympathetic outflow and increase parasympathetic outflow
what is autonomic dysreflexia?
loss of supra spinal control (hypothalamus and solitary nucleus) of sympathetic NS and sacral segments (parasympathetic) of cord
uninhibited mass autonomic reflex response to noxious stimulus below level of injury
in what population is autonomic dysreflexia common?
pts with SCIs - especially cervical and high thoracic lesions (usually above T5/T6)
explain the vicious cycle of hypertension with autonomic dysreflexia
blood pressure elevates and the normal compensation method (decrease in sympathetics) cannot pass from higher centers thru level of lesion BUT message to slow the heart can travel through vagus n and cause bradycardia. way to solve dec HR is to inc BP, and cycle continues
s/s of autonomic dysreflexia
sympathetic below lesion and parasympathetic above lesion
pounding headache (bc of inc BP)
really high BP (>200/100)
slow pulse (<60bpm, symp)
flushing and sweating above lesion level (vasodilation)
pallor, goosebumps, cold clammy skin below level of lesion (vasoconstriction, symp)
nasal congestion (parasympathetic)
treatment for autonomic dysreflexia
alleviate noxious stimuli if possible
sit pt up to create orthostatic HTN
frequent bp checks
what medication should patients with frequent autonomic dysreflexia have, and what does it do?
atropine, decreases BP and increases HR
what medication should be used in emergent care for autonomic dysreflexia, and what does it do?
nitroglycerine, vasodilates
in what regions of the spinal cord is there a lordosis?
cervical and lumbar
in what regions of the spinal cord is there a kyphosis?
thoracic and sacral
how are cervical nerve roots named?
nerve root is ABOVE the vertebral it is named for (i.e., C1 nerve is above CV1)
how are nerve roots named at T1 and below?
nerve root exits BELOW vertebra it is named for (i.e., T1 nerve is below TV1)
what is the conus medullaris?
the termination of the spinal cord
what is the filum terminale internum?
tethered cord that prevents spinal cord from retracting or bouncing around
function of vertebral body
support
function of vertebral arch
protective (protects spinal cord)
made up of 2 pedicles and 2 laminas
function of vertebral foramen
houses spinal cord
function of intervertebral foramina
houses spinal nerves and vessels
pedicle
goes between transverse process and body
looks like tear drop on x ray film
lamina
goes between transverse process and spinous process
what structures form an intervertebral foramina?
inferior vertebral notch of vertebra above + superior vertebral notch of vertebra below
what structures form a facet joint?
inferior articulating process of vertebra above + superior articulating process of vertebra below
how many projections are there off the vertebral arch? (name them)
7 2 transverse processes 1 spinous process 2 SAP 2 IAP
distinguishing characteristics of cervical vertebrae
small, broad body (wider medial-lat than ant-post)
vertebral foramen is triangular
bifid spinous process
SAP faces posteriorly and up at 45 degrees
C1-C7 have transverse foramen
what do the transverse foramen house?
vertebral arteries
sympathetic nerves
venous plexus
what is an uncus (uncinate process) and where is it found?
found C3-C6 ONLY
prevents posterior translation of the vertebra
looks like little lip on lateral aspect of the body
at which levels does the vertebral artery travel?
CV1-CV6
cervical rotation: how is the movement split among vertebrae?
C1/C2 does 50% of rotational motion
C3-C7 does remaining 50%
characteristics of C1
no body - occupied by dens of C2
articulates with occiput
no true spinous process
has lateral masses
movements of C1
between occiput and atlas primarily glide/ chin tuck flex/ext 15 deg (small "yes" nod) sidebending 5 deg 0 deg rotation
characteristics of C2
called axis - think “axis of rotation”
distinguished by dens
small transverse processes
what holds the dens in place?
alar ligament and transverse ligament
movements btwn C1 and C2
40-45deg rotation (1/2 of cervical rotation)
0 deg sidebending
attachments of transverse ligament of atlas
C1 to C1
attachments of alar ligament
C2 to occiput
how might the dens fracture, and how would you figure it out?
flexion based accident or compression injury
open mouth x-ray
cervical myelopathy can occur due to…
pressure from herniated disc, bone spur, spinal stenosis, tumor, vertebral fracture
cervical myelopathy definition and its symptoms
compression of spinal cord s/s: neck pain numbness in both arms and hands muscle weakness in both legs balance disturbances incoordination of hands or feet
characteristics of thoracic vertebrae
- slightly larger in size
- have costal demifacets at junction of body and pedicles
- facets on transverses processes articulate with tubercle of ribs
- transverse and A-P dimension almost equal
- round vertebral foramen
- spinous process slants down and posterior (helps with protection)
- SAPs face posteriorly at 60 degree angle
what is a demifacet?
half a facet; found in thoracic vertebrae
orientation of SAPs throughout the spine
cervical: 45 degrees, posterior and up
thoracic: 60 degrees, posterior and up
lumbar: almost vertical (SAP faces medially and posteriorly)
what does a rib articulate with?
inferior costal facet of vertebra above
superior costal facet of vertebra below
transverse costal facet of vertebra below
rib is named for the level of…
superior costal facet and transverse costal facet