Unit VII: Sympathetics

Question 1

General course of pre-ganglionic sympathetic neurons Pg 267

Answer 1

Lateral horn T1-L2 or L3 -> anterior rootlets -> anterior primary ramus -> enter sympathetic trunk via white ramus communicans -> some synapse on post-ganglionic cells in the trunk, some pass through in splanchnic nerves to synapse in prevertebral plexuses

Question 2

Sympathetic are classical _____ (cholinergic or adrenergic) Pg 267

Answer 2

Adrenergic

Question 3

Sympathetic fibers release what? Pg 267

Answer 3

Acetylcholine

Question 4

Where does the sympathetic trunk extend from? Pg 267

Answer 4

Superior cervical ganglion inferior to ganglion impar

Question 5

How many ganglion in each sympathetic trunk? Pg 267

Answer 5

21 or 22 (2-3 cervical, 11 thoracic, 4 lumbar, and 4 sacral)

Question 6

Location of the sympathetic trunk Pg 267

Answer 6

Posterior to the carotid sheath in the cervical area, anterior to the necks of the ribs in the upper thoracic area, more medial resting on the lateral aspects of the vertebral bodies in the lower thoracic and lumbar areas, anterior aspect of the sacrum, and joining at the ganglion impar at the coccyx

Question 7

Where does the cervical sympathetic trunk and ganglion lie? pg 267

Answer 7

Between the carotid sheath and the longus colli and longus capitis muscles

Question 8

Does the cervical sympathetic trunk and ganglion have white rami communicans? Pg 267

Answer 8

NO

Question 9

Does the cervical sympathetic trunk and ganglion have gray rami communicans? Pg 267

Answer 9

Yes, one to each cervical nerve

Question 10

How many cervical ganglion are there and what are their names? Pg 268

Answer 10

3; superior, middle, and inferior cervical ganglion

Question 11

The inferior cervical ganglion may fuse with the first thoracic ganglion to form what ganglion? Pg 268

Answer 11

Stellate

Question 12

Which cervical ganglion is the largest? Pg 268

Answer 12

Superior

Question 13

What forms the superior cervical ganglion? Pg 268

Answer 13

Union of upper four cervical ganglion

Question 14

Where is the superior cervical ganglion located? Pg 268

Answer 14

C2-C3, between carotid sheath and longus capitis muscle

Question 15

How are post-ganglion fibers distributed from the superior cervical ganglion? Pg 268

Answer 15

Anterior, medial, and lateral branches

Question 16

What do the lateral branches from the superior cervical ganglion communicate with? Pg 268

Answer 16

Anterior primary rami of C1-4 as well as come cranial nerves (IX, X, XII)

Question 17

Which branch off the superior cervical ganglion is the gray ramus communicans? Pg 268

Answer 17

Lateral

Question 18

Where do the medial branches off the superior cervical ganglion travel? Pg 268

Answer 18

Larynx, pharynx and the heart

Question 19

What are branches to the heart from the medial branches off the superior cervical ganglion called? Pg 268

Answer 19

Superior cardiac nerves

Question 20

What kind of information is carried in superior cardiac nerves? Pg 268

Answer 20

Efferent information only

Question 21

Where do the anterior branches off the superior cervical ganglion travel? Pg 268

Answer 21

Follow the common and external carotid arteries, innervating blood vessels that supply structures inside and outside the skull

Question 22

Which cervical ganglion is the smallest? Pg 268

Answer 22

Middle

Question 23

Where is the middle cervical ganglion located? Pg 268

Answer 23

C6

Question 24

Middle cervical ganglion communicates with anterior primary rami of C5 and C6 nerves via what? Pg 268

Answer 24

Gray rami communicans

Question 25

Which branch of the middle cervical ganglion reaches the thyroid and parathyroid glands? Pg 268

Answer 25

Thyroid branches

Question 26

Cardiac branches from the middles cervical ganglion travel to the heart as what nerves? Pg 268

Answer 26

Middle cardiac nerves

Question 27

What % of the time does the inferior cervical ganglion fuse with the first thoracic ganglion? Pg 270

Answer 27

80%

Question 28

Where is the inferior cervical ganglion located? Pg 270

Answer 28

Level of C7 transverse and neck of first rib

Question 29

Inferior cervical ganglion communicates with anterior primary rami of C7 and C8 nerves via what? Pg 270

Answer 29

Gray rami communicans

Question 30

Cardiac branches from the inferior cervical ganglion travel to the heart as what nerves? Pg 270

Answer 30

Inferior cardiac nerves

Question 31

Where do the branches from the inferior cervical ganglion travel? Pg 270

Answer 31

Subclavian artery and form plexuses around it and its branches ie. axillary and vertebral arteries

Question 32

How many thoracic ganglion are there? Pg 270

Answer 32

11-12

Question 33

Do all thoracic nerves have white rami communicans, gray rami communicans, or both? Pg 270

Answer 33

Both

Question 34

Where are thoracic ganglion located in the superior thorax? Pg 270

Answer 34

Anterior to the rib heads

Question 35

Were are thoracic ganglion located in the inferior thorax? Pg 270

Answer 35

Lateral aspects of the vertebral bodies

Question 36

What do branches from the upper 5 thoracic ganglion supply? Pg 270

Answer 36

Structures in the thoracic cavity

Question 37

What kind of information is carried in branches from the upper 5 thoracic ganglion? Pg 270

Answer 37

Post-ganglionic sympathetic fibers and visceral afferents

Question 38

How many splanchnic nerves are associated with the lower 7 segments of the thoracic sympathetic trunk? Pg 270

Answer 38

3

Question 39

What are the names of the 3 splanchnic nerves associated with the lower 7 segments of the thoracic sympathetic trunk Pg 270

Answer 39

1) greater splanchnic 2) lesser splanchnic 3) least splanchnic

Question 40

Path of the greater splanchnic nerve Pg 270

Answer 40

Formed from the 5th-9th ganglion, terminates in the celiac ganglion

Question 41

Path of the lesser splanchnic nerve Pg 270

Answer 41

Formed from 9th and 10th or 10th and 11th ganglion, terminates in the aorticorenal ganglion

Question 42

Path of the least splanchnic nerve Pg 270

Answer 42

Formed from the 12th ganglion, terminates in the renal plexus

Question 43

Where is the lumbar sympathetic trunk located? Pg 271

Answer 43

Retroperitoneal space, on the lateral aspects of the lumbar vertebral bodies

Question 44

How many lumbar ganglion are there? Pg 271

Answer 44

4

Question 45

Which lumbar nerves have white rami communicans? Pg 271

Answer 45

The first 2 sometimes the 3rd

Question 46

Which lumbar nerves have gray rami communicans? Pg 271

Answer 46

ALL

Question 47

How many splanchnic nerves are associated with the lumbar sympathetic trunk? Pg 271

Answer 47

2-4

Question 48

Splanchnic nerves associated with the lumbar sympathetic trunk carry what kind of information where? Pg 271

Answer 48

Pre-ganglionic sympathetic to the plexus surrounding the abdominal aorta

Question 49

Where is the sacral sympathetic trunk located? Pg 271

Answer 49

Anterior aspects of the sacrum, medial to the anterior sacral foramina

Question 50

How many sacral ganglion are there? Pg 271

Answer 50

4-5

Question 51

Which sacral nerves have white rami communicans? Pg 271

Answer 51

NONE

Question 52

Which lumbar nerves have gray rami communicans? Pg 271

Answer 52

All

Question 53

Where do the sympathetic trunks converge? Pg 271

Answer 53

Anterior surface of the coccyx (ganglion impar)

Question 54

Preganglionic axons travel from __-__ cord levels to enter the sympathetic trunk Pg 271

Answer 54

T1-L2(L3)

Question 55

Preganglionic axons that influence the head and neck are carried in what nerves and synapse where? Pg 271

Answer 55

T1-T2 nerves, superior cervical ganglion

Question 56

Preganglionic axons that influence the heart are carried in what nerves and synapse where? Pg 271

Answer 56

T1-T4 nerves, one of the three cervical ganglion

Question 57

Preganglionic axons that influence the lungs are carried in what nerves and synapse where? Pg 272

Answer 57

T2-T4 nerves, 2nd, 3rd, and 4th thoracic ganglia

Question 58

Preganglionic axons that influence the upper extremities are carried in what nerves and synapse where? Pg 272

Answer 58

T3-T7, middle cervical and inferior cervical/stellate ganglia

Question 59

Preganglionic axons that influence the abdominal viscera are carried in what nerves and synapse where? Pg 272

Answer 59

T5-T12, lower thoracic ganglion (may also pass through to be carried by the greater, lesser, least splenic nerves)

Question 60

Preganglionic axons that influence the pelvic viscera are carried in what nerves and synapse where? Pg 272

Answer 60

T10-L2, lower thoracic, lumbar, and pelvic ganglia

Question 61

Preganglionic axons that influence the lower extremities are carried in what nerves and synapse where? Pg 272

Answer 61

T10-L2, 2nd-4th sacral ganglion

Question 62

Fibers are carried from the sympathetic trunk in what 3 ways? Pg 272

Answer 62

1) nerves 2) blood vessels 3) direct branches

Question 63

What do fibers of the greater splanchnic nerve supply? Pg 275

Answer 63

The esophagus and thoracic aorta above the diaphragm, fibers also transmitted through the celiac plexus to much of the abdominal viscera

Question 64

What do fibers of the lesser splanchnic nerve supply? Pg 275

Answer 64

The same abdominal structures as the greater splanchnic nerve with the addition of suprarenal glands

Question 65

What do fibers of the least splanchnic nerve supply? Pg 275

Answer 65

Kidneys through the renal plexus