Autonomics and Neurogenic Bladder

Question 1

The intermediolateral cell column is found at what spinal levels?

Answer 1

T1-L2

Question 2

The rostral ventrolateral medulla is associated with what reflex?

Answer 2

Baroreceptor reflex (and maintenance of BP)

Question 3

What fibers are transmitted through the white rami communicantes?

Answer 3

Preganglionic sympathetic fibers

Question 4

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

Answer 4

Superior cervical ganglion (C4)

Question 5

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

Answer 5

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

Question 6

What cranial nerves do the parasympathetic outputs travel in?

Answer 6

III - oculomotor

VII - Facial

IX - Glossopharyngeal

X - Vagus

Question 7

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

Answer 7

Edinger-Westphal (PNS, CN II and III)

Found in the midbrain

Question 8

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

Answer 8

Superior salivatory nucleus (CN VII)

Pons

Question 9

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

Answer 9

Inferior salivatory nucleus (CN IX)

Medulla

Question 10

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

Answer 10

Dorsal nucleus of vagal nerve (CN X)

Medulla

Question 11

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

Answer 11

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

Question 12

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

Answer 12

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

Question 13

Where do fibers from the superior salivatory nucleus synapse?

Answer 13

Sphenopalatine ganglion => lacrimal gland

Submandibular ganglion => submandibular and sublingual glands

Question 14

Where do fibers from the inferior salivatory nucleus synapse?

Answer 14

Otic ganglion => parotid gland

Question 15

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

Answer 15

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

Question 16

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

Answer 16

Internal carotid artery dissection (cavernous sinus)

Question 17

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?

Answer 17

Post-ganglionic fibers

Question 18

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

Answer 18

NE - Pupil dilation

E - No pupil dilation

(also no sweating)

Question 19

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

Answer 19

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

Aortic arch (CN X) - only increases in BP

Question 20

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

Answer 20

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

Question 21

How is the valsalva maneuver work with baroreceptor reflex?

Answer 21

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

Question 22

When is carotid massage appropriate?

Answer 22

Evaluation of SVTs

Massage baroreceptors can stimulate vagal inhibition of the heart

Question 23

What is the main consequence of baroreflex afferent failure?

Answer 23

Fluctuationg hypertension

Question 24

What is the main consequence of baroreflex efferent failure?

Answer 24

Orthostatic hypotension

Question 25

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

Answer 25

Lumbar **Sympathetics** (T12-L2), sacral splanchnic N/hypogastric N. Relax detrusor **Contract internal urethral** (don't want to pee during the test)

Question 26

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?

Answer 26

Sacral parasympathetics (S2-4), pelvic splanchnic Ns. Contract detrusor m. Relax internal urethral sphincter

Question 27

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

Answer 27

Excitatory =\> Sacral parasympathetic nucleus Inhibitory =\> Onuf nucleus

Question 28

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

Answer 28

Medial frontal cortex

Question 29

Uninhibited neurogenic bladder is caused by a lesion where?

Answer 29

Medial frontal cortex =\> unable to inhibit pontine micturition center (seen in elderly, w/ parkinson's, hydrocephalus, dementia, meningioma)

Question 30

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

Answer 30

Spastic bladder - lack of coordination b/w detrusor and sphincter (occurs in trauma or multiple sclerosis)

Question 31

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

Answer 31

Decreased bladder volume Increased intravesicular pressure =\> hypertrophy of bladder wall =\> volume reduction Urinary retention occurs in late phase

Question 32

Where is the lesion in a flaccid neurogenic bladder?

Answer 32

Sacral spinal cord/Cauda equina/Conus medullaris

Question 33

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

Answer 33

Increased bladder volume Decreased intravesicular pressure Urinary retention Absent anal reflex and perianal anesthesia