Lecture 52: ANS Flashcards Preview

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Flashcards in Lecture 52: ANS Deck (38):
1

Central autonomic network: cortical

Insular, amygdala, anterior cingulate (goal-directed behavior)

2

Central autonomic network: subcortical

Hypothalamus/pre-optic area, brainstem nuclei

3

Central autonomic network: brainstem

AFFERENT: nucleus of solitary tract (visceral afferents/medullary reflexes); EFFERENT: ventrolateral medulla (nucleus ambiguus, dorsal motor nucleus of vagus)

4

Sympathetic chain ganglia runs through what levels?

T1 - L3

5

Parasympathetic outflow is divided into what two regions?

Cranial (vagus) and sacral (pelvic/distal GI)

6

Sympathetics of the eye: general description of tract

From midbrain--> exit in upper thoracic --> rise with chain ganglia --> carotid plexus --> lesser ciliary nerve

7

Parasympathetic control of the eye travel with which CN? Nucleus?

III; Edinger-Westphal

8

Horner's syndrome: lesion, symptoms (3), classical lesions (2)

Lesion of sympathetic innervation; mild ptosis, meiosis, anhidrosis; lesion of apex of lung (Pancoast tumror) or dissection of carotid artery

9

CN III Palsy symptoms (3)

Down and out, ptosis, mydriais

10

ANS control of blood pressure regulates slow/rapid changes

Rapid (response to changes in position)

11

Afferent BP signal (receptors, nerves, nucleus)

Baroreceptors and chemoreceptors; CN IX and X; solitary nucleus

12

Efferent BP signal (para and sympha)

Parasympathetic to heart via vagus and sympathetic to heart/arterioles

13

What are two symptoms of dysfunction of BP control?

Hypotension and syncope (brief)

14

Where is body temperature regulated?

Preoptic area and anterior hypothalamus

15

Sweating is under para/sympa control? What are these nerves called? Special fact about them?

Sympathetic control; sudomotor fibers; terminal NT is ACh

16

Two disorders of sweating

Hyperhidrosis and hypohidrpsis

17

Which sweating disorder is related to lesions/neurodegenerative disorders?

Hypohidrosis

18

Pelvic innervation (level/type of innervation)

F

19

Overflow incontinence

Atonic bladder: bladder fails to empty

20

What is the most common cause of overflow incontnence

Outflow obstruction

21

Neurological causes of overflow incontinence

Most common: small fiber neuropathy (diabetes); cauda equina/conus medullaris; mononeuropathies

22

Detrusor hyperreflexia

Spastic bladder: bladder contracts when not trying to urinate

23

Detrusor dyssnergia

Contraction of sphincter is not coordinated with that of the detrusor due to disconnection from pontine center

24

What is a first-line test for ANS function?

Continuous BP/HR/respiration monitoring

25

What are the provocative maneuvers to test ANS function?

Tilt table, sinus arrhythmia, valsalva maneuver

26

Describe tilt table and normal findings

Patients go from lying down --> 70 degrees to test BP; HR and BP does not change upon tilt

27

Describe sinus arrhythmia

Test HR variability as we breathe in and out

28

Describe the Valsalva maneuver and normal findings

Monitors BP response to during continued expiration; BP should initially increase (due to force of breathing), decrease (due to decreased venous return because of increased thoracic pressure), then recover (due to vasoconstriction and HR increase), then drop (due to end of exhale), then increase (due to compensatory mechanisms described above), then return to normal

29

How do we test sweating (name of two tests, descriptions)?

1. Thermoregulatory sweat test: cover body in powder that changes color during sweating and place in hot box; 2. Quantitative Sudomotor Axon Reflex: give sweat gland ACh and see if they respond by sweating

30

Approach to syncope: 3 realms of differential

1. Cardiac; 2. Neurodegenerative (central vs peripheral); 3. "Benign" (vasovagal, POTS)

31

When orthostatic hypotension is caused by a neuro problem, what is this problem? HR/MAP tilt signs?

Neurodegenerative; increase in HR, decrease in MAP

32

Vasovagal syncope is what? What brings it on and what are the HR/MAP tilt signs?

"Common faint," brought on by sudden increase in vagal tone, bradycardia and hypotension

33

Postural orthostatic tachycardia syndrome (POTS) HR/MAP tilt signs. What can this be associated with (3)?

Increase in HR, no change in MAP; post-viral, migraine, fibromyalgia

34

What Parkinson's disease has a large ANS component?

Multiple systems atrophy

35

What do we call the peripheral counterpart of ANS disorder? Name four causes for long-term neuropathy

Autonomic neuropathy; most common: DM, amyloid (uncommon), hereditary, connective tissue disease

36

Four causes of acute/subacute autonomic neuropathy

Toxic (chemotherapy), G-B, immune-mediated/post-viral, paraneoplastic

37

Steps of treatment for orthostatic intolerance

1. Review meds; 2. Life style factors: salt + water/stockings/head of bed/strength training; 3. Meds (to increase BP): florineft, midodrine, droxidropa

38

What medication can be helpful for POTS

Pyridostigmine (ACHE inhibitor)

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