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Which organs receive only sympathetic innervation?
- 1) sweat glands
- 2) piloerector muscles
- 3) most small blood vessels (well technically not organs).
What is the organization of the PNS and SNS?
- - cell bodies in the brain stem or spinal cord
- - efferent axons leave these cell bodies and synapse on ganglia-->axons from these second order neurons then synapse on the target organ. (except the adrenal medulla).
How is the adrenal medulla innervated?
directly by SNS preganglionic fibers.
Where are the SNS cell bodies located?
intermediolateral cell column of the spinal cord from T1 to L2 (thoracolumbar system).
Where are the cell bodies for the PNS?
CN nuclei 3,7,9 and 10 and the IML cell column at S2-S4 (craniosacral system).
CN 3 has ganglion _____ and is destined for the _______ and _______
ciliary; ciliary muscle and sphincter pupillae
CN VII _____ganglion with destination of ____ and ______ganglion with destination of ______ and _____
sphenopalatine; lacrimal gland
submandibular; submandibular and sublingual glands
CN IX has _______ ganglion with destination ______
otic; parotid gland
CN X ______ ganglion with destination ____, ____, ____, ____, ____
multiple; heart, larynx, trachea, lungs, GI tract.
What is the neurotransmitter for all preganglionic fibers in the autonomic nervous system?
THE SNS postganglionic fibers except for the sudomotor fibers use ____as the neurotransmitter.
Which nervous system is responsible for urine storage?
Which neurotransmitter is needed to relax the detrusor muscle and contract the internal sphincter?
What is the Quantitative Sudomotor Axon Reflex Testing (QSART)?
- test of postganglionic sudomotor function.
- - can identify postganglionic sympathetic failure which can be seen in small fiber neuropathies.
- - can identify excess sweating which can be found with reflex sympathetic dystrophy.
What are some tests of sympathetic vasomotor function?
- - tilt test (checking for HR and BP changes)
- - Valsalva (changes in BP)
- - Checking for BP changes with stressors such as exercise and cold
What are the findings in Valsalva that would indicate sympathetic and parasympathetic dysfunction?
- - absence of the usual BP overshot in phase 4 suggest sympathetic NS dysfunction
- - HR usually drops following phase 4 due to increased vagal tone. lack of this reflex bradycardia suggests parasympathetic dysfunction.
What are the characteristics of Chaga's Disease?
- autonomic neuropathy; orthostatic hypotension, bradycardia, megaesophagus, megacolon and congestive cardiomyopathy.
What is the cause of Chaga's disease?
Trypanosoma cruzi, a parasite found in Central and South AMerica
What are some autonomic nervous system abnormalities that can be seen in patients with diabetes?
- - postural hypotension
- - resting tachycardia
- - nocturnal diarrhea
- - delayed gastric emptying
- - impotence
- - distal anhydrosis
- - miotic pupils with a slow light reflex
What is typically seen in patients with dopamine B-hydroxylase deficiency?
lack of norepinephrine
What chromosome has the gene for dopamaine B hydroxylase deficiency?
What is seen in neonates with dopamine B hydroxylase deficiency?
- - hypothermia
- - hypoglycemia
- - hypotension
What is seen in adults with dopamine B hydroxylase deficiency?
ptosis and orthostatic hypotension
How can you treat postural hypotension in pts with Dopamine B hydroxylase deficiency?
with L-Dops which is DL-threo-dihydroxyphenylserine that is decarboxylated by dopa decarboxylase to NE.
What are the characteristics of Fabry's Disease?
hypohidrosis, decreased tear and saliva production, gastrointestinal dysmotility and impotence.
What can also be seen in Fabry's Disease?
- angiokeratoma, abdominal pain, lancinating pain in the extremities due to small fiber neuropathy and renal failure.
What is Fabry's disease?
x- linked recessive sphingolipidosis due to alpha-galactosidase deficiency.
What is common to all Hereditary Sensory and Autonomic Neuropathies (HSAN)?
lack of sensitivity to pain
What is Riley-Day Syndrome?
- - Familial Dysautonomia (HSAN III)
- - autosomal recessive condition frequently found in Ashkenazi Jews.
- - due to a mutation in IkappaB kinase complex associated protein)
- - chromosome 9q31
How does Riley-Day syndrome present?
at birth with hypothermia, hypotonia and poor feeding.
Distinctive PE finding in HSAN III (Riley Day)?
absence of fungiform papillae on the tongue (lateral and tip) and lack overflow emotional tears.
What is Lambert Eaton Myasthenic Syndrome?
- NM jxn d/o due to ABs directed against P/Q type voltage gated ca channels.
- may be due to an underlying malignancy like small cell lung ca.
Lamber Eaton symptoms:
dry mouth, constipation, proximal muscle weakness, especially the thighs and decreased reflexes. strength may improve after exercise.
In what situations should hyperventilation with EEG not be performed?
- - hx of cerebrovascular disease
- - sickle cell disease or trait
- - CF
- - CHD
- - asthma
- - Moyamoya disease
In what situations can prolonged slowing occur?
What is delta frequency?
< 4 hz
what is theta frequency?
what is alpha frequency?
what is beta frequency?
What are Kappa waves and when do they occur?
low amplitude waves in the temporal regions of alpha or theta frequency. They occur during cognitive tasks/thinking
what are lambda waves and when do they occur?
positive sharp transients in the occipital area seen during visula scanning.
what is mu rhythm?
7 to 11 hz activity seen best over the centroparietal regions. it is attenuated by movement or thoughts of movement of the contralateral body.
What drugs can cause seizures in people who don't have epilepsy?
- meperidine overdose
What is the cause of Subacute Sclerosing Panencephalitis?
What are the states of SSPE?
- I: personality changes
- II: myoclonic jerks and further intellectual deterioration
- III: stupor, extrapyramidal signs, autonomic instability, ridigity, hyperactive reflexes
- IV: chronic vegetative state
What will the EEG show in stage II of SSPE?
high amplitude periodic sharp wave complexes every 4 to 15 seconds, usually generalized.
What are the EEG requirements for brain death?
- - at least 8 electrodes need to be used
- - sensitivity should be set for 2 microvolts
- - interelectrode distance should be at least 10cm
- impedance should be between 100 and 5000 ohms
- - low frequency filter should be set for < 1 hz
- - high frequency filter should be set for > 30 hz
- - duration of the study should be at least 30 minutes
For EMG: latency reflects:
the fastest conducting motor fibers
the amplitude in an EMG reflects:
the number of muscle fibers
the duration in EMG reflects:
the synchrony of muscle fiber firing.