Superior and Posterior Mediastinum - A Partial Study Guide

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Questions for the Superior and Posterior Mediastinum, and the Autonomic Nervous System

True/False - August 22, 2011

1. Collectively, the central nervous system plus the peripheral nervous system equals the nervous system.
2. The autonomic nervous system includes a preganglionic neuron located in the central nervous system and postganglionic neuron located in the peripheral nervous system.
3. Afferent nerves are said to affect the contraction of muscles and efferent neurons are said to effect our sensations and perceptions.
4. Neural circuits in the spinal cord may effect reflexive movement without volitional control.
5. Reflexively withdrawing your hand from a hot stove minimizes tissue damage relative to if you had to "think" about withdrawing your hand of your own volition.
6. The autonomic nervous system operates outside of volition.
7. Despite that autonomic reflexes are common, the afferent side of the reflex arc is not, by definition, part of the autonomic nervous system.
8. The parasympathetic division of the autonomic nervous system has shorter postganglionic fibers than does the sympathetic division of the autonomic system.
9. The thoracic sympathetic trunk ganglia host cell bodies belonging to the parasympathetic division of the autonomic nervous system.
10. The splanchnic nerves of the posterior mediastinum pass from the thorax into the abdominopelvic cavity.
11. The dorsal root ganglion hosts preganglionic cell bodies of the parasympathetic division of the autonomic nervous system.
12. Dorsal and ventral roots of the spinal cord converge to from a spinal nerve.
13. The distal termination of a spinal nerve is into ventral and dorsal rami.
14. Communicating between the sympathetic trunk ganglia and the intercostal nerves are ventral and dorsal rami.
15. Surgical disruption of the gray rami communicantes of thoracic sympathetic trunk ganglia is a treatment for excessive sweating of the hands.
16. Surgical disruption of the white rami communicantes of thoracic sympathetic trunk disrupts autonomic functions to viscera of the abdominopelvic cavity.
17. The greater, lesser, and least splanchnic nerves terminate at the celiac, superior mesenteric, and inferior mesenteric ganglia.
18. The proximal to distal orientation of the greater splanchnic nerve is inferior, medial and anterior.
19. The vagus nerve conveys preganglionic neuronal fibers into the thorax and abdominopelvic cavity.
20. The craniosacral division of the autonomic nervous system refers to the sympathetic division of the autonomic nervous system.
21. The thoracic and abdominal viscera have parasympathetic postganglionic cell bodies located in intrinsic ganglia.
22. The deep cardiac plexus is located on the anterior surface of the trachea at the bifurcation into main bronchi.
23. The superficial cardiac plexus is applied to the arch of the aorta near to the ligamentum arteriosum.
24. Diaphragmatic breathing is controlled by the autonomic nervous system.
25. The parietal pleura, but not the visceral pleura, has sensation mediated by the somatic nervous system.
26. Pleurisy irritates both visceral and somatic afferent nerve fibers.
27. The cell bodies the serve visceral pain of the heart are located in the dorsal root ganglia of T1-4. (This is true)
28. Embarrassment of the heart activates visceral fibers that share the same dorsal root ganglia as somatic fibers that provide sensation of the medial arm.
29. Visceral "pain" refers along dermatomal representations.
30. The azygous system mediates venous drainages of the thoracic cavity.
31. Right posterior intercostal spaces 1-2 drain into the arch of the azygous.
32. The left superior intercostal vein drains into the arch of the azygous.
33. The ductus arteriosus shunts the pulmonary and aortic arteries during fetal development and, post-partum, obliterates as the ligamentum arteriosum.
34. The thoracic duct crosses the posterior surface of the right posterior intercostal arteries.
35. In the case of coarctation of the aorta there is a reversal of blood flow in the left subclavian artery.

True/False - August 23, 2010

1. The dorsal and ventral horns are named parts for the gray matter of the spinal cord.
2. The dorsal and ventral roots are nerve branches arising directly from the spinal cord.
3. The dorsal and ventral roots combine to form a nerve plexus.
4. The dorsal root and the ventral root has a ganglion within the spinal canal.
5. The dorsal root and the ventral root combine to form a spinal nerve.
6. A spinal nerve terminates distally by elaborating a dorsal ramus and a ventral ramus.
7. Dorsal rami, but not ventral rami, enter into somatic plexuses.
8. Afferent fibers make up the dorsal roots and efferent fibers make up the ventral roots.
9. The interneuron within a reflex arc relays information from afferent fibers to efferent fibers.
10. Dropping an unexpectedly hot potato involves rapid extension of the fingers brought about by the interplay of afferent neurons, interneurons, and efferent neurons.
11. Efferent fibers of the somatic nervous system innervate skeletal muscle.
12. Efferent fibers of the autonomic nervous system innervate skeletal.
13. Tradition includes visceral afferent fibers as part of the autonomic nervous system.
14. The autonomic nervous consists of three efferent neurons.
15. The preganglionic neuron of the autonomic nervous system is located in nuclei within the central nervous system.
16. Sympathetic trunk ganglia are known as paravertebral ganglia.
17. Collateral ganglia of the autonomic nervous system are located at the lateral margins of arteries.
18. Intrinsic ganglia of the autonomic nervous system are located in enteric ganglia of the target organ.
19. The thoracolumbar part of the autonomic nervous system refers to the sympathetic division of the autonomic nervous system.
20. The craniosacral part of the autonomic nervous system refers to the parasympathetic division of the nervous system.
21. Visceral afferent information passes through two sensory cell bodies before arriving at the spinal cord.
22. Preganglionic fibers derived from the sympathetic division of the autonomic nervous system enter the sympathetic trunk ganglia.
23. Preganglionic fibers enter the sympathetic trunk by way of a white ramus communicans.
24. Gray rami communicantes convey postganglionic fibers.
25. The sympathetic trunk elaborates gray rami from the upper cervical region to the lower sacral region.
26. The sympathetic trunk elaborates white rami from the 1st thoracic cord level to the 2nd lumbar cord level.
27. The S3 cord level is at the L2 vertebral level.
28. Splanchnic nerves branch from the anterior margin of the sympathetic trunk and rami communicantes branch from the posterior margin of the sympathetic trunk.
29. Splanchnic nerves derived from the T5-9 cord levels combine to form the greater splanchnic nerve.
30. The viscera are dual innervated - part from the autonomic nervous system and part from the somatic nervous.
31. The viscera receive postganglionic fibers from the sympathetic nervous system and preganglionic fibers from the parasympathetic nervous system.
32. The superficial cardiac plexus is located on the anterior surface of the bifurcation of the trachea.
33. The superficial cardiac plexus is located on the arch of the aorta near the ligamentum arteriosum.
34. The deep cardiac plexus supplies fibers to the atrioventricular node.
35. Aneurysm of the aortic arch may damage the right recurrent laryngeal nerve.
36. The intercostobrachial cutaneous nerve (lateral branch of T2) is said the mediate referred pain from the heart.
37. Visceral afferent high threshold ("pain") fibers from the epicardium project to the T2 cord level.
38. Dermatomal charts show the distribution of afferent fibers projecting to a specific cord level.
39. The afferent fibers of a particular spinal nerve represent the distribution of a single dermatome.
40. The upper lateral quadrant of the right breast drains lymph into the left lymphatic duct.
41. Coarctation of the aorta causes retrograde blood flow in the posterior intercostal arteries.

True/False - August 2009

1. The parasympathetic division of the autonomic nervous system generally has postganglionic cell bodies in intrinsic ganglia at the target organ.
2. Intermediolateral cell columns are identified from spinal levels T1-12 and and S1-3.
3. Dorsal and ventral rami belong the the autonomic nervous system whereas gray and white rami are uniquely belong to the somatic nervous system.
4. The sympathetic trunk extends the entire length of the vertebral column.
5. Nerve fibers derived from gray rami typically travel within the sympathetic trunk.
6. Fibers derived from white rami travel anterior, medial, and inferior from the sympathetic trunk within the splanchnic nerves.
7. The esophageal plexus receives postganglionic fibers derived from the vagus nerve.
8. The greater, lesser, and least splanchnic nerves leave the thorax by passing through the esophageal plexus.
9. The thorax receives parasympathetic fibers nearly entirely, if not entirely, from the vagus nerve.
10. The cardiac nerves carry sympathetic nerves from the cervical region into the supericial and deep cardiac plexuses.
11. Intermediolateral cell colums host preganganglionic sympathetic cell bodies at thoracic spinal levels and parasympathetic postganglionic cell bodies at sacral spinal levels.
12. The vertebral projection of the xiphoid process is to T10 and the spinal nerve that provides sensory innervation to skin overlying the xiphoid is T10.
13. The superficial cardiac plexus is applied to the lateral margin of the aorta near the ligamentum arteriosum and the deep cardiac plexus is located on the anterior surface of the bifurcation of the trachea.
14. The cardiac plexuses receive both sympathetic and parasympathetic postganglionic fibers.
15. For the most part, the parasympathetic nervous system mediates homeostatic processes.
16. The sympathetic nervous system directly strengthens muscle contractions during stressful events.
17. Dilation of deep vasculature and contraction of peripheral vasculature is mediated by the parasympathetic nervous system.
18. Sensory fibers that follow pathways hosting sympathetic fibers tend to mediate high threshold (pain) sensation and sensory fibers that follow parasympathetic pathways tend to mediate low threshold (homeostatic) sensation.
19. Arising from the posterior margin of sympathetic trunk ganglia are splanchnic nerves and from the anterior margin are gray and white rami.
20. Spinal nerves convey autonomic, somatic, and viscerosensory fibers.
21. Visceral sensation, relative to somatic sensation, is dull, aching, and poorly localized.
22. Crosstalk between the viscerosensory and somatosensory systems is thought to occur in the dorsal root ganglia and, thus, explains referred pain.
23. Viscerosensation from the heart projects to spinal level T2 along cardiac nerves and the intercostobrachial cutaneous nerve is derived from spinal nerve T2.
24. The fibrous coat of the pericardium of innervated by the somatic nervous system whereas the epicardium is innervated by the viscerosensory system.
25. The diaphragm muscle is innervated by parasympathetic postganglionic fibers conveyed by the phrenic nerve.
26. Posterior intercostal spaces 2-4 on the right drain into the superior intercostal vein, a tributary of the arch of the azygos vein.
27. Posterior intercostal spaces on the left generally drain into the accessory hemiazygos vein.
28. The 9th anterior intercostal space drains into the internal thoracic vein.
29. Branches from musculophrenic artery anastomoses with the 10th posterior intercostal artery.
30. Posterior intercostal spaces 1-2 are derived from the costocervical trunk on the left and the brachiocephalic artery on the right.
31. The inferior and superior vena cava are shunted by veins that fun along the vertebral column.
32. The right recurrent laryngeal nerve ascends on the medial surface of the aortic arch.
33. The left recurrent laryngeal nerve passes the posterior margin of the ligamentum venosum.
34. The thoracic duct passes through both the posterior and superior mediastinum.
35. The thoracic duct drains into the subclavian vein on the left and into the brachiocephalic vein on the right.
36. The lymphatic drainage of the upper lateral quadrant of the right breast drains into the right lymphatic duct.

Definition and Short Answer

1. What is the difference between a spinal level and a vertebral level?
2. Splanchnic nerve

Essay

1. Cardiac embarrassment may provoke pain along the medial aspect of the left upper limb. Explain.
2. Discuss the course of the left vagus nerve though the thorax. Include key relations at several locations (e.g. mediastinal regions).
3. Explain the mechanism leading to pain of the left shoulder and medial arm during cardiac embarrassment.
4. What structures lie immediately to the left of the arch of the azygos vein?
5. Follow the course of the esophagus in the thoracic cavity. Identify 4 areas of constrictions of the esophagus in the thorax.
6. Discuss the pattern of blood flow when there is coarctation of the aorta.
7. What fascial layers compromised by a breast cancer that directly invades into the lung.

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