1. Autonomics - Viscerosomatics
Clicker: 06
Session ID:

2. Which of the following is the origination of the PNS?
Thoracolumbar
Cervicothoracic
Craniosacral
Craniothoracic

3. The preganglionic cell bodies of the PNS are found in which cranial nerves?
III, VII, IX, X
III, IV, V, VI
III, VII, X, XI
III, V, VII, IX

4. Which of the following is not a feature of somatic innervation?
It deals with the innervation of skeletal muscles
It consists of a one neuron synapse
Ach is released and binds to nicotinic receptors
It consists of a two neuron synapse

5. Ach, nicotinic Ach, muscarinic NE, alpha or beta NE, nicotinic
When innervating sweat glands, the postganglionic neurotransmitter ______ binds to a ________ receptor
Ach, nicotinic
Ach, muscarinic
NE, alpha or beta
NE, nicotinic

6. Epinephrine Norepinephrine Ach Cortisol
Which of the following is the major product released from the adrenal medulla upon Ach binding to its nicotinic receptor?
Epinephrine
Norepinephrine
Ach
Cortisol

7. The SNS causes each of the following except…
Mydriasis
Bronchial dilation
Arteriole constriction
Erection

8. The PNS causes each of the following except…
Decreased heart contractility
Increased GI motility
Erection
Inhibits bladder contraction

9. What is the definition of facilitation?
The maintenance of a pool of neurons in a state of partial or sub threshold depolarization
The maintenance of a pool of neurons in a state of partial or sub threshold hyperpolarization
Input from visceral structures that increase the manifestations of somatic tissues
Input from somatic structures that increase the manifestations of visceral tissues

10. Your preceptor pimps you and asks, “what is the mechanism behind referred pain?”
It is the convergence of sympathetic and parasympathetic inputs at the spinal interneuron level
It is the convergence of somatic and visceral inputs at the spinal interneuron level
It is the simultaneous stimulation of two different spinal interneuron levels from one stimulus
It is the simultaneous stimulation of two different somatic areas whose afferent innervations converge at the same spinal interneuron area

11. A cholinergic drug causes which of the following?
Increase in sympathetic tone
Decrease in sympathetic tone
Decrease in parasympathetic tone
Increase in parasympathetic tone

12. Your patient has many ulcerations found at the junction of the esophagus and the stomach. At what spinal level might he experience somatic manifestations? C3 C7 T2 T6

13. C3: no viscerosomatic reflexes at this level
Your patient has many ulcerations found at the junction of the esophagus and the stomach. At what spinal level might he experience somatic manifestations?
C3: no viscerosomatic reflexes at this level
C7: no viscerosomatic reflexes at this level
T2: cervical upper esophagus (T2-4)
T6: lower esophagus & stomach (T5-8)

14. Gallbladder Spleen Liver Appendix
Your patient is experiencing pain at the T10 spinal level on the right. Which organ is most likely experiencing distress?
Gallbladder
Spleen
Liver
Appendix

15. Gallbladder: T9-10 R Spleen: T5-11 Liver: T6-9 Appendix: T12
Your patient is experiencing pain at the T10 spinal level on the right. Which organ is most likely experiencing distress?
Gallbladder: T9-10 R
Spleen: T5-11
Liver: T6-9
Appendix: T12

16. Your patient now has a kidney stone
Your patient now has a kidney stone. Which of the following levels can you expect to see somatic dysfunction?
T5-7
T9-10
T10-L1
L2-L5

17. Your patient now has a kidney stone
Your patient now has a kidney stone. Which of the following levels can you expect to see somatic dysfunction?
T5-7: upper extremity
T9-10: ovary/teste
T10-L1: kidney, ureters, bladder
L2-L5: no viscerosomatic reflexes at this level

18. The gonadal parasympathetic innervation is through which nerve?
Vagus
Pelvic splanchnics
Sacral splanchnics

19. Which of the following are you trying to achieve in mechanical rib raising?
Mobililze abnormal fluid collection
Balance the sympathetic chain
Increase chest wall motion
All of the above

20. Review Somatic Visceral Innervation of skeletal muscles
One neuron synapse
Ach binds to nicotinic receptors
Visceral
Two neuron synapse
SNS
PNS

21. Review SNS PNS Thoracolumbar Short preganglionic fibers
Release Ach on nicotinic receptors
Long postganglionic fibers
Release NE on alpha or beta receptors
Synapse in sympathetic chain or preaortic ganglia
PNS
Craniosacral
Long preganglionic fibers
Release Ach on nicotinic receptors
Short postganglionic fibers
Release Ach on muscarinic receptors
Synapse near the walls of the viscera to be innervated

22. Review Sympathetic cholinergic Adrenal Medulla Innervates sweat glands
Similar to SNS but postganglionic neurotransmitter is Ach on muscarinic receptors
Adrenal Medulla
One neuron synapse
Ach binds to a nicotinic receptor to stimulate gland
NE & Epinephrine** released into blood stream

23. Viscerosomatic Reflexes Review
Head & neck T1-4
Heart T1-5
Lung T2-5
Cervical upper esophagus T2-4
Thoracic mid esophagus T3-6
Lower esophagus & stomach T5-8
Spleen & pancreas T5-11
Liver T6-9
Gallbladder T9-10 R
Small intestine T9-11
Appendix T12
Ovary/testes T9-10
Kidneys T10-L1
Ureter T10-L1
Bladder T10-L1

24. Viscerosomatic Reflexes Review
Prostate & urethra L1-2
Cervix L1-2
Ascending & transverse colon T10-12
Genital T12
Uterus T10-L1
Descending & sigmoid colon & rectum L1-2
Adrenal T8-10
Upper extremity T5-7
Lower extremity T10-L2

25. Techniques Dorsal Inhibition Thoracolumbar myofascial release
span the width of the erector spinae bilaterally, bring fingers & thenar/hypothenar eminences closer together
Thoracolumbar myofascial release
Add anterior & lateral tension (direct component), hold direction of ease in all 3 planes (indirect component)
Mechanical Rib Raising
Pull the ipsilateral paraspinal muscle toward you, add a superior & lateral pumping of your fingers

26. Techniques Rib raising with indirect MFR
Motion test an area of TART in all 3 planes of motion. Stack each indirectly
Ventral Inhibitory Release of SNS
Celiac ganglion T5-9:
digestion - heart burn, gastric reflux
Superior mesenteric ganglion T10-11:
absoprtion - gas or bloating
Inferior mesenteric ganglion T12-L2:
elimination – diarrhea or constipation
sexual dysfunction – premature ejaculation or inability to orgasm

27. Techniques Dorsal inhibitory release of PNS Sacral Inhibition
Killer fingers
Sacral Inhibition
Place cephalad hand on patients sacrum with fingers pointing downwards. Place other hand on top. Gradually increase downward pressure & hold
Sacral Rocking
Similar position to above but interlock hands making contact with the base & apex of the sacrum. Follow inherent rocking of the sacrum by leaning side to side

28. Treatments Mesenteric Release Sequence
Duodenum, Ileum & jejunum, Cecum, Ascending colon, Descending colon, Sigmoid colon
Not performed on the transverse colon