Autonomic nervous system anatomy — MCQs

A 48-year-old man with retroperitoneal sarcoma requires extensive resection including portions of the sympathetic chain from T10-L2 and the celiac/superior mesenteric ganglia. Preoperative evaluation is needed to predict postoperative autonomic consequences. The multidisciplinary team must evaluate which combination of deficits is most likely based on the precise anatomical structures being resected and the potential for compensation.

A 62-year-old man with atrial fibrillation undergoes catheter ablation of the pulmonary vein ostia. Post-procedure, he develops gastroparesis, but his cardiologist notes preserved heart rate variability and normal baroreceptor responses. Surgical anatomy review suggests the ablation may have damaged autonomic structures. Evaluate the most likely anatomical explanation for isolated gastric dysmotility with preserved cardiovascular autonomic function.

A 35-year-old woman with familial dysautonomia (Riley-Day syndrome) presents with absent corneal reflexes, impaired lacrimation, and absent fungiform papillae on the tongue, but preserved parotid gland function. Genetic testing confirms IKBKAP gene mutation affecting neural crest cell migration. Evaluate which embryological principle explains this specific pattern of autonomic and sensory deficits while certain parasympathetic functions remain intact.

A 50-year-old man undergoes bilateral truncal vagotomy for refractory peptic ulcer disease. Postoperatively, he develops gastroparesis, but surprisingly maintains normal pancreatic enzyme secretion and normal bile flow during meals. Analysis of his preserved functions suggests alternate autonomic pathways are compensating. Which anatomical principle best explains the preservation of these exocrine functions despite vagotomy?

A 42-year-old man with chronic pancreatitis undergoes celiac plexus block for pain management. Post-procedure, he experiences orthostatic hypotension and diarrhea but maintains normal heart rate responses to Valsalva maneuver and normal pupillary reflexes. Analysis of these findings suggests selective blockade of specific autonomic pathways. Which combination of autonomic effects best explains this clinical presentation?