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Pathophysiology > EXAM 2 - Week 5 (pain, ear, eye) > Flashcards

EXAM 2 - Week 5 (pain, ear, eye) Flashcards

1
Q

What are the two tracts of the spinothalamic bundle in the spinal cord? What does it connect to?

A

Neospinothalamic tract
Paleospinothalamic tract

Connects with reticular formation of brain

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2
Q

Neospinothalamic tract

A

Fast impulses; actue pain

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3
Q

Paleospinothalamic tract

A

Slow impulses; chronic/dull pain

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4
Q

Pain Control - Gate Open

A

Painful stimulus - substance P - pain stimulus to brain - RAS alert - pain received

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5
Q

Pain Control - Gate Closed

A

Painful stimulus - interneuron activated by efferent impulses from brain or affront impulses from touch stimulus - interneuron releases Enkephalin - Enkephalin blocks opiate receptors - thus Substance P is NOT released - Gate closed/transmission blocked on affarent tract

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6
Q

Nociceptive pain

A

Caused by stimulation of peripheral nerve fibers; respond only to stimuli approaching or exceeding harmful intensity

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7
Q

Neuropathic pain

A

Caused by damage/disease affecting nervous system - involves “imbodily” findings

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8
Q

Psychogenic

A

AKA psychoalgia, somatoform pain

Pain caused by increased or prolonged mental, emotional, or behavioral factors - sufferers are often stigmatized b/c medical professionals and public thinks these pains are not real

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9
Q

Pain Characteristics - Somatic Pain

A

From skin (cutaneous) or bone muscle and conducted by sensory fibers

  • Fades once injury heals
  • Respond well to NSAIDs
  • Nocicpetors pick up sensations r/t temperature, vibration, and swelling
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10
Q

Pain Characteristics - Visceral Pain

A

Pain resulted from activation of nociceptors of thoracic, pelvic, or abdominal viscera, conducted by sympathetic fibers

  • Sickening, deep, dull, squeezing feeling
  • Symptoms often include nausea, vomit, change in vitals, emotional manifestation
  • Highly sensitive to dissension, ischemia, and inflammation
  • Diffuse - difficult to localize
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11
Q

What is Referred Pain?

A

Pain may be perceived at site distant from source

  • Characteristic of visceral damage in the abdominal organs , heart attack, or ischemia in the heart
  • Multiple sensory fibers from different sources connecting to single level of spinal cord make it difficult for brain to discern actual origin of pain
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12
Q

What can increase Pain Tolerance?

A

Endorphin release

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13
Q

What can decrease Pain Tolerance?

A

Fatigue, or stress

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14
Q

COLDSPA

A 
character
onset
location
duration 
symptoms 
precipitating events
alleviating factors
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15
Q

Pain Management - Opiate-like Chemicals (Opioids)

A

Secreted by interneurons of the CNS (endogenous)

  • Block conduction of pain impulses to the CNS
  • Resemble morphine

Ex: Enkephalins, dynorphins, beta-lipoproteins

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16
Q

Analgesic Drugs - Mild Pain

A

ASA, NSAIDs, Acetominophen

  • Decreases pain at peripheral site
  • Antipyretic
  • ASA and NSAIDs are anti-inflammatory
  • ASA and NSAIDs have many adverse effects (nausea, gastric ulcers, bleeding, allergies)
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17
Q

Analgesic Drugs - Moderate Pain

A

Codeine, Oxycodone

  • Acts on central nervous system and effect perception
  • Adverse effects: Narcotic (opium) - often combined with ASA/acetominophen
  • High dose may depress respiration
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18
Q

Analgesic Drugs - Severe Pain

A

Morphine, Meperidine

  • Acts on central nervous system; euphoria and sedation
  • Adverse effects: Narcotic - tolerance and addiction
  • High dose depresses respiration, nausea, constipation common
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19
Q

Pain mangement - PCA?

A

PCA = patient controlled analgesia

  • Patient administers medication as needed
  • Lessen overall consumption of narcotics
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20
Q

Structure of the Ear - external ear

A

Captures and amplifies sound

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21
Q

Structure of the Ear - middle ear

A

Transmit sound waves from tympanic membrane to nerve center of the ear
-May be stimulated by head movement position

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22
Q

Structure of the Ear - inner ear

A

Ventilation of middle ear and equalizing middle ear in pressure change
-Drainage: secretion will drain to the nasopharynx from the inner ear

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23
Q

Otitis Externa

A

Inflammation of the external ear (can be due to infection)

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24
Q

Swimmer’s Ear

A

Often seen with otitis external

Water sits in the ear and doesn’t drain out. This creates an optimal environment for bacterial growth.
Hair follicles get infected, and can lead to ischemia

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25
Q

Barotrauma

A

Changes in the tympanic membrane due to blood/fluid buildup behind the membrane
-Extremely painful!

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26
Q

Otitis Media

A

Inflammation of the middle ear
AOM = acute otitis media
OME = otitis media with effusion

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27
Q

Mastoiditis

A

Ear infection spread to the mastoid bone causing

  • Ear pain
  • Otorrhea
  • Fever
  • Headache
  • Swelling and redness behind the ear
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28
Q

Otosclerosis

A

New spongy bone formation around stapes and ova window in the inner ear

  • Now these bones cannot properly transfer sounds into the inner ear, leading to progressive deafness
  • Ringing in the ears (Tinnitus)
  • Hearing loss on innervation of ear (Vertigo)
29
Q

Conductive Hearing loss

A

Sounds are not produced through tympanic membrane, stapes, and ova window

30
Q

AOM

A

Acute Otitis Media - infection in the middle ear, associated with upper respiratory infections
-Infected fluid in the middle ear creates an optimal environment for pathogen growth

Recurrent: more than 3 episodes in 6 months, or more than 4 episodes in a year

Clinical Manifestations: enlarged periacular lymph nodes, rinorrhea (runny nose), fever, impaired hearing

Treatment: antibiotics if unresponsive to observation

31
Q

OME

A

Otitis Media with Effusion

  • No infection, just fluid build up
  • Trapping of fluid by obstruction in the Eustachian tube
  • Not an infection thus not associated with inflammation
  • Acute pain from pressure on the tympanic membrane; this pressure can also lead to impaired hearing
32
Q

Neural dysfunction of the inner ear (3)

A

Sensorineural Hearing loss
Tinnitus
Equilibrium disruption

33
Q

Sensorineural Hearing Loss

A

Occurs due to permanent damage to the cochlea of the inner ear (due to disease, trauma, genetic defect)

34
Q

Tinnitus

A

Ringing in ears

35
Q

Equilibrium disruption

A

Could be from vertigo

36
Q

Objective Vertigo

A

Person is still but feels that everything around is moving

37
Q

Subjective Vertigo

A

Person is in motion but the room is still

38
Q

Physiologic Vertigo

A

Motion sickness from repeated rhythmic stimulation

39
Q

Meniere disease

A

Occurs due to fluid build up in the inner ear, creating pressure build up in the cochlea and vestibule. The increased pressure creates a feeling that the ear is full.

Caused by trauma, infection, or endocrine disorders

-Equilibrium disruption

40
Q

Labyrinthitis

A

Inflammation of the inner ear

41
Q

Hyperopia

A

Farsightedness
-Anterior:posterior dimension of eyeball is too short causing the focal point to fall behind the retina

-Convex lenses needed

42
Q

Myopia

A

Nearsightedness

-Anterior:posterior dimension of eyeball is too long causing the focal point to fall in front

43
Q

Presbyopia

A

Loss of nearsightedness commonly associated with aging

44
Q

Strabismus

A

Any abnormality of eye coordination and alignment that results in loss of binocular vision

R/t paralysis of eye muscles or weak eye muscles, or other issues that lead eye to pull inward
-Eye pulls toward the stronger muscle and away from the weaker muscle

Can lead to amblyopia if left untreated

45
Q

Amblyopia

A

Lazy eye = diminished vision when there is no detectable lesion in the eye

Brain processes input from normal in view, but over time, brain will block any input from the affected eye, causing permanent blindness in that eye

46
Q

Diplopia

A

Double vision that occurs when binocular vision isn’t quite lined up

_more permanent damage occurs if r/t muscle tissue

47
Q

Nystagmus

A

Involuntary rhythmic occultation of eye movement that happens when trying to focus on an object in the extremities of our peripheral vision

R/t semilunar ducts and vestubuler apparatus of ears

48
Q

Ptosis

A

Weakness of the lavender muscle (the muscle that holds up the eyelid)

49
Q

Entropion

A

Lower lid turns IN, causing eye irritation and tearing

50
Q

Ectropion

A

Lower lid turns OUT, causing eye irritation, tearing, and dryness

51
Q

Hordeolum

A

Infection of the sebaceous glands of eyelid
“sty”
Can be internal or external

52
Q

Chalazion

A

Chronic inflammation of myobomium gland inside the eyelid that leads to constant sty

53
Q

Conjunctivitis

A

Inflammation of conjunctiva

Viral vs Bacterial

54
Q

Bacterial Conjunctivitis

A

Caused by Chlamydia trachomatis and Neisseria gonorrhea

Creates lots of crusting, yellow-green drainage

Can be seen in babies at birth

55
Q

Viral Conjunctivitis

A

Viral infection, AKA pink eye

Causes profuse watery discharge, redness/pink of the eye

VERY contagious

Typically starts in one eye then spreads to the other from wiping that eye and touching the other

56
Q

Keratitis

A

Herpes Simplex infection of the cornea that causes severe pain and photophobia
-Can be from Herpes lesions around the mouth, or transferred by fingers, dental visits sprays of contaminated saliva

Increases risk of ulceration/eroding of the cornea. The scar tissue formation and trauma to cornea interferes with vision and can lead to permanent damage to the vision.

57
Q

Glaucoma Pathophysiology

A

Vision loss due to increased intraocular pressure buildup from aqueous production issue

Congenital or acquired lesions mechanically obstruct aqueous outflow (not flushed out properly). This increases the intraocular pressure causing atrophy of optic nerve axons. Changes in the axons causes pallor of optic cup and increase in the size and depth of the optic cup. This change in the cup precedes vision loss. If the optic disk breaks away from the nerve, it can cause blindness.

58
Q

Glaucoma categorizations

A

Angle closure (emergency) vs open angle (slow damage)
Congential vs acquired
Primary (no evidence of pre-existing conditions) vs secondary (result of other inflammatory process in the eye)

59
Q

Primary Open Angle Glaucoma

A

Chronic
Clogged trabecular network at the point where the iris and cornea meets causes impaired aqueous human drainage, leading to increased intraocular pressure (IOP).

IOP causes blind spots in the field of vision, initially limited to the periphery but then progresses centrally

Gradual, irreversible vision loss

60
Q

Acute Angle Closure Glaucoma

A

Acute
Rapid IOP from blocked aqueous humor drainage, induced by increased pupil dilation.

The eye pain can lead to headache, nausea, blurred vision, and rainbows around lights at night.

The damage to the optic nerve leads to vision loss.

Medications can help alleviate the pressure, but surgery is needed to unclog routes

61
Q

Cataracts

A

Progressive opacity or clouding of the lens leading to blurry vision

Rate of impairment varies per individual; one eye can develop faster than the other

Changes can be r/t age, metabolic abnormalities (smoking, DM), excessive exposure to sunlight, congenital, or traumatic.

Makes night driving difficult

Outpatient surgery involves lens replacement where they implant intraocular lenses.

62
Q

Macular Degeneration

A

Loss of central vision due to degeneration of the retinal macular (and fovea)

63
Q

Fovea

A

Central portion of the retinal macula where all vision signals come to and sent from

64
Q

Dry (atrophic) Macular Degeneration

A

Atrophy and degeneration of the outer retina
Drusen deposition: fatty lipid deposits (drusen) develop in the macula, affecting blood flow, leading to damage to the fovea and thus scar tissue formation in the fovea. Damaged fovea leads to damage to central retinal macula

Slow progression of symptoms

No cure- need regular screening and monitoring

65
Q

Wet (exudative) Macular Degeneration

A

Mini ‘hemorrhaging’ in the back of the eye leads to rapid and severe vision loss and eventually blindness

Formation of a choroidal neovascular membrane, which are weaker than normal vessels, thus are prone to leakage. Leakage and hemorrhage of serous fluid causes damage to the retinal macula and separates the optic disk from back of the eye.

Starts with a dark central spot with vision loss in the central field first. As damage increases, vision loss spreads center outward.

Decreases ability to read, recognize faces, colors, etc.

Not reversible or treatable.

66
Q

Retinal Detachment

A

Emergency eye condition that typically results from trauma

There is no pain, but bright flashes of light in the peripheral vision, blurred vision, floaters, and shadow blindness in part of the visual field occur.

67
Q

Acute/Closed Angle Glaucoma

A

Emergency eye condition that bring on sudden onset of severe pain (due to IOP), blurred vision with halos around lights, loss of vision

68
Q

Herpes Zoster Keratitis

A

Emergency eye conditions that is like shingles but in the eye

Painful, red eye, tearing, blurred vision, photophobia

Occlusion to the artery that provides eye with blood causes the eye to become ischemic and thus stops working, causing sudden vision loss.

Important to get history to see if its related to herpes zoster

69
Q

Central Retinal Artery Occlusion

A

Sudden vision loss, painless

Pathophysiology (8 decks)

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