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Pathophysiology > module 6 chapter 46; ear, eye, taste, smell > Flashcards

module 6 chapter 46; ear, eye, taste, smell Flashcards

1
Q

external ear components

A

auricles
canal
tympanic membrane

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2
Q

auricles

A

catch and funnel sound waves into ear canal

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3
Q

canal

A

somewhat S shaped from opening till tympanic membrane
protection from foreign objects and access to sound
glands along canal, secrete cerumen: coats hairs and prevents foreign bodies

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4
Q

tympanic membrane

A

thin, elastic, highly sensitive to changes in pressure

sound waves hit it and cause vibration

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5
Q

middle ear function

A

bony, air containing structure

sound energy is transmitted from air to fluids of inner ear

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6
Q

middle ear components

A

ossicles: attached to tympanic membrane

eustachian tube

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7
Q

ossicles

A

malleus (hammer)
incus (anvil)
stapes (stirrup)

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8
Q

eustachian tube

A

equalization of pressure against inner and outer surfaces of tympanic membrane.
has mucosal lining, extends form middle ear to nasopharynx

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9
Q

Inner ear components

A

oval window
cochlea
semicircular canals

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10
Q

cochlea

A

3 parallel tubes

  • scala vestibuli (perilymph)
  • scala media (endolymph)
  • scala tympani (perilymph)
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11
Q

perilymph and endolymph

A

transmit mechanical vibrations from footplate of the stapes to the organ of corti

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12
Q

organ of corti

A

contains receptors for hearing, lies on basilar membrane

  • has sensory hairs and supporting cells
  • cells innervated by sensory fibers of vestibulocochlear nerve (VIII)
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13
Q

tectorial membrane

A

flexible flap of tissue over hanging the organ of corti
- hairs of sensory cells within organ of corti in contact
- wave of periphymph -> movement of basilar membrane -> pull or shearing of hairs across tectorial membrane
This action transforms mechanical energy of sound into electrical impulses stimulating CNVIII

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14
Q

ear and balance

A

sense organ of equilibrium

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15
Q

trigger of balance

A

activation of receptor hair cell in semicircular canals
- movement of head -> movement of endolymph in semicircular canals -> hair creates nerve impulse in vestibular portion of CNVIII -> transmitted to brain

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16
Q

vertigo

A

common symptom of vestibular disorder

- sensation of motion without movement or exaggerated sense of motion

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17
Q

vertigo s/s

A

N/V
pallor
sweating
nystagmus

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18
Q

causes of vertigo

A

common: peripheral vestibular cause
uncommon: CNS cause
disorders of brainstem or cerebellum
- tissue ischemia r/t atherosclerosis
- tumors
- psych disorders
- migraines
- multiple scerosis

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19
Q

vertigo tx

A

aimed at cause
antihistamines
anticholinergics

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20
Q

loss of hearing r/t occlusion s/s

A

none usually
insect: wing sounds and movement -> distress
pain
drainage

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21
Q

otosclerosis

A

localized, inflammatory disease of metabolism of endochondral bone of otic capsule
- abnormal removal of mature dense otic capsule bone -> replaced by bone with increased thickness -> progressive conductive, sensorineural, or mixed hearing impairment

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22
Q

otosclerosis and bone lesions

A

form around ossicles of middle ear - inner ear

  • stapes: decreased transmission of sound waves
  • cochlea: permanent sensorineural hearing loss
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23
Q

otosclerosis tx

A

surgically: preventative
stapedectomy: insert prostesis

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24
Q

conductive hearing loss

A

sound does not reach cochlea

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25
Q

sensorineural hearing loss

A

mechanism in inner ear disturbed, in cochlea or vestibulocochlear nerve to brain

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26
Q

presbycusis

A

age related hearing loss
sensory
metabolic
mechanical

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27
Q

sensory presbycusis

A

atrophy and degeneration of sensory and supporting cells

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28
Q

neural presbycusis

A

loss of neurons in cochlea and CNS

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29
Q

mechanical presbycusis

A

middle ear changes in properties -> conductive hearing loss

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30
Q

otitis media

A

inflammation of middle ear
almost always related to disfunction of eustatian tube, dx with presence of effusion
- more common in winter: URI
- children more susceptible: short, flexible, and horizontal eustachian tube

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31
Q

otitis media risk factors

A 
pacifiers
secondhand smoke
reflux
poor socioeconomic living
daycare
males
natives
eskimo
craniofacial abnormalities
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32
Q

acute otitis media

A

sudden onset of ear pain associated with URI

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33
Q

acute otitis media s/s

A 
pain
children;
- irritable
- difficulty eating and sleeping
- tugging
- fever
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34
Q

otitis media tx

A

abx
pain relief
manage fever
surgical tubes with recurrent

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35
Q

chronic otitis media

A 
inflammation of middle ear > 12 weeks
irreversible damage
- atrophy
- perforation of tympanic membrane
- adhesions
 - calcification of ossicles
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36
Q

chronic otitis media tx

A

surgical removal of debris from middle ear
tubes
adenoidectomy: help with eustachian tube function

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37
Q

vision requires 3 processes

A

formation of image on retina
stimulation of rods and cones
conduction of nerve impulses to brain

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38
Q

3 basic layers of eye

A

sclera
choroid
retina

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39
Q

sclera

A

white, opaque, made up of dense connective tissue
protects inner structure
maintains shape
clear portion: cornea

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40
Q

cornea

A

has greater curvature than rest of sclera, causing it to protrude.

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41
Q

canal of schlemm

A

deep in sclera, at conjunction with cornea

drains aqueous humor

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42
Q

ocular muscles are fixed to

A

sclera

43
Q

choroid

A

highly vascularized, darkly pigmented

attached to iris; pigments responsible for eye color

44
Q

iris

A

controls size of pupil

45
Q

lens

A

behind pupil, is clear and avascular

elastic membrane, elasticity helps focus light stimuli on retina

46
Q

anterior chamber of eye

A

filled with aqueous humor

drained by canal of schlemm

47
Q

aqueous humor

A

anterior chamber of eye
provides O2 and nutrients to lens and cornea
continually formed and resorbed
- balance is total volume and pressure of intraoccular fluid.

48
Q

posterior chamber of eye

A

portion behind lens

contains thicker fluid: vitreous humor

49
Q

inner most layer of visual pathway

A

retinal layer: light waves turn into nerve impulses
several layers
2 types of photoreceptors: rod and curves
4 types of neurons: bipolar, ganglion, horizontal, amacrine

50
Q

vision pathway steps retinal layer

A

photoreceptors synapses with bipolar cells then goes to ganglion cells
ganglion axons converge and leave eye in optic nerve

51
Q

photoreceptor: rods

A

nighttime and peripheral vision

outnumber cones 20:1

52
Q

photoreceptor cones

A

stimulated by relatively high intensity light responsible for color and visual acuity
- greater concentration in macula: responsible for detailed vision

53
Q

horizontal and amacrine cells

A

modify transmission from photoreceptors to ganglion cells

sharpen and enhance responses of ganglion

54
Q

Pigmented layer of retina

A

one cell thick: epithelium
removes metabolic cellular debris from photoreceptor cells
prevents new vessel growth into retina
absorbs light to diminish scattering -> enhanced vision

55
Q

image on retina is

A

upside down and reversed left to right

- at optic chiasm nerve fibers cross over to other side

56
Q

myopia

A

eye elongated, image focuses in front of retina rather than on it: fuzzy image
nearsightedness: corrected with concave lenses
unable to see distant objects clearly

57
Q

hyperopia

A

eye shorter than normal, image focuses behind retina: fuzzy image
farsightedness: corrected with convex lenses

58
Q

presbyopia

A

loss of accommodative capacity
inability to see near objects in middle age
corrected with reading glasses

59
Q

astigmatism

A

irregular curve of cornea or lens -> distorted image

corrected with lens formed with opposite curvature

60
Q

strabismus

A

cross-eyedness, condition of ocular misalignment

- abnormal neuromuscluar control of eyes

61
Q

strabismus s/s

A 
squinting
frowning with reading
closing one eye to see
trouble picking up objects
dizzy
headache
62
Q

strabismus tx

A 
occlusion therapy: patching of good eye
corrective lens 
surgery on eye muscles
prisms 
exercises for eye
63
Q

amblyopia

A

poor vision even with corrective lens in one or both eyes
most common cause of dec. vision in peds
results from: altered visual development despite normal appearing retinal and optic pathways

64
Q

amblyopia tx

A

dx at earlier age is better
atropine to blur vision
patching of stronger eye

65
Q

cataracts

A

clouding or opacity of lens
gradual painless, blurring of vision and eventual loss of sight.
by 80, 50- 70% of americans have cataracts

66
Q

causes of cataracts

A 
aging
trauma: lens rupture and swlling
congenital: downs, intrauterine rubella
metabolic: DM, hypoparathyroidism
systemic/inhaled corticosteriods
cigarette smoking 
heavy ETOH
67
Q

cataracts s/s

A

increased glare at night
one or both eyes
blurred vision
altered color perception

68
Q

retinal detatchment

A 
usually spontataneous
could be secondary to 
- trauma
- eye tumors
- myopia
- cataract extraction
69
Q

3 categories of retinal detachment

A

exudative (serous)
tractional
spontaneous/ rhegmatogenous

70
Q

exudative retinal detachments

A

results from accumulation of serous or hemorrhagic fluid in subretinal space

  • sudden severe HTN
  • inflammation
  • neoplastic effusion
71
Q

tractional retinal detachment

A

mechanical forces on retina caused by fibrosis or scarring pull it away

  • injury or surgery to eye
  • diabetic retinopathy
72
Q

spontaneous/ rhegmatogenous retinal detachment

A

as people age vitreous humor decreases -> traction, causing separation

73
Q

retinal detachment and vitreous fluid

A

fluid flows behind retina leading to traction and progressive detachment

74
Q

retinal detachment s/s

A

sudden appearance of floating spots
odd flashes of light
blurry vision in single eye
“curtain pulled down”

75
Q

diabetic retinopathy

A

disease of vasculature in retina

  • capillaries lose ability to transport RBC -> hypoxia and decreased nourishment of retina
  • vascular and neuronal degeneration, vascular leakage, macular edema, retinal neovascularization
76
Q

2 categories of diabetic retinopathy

A

nonproliferative

proliferative

77
Q

nonproliferative diabetic retinopathy

A

retinal veins become dilated and microaneurysms develop

  • result of damaged vascular epilthelium
  • small retinal hemorrhages and cotton-wool spots
    early: visual changes minimun or resolves in few days.
    progresses: retinal edema -> affected visual acuity
78
Q

proliverative diabetic retinopathy

A

developments of new abnormal vessels caused by decreased retinal blood flow and ischemia
affects vision in 2 ways
- abnormal and prone to leak in the vitreous cavity -> vitreous hemmorhage
- firmly attach to retina and grow out into vitreous humor -> traction on retina -> detachment

79
Q

diabetic retinopathy s/s

A

blurred, darkened, and distorted vision
changes in vision may fluctuate
some unable to read

80
Q

age related macular degeneration (AMD)

A

leading cause of blindness among older adults
bilateral progressive degeneration with central vision loss
- decreased ability for O2 to diffuse to retinal pigment epithelium and photoreceptors -> release of growth factors and cytokines -
> growth of vessels into subretinal space
– new vessels leak -> distortion and reduction in clarity of central vision
may also result from cell death and atrophy of retinal pigment epithelium

81
Q

AMD risk factors

A 
age
female
smoing
family hx
increased cholesterol
cardiovascular disease
HTN
obesity 
hx cataract surgery
linked with oxidative stress and inflammatory chemicals
82
Q

2 groups of AMD

A

dry (nonneovascular atrophic degeneration)

wet (neovascular or exudative)

83
Q

dry AMD

A

most common
subretinal accumulation of cellular debris: drusen
metabolic dysfunction of retina
initially affects one eye, will spread to other

84
Q

drusen

A

appear as discrete yellow deposits on retina on exam

85
Q

wet AMD

A

visual loss more rapid onset
more severe visual disruption
impairment of barrier function -> subretinal collections of fluid -> retinal detachment or neovascularizations

86
Q

AMD s/s

A 
painless
atrophic (dry): 
- slightly blurry vision
- decreased fine detail
- need more light 
exudative (wet):
- progressive blurring
- hallmark: wavy appearance of straight lines
- vision may be lost rapidly or occur suddenly
87
Q

Disorders of smell

A

decreased smell:
- smokers
- conditions involving congestion and swelling of nasal mucosa
- head trauma: loss of smell r/t shearing of the neuronal fibers
- tumors and large cerebral aneurysms of anterior cerebral and anterior communicating arteries
Olfactory hallucinations
- epilepsy and psych disorders

88
Q

disorders of taste

A

decreased taste (gustatory)

  • smoking; dryness of tongue and mucous membranes
  • meds: antidepressant, antithyroid, antirheumatic, anticancer
  • flu like illness
  • lesions on thalamus and parietal lobe
89
Q

disorders of taste and smell s/s

A 
dec. smell often complains of dec. taste
decreased appetite
increased sugar, salt, and seasonings
no reaction to strong smells
do not notice body odor
increased risk accident d/t not smelling gas/smoke
increased ingestion of spoiled food
90
Q

chronic open angle glaucoma

A

disease often bilateral
genetic component noted
no s/s in early stages
intraocular pressure consistently elevated
gradual loss of peripheral vision (tunnel vision)
retinal ganglion cell apoptosis -> axonal loss in optic nerve
optic disc atrophy
vague persistent dull eye pain,
inability to distinguish colors
halos around lights

91
Q

acute angle closure glaucoma

A
  • abnormal angle between the pupil and lateral cornea
  • angle is narrow and blocks the outflow of aqueous humor when pupil is dilated
  • rapid onset: can lead to medical emergency
  • forward displacement of iris toward cornea with dilation harrows or closes changer angle
  • rapid increase in pressure ->ischemia
  • s/s:
    • severe eye pain
    • N/V
    • blurred vision with halos
    • redness of eye
    • steamy cornea
    • dilated pupil that is non-reactive to light
92
Q

dx of glaucoma

A

intraocular pressure measurements
central visual field test
exam of optic disk

93
Q

newborn vision

A

at birth: 20/400
by 6 month: 20/30
blink reflex, corneal reflex, and pupillary reaction to light
unable to coordinate head and eyes: dolls eyes reflex
shape of eyeballs, cornea, and lens changes with growth
stereopsis (depth perception) by 7 months of age
binocularity (perceived vision from both eyes simultaneously) begins at 6 weeks and established at 4 months.

94
Q

geriatric vision

A
  • decreased skin elasticity, changes in lacrimal gland function, and shrinking of vitreous body.
  • changes to retina and lens -> decreased color vision and discrimination, reduced contrast sensitivity, and diminished accommodation
  • retinal changes: loss of luteal pigment in macular areas
  • > reduced light sensing of rods and cones
  • development of presbyopia r/t decreased elasticity of lens and decrease in the effectiveness of the ciliary muscle. (inability to focus on near objects)
95
Q

conductive hearing loss 4 mechanisms

A

obstruction
mass loading
stiffness
discontinuity

96
Q

hearing loss obstruction

A

cerumen impaction most common

97
Q

hearing loss mass loading

A

middle ear effusion

98
Q

hearing loss stiffness

A

otosclerosis

99
Q

hearing loss discontinuity

A

ossicular disruption

100
Q

meniere disease

A

idiopathic
impairment of inner ear to regulate normal homeostatic systems
- production, maintenance, recycling of endolymph and perilymph

101
Q

cause of meniere disease

A 
autoimmunity
allergies
viral and bacterial infections
head trauma
chronic stress 
-men and women equally
- usually in 50's
102
Q

meniere’s s/s

A

episodic tinnitus
vertigo
sensations of ear fullness
fluctuating hearing loss

103
Q

menieres tx

A 
symptomatic relief
- antiemetic, anticholinergics, 
low sodium diet
smoking cessation 
management of stress
dec. caffeine
surgical interventions
anti-migraine meds

Pathophysiology (80 decks)

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