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

Question 1

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

Answer 1

Neospinothalamic tract
Paleospinothalamic tract

Connects with reticular formation of brain

Question 2

Neospinothalamic tract

Answer 2

Fast impulses; actue pain

Question 3

Paleospinothalamic tract

Answer 3

Slow impulses; chronic/dull pain

Question 4

Pain Control - Gate Open

Answer 4

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

Question 5

Pain Control - Gate Closed

Answer 5

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

Question 6

Nociceptive pain

Answer 6

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

Question 7

Neuropathic pain

Answer 7

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

Question 8

Psychogenic

Answer 8

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

Question 9

Pain Characteristics - Somatic Pain

Answer 9

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

Question 10

Pain Characteristics - Visceral Pain

Answer 10

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

Question 11

What is Referred Pain?

Answer 11

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

Question 12

What can increase Pain Tolerance?

Answer 12

Endorphin release

Question 13

What can decrease Pain Tolerance?

Answer 13

Fatigue, or stress

Question 14

COLDSPA

Answer 14

character
onset
location
duration 
symptoms 
precipitating events
alleviating factors

Question 15

Pain Management - Opiate-like Chemicals (Opioids)

Answer 15

Secreted by interneurons of the CNS (endogenous)

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

Ex: Enkephalins, dynorphins, beta-lipoproteins

Question 16

Analgesic Drugs - Mild Pain

Answer 16

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)

Question 17

Analgesic Drugs - Moderate Pain

Answer 17

Codeine, Oxycodone

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

Question 18

Analgesic Drugs - Severe Pain

Answer 18

Morphine, Meperidine

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

Question 19

Pain mangement - PCA?

Answer 19

PCA = patient controlled analgesia

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

Question 20

Structure of the Ear - external ear

Answer 20

Captures and amplifies sound

Question 21

Structure of the Ear - middle ear

Answer 21

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

Question 22

Structure of the Ear - inner ear

Answer 22

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

Question 23

Otitis Externa

Answer 23

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

Question 24

Swimmer’s Ear

Answer 24

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

Question 25

Barotrauma

Answer 25

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

Question 26

Otitis Media

Answer 26

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

Question 27

Mastoiditis

Answer 27

Ear infection spread to the mastoid bone causing - Ear pain - Otorrhea - Fever - Headache - Swelling and redness behind the ear

Question 28

Otosclerosis

Answer 28

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)

Question 29

Conductive Hearing loss

Answer 29

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

Question 30

AOM

Answer 30

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

Question 31

OME

Answer 31

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

Question 32

Neural dysfunction of the inner ear (3)

Answer 32

Sensorineural Hearing loss Tinnitus Equilibrium disruption

Question 33

Sensorineural Hearing Loss

Answer 33

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

Question 34

Tinnitus

Answer 34

Ringing in ears

Question 35

Equilibrium disruption

Answer 35

Could be from vertigo

Question 36

Objective Vertigo

Answer 36

Person is still but feels that everything around is moving

Question 37

Subjective Vertigo

Answer 37

Person is in motion but the room is still

Question 38

Physiologic Vertigo

Answer 38

Motion sickness from repeated rhythmic stimulation

Question 39

Meniere disease

Answer 39

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

Question 40

Labyrinthitis

Answer 40

Inflammation of the inner ear

Question 41

Hyperopia

Answer 41

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

Question 42

Myopia

Answer 42

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

Question 43

Presbyopia

Answer 43

Loss of nearsightedness commonly associated with aging

Question 44

Strabismus

Answer 44

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

Question 45

Amblyopia

Answer 45

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

Question 46

Diplopia

Answer 46

Double vision that occurs when binocular vision isn't quite lined up _more permanent damage occurs if r/t muscle tissue

Question 47

Nystagmus

Answer 47

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

Question 48

Ptosis

Answer 48

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

Question 49

Entropion

Answer 49

Lower lid turns IN, causing eye irritation and tearing

Question 50

Ectropion

Answer 50

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

Question 51

Hordeolum

Answer 51

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

Question 52

Chalazion

Answer 52

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

Question 53

Conjunctivitis

Answer 53

Inflammation of conjunctiva Viral vs Bacterial

Question 54

Bacterial Conjunctivitis

Answer 54

Caused by Chlamydia trachomatis and Neisseria gonorrhea Creates lots of crusting, yellow-green drainage Can be seen in babies at birth

Question 55

Viral Conjunctivitis

Answer 55

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

Question 56

Keratitis

Answer 56

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.

Question 57

Glaucoma Pathophysiology

Answer 57

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.

Question 58

Glaucoma categorizations

Answer 58

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)

Question 59

Primary Open Angle Glaucoma

Answer 59

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

Question 60

Acute Angle Closure Glaucoma

Answer 60

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

Question 61

Cataracts

Answer 61

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.

Question 62

Macular Degeneration

Answer 62

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

Question 63

Fovea

Answer 63

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

Question 64

Dry (atrophic) Macular Degeneration

Answer 64

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

Question 65

Wet (exudative) Macular Degeneration

Answer 65

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.

Question 66

Retinal Detachment

Answer 66

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.

Question 67

Acute/Closed Angle Glaucoma

Answer 67

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

Question 68

Herpes Zoster Keratitis

Answer 68

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

Question 69

Central Retinal Artery Occlusion

Answer 69

Sudden vision loss, painless