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patho ch 12
altered somatic/special sensory function
| Question | Answer |
|---|---|
| sensory receptors | connect external/internal environment with nervous system |
| general sensory receptors | pain/temperature/pressure/touch/chemical stimulation |
| special senses | vision hearing balance gustation olfaction |
| gustation | sense of taste |
| sensory pathways operate on | conscious and subconscious level (voluntary vs involuntary) |
| somatic nervous system | subdivision of peripheral nervous system control voluntary movement + transmit sensory information to CNS |
| sensory input (SNS) | carries signal from sensory receptor to CNS |
| motor input | send signal from CNS to skeletal muscle for voluntary movement |
| spinal reflex arcs | reflexive involuntary motor responses of SNS -- for immediate protective purposes ie. withdrawing hand from hot objects |
| what are the impacts of sensory perceptions | shapes responses -> eg. pain from injury, comfort from familiar voice |
| altered sensations cause | impaired physical, psychological and social functions |
| somatosensory network | general somatic afferent neurons special somatic afferent neurons general visceral afferent neuron brain informed about external (skin/muscle) and internal conditions (organs) |
| general somatic afferent neurons function | pain touch temperature |
| general somatic afferent neuron location/distribution | found throughout body, especially in skin/muscle/connective tissue |
| special somatic afferent neurons function | signals for proprioception (position and body movement) balance/movement |
| proprioception | positional and body movement sensation |
| special somatic afferent neurons location/distribution | found in muscle/tendon/joints |
| general visceral afferent neurons locations/distribution | found in visceral/internal structures |
| general visceral afferent neurons function | inform about internal states ie fullness, discomfort homeostasis/wellbeing |
| pain | sensation tied to tissue damage and emotional response chronic vs acute |
| purpose of pain | protective function to trigger reflex to minimize injury/protect affected area in healing |
| what transmits pain | pain transmitted by somatosensory pathways touch/temperature/proprioception |
| mechanoreceptors | detect vibration/pressure/stretching sound |
| thermoreceptors | detect change in temperature cold/warmth extreme temperatures |
| nociceptors | transmit pain and itching signals |
| chemoreceptors | respond to changes in chemical levels TASTE/SMELL receptors ie. O2/CO2 levels, pH |
| types of mechanoreceptors | baroreceptors and osmoreceptors |
| osmoreceptors | transmit cell stretch signals |
| photoreceptors | rods and cones transmit vision |
| first order neurons | bring sensory info from periphery to CNS |
| second order neurons | transmit from spinal cord/brainstem to thalamus |
| third order neurons | relay info from thalamus to primary somatosensory cortex final perception emerges once somatosensory cortex receives impulses |
| thalamus role in sensory processing | acts as a relay station to process and transmit sensorimotor signals |
| dorsal root ganglia function | sensory unit cluster of sensory neuron cell bodies located at dorsal root of spinal nerve in PNS |
| how are somatosensory impulses transmitted | environmental stimuli converted into electrical impulses |
| A-alpha dorsal root ganglia fiber | large/myelinated, fast conduction (proprioception) |
| A-beta dorsal root ganglia fiber | medium/myelinated, moderate conduction (touch/pressure) |
| A-delta dorsal root ganglia fiber | small/myelinated, slower conduction (fast pain/cold) |
| how do nerve fiber size/myelination affect conduction | larger nerve fibers conduct signals faster myelinated fibers conduct signals faster |
| C fiber dorsal root ganglia | small/unmyelinated, slowest conduction (slow, diffuse pain/warmth/itch) |
| dermatomes | sensory region innervated by single pair of dorsal root ganglia reflecting segmental organization of spinal cord |
| discriminative pathway | communicate fine touch/spatial orientation/vibration/muscle-joint movement primary dorsal root ganglion neuron dorsal column neuron thalamic neuron 2 point discrimination + precise identification of stimulus location |
| anterolateral pathway | anterior/lateral spinothalamic tracts transmit pain/crude touch/pressure multiple synapses with slower conduction and autonomic responses (RAS triggered) |
| RAS | reticular activating system regulates arousal, consciousness, and the sleep-wake cycle |
| informed perception | spinal cord only able to process up to automatic reflexive action further processing needs to start at thalamus -> somatosensory cortex |
| where does awareness/recognition of stimuli begin | thalamus further refinement for interpretation in somatosensory cortex |
| somatosensory modalities | refers to nature of perceived stimuli determined by receptor specificity, impulse transmission and central interpretation differing modalities allows differing interpretation of refined impulse |
| stimulus discrimination | different parts of body can have differing levels of receptor density/activation threshholds ie. finger tips vs back of hand |
| 2 point discrimination | exemplifies stimulus discrimination differences across body regions |
| acuity | the ability to locate and discern stimulus details |
| tactile stimulation by what class of nerve fibers | A-alpha fibers (large/myelinated) |
| types of tactile nerve fibers | free nerve ending Meissner corpuscules Merkel disks Pacinian corpuscles hair follicle receptors Ruffini endings |
| Meissner corpuscle | highly developed sense of touch |
| Merkel disks | movement of light object over skin vibrations |
| Pacinian corpuscles | vibration detection |
| hair follicle receptors | detect movement on body surface |
| Ruffini endings | detect heavy/continuous touch and pressure |
| free nerve endings | detect touch/pressure |
| speed of thermoreceptors | slower conduction rate than tactile sensation |
| proprioception involves what nerves | proprioceptors muscle spindles Golgi tendon organs stretch receptors |
| what mediates proprioception | pathways in posterior column vestibular system (ears) |
| where is proprioception processed | thalamus and cerebral cortex |
| nociceptive pain | pain not initiated in the CNS originates from skin/joint/muscle/bone/organs |
| neuropathic pain | pain originating within CNS atypical transmission not involving nociceptors |
| nociceptive pain vs neurogenic pain | nociceptive pain can be treated with NSAID/opioids neurogenic pain needs nerve blocks/anticonvulsants |
| transduction | electrical impulses promote release of algesic substances |
| algesics | pain causing substances substance P H ion K ions serotonin histamines |
| modulation | substances released in response to pain stimuli from activation of inhibitory processes (ie serotonin, NE, endorphins) |
| perception of pain | sensory - primary somatosensory cortex emotional - limbic system subjective reaction to stimuli |
| pain threshold | intensity of pain needed to elicit response |
| perceptual dominance (pain) | existence of pain at another location which is given more attention |
| pain tolerance | degree of pain is endured (duration vs intensity) before initiating response |
| what class of nerve fibers conduct pain | sharp rapid/immediate pain = A-delta fiber dull linger pain = C-fibers |
| total pain theory | recognizes physical pain contributes and is affected by other types of distress like spiritual/psychological/social |
| gate control theory | pain conceptualized primarily as physiological event in brain to increase/decrease (open/closed gate) flow of impulse from PNS to CNS gate in substantia gelatinosa |
| Pattern theory | light touch vs intense pressure causes different experiences pain influenced by duration, quantity of tissue involved, summation of impulses |
| specificity theory | pain has dedicated neural architecture simplify pain management -> focus blocking/altering signals in specific pathways |
| substantia gelatinosia | collection of cells in gray matter extending throughout dorsal horn of spinal cord to medulla oblongata |
| neuromatrix theory | culture, past trauma, genetics and personal expectations influence pain perception neuromatrix explain phantom pain -- brain has built in representation of body |
| phantom pain | pain persisting after amputation no actual nociceptors signaling pain |
| PAINAD | advanced dementia breathing - negative vocalization- facial expression - body languange - consolability |
| N-PASS | neonates crying/irritability - behavior - facial expression - extremities tone |
| classification of pain locations | cutaneous deep visceral referred |
| classification of pain quality | sharp burning throbbing diffuse |
| classification of pain duration | acute (<3 month) vs chronic (>3 months) |
| acute pain | sudden onset + self-limiting responsive to treatment d/t disease/inflammation/injury |
| chronic pain | persistent (3+ months) treatment resistant anorexia + insomnia + depression |
| tx of pain | analgesia pharmacologic vs nonpharmacologic functional improvement as secondary goal |
| analgesia | pain relieving |
| nonpharmacologic tx of pain | CBT hot/cold TENS acupuncture distractions |
| TENS | transcutaneous electrical nerve stimulation |
| pharmacologic tx of pain | non-narcotic analgesics opioids adjuvant analgesics |
| cornea | clear transparent structure covering exterior of eye refracts/bends light |
| pupil | eye structure that can contract/constrict control amount of light |
| lens | fine tuning focus; change shape via ciliary muscle for focusing of images |
| anterior chamber of eye | behind cornea aqueous humor |
| posterior chamber of eye | behind iris and in front of lens vitreous humor |
| what does vision rely on | light entry, focusing, neural processing |
| how does vision sensation occur | light contacts cornea -> pass thru pupils to lens -> lens adjust shape to focus image on retina -> retinal cones/rods initiate nerve impulse -> optic nerve -> occipital lobe |
| rods | detect low light levels |
| cones | facilitate color vision and high acuity |
| macula | center of the retina responsible for central vision, color vision and fine detail |
| fovea | center of macula site where cones promote night vision and peripheral vision |
| color blindness | absence of single group of color receptive cones |
| concave lens vs convex lens | concave lens diverge light rays = myopia treatment convex lens converge light rays in center = hyperopia treatment |
| saccades (vision) | quick shifts from one object to another |
| pursuit (vision) | smooth tracking of moving targets |
| convergence/divergence (vision) | simultaneous inwards/outwards movement of both eyes |
| vestibular movements (vision) | eye adjust to head position via inner ear feedback |
| fixation maintenance (vision) | small corrective actions to sustain focus |
| eye movement control via which CNs | CN III, IV, VI occulomotor, trochlear, abducens |
| extraocular muscles | superior rectus/oblique muscles inferior rectus/oblique muscle lateral/medial rectus muscle |
| strabismus | eyes don't look at same direction at the same time crosseyed |
| nystagmus | involuntary rapid eye movement eye oscillates -> indicates neuro/vestibular dysfunction |
| external protective eye structure | eyelids/eyelashes conjunctiva |
| conjunctiva | lines eyelid and cover sclera lubrication |
| lacrimal glands | produce tears to protect against bacterial infection |
| tears (eye) | supplies nutrients, remove waste and lubricate contains lysozymes |
| puncta | opening into tear ducts |
| aqueous humor | produced by ciliary body flow from posterior to anterior chamber maintain intraocular pressure and clarity |
| glaucoma | increased intraocular pressure due to aqueous humor imbalances |
| potential sources of alteration in visual function | structural - corneal/lens/retinal damage muscular - motor dysfunction (EOM/CN) neurologic - image transmission vs processing issue |
| myopia | nearsightedness correction via concave lens |
| hyperopia | farsightedness correction via convex lens |
| astigmatism | irregular curvature of cornea/lens causing blurred images |
| presbyopia | age related reduced lens accommodation correction with bifocals |
| diplopia | double vision when vision falls on noncorresponding retinal areas |
| amblyopia | uncoordinated focus -> suppressed vision in one eye |
| conjunctivitis | pink eye inflammation of conjunctiva dt virus/bacteria/allergens |
| viral conjunctivitis | often affect one eye with minimal discharge |
| bacterial conjunctivitis | typically both eyes involved, heavy discharge |
| allergic conjunctivitis | itching/redness and tearing in both eyes |
| cataracts | progressive lens clouding (protein aggregations) scatters incoming light classified via location + progression speed |
| cataract tx | surgery |
| nuclear sclerosis | type of cataract -> age associated cataract formation farsighted vision impacted more than nearsighted vision |
| snellen | far distance eye test 20/20 normal vision |
| jaeger | near distance eye test 12-14 inch distance |
| normal intraocular pressure | 10-21 mmHg increased PSI = glaucoma |
| tx for altered vision (refractive error) | corrective lens for refractive error (glasses/contacts) surgical intervention for myopia/hyperopia/astigmatism/cataract |
| strabismus tx | patch therapy muscle surgery |
| glaucoma tx | pharmacologic surgical intervention |
| external ear anatomy/function | auricle and ear canal funnel sound to tympanic membrane |
| auricle | aka pinna outer ear flexible cartilage -> collect sound wave into ear canal |
| middle ear anatomy/function | tympanic membrane ossicles auditory tube transduce mechanical vibration |
| internal ear | bony/membranous labyrinth cochlea vestibular apparatus house hair cells for hearing/balance |
| ear canal | external acoustic meatus lined with small hair and cerumen producing glands |
| cerumen | ear wax trap debris and defend against pathogen |
| ossicles | 3 bones (malleus - incus - stapes) link tympanic membrane to oval window -> amplify/transmit mechanical energy |
| eustachian tube | pressure regulation connect nasopharynx to temporal bone cavity |
| eustachian tube in children | shorter in length more prone to infections |
| bony labyrinth | filled with perilymph similar to ECF |
| membranous labyrinch | filled with endolymph used for balance |
| cochlea | uses organ of corti (haircell) for hearing -> transmission into electrical signals via cochlear nerve |
| vestibular apparatus | detect head movement and position for balance semicircular canal/utricle/saccule |
| vestibulocochlear nerve | CN VIII hearing (cochlear) balance (vestibular) |
| how does hearing process work | soundwave vibrate tympanic membrane/ossicles -> conversion to mechanical energy from stapes -> cochlear fluid + organ of corti hair cells depolarize/hyperpolarize -> nerve impulse travel via CN VIII to auditory cortex in brain |
| how does balance work | hair cells (vestibular receptors) detect perilymph movement in semicircular canal nerve conduction into cerebellum |
| otitis externa | swimmer's ear inflammation/infection/edema of ear canal itching, pain, drainage, mild hearing loss |
| mastoiditis | infection -> inflammation of hair cells in mastoid bones |
| otosclerosis | abnormal bone growth at oval window -> stapes immobilized autosomal |
| sensorineural hearing loss caused by | destruction of cochlear haircells/neural pathways |
| tinnitus caused by | cochlear damage, HTN |
| Meniere disease | vertigo sensorineural hearing loss tinnitus |
| presbycusis | hearing loss related to aging tinnitus association |
| labyrinthitis | membranous labyrinth inflammation vertigo + hearing deficit |
| dB vs Hz | decibel - sound intensity hertz - frequency (high/low pitch) |
| what part of ear is affected in conductive hearing loss | external/middle ear |
| what part of ear is affected in sensorineural hearing loss | internal ear structures |
| types of hearing loss | sensorineural conductive mixed (conductive + sensorineural) central processing (auditory processing) |
| central auditory processing disorder | altered auditory signal processing in brain |
| tympanometry | measure tympanic membrane motility to identify middle ear fluid, perforation or cerumen blockage |
| acoustic reflex measurement | evaluate stapedius muscle response to loud sound |
| bone conduction test | rinne test eval sensorineural hearing loss |
| otoacoustic emissions | OAE evaluation of outer hair cell function within cochlea |
| vestibular evoked myogenic potential | VEMP evaluate saccule and vestibular pathway |
| hearing aids | amplify sounds -> improve speech perception |
| cochlear implant | directly stimulate cochlear nerve endings bypass damaged structure |
| gustation nerve involvement | CN VII and IX (facial and glossopharyngeal) -> medulla/thalamus/gustatory cortex |
| risk factor for altered gustation | smoking drug effects nutritional deficiency URI (ie COVID) |
| smell nerve involvement | olfactory receptors -> CN I (olfactory nerve) -> olfactory bulb -> olfactory cortex |
| fibromyalgia pathophysiology | nerves become overresponsive to normal stimuli no well defined pathogenesis or cure no structural/functional abnormality |
| fibromyalgia risk factors | possible genetic (familial + epigenetic influence) stress/depression -> may amplify pain |
| fibromyalgia clinical manifestations | MSK pain + tenderness fatigue unimproved w/ sleep muscular stiffness depression/anxiety + cognitive difficulties (fibro fog) low serotonin level |
| dx for fibromyalgia | chronic widespread pain for 3+ month localized pain to specific tender points (at least 12/18) Dx of exclusion + R/O other cause of MSK pain |
| tx for fibromyalgia | CBT/stress reduction massage + gentle exercise analgesics + anticonvulsants (gabapentin/pregabalin) + muscle relaxant antidepressants (serotonin/NE reuptake blockers) |
| migraine pathophysiology | recurrent throbbing HA lasting 1-2 days trigeminal nerve and vasculature dysfunction unknown cause |
| migraine risk factor | serotonin and calcitonin gene related peptide (CGRP) ?genetic component |
| clincial manifestations of migraine | UNILATERAL throbbing pain prodrome - mood change/craving/fatigue nausea/vomiting photosensitivity |
| migraine aura | visual/sensory disturbance |
| migraine postdrome phase | lingering fatigue concentration issue mood shift |
| migraine stages | prodrome (hrs to days) aura (5-60 min) headache (4-72 hr) postdrome (24-48 hr) |
| dx for migraine | 5+ HA episodes lasting up to 4-72 hr unilateral head pain + pulsation nausea/vomiting + photosensitivity r/o other etiology (tumor/meningitis) -> CT/MRI |
| tx for migraine | trigger avoidance/exercise/reduce stress NSAID/triptans/ergot alkaloids B-blocker - antiseizure med - CGRP inhibitors (for severe/frequent) hormone stabilization + antiemetics for nausea |
| triptans | mimic serotonin (serotonin receptor antagonist) -> aid vascular constriction + limit pain pathway in migraine |
| ergot alkaloids | bind to subtype of serotonin receptor -> reduce blood vessel swelling |
| otitis media pathophyi9sology | middle ear infection (most common d/t Eustachian tube) URI -> fluid buildup viral/bacterial proliferation in trapped fluid chronic/recurrent -> complications like mastoiditis |
| clincial manifestations of otitis media | otalgia (pulling/tugging infant ears) fever URI symptoms red/bulging tympanic membrane in AOM fluid behind tympanic membrane = effusion |
| AOM | acute otitis media |
| Dx for otitis media | otoscopic eval of ear canal Hx - otalgia/fever/fussiness ear discharge if perforation |
| tympanic membrane color in AOM vs OME | AOM = red color OME (otitis media w/ effusion) = gray with effusion |
| tx for otitis media | analgesic/warm compress abx therapy (children 6+ month) w/ severe symptom surgical intervention for recurrent/chronic fluid - tympanostomy tube |
| abx for otitis media | reserved for severe/prolonged symptom to avoid abx resistance |
| tympanostomy | surgical intervention to ventilate middle ear + reduce fluid accumulation |
| Meniere disease pathophysiology | altered vestibular function dt excessive endolymph (fluid dysregulation) in membranous labyrinth dilation + possible rupture in labyrinth unclear etiology unpredictable vertigo episodes |
| clinical manifestations of meniere dz | episodic vertigo w/ nausea/vomiting tinnitus + aural fullness sensorineural hearing loss varying intensity/frequency of vertigo attacks |
| dx criteria for meniere's | hearing/balance test sensorineural hearing loss confirmation episodes of vertigo at least 20 min r/o causes of dizziness |
| tx for meniere's | diuretic/antiemetics/vestibular suppresants salt restriction betahistine - diminish vertigo frequency surgical interventions |
| macular degeneration pathophysiology | damage to macula (central vision) dry vs wet (wet worse -> faster/more severe) |
| dry macular degeneration | atrophic involve drusen deposits -> thins macula slow progression |
| wet macular degeneration | exudative choroidal neovascularization -> new blood vessels form under retina/macula -> fluid leaking = distorted vision faster/more severe progression |
| macular degeneration risk factors | age inflammation genetic poor retinal perfusion |
| clinical manifestations of macular degeneration | central vision distortion (blurriness in center of vision -> big black spot in center of vision) difficulty reading/recognizing/driving |
| dx for macular degeneration | ophthalmic eval w/ dilation -> visualize drusen deposits/choroidal neovascularization amsler grid testing -> reveal wavy/blurred lines fluorescein angiography (identify leaky blood vessel) optical coherence tomography - imaging of retinal layer |
| tx for dry macular degeneration | no tx for dry MD |
| tx for wet macular degeneration | anti-VEGF therapy = reduce neovascularization laser photocoagulation/photodynamic therapy = seal leaking vessels vision aid/lifestyle adaptation |
| anti-VEGF | anti vascular endothelial growth factors -> slow vessel growth/leakage |
| glaucoma pathophysiology | elevated IOP = damaged retinal nerve possible normal IOP w/ optic nerve damage dt optic nerve hypersensitivity |
| types of glaucoma | open angle glaucoma angle closure glaucoma |
| open angle glaucoma | most common - early asymptomatic w/ progressive loss of peripheral vision slow aqueous drainage thru trabecular meshwork |
| angle closure glaucoma | sudden blockage of fluid drain acute IOP rise severe eye pain HALOS around light + rapid vision change nausea aggressive tx necessary |
| dx for glaucoma | tonometry ophthalmoscopy -> optic nerve cupping/pallor visual field testing -> blind spots/decrease peripheral vision gonioscopy |
| tonometry | measure IOP normal 10-21 mmHg >22 mmHg suggest risk |
| gonioscopy | examine angle structure -> distinguish open angle vs angle closure glaucoma |
| glaucoma tx | lower IOP -> increase aqueous humor outflow or reduce production B-blocker A-adrenergic agonist prostaglandin analog miotics trabeculoplasty/iridotomy -> restore/create drainage pathway |
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sleepingbear