Transcript Document

ESSENTIALS OF A&P
FOR EMERGENCY CARE
CHAPTER
11
The Senses:
The Sights and Sounds
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Multimedia Asset Directory
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Opthalmic Mediations and their Delivery Video
Eye Anatomy Animation
Middle Ear Animation
Adolescent Ear Animation
Child's Ear Animation
Tympanic Membrane Thermometer Measurements Video
Heat Therapy Video
Cold Therapy Video
Cataracts Video
Conjunctivitis Video
Otitis Media Video
Audiologists Video
Opthalmologists and Opticians Video
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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Introduction
• All of the input from your environment
must be taken in by your special senses
and interpreted by your brain so you can
understand and appreciate the
experience.
• The senses that gather sensory input are
also protective in nature and need to be
highly integrated with the nervous system
for our survival.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
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Learning Objectives
• Distinguish between general and special
senses.
• Describe the internal and external
anatomy and functions of the eye.
• Describe the internal and external
anatomy and functions of the ear.
• Discuss the process involved with the
senses of taste, smell, and touch.
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Learning Objectives
• Contrast the types of pain and the pain
response.
• Explain several common disorders of the
eye and ear.
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Overview
• In addition to the senses of vision, hearing,
smell, taste, and touch there are also the
senses of pain, pressure, temperature,
position, balance, and feelings of hunger
and thirst that are also important to our
survival.
• The senses of sight, hearing, balance,
taste, and smell are referred to as our
special senses.
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Pronunciation Guide
Click on the megaphone icon before each item to hear the pronunciation.
amblyopia (AM blee OH pee ah)
aqueous humor (AY kwee us HYOO mer)
auricle (AW rih kul)
cataract (KAT ah rakt)
cerumen (seh ROO men)
ceruminous glands (seh ROO men us)
choroid (KOH royd)
ciliary muscles (SILL ee AIR ee)
cochlea (KOCK lee ah)
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Pronunciation Guide
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conjunctiva (KON junk tih vah)
endolymph (EN doe limf)
eustachian tubes (yoo STAY she an)
external auditory meatus (AW dih tor ee mee AYE
tus)
glaucoma (glaw KOH mah)
gustatory sense (GUSS ta TOH ree)
hyperopia (HIGH per OH pee ah)
incus (ING kus)
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Pronunciation Guide
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labyrinth (LAB ih rinth)
lacrimal apparatus (LAK rim al app ah RA tus)
malleus (MALL ee us)
Ménière’s disease (MAIN ee airz)
myopia (my OH pee ah)
ossicle (AHS ih kull)
otitis media (oh TYE tiss MEH dee ah)
perilymph (PER ih limf)
pinna (PIN ah)
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Pronunciation Guide
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presbyopia (PREZ bee OH pee ah)
sclera (SKLAIR ah)
stapes (STAY peez)
tactile corpuscles (KOR pus el)
tinnitus (tin EYE tus)
tympanic membrane (tim PAN ik)
vestibule chamber (VES tih byool)
vitreous humor (VIT ree us HYOO mer)
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The Different Senses
• Our body senses allow us to experience
all aspects of our journey, allowing us to
see, hear, smell, taste, and feel the world
around us.
• Our senses allow us to monitor and detect
changes in the environment, sending this
information to the brain via sensory
(afferent) neurons. The brain interprets the
information and makes the appropriate
motor (efferent), response.
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Classification of Senses
• The senses of sight, sound, equilibrium,
taste, and smell are referred to as the special
senses. They are in well-defined areas. Other
senses scattered throughout our body are
referred to as general senses including the
sensation of touch, heat, cold, pain, nausea,
hunger, thirst, and pressure (or deep touch).
• Cutaneous senses use the receptors of the
skin, while visceral senses include nausea,
hunger, thirst, and the need to urinate and
defecate.
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ESP
• One controversial sense is Extrasensory
Perception.
• This means senses outside the normal
sensory perception.
• There is still debate over whether this
sense exists.
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Sense of Sight
Overview
• The eye has many similarities to a camera. The
light rays from the image you view pass through
the pupil, and then through the lens, where they
are focused on the retina (photoreceptors).
• The iris allows the right amount of light to enter
the eye for proper focusing.
• External structures of the eye help to provide
protection.
• The lacrimal glands secrete tears to help keep
the eye clean.
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External Structures of the Eye
• The orbit is a cone-shaped cavity formed
by the skull that houses and protects the
eyeball. This cavity is padded with fatty
tissue that acts as a cushion to prevent
injury.
• Six short muscles connect the eyeball to
the orbit, and allow rotary movement so
you can see in all directions.
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External Structures of the Eye
• The eyelids close over the eye to protect it
from light, foreign particles, or impact
injury. Eyelashes in the eyelid help to
prevent large particles from entering the
eye.
• The eyelids also contain sebaceous
glands that secrete oil to keep the eyelids
soft and pliant, and make the eyelashes
slightly sticky to trap particles.
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External Structures of the Eye
• The conjunctiva is a membrane over the
surface of the eyeball that acts as a
protective covering for the exposed
surface.
• The lacrimal apparatus produces and
stores tears and contains the lacrimal
gland and its corresponding ducts.
• The lacrimal gland produces tears, spread
by blinking, for cleaning and lubrication.
Tears act as an antiseptic.
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Figure 11-1 Lacrimal structures of the eye.
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Internal Structures of the Eye
• The globe-shaped eyeball is the organ of
vision and is separated into two chambers
of fluid that help to protect the eye.
• The fluids of the eye are called humors.
Aqueous humor is watery and bathes the
iris, pupil, and lens and fills the anterior
and posterior chambers. Vitreous humor is
a clear jelly-like fluid that occupies the
entire cavity behind the lens.
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Layers of the Eye
The Sclera
• The eye has three layers.
• The sclera is the outermost layer and is a
tough fibrous tissue that serves as a
protective shield.
• The sclera contains the cornea, which is
transparent to allow light to pass through
and curved to bend the entering light to
focus it on the retina.
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Layers of the Eye
The Choroid
• The choroid is the middle layer. It is a
highly vascularized and pigmented region
that provides nourishment to the eye.
• This layer contains the iris and the pupil.
The iris is the colored portion of the eye
that controls the opening, or pupil, where
light passes into the eye. The iris is a
sphincter that in low light relaxes, allowing
the pupil to dilate so more light can enter.
Essentials of A&P for Emergency Care
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Layers of the Eye
The Choroid
• Located behind the pupil is the lens, which is
surrounded by ciliary muscles.
• These muscles can alter the shape of the
lens, making it thinner or thicker to allow the
incoming light rays to focus on the retina.
• This process is called accommodation, which
basically combines changes in the size of the
pupil and the lens curvature to make sure the
image converges in the same place on the
retina and therefore is properly focused.
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Layers of the Eye
The Retina
• The retina is a delicate membrane that
continues posteriorly and joins the optic nerve.
• The retina contains two types of light sensing
receptors called rods and cones. The rods are
active in dim light and do not perceive color,
while the cones are active in bright light and do
perceive color.
• These receptors contain photopigments that
cause a chemical change when light hits them,
causing impulses to be sent to the optic nerve.
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Layers of the Eye
The Retina
• The information is then sent to the brain, where
the impulse is interpreted, in the visual cortex of
the occipital lobe, and we “see” the object.
• In summary, light rays enter the eye and pass
through the cornea, aqueous humor, pupil, lens,
and vitreous humor and are focused on the
retina. Here the photoreceptors in the retina
cause an impulse to be sent to the optic nerve
(Cranial Nerve II), which carries it to the occipital
lobe of the brain for the interpretation we call
vision.
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Figure 11-2 Internal structures of the eye.
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Table 11-1 Structures and Functions of the Eye.
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Table 11-1 (continued) Structures and Functions of the Eye.
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From the Streets:
Anisocoria
• Anisocoria, or unequal pupils, is a concern
in the emergency patient.
• Pupillary construction is controlled by the
oculomotor nerve (CN III).
• In the trauma patient, anisocoria may
indicate intracranial injury.
• In the medical patient, anisocoria may
indicate intracranial bleeding or tumor.
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From the Streets:
Anisocoria
• Anisocoria can be a normal finding.
• 20% of the population has some degree of
anisocoria.
• The difference is typically 1mm or less and
is not accompanied by other findings.
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From the Streets:
Eye Emergencies
• Two types of doctors specialize in these
disorders:
– Ophthalmalogists
 Physicians who specialize in the medical and
surgical management of eye disorders.
– Optometrists
 Doctors of optometry who perform refractive
examinations and prescribe glasses and contact
lenses.
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From the Streets:
Conjunctival Emergencies
• Acute eye pain or a red eye are the most
common initial complaints.
• Trauma can cause the fragile blood
vessels within the conjunctiva to repture,
called subconjuctival hemorrhage.
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From the Streets:
Conjunctival Emergencies
• Common causes:
– Trauma
– Sneezing
– Coughing
– Vomiting
– Straining
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Figure 11-3 Conjunctival abrasion overlying a large subconjunctival hemorrhage.
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From the Streets:
Blunt Eye Trauma
• Blunt trauma to the eye can cause
swelling of the lids and the periorbital
tissues.
• Bleeding into the anterior chamber is
called a hyphema.
• The patient’s head should be elevated to
decrease intraocular pressure.
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From the Streets:
Blunt Eye Trauma
• Blunt trauma to the eye can result in a
blowout fracture in which the walls of the
orbit are damaged.
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Figure 11-4 Trauma to the right eye including complex upper lid laceration.
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From the Streets:
Penetrating Eye Trauma
• Any injury that penetrates the globe or
ruptures the globe is extremely serious
• Common causes:
– BB pellets
– Lawn mower projectiles
– Grinding injuries
– Knife wounds
– Gunshot wounds
• Treatment includes placing a protective
shield over the affected eye.
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Figure 11-5 Enucleation of the right eye following blunt trauma.
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From the Streets:
Chemical Injuries
• The severity of a chemical injury is directly
related to the chemical agent involved.
• Treatment includes irrigating the eye with
copious amounts of water for 10 minutes.
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From the Streets:
Ultraviolet Keratitis
• Ultraviolet keratitis is sever pain, tearing,
light sensitivity, and foreign-body
sensation that occurs after exposure to
intense heat or bright light.
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From the Streets:
Acute Glaucoma
• Failure of the aqueous humor to enter the
canal of Schlemm.
• The patient complains of cloudy vision,
eye ache, frequent nausea and vomiting.
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The Sense of Hearing
• The ear is responsible for hearing and
maintaining our equilibrium, or sense of
balance.
• We hear by receiving vibrations, usually
via the air, and translating them into an
interpretable sound via the eighth cranial
nerve.
• The ear can be separated into three
divisions: the external ear, the middle ear,
and the internal ear, or labyrinth.
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Figure 11-6 Structures of the ear.
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The External Ear
• The external ear is the outer projection –
the part we can see, called the pinna or
auricle.
• It also includes the canal leading into the
middle ear, called the auditory canal or
external auditory meatus.
• The canal contains ear wax called
cerumen, secreted by the ceruminous
glands to lubricate and protect the ear.
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The External Ear
• At the end of the canal is the ear drum, or
tympanic membrane, where the external
ear ends.
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The Middle Ear
• The middle ear, or tympanic cavity, is a
space that contains three small bones, or
ossicles.
• The ossicles are joined so they can
amplify the sound waves the tympanic
membrane receives from the external ear.
• Once amplified, the sound waves are
transmitted to the fluid in the inner ear.
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The Middle Ear
• The bones of the ear are named for their shape.
• The hammer, or malleus, is attached to the
tympanic membrane.
• The anvil, or incus, is attached to the hammer.
• The stirrup, or stapes, is attached to the incus
and connects to a membrane called the oval
window that begins the inner ear.
• The ossicles can amplify sound up to 22 times
the original level.
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The Middle Ear
• The eustachian tubes allow for air
pressure on either side of the eardrum to
be equalized.
• The tubes connect the nasal cavity and
pharynx to the middle ear.
• This equalizing of pressure allows the
eardrum to freely vibrate with incoming
sound waves. Sudden pressure changes,
like flying in an airplane, can affect this
area, which is why our ears “pop.”
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The Inner Ear
• The oval window transmits sound waves
into the inner ear.
• The inner ear is divided into three
separate, hollow, bony spaces that form a
maze, or labyrinth. As a result, this area
can also be called the bony labyrinth.
• The three areas include the cochlea, the
vestibule chamber, and the semicircular
canals.
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Sound Transmission in the
Inner Ear
• The cochlea is a bony spiral or snail shellshaped entrance to the internal ear, and is
connected to the oval window membrane.
• The cochlea contains fluid called
perilymph which helps transmit the sound
through this area.
• The sound is then transmitted to another
section of the cochlea which contains
another fluid, endolymph.
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Sound Transmission in the
Inner Ear
• The sound is then carried to tiny hairlike
receptors that are stimulated and conduct the
signal to the brain via the vestibulocochlear
nerve (cranial nerve VIII).
• In summary, sound waves enter the external
canal and vibrate the eardrum or tympanic
membrane in a process called sound
conduction.
• The middle ear then amplifies the sound through
the respective ossicles. This process is called
bone conduction of sound.
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Sound Transmission in the
Inner Ear
• The last ossicle (stapes) vibrates and
causes a gentle pumping against the oval
window membrane. This causes cochlear
fluid to vibrate small hairlike neurons found
in an area called the organ of Corti. A
nerve impulse is sent to the temporal lobe
of the brain, where it is interpreted as
sound, a process called sensorineural
conduction.
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Sound Transmission in the
Inner Ear
• Low-intensity sound waves, similar to a
clock ticking, send vibrations that cause
the sensory cells to move in waves that
are interpreted by the brain as that “tick
tock” sound.
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Vestibular Sense in the Inner Ear
• The ear is also responsible for your sense
of balance or equilibrium. The semicircular
canals process sensory input related to
equilibrium. They contain nerve endings or
receptors in the form of hair cells. The
semicircular canals are three loops within
the inner ear that help to maintain balance.
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Vestibular Sense in the Inner Ear
• Like the cochlea, the semicircular canals
are filled with endolymph fluid, and each
canal contains a sensory receptor. This
fluid moves when you change body
position. The movement is picked up by
the sensory receptor, which triggers a
nerve impulse to travel to the brain stem
and the cerebellum.
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Vestibular Sense in the Inner Ear
• Here the impulse is interpreted as body
position to help maintain muscle
coordination and body equilibrium.
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Figure 11-7 The structures of the inner ear.
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Table 11-2 Structures and Functions of the Ear.
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Table 11-2 (continued) Structures and Functions of the Ear.
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Taste
• The sense of taste is referred to as the
gustatory sense.
• The tongue is covered by tiny bumps
called papillae, each of which contains
several taste receptors (taste buds). Taste
buds can also be found in other parts of
the mouth, including the lips and back of
the throat.
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Taste
• Taste buds send signals to the brain via
three distinct cranial nerves. One nerve
detects the anterior two-thirds of the
tongue, a second detects the posterior
portion of the tongue, and the third detects
the throat area.
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Taste
• Taste buds detect five tastes: sweet, sour, salty,
bitter, and umami. Umami is included with the
traditional four because it is the distinct taste of
glutamates, which cannot be duplicated by the
combination of any of the other four tastes.
• Taste preferences may change with the body’s
need, which is why pregnant women may crave
a variety of foods throughout their pregnancy.
• The refinement of food taste is primarily
dependent on the sense of smell and the
number of functioning taste buds.
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Figure 11-8 The sense of taste.
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Smell
• The sense of smell arises from the
receptors located in the olfactory region or
the upper part of the nasal cavity.
• We “sniff” to bring the smell into the area
where it can be interpreted.
• Taste and smell are closely related, and
pleasant food odors stimulate digestive
enzymes.
• Smell is also closely linked to memory.
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Figure 11-9 The sense of smell.
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Touch
• Touch receptors are small rounded
bodies, called tactile corpuscles, located in
the skin, especially concentrated in the
fingertips and the tip of the tongue.
• Temperature sensors are also located in
the skin, with separate sensors for heat
and cold.
• Adaptation occurs when sensory
stimulation is continually applied, changing
your perception of temperature.
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Clinical Application:
Heat and Cold Therapy
• Heat and cold therapy are used for a
variety of injuries, relying on our bodies
physiological response to temperature
change. Heat relaxes muscles and dilates
blood vessels, bringing more blood flow to
the site of injury. Cold constricts blood
vessels and minimizes the amount of
bleeding and swelling at the site.
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Pain
• Pain is a very important protective sense. It is
our body’s way of making us pay attention to
danger.
• Pain is the most widely distributed sense, being
found in skin, muscle, joints, and internal organs.
• The pain receptors are merely branchings of
nerve fibers called free nerve endings.
• Pain receptors do not adapt and you feel pain as
long as the stimulus is there.
• Pain threshold appears to vary among patients.
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Types of Pain
• Referred pain – originates in an internal
organ and is felt in another region of the
skin; an example is liver and gallbladder
pain which may be felt in the right shoulder
• Phantom pain – pain felt in an area that no
longer exists, for example, pain felt after
an amputation
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Figure 11-11 Various sites of referred pain.
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Figure 11-12 The sense of touch.
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From the Streets:
Pain
• Analgesics are medications that help to
alleviate pain.
• Inadequate analgesia remains a problem
in emergency care, especially in children.
• Because pain is subjective, it is often
difficult to assess.
• NSAIDs are used to treat mild to moderate
pain.
• Opioid analgesics are used to treat
moderate to severe pain.
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Common Disorders of the Eye
• Conjunctivitis – inflammation of the
membrane that covers the eye; can be
acute or chronic, caused by pathogens or
irritants, and is sometimes called pink eye.
• Cataract – clouding of the lens; incidence
may increase with increased exposure to
sunlight; untreated, cataracts can lead to
blindness. Cataract surgery was one of the
earliest surgical procedures, dating back
to ancient Greece.
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Common Disorders of the Eye
• Glaucoma – increased pressure in the
fluid of the eye which interferes with optic
nerve function; occurs in 20% of adults
over forty, and is cause of 15% of cases of
blindness in the U.S.
• Hyperopia – results from the flattening of
the globe of the eye or a refraction
problem where light rays focus behind the
retina; Farsightedness
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Common Disorders of the Eye
• Presbyopia – is farsightedness that occurs
with age, usually between 40 and 45
years.
• Myopia – objects at a distance appear
blurred; also called nearsightedness
• Amblyopia – also called a lazy eye, this
occurs in childhood and results in poor
vision because one eye does more work
than the other
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Using the Eyes to Diagnose Other
Problems
• The eyes can help diagnose a variety of
non-visual diseases.
• A yellow tint to the conjunctiva (jaundice)
can indicate liver disease.
• REM (rapid eye movement) is a stage of
sleep and can be measured in sleep
studies to help diagnose sleep disorders.
• Responsiveness of the pupil to light can
diagnose neurological problems (PERLA).
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Figure 11-13 Some common eye disorders. (A) Cataract of right eye.
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Figure 11-13 (continued) Some common eye disorders. (B) Pinkeye.
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Figure 11-13 (continued) Some common eye disorders. (C) A herpes virus infection.
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Common Disorders of the Ear
• Otitis Media – infection of the inner ear
• Labyrinthitis – inflammation of the inner
ear, often caused by high fevers, resulting
in vertigo
• Ménière’s disease – a chronic infection
that affects the labyrinth and leads to
progressive hearing loss and vertigo
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Common Disorders of the Ear
• Deafness – partial or complete hearing
loss caused by many conditions including
damage of any ear structure from the
tympanic membrane to the auditory nerve
• Tinnitus – ringing in the ear, sometimes
caused by taking too much aspirin
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Snapshots from the Journey
• The senses of sight (eyes), sound and
equilibrium (ears), taste (tongue), and
smell (nose) are called special senses.
The body feels other sensations, such as
touch, heat, cold, and pain, which are
called general senses.
• The eye is very similar to a camera with
lens cover (eyelids), opening (pupil), the
shutter (iris), the lens (eye lens), and the
photoreceptive film (retina).
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Snapshots from the Journey
• Light rays enter the eye and pass through
the cornea, aqueous humor, pupil, lens,
and vitreous humor and are focused on
the retina. The photoreceptors in the retina
cause a chemical impulse to be sent to the
optic nerve, which carries it to the brain for
the interpretation we call vision.
• The ear has three major divisions: the
external, middle, and inner ear. The ear is
the organ for hearing and maintaining our
sense of balance.
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Snapshots from the Journey
• Sound waves enter the external canal and
vibrate the tympanic membrane. The
middle ear amplifies the sound through the
receptive, tiny ossicles.
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Snapshots from the Journey
• The last ossicle, the stapes, vibrates and
causes a gentle pumping against the oval
window membrane, causing cochlear fluid
(perilymph) to move and transmit the
sound to endolymph, and then to small
hairlike nerves, eventually reaching the
hearing centers in the brain where the
sound is interpreted.
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Snapshots from the Journey
• The semicircular canals are responsible
for maintaining body balance.
• Our sense of taste, or gustatory sense,
has traditionally been thought to consist of
sweet, sour, salty, and bitter, but a fifth
taste, umami, has recently been
distinguished as its own category. The
sense of taste originates on taste buds on
the tongue and is closely associated with
the sense of smell.
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Snapshots from the Journey
• The sense of smell arises from the
olfactory region of the nose.
• The sense of touch allows perceptions of
pain, temperature, pressure, traction, and
the sensation of being “tickled.”
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Case Study
A 40-year-old male patient presents with
complaints of tinnitus and vertigo. He
complains that his hearing is getting
progressively worse and he is having dizzy
spells and nausea.
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Case Study Questions
• Describe the patient’s complaints in your
own words.
• What possible disease is present?
• What part of the ear is affected, and why?
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From the Streets
• You respond to a 22 year-old carpenter
who complains of left eye pain after using
a power sander without eye protection. His
left eye hurts more when it moves and the
outer most layer is red, moist, & inflamed.
His pupil exam reveals PERLA and extraocular movements (tracking an object
moving six directions in the visual field)
are intact.
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From the Streets Questions
• What is his most likely diagnosis?
• What is the outermost layer of the eye
called?
• What does PERLA stand for?
• What cranial nerve is assessed during an
eye exam?
• What cranial nerves are assessed when
checking extraocular movements?
• What is his prognosis?
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From the Streets Questions
• What is his most likely diagnosis? Foreign
body in the eye (conjuctivitis)
• What is the outermost layer of the eye
called? Conjunctiva
• What does PERLA stand for? Pupils equal,
reactive to light and accommodation.
• What cranial nerve is assessed during an
eye exam? Cranial nerves II (optic)
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From the Streets Questions
• What cranial nerves are assessed when
checking extraocular movements? Cranial
nerves III (oculomotor), IV (trochlear), and
VI (abducens)
• What is his prognosis? Most foreign bodies
can be removed with irrigation of sterile
water
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End of Chapter
Review Questions
1. The part of the eye that allows varying
amounts of light into the retina is the:
a. Lens
b. Humor
c. Iris
d. Optic nerve
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Review Questions
2. The photopigment structures responsible
for the ability to see colors are:
a. Cones
b. Rods
c. Iris
d. Pupil
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Review Questions
3. The incus is found in the:
a. Inner ear
b. Middle ear
c. External ear
d. Region of South America
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Review Questions
4. What is the correct descending order for
the media through which sound travels,
with the best medium listed first:
a. Liquid, air, solid
b. Solid, liquid, air
c. Air, liquid, solid
d. They are all equal
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Review Questions
5. Another word for the sense of taste is:
a. Olfactory
b. Vertigo
c. Mastication
d. Gustatory
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Review Questions
6. Damage to the tympanic membrane can
cause this kind of deafness:
a. Nerve
b. Conduction
c. Membranous
d. All of the above
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Review Questions
7. Which part of the body has the highest
density of touch receptors?
a. Fingers
b. Forearm
c. Back
d. Buttocks
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Review Questions
1. The two functions of the auditory system
are __________ and _____________.
2. The three ossicles of the ear
are__________, __________, and
__________.
3. A man with red green color blindness is
missing one type of ________, a retinal cell.
4. A woman presents with pain in her upper
right abdomen and back. Which organ is
inflamed?
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Review Questions
5. People who spend a lot of time in the sun
are more likely to develop this eye disorder.
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Review Questions
1. Differentiate between special and general
senses.
2. What are the five basic tastes? How are
taste and smell related?
3. Define “adaptation” in relation to
temperature sensors.
4. Trace the path of light rays from the world
to the brain. Explain how rays are focused.
5. Explain the journey of sound waves from
the environment to the brain.
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