1. Understand the value of A&P and its relationship to Pathophysiology.

Anatomy & Physiology broken into the following two components:

a) anatomy – science of body structures and relationships among them (e.g., chemicals  cell  tissue  organ  organ
system  organism)
b) physiology – science of body functions, how the body parts work

Pathophysiology - study of alterations in normal mechanical, physical, and biochemical functions (physiology)

** Need to understand normal structure and function (A&P) in body before can know alterations/what is abnormal
(Pathophysiology) in body **

Other sciences (histology, morphology, biology, chemistry, pathology, microbiology) support understanding, but main basis of
Pathophysiology is due to Anatomy & Physiology

2. Discuss health, illness and disease.

Health – condition of being sound in body, mind, and spirit; measured by absence of physical disease/pain; subjective; person
can have a disease but be considered “healthy”

Illness – state that results in suffering or distress; gauged by physical symptoms, as well as emotional, psychological, or
spiritual distress

Disease – impairment of cell, tissue, organ, or system functioning; result of altered body functions

Health --------------------------------------------- Illness

• On continuum and not exclusive concepts; depends on individual’s perception

• Continuum is dynamic; can fluctuate over time
• Health encompasses physical, emotional, psychological, and spiritual well-being
3. State the three levels of prevention:

1) Primary prevention – prohibits the disease condition from occurring (ex – wearing a bike helmet to prevent head injury).

2) Secondary prevention – early detection and treatment of disease through screening (ex – performing breast or testicular
self-examinations for early cancer detection).

3) Tertiary prevention – rehabilitation of the patient after detection of disease; focuses on preventing complications or
progression of the condition (ex – using physical therapy and occupational therapy interventions to improve gross and fine
motor function after a stroke).

4. Discuss individual & population based perspectives of pathophysiology:

• Individual based perspective = the study of health alterations as they pertain to the individual; involves the following
concepts:
o Pathogenesis – origination and development of a disease or illness; how the disease starts, proceeds, and
resolves; includes risk factors (vulnerabilities), precipitating factors (triggers), and etiology (cause)
o Pathogen – disease causing organism
o Etiology – cause of disease; may be categorized as:
 Idiopathic – health condition without a clear etiology
 Multifactorial – etiology is not well understood, several events leading to the development of a
condition, often involving both genetic and environmental factors
 Nosocomial – caused by exposure to the health care environment
 Iatrogenic – inadvertent result of medical treatment
o Clinical manifestations – presenting signs and symptoms of an illness; may be local, systemic, acute, chronic
(characterized by remissions and exacerbations), or subacute (duration and severity between acute and chronic)
o Diagnosis – may be medical or nursing; often associated with a prognosis (poor prognosis predicts significant
morbidity or early mortality)

• Epidemiology = the study of disease in populations

 o Involves recognizing where a health problem is most prevalent, who is most affected, why the problem is so
prevalent, how to eradicate the problem, reduce morbidity (poor quality of life), track mortality (death rates),
and target public health interventions to prevent spreading or increased severity
o Population focused health care depends on statistics to guide and direct interventions:
 Incidence – rate of occurrence of a health condition at any given time; probability that a condition will
occur in a certain population
 Prevalence – percentage of a population that is affected by a particular disease at a given time
 Endemic – incidence and prevalence are stable and predictable
 Epidemic – dramatic increase in the incidence of a health condition in a population, above the endemic
rate
 Pandemic – when an epidemic spreads across continents

5. Discuss the relevance of age, gender, ethnicity, locale, and socioeconomic factors to disease:

• Epidemiology promotes an understanding of those most likely to be affected with certain disease processes based on
gender, age, race, locale, socioeconomic factors, or ethnicity
o Helps to identify those who are most at risk of developing the disease in order to provide effective primary and
secondary prevention activities
• Health professionals should avoid comparing what is considered “normal” to the 70-kilogram (154-pound) White male
(ex – presentation of myocardial infarction often differs in men and women)
• Importance of recognizing divergent health care beliefs (ex – belief that human energy fields, spirits, ancestors, or
religious icons play a role in health and disease)

#6. Discuss the cell and its components

Structure Function
Cytoplasm colloid substance surrounding the cell nucleus composed of
water, proteins, fats, electrolytes, glycogen and pigments
Organelles structures within cells that perform distinct functions
Endoplasmic reticulum (ER) -network of tubules that produce proteins and fat
 -regulate ions within cells
a) Rough: synthesizes protein via ribosomes and produces
lysosomal enzymes (acid hydrolases)
b)Smooth: synthesizes lipids, lipoproteins, and steroid
hormones
-they also regulate intracellular calcium levels
Golgi apparatus Membraneous structure that prepares substances produced
by ER for secretion out of cell
Lysosome -Small sacs surrounded by membranes
-digest cellular debris with hydrolytic enzymes
-important in metabolism of particular substances
Peroxisomes -membrane-enclosed sacs; smaller than lysozymes
-contain oxidases that neutralize oxygen free radicals
(atoms carrying an unpaired electron and no charge)
-promote survival of cell by neutralizing harmful
substances
Proteosomes -large organelles that recognize abnormally folded or
formed proteins
-involved in proteolysis (protein breakdown)
Mitochondria -principal producer of cellular energy (ATP)
-contains cytochrome enzymes of terminal electron
transport necessary for ATP production
-contains enzymes needed for the citric acid cycle, fatty
acids oxidation, and oxidative phosphorylation
Nucleus -enclosed by nuclear envelop and contains DNA
-each cells contains 23 pairs of chromosomes (coiled
structures of chromatin forming individual gene codes)
Nuclear envelop -contains pores that provide access for protein products to
move from nucleus to cytoplasm of cells
Gene Individual units of inheritance; located in chromosomes
Cytoskeleton -comprised of tubule and filament structures which
contribute to cell shape, movement, and intracellular
transport
 -microtubules: thin protein structures composed of tubulin
-Intermediate: comprise filaments with diameter sized
between thin and thick filaments
-Thick: comprise the protein myosin

#7. Describe cellular changes in relationship to injury

Apoptosis

programmed cell death e.g. rbc only live for 21 days and then die

both physiologic and pathologic

Necrosis

death of cell related to cell injury

 associated with inflammation

#8. Identify maladaptive cellular responses.

Atrophy: decreased cell size due to lack of use e.g. limb in cast

Hypertrophy: increase in cell size without increase in cell number e.g. in body builders

Hyperplasia: increase in both cell size and number of cells in response to increased demand

Metaplasia: change from one type of cell to another e.g. lining of a chronically inflamed bladder

Dysplasia: change in size of shape or arrangement

9) Examples of diseases related to maladaptive changes in cells

 • AIDS
• Anaphylaxis
• Systemic Lupus erythematosus
• Rh Isoimmunization

10) In order for cells to balance their contents and maintain proper levels of fluids and electrolytes, they use several transport
mechanisms, both passive and active. Vital electrolytes are Sodium (NA+), Potassium (K+), Calcium (Ca2+), Magnesium (Mg2+),
Chlorine (Cl-), & Phosphate (HPO42-).

• Passive Transport is named so because it does not require additional energy. Because of this, particles move easily across the
cell membrane.
o Diffusion, where particles move from a area of high concentration to one of lower concentration (aka along the
concentration gradient) is the simplest example. The rate depends on the size of the particle and by the size of the
membrane pore (passage between extra cellular and intracellular environment.)
o While particles can’t pass through the cell membrane, water can. This process, called osmosis, allows water to move
from an area of high concentration (of water) to low concentration. The pressure generated by this is called osmotic
pressure.
o Some substances need a special transport protein to help them pass through a cell membrane. This is called facilitated
diffusion and is needed for particles that are hydrophobic or very large. Since ions can’t diffuse through the lipid
portion of the cell membrane a type of facilitated diffusion called ion channels are utilized. These channels come in
several forms. They might be open without the need for stimulation (leakage channel) or require a stimulus (gated
channel) such as a change in membrane potential (voltage-gated), binding of a ligand to a receptor (ligand-gated) or
stimulated by vibration, stretching, or pressure (mechanically-gated).
• Active Transport requires a (relatively) large amount of energy when moving particles across the cell membrane, since it
moves against the concentration gradient or the electrochemical gradient of the environment.
o When this energy comes directly from a single source (such as ATP, light, or redox) it is referred to as primary active
transport. The most common example is the Sodium-Potassium-ATPase, in which sodium is pimped out of a cell
against a very high concentration gradient while pumping potassium into a cell against a high concentration gradient.
 o Sometimes, the energy comes from the movement of other particles. Secondary Active Transport can be used to
move particles in opposite directions such as in the Sodium-Calcium antiporter membrane protein. In this, the
“downward” motion of sodium (along the concentration gradient) into the cell provides the energy for the
countertransport of calcium out of the cell (against the concentration gradient). Another type of secondary active
transport is cotransport. In this type, two molecules move in the same direction across the cell membrane. One
molecule, moving along the electrochemical gradient, provides the energy for the other molecule to move against the
concentration gradient.

11) The trigger for inflammation is tissue injury.

• Injury Includes:
o Invasion by microorganism
 Bacteria, virus, parasites
o Cellular mutation
o Anoxia (complete deprivation of O2)
o Physical damage
 trauma
o Chemical damage
• Tissue / site of damage includes:
o Cell
o Tissue
o Organ
o Organ System

Vascular response (#15)

 ***Widening & opening blood vessels to increase blood flow to site of injury
Vasoactive chemical mediators facilitate blood vessel opening & are responsible for clinical manifestations common to
inflammatory response
Prostaglandins, leukotrienes, histamine (released from mast cells, basophils, platelets, neutrophils, endothelial cells,
monocytes/macrophages)
Leads to vasodilation & increased capillary permeability
Blood & fluid inc b/c: 1) blood composed of cells active in phagocytosis & cells essential in promoting healing & developing
immune response; 2) fluid dilutes harmful
Clinical manifestations: localized redness, heat, swelling, pain, loss of function
Cellular response

***To alert the products of healing to attend to the site of injury

Chemotactic mediators (chemokines) stimulate cellular response
Leads to 1) chemotaxis, 2) adherence, 3) migration, (& phagocytosis)
Chemotactic factors activated & attract specific types of cells (ex. Neutrophil chemotactic factor attracts neutrophils)
Adherence – attraction & binding of blood cells (regulated by chemotactic factors & receptors that bind leukocytes to surface
endothelial cells)
Diapedesis – cells, esp leukocytes move across endothelial cells to injury site -> then positioned to engulf & destroy offending agent
& remove dead tissue
Cellular response leads to:
Acute inflammation – PMNs, Platelets, Mast Cells
Chronic inflammation – Macrophages, Lymphocytes

Signs & Treatment of Inflammation (#16)

Local: Cardinal signs (redness, heat, swelling, pain, loss of function) b/c of vasodilation & fluid
 Lymphadenitis – enlargement/inflammation of nearby lymph nodes as function of filtering/draining harmful substances at injury site
Systemic: pyrexia, leukocytosis, higher % circulating plasma proteins
Treatment for acute inflammation designed to reduce swelling & pain and ultimately to:
1) Reduce blood flow to local area

2) Decrease swelling

3) Block action of various chemical mediators

Treatment goal: to minimize damage to healthy, unaffected tissue

Pharmacologic:
Aspirin – inh conversion arachidonic acid to prostaglandin -> suppress inflammation, reduce pain, reduce fever
NSAIDs – inh conversion arachidonic acid to prostaglandin (ex ibuprofen)
Glucocorticoids – interrupt inflammatory process: inh synth chemical mediators & reduce swelling, warmth, redness, & pain;
suppress infiltration of phagocytes & avert tissue damage from release lytic enzymes; suppress lymphocyte proliferation;
reduce immune component inflammation (ex prednisone)
Nonpharmacologic:
Rest, ice, compression, elevation; optimal fluid & nutrient intake

17 Differentiate between the innate and adaptive immune responses & the cells involved.
Innate Immune Response- responsible for early, rapid response to pathogens without prior exposure; Cells involved:
Neutrophilsphagocytosis Natural Killer Cell non-specific cellular antigen destruction Dendritic cell Antigent presenting
Monocyte/Macrophage Phagocytosis

Adaptive Immune Response- cell-mediated and humoral immunity; specific immune response occurring during a lifetime Cells
involved T & B Lymphocytes T-cells in specific immune response Cytotoxic T Cell (CD8) Specific cellular antigen destruction
Helper T Cell (CD4) Activation of antigen-specific T cell AND B-cell in humoral immunity Memory Cells Efficient, rapid
antibody response to subsequent antigen recognition Plasma Cells Secretion of antibody/ immunoglobulin Ig
18 Differentiate cell-mediated versus humoral immunity & the cells involved.

Humoral immunity: Activation of B-Cells

Th1 activates macrophages
Antigen Presenting CellPresented to the CD4 Cells <
Th2 activates B cell differs into
PLASMA Cells/ MEMORY Cells

Cell-Mediated: Activation of Cytotoxic T-cell

Antigen presenting Cell presented to CD8 w/ Tc CD8 100% active w/ Thelper cellfinds Release of Cytokins
infected cells displaying antigen attached
After finding infected cell they release granzyme and polymer perforin that will lyses infected cells

19 Differentiate the basic types of microorganisms.

Bacteria are single celled microorganisms with a complex outer cell wall. They do not require human host to reproduce: divide by
binary fission. Some bacteria produce toxins. Treatment: Antibiotics/antibacterials
Viruses are considered obligate intracellular parasites, have a protein coat and a core of either RNA or DNA. Viruses cannot replicate
outside the host cell. Treatment: Anti-virals may be effective in reducing time of infection if initiated at onset
Fungi are relatively large organisms compared to bacteria and viruses. Unicellular forms are called yeast, and multi-cellular forms are
called molds. Reproduce by budding, extension of hyphae, or production of spores. Treatment:
Antifungals
Protozoa are unicellular, complex microorganisms. Characterized by an irregular or fluctuant shape without a cell wall and many are
motile. Transmission occurs through sexual contact, contaminated food or water, or vectors. Treatment:
Variable; antibiotics may be effective in some cases
20. Identify phases of acute infection.
Type I, immediate hypersensitivity reaction: IgE-mediated allergic reaction occurs within min of exposure. Local reaction causes
inflammation; systemic reaction anaphylactic can be life threatening. Example Bee Sting or peanut allergy/ activated immune cells:
Helper T(Th2), Mast Cells, and Basophils
Type II, antibody-mediated reaction: IgG or IgM mediated, result of mistaken identity, usually a harmless substance is identified as
harmful. Reaction is tissue specific, and causes destruction of cell by antibody binding to antigen on cell surface. Seen in certain drug
reactions, blood transfusion reactions, Graves disease, and hemolytic disease of the newborn. Activated immune cells: Macrophage
Type III, immune complex-mediated reaction, IgG & IgM mediated, is the indirect result of complement activation stimulated by the
deposition of insoluble antigen-antibody complexes. Respond with local symptoms of itching and rash as well as systemic symptoms
of edema and fever can occur 7 days after exposure. Activated immune cells: Complement and Neutrophils
Type IV, cell-mediated hypersensitivity reaction, T-cell mediated Inflammatory response leading to cell lyses, Reaction to exposure
takes about 24-72 hours, This condition is often referred to as contact dermatitis. Poison ivy is an example of Type IV. Activated
immune cells: CD8 T-Lymphocytes and CD4 Th1 Lymphocytes.
21 Explain how communicable diseases are transmitted and controlled.
Communicable diseases are those that spread from person to person, often through contact with infected blood and body fluid.
Transmission: Direct Contact- Which implies physically touching or otherwise coming in contact
with the reservoir
Droplet transmission- Larger respiratory particles, produced by sneezing, coughing, or talking, can pass through the
air from the reservoir to the host. Host must be within three feet of reservoir
Airborne transmission- Smaller respiratory particles can remain suspended in the air and are subject to airborne
transmission. The particles remain in the area of the reservoir for an extended period of time. A person who enters this area and
breathes the air can be infected.
Vector Transmission- A vector is a vehicle that harbors the pathogen and carries it to the host. Biological vectors are
those that support the life cycle of the pathogen. An example is mites, ticks, and spiders. Mechanical vectors are not essential to the
life cycle of the pathogen example dogs, mosquitoes, and even food.
Universal precautions are standard of health care that recognizes all blood and body fluid as potentially infected. Universal
precautions dictate that health care providers wear gloves when having any contact with blood or body fluid. Masks and protective
eyewear are also recommended if splattering of blood or body fluids is anticipated.
22 List the common sexually transmitted diseases

STDs caused by bacteria: Chlamydia; Gonorrhea, Syphilis

STDs caused by viruses: Human PapilomaVirus HPV, Genital herpes, Genital warts, HIV/AIDS, Hepatitis B/D (A,C,E rarely),
Molluscu Contagiosum (poxvirus)

STD caused by protozoan: Trichomoniasis (Tichomonas vaginalis)

STD's* caused by fungi: Yeast infections (Candida albican), Jock itch (Tenia cruis)

STD's caused by parasites: Pubic Lice/Crabs (Pediculosis pubis), Scabies (Sarcoptes scabiei)
23 Describe their major clinical manifestations and complications.
HPV Human Papilloma Virus
HPV- is implicated as a common factor in the development of cervical dysplasia. HPV enters the host cell and can be integrated into
its genome. The changes in the DNA are translated into unregulated cellular reproduction an can potentially result in cancer, although
not all strains of the virus are considered to be potentially oncogenic.
Pelvic Inflammatory Disease:
Chlamydia- Have unique category of pathogens that have characteristics of both bacteria and viruses. They reproduce through binary
fission yet are obligate intracellular parasites. These pathogens use the host metabolism to reproduce. Four phases of life 1st
nd
inactive elemental body enters the host 2 elemental body becomes metabolically active and transforms into a reticulate body, which
takes over host cell 3rd Now capable of replication 4th Each replicated pathogen goes through the life cycle, causing epithelial cell
necrosis.
Gonorrhea- attaches to the surface of urogenital epithelial cells using hair like extensions, called pili. After attaching to the epithelial
cells lining the reproductive tract, the offending microorganisms elicit acute inflammatory and immune responses. The reproductive
track becomes hyperemic and edematous. The fallopian tubes become obstructed with purulent exudates.
Clinical manifestation: Early infection with either pathogen is often asymptomatic, increasing the likelihood of transmission to others.
As the infection ascends and the inflammatory and immune responses become more intensified, common clinical manifestations
include abdominal pain, fever, malaise

HIV/Aids
HIV/AIDS- is an enveloped retrovirus that infects CD4 T cells, dendritic cells, and macrophages. Symptoms of the primary infection
include vague flu-like complaints associated with the activation of CD8 cytotoxic T cells and CD4 Th1 cells. The Hallmark of AIDS
is the loss of cell-mediated and humoral immunity due to the loss of CD4 Th1 cells. Clinical Manifestation: Cell mediated immunity is
lost when the CD4 T cell level is too low, contributing to the risk of opportunistic infection. Resistance is lost to many common
pathogens, including the fungi candida. Activation of latent viruses may occur, promoting sympotoms and disease. Pneumonia,
especially the type caused by Pneumocystis carinni, is a common opportunistic infection.
Hepatitis
Viral Hepatitis refers to inflammation of the liver caused by viral infection. Hepatitis viruses are A, B, C, D, and E. Hepatitis B/D/C
most commonly associated with blood and bodily fluid. Al types of viral hepatitis can cause acute, icteric illness. Three phases occur
when infected. 1st Prodrome: period of fatigue, anorexia, malaise, headache, and low-grade fever. 2nd Icterus: marked by the onset of
jaundice, dark urine, and clay-colored stool. This phase corresponds to the clinical illness phase. The liver is enlarged and tender. 3rd
Recovery: marked by resolution of jaundice around 8 weeks after initial exposure.

TINEA
Tinea cruris jock itch- Fungal infection, major mode of transmission is direct contact. Clinical Manifestation: characterized by
erythematous lesions that have central clearing and raised borders.
Ch. 10

Review the somatosensory nervous system (#24)

Sensory systems relay info (re. touch, temp, pain, body position) throughout body from periphery to CNS
using sensory receptors, ascending pathways, & processing centers
Classes sensory receptors:
Mechanoreceptors (hair, stretch, equilibrium, skin)
Chemoreceptors – taste & smell
Osmoreceptors – blood osmotic pressure
Photoreceptors – light
Thermoreceptors – radiant heat energy
Phonoreceptrs - sound
Nociceptors – pain
Neuronal Organization
First-order neurons – sensory info from periphery to CNS; least #
Second-order neurons – sensory input from reflex networks & sensory pathways to thalamus
Third-order neurons – sensory info from thalamus to cerebral cortex; greatest #
Somatosensory Neuronal Transmission
Dorsal root ganglia (cell body, peripheral branch, & central axon) responds in distinct ways to different
stimuli
Type A fibers – largest diameter, myelinated -> rapid impulse conduction (pressure, touch, cold
sensation, heat pain); Type A alpha & beta fibers may promote inhibitory effects & diminish pain
sensation
Type B fibers – myelinated, smaller diameter -> slower conduction rate (mechanoreceptors in cutaneous
& subcutaneous areas of skin stim)
Type C – unmyelinated, smallest diameter -> slowest conduction rate (warm-hot sensation, mechanical,
chemical, heat-induced, & cold-induced pain)
Dermatomes – innervated by single pair dorsal root ganglia
 Discriminative pathway – communicates sensory info, including discriminative touch & spatial
orientation (stim by vibration, touch, muscle joint movement); allows ID object based on touch or
location of skin touch in 2 different areas called two-point discrimination)
Anterolateral pathway – pain, temp, crude touch, & pressure not requiring specific location of origin of
stimulus transmitted; “startle” reaction; autonomic responses (inc BP & HR, sweat, dilation pupils,
constriction blood vessels); multiple synapses & slow conduction
Somatosensory Processing (pg. 256)
After stimuli reach thalamus -> further refinement in somatosensory cortex -> somatosensory
association areas interpret stimuli into learned perceptions
Somatosensory modalities – specific nature of perception of various stimuli (subjective interpretation
of stimulus – ex diff btwn temp & touch) – Table 10.2 pg. 256
Stimulus discrimination – Acuity (locate site of initiation of stimulus)
Tactile stimulation – lg, myelinated fibers (touch, pressure, vibration)
Thermal sensation – Thermoreceptors – cold, warmth, pain
Position/Sensation

Identify the common mechanisms of vision, hearing, smell & taste (#25)

Structures Path, etc

Vision Cornea – clear transparent structure covering exterior wall of
eye
Pupil – opening in iris (colored part); controls amt light
entering by dilating/constricting
Lens – clear; responsible for fine-tuning focus; accommodate
– can change shape b/c of ciliary muscles, allowing clear
Light entering eye through cornea -> through pupil
-> passes through lens & vitreous humor -> refracted
onto retina -> rods & cones convert light into
electrical impulse ->
Bipolar neurons -> ganglion neurons -> axons meet
at optic disk -> exit eye as optic nerve -> optic
chiasm (medial halves of retinal nerves crossover) ->
vision at various dist optic tract -> thalamus -> occipital lobe for
processing
Anterior chamber – behind cornea w/lens & iris as other
boundaries; contains aqueous humor – nourishes lens & Visual processing – visual images coordinated in
cornea brain

Posterior chamber – behind iris, in front of lens

Vitreous chamber – behind lens; contains clear, gelatinous Eye Movements:

fluid (vitreous humor)
Saccades – look from point A to B
Retina – over posterior 2/3 of eye; contains photoreceptor
cells (rods & cones) Pursuit – smoothly following movement

Rods – produce rhodopsin – allows vision in dim light & Covergence/divergence – both in/out
peripheral vision; most highly concentrated in peripheral
retina Vestibular – eyes adjust to head moving

Cones – to see bright light & color; visual acuity; Fixation maintenance – position/accommodate both
erythrolabe, clorolabe, cyanolabe eyes

Macula – center of retina; responsible for central vision,

color vision, fine detail
Protection:
Fovea – in center of macula; where cones most dense (no
rods here) Eyelids (blinking)

Extraocular muscles – rotation & horizontal & vertical Eyelashes

movement of eyes (6 muscles)
 6 muscles innervated by oculomotor (III), trochlear (IV), & Conjunctiva (mucous membrane)
abducens (VI) cranial nerves
Tears (lacrimal glands)
Trabecular network – meshlike structure for reabsorption of
aqueous humor into canal of Schlemm -> venous system Aqueous humor (produced by ciliary body) –
(also reabsorbed by uveal-scleral outflow pathway) maintains eye pressure & provides nutrients to
cornea & lens

Hearing Pinna – outer ear; cartilage & soft tissue; collects & funnels Sound -> pinna -> external auditory meatus ->
sound vibrations into opening of ear canal (external auditory tympanic membrane moves -> repositions ossicles ->
meatus) change sound waves to mechanical vibration ->

External auditory meatus – cartilage; covered w/small hairs & In & out movement at stapes footplate (patterns
glands that secrete cerumen match initiating sound waves) -> malleus -> incus ->
stapes -> oval window -> cochlea -> organ of Corti
Tympanic Membrane – eardrum; boundary middle ear; -> hair cells -> acoustic vestibulocochlear cranial
movement causes repositioning of ossicles nerve -> cochlear nucleus -> fibers from each ear
divide into 2 pathways & 1 crosses over to auditory
Ossicles – connection btwn eardrum & inner ear; malleus cortex on contralateral hemisphere -> processed by
(hammer), incus (anvil), stapes (stirrup) central auditory system

(Middle ear in air-filled mastoid portion temporal bone)

Oval window – stapes footplate fits into; marks boundary Protection:

btwn middle ear & inner ear
Hairs in ear canal
Cochlea – bony structure in inner ear important in hearing;
filled w/endolymph & perilymph (fluid) Cerumen

Organ of Corti – sensory receptor within cochlea that

 contains hair cells (receptors responsible for neural impulse
allowing hearing; stim by motion of cochlea’s fluid)

Semicircular canals, utricle & saccule – affect balance

Eustachian tube connects middle ear to nasopharynx –

provides pressure equalization

Smell Regulated by olfactory receptors in each nasal cavity Olfactory hairs -> olfactory receptors ->
unmyelinated axons -> merge w/other olfactory
Olfactory hairs – protrude from receptor segments that extend axons to form olfactory nerve (cranial nerve I) ->
through nasal epithelium olfactory bulb -> olfactory cortex (interpretation &
processing)

Taste Mediated by chemoreceptors in taste buds of oral cavity
Taste cells (on taste buds) – sensory receptors responsible for
triggering impulse perceived as taste
4 types taste: sweet, sour, salty, bitter
Dissolved substance penetrates taste buds -> taste
receptor on gustatory hairs of taste cells -> facial
nerve (cranial nerve VII) & glossopharyngeal nerve
(IX) -> synapse in medulla & thalamus -> to
gustatory cortex in parietal lobe
Indirectly affected by visual, thermal, scent, pain
sensations, & by environmental factors, drug
reactions, & clinical conditions

Compare & Contrast common abnormalities of vision and hearing (#26)

Vision Both Hearing

Errors in refraction – myopia (nearsightedness; Caused by: Damage to External Ear: often caused by inflammation,
lens thickness; fix w/biconcave lens), hyperopia structures (prob drainage, obstruction
(farsightedness; fix w/biconvex lens), w/drainage, loss of
astigmatism (irreg curvature of cornea or lens movement or Otitis externa – inflammation of skin of external
->blurry; fix w/glasses, laser surgery), accommodation, ear -> pain & discomfort (swimmer’s ear); b/c of
presbyopia (farsightedness b/c of aging – ciliary damage to protective moisture in ear canal or altered integrity of skin in
muscle & lens unable to accommodate for near structures) ear canal -> itching, redness, tenderness, narrowing
vision; fix w/bifocals) of tissues, mild hearing loss
Motor dysfunction

Alterations in eye movement – strabismus Impaired neural Middle Ear: inflammation, trauma, obstruction
(cross-eyed b/c extrinsic eye muscles conduction often related
uncoordinated), esotropia (bran suppresses 1
image when cross-eyed -> maintain normal Inflammation Abnormally patent eustachian tubes promote fluid
vision), amblyopia (lazy eye b/c of muscle movement from nasopharynx to middle ear;
imbalance), diplopia (usu from uncoordinated Aging obstruction eustachian tube may promote
extraocular muscles -> double vision), absorption air from middle ear (replaced by serous
nystagmus (involuntary oscillation of eye; Loss of mobility fluid)
congenital or acquired)
Infection Loss tympanic membrane mobility

Barotrauma – injury from inability of ear to

equalize barometric stress

Otitis media – infection of middle ear; hearing loss

may result from immobility of tympanic membrane,

Alterations in Protective Eye Structures –
conjunctivitis (inflammation of mucous
membrane lining eye – pink eye; viral-1 eye,
watering, little discharge; bacterial-2 eyes, heavy
discharge; allergic-both eyes, itching, redness,
tearing), cataracts – from clouding of lens ->
scatters incoming light onto retina; nuclear
(aging, center lens, most common); cortical (lens
cortex, outer lens toward center); subscapular
(back of lens, maybe from diabetes & severe
hyperopia)
fluid accum of middle ear, scarring from rupture
eardrum
Mastoiditis – bacterial infection causing
inflammation of air cells of mastoid bone ->
meningitis, brain abscess, facial palsy
Otosclerosis – most common cause chronic,
progressive, conductive hearing loss (slow
formation spongy bone at oval window immobilizes
footplate of stapes -> impairs conduction of
vibration)
Internal Ear: r/t destruction cochlear hair cells or
damage to neural pathways
Tinnitus – caused by noise-induced hearing loss,
sensorineural hearing loss consistent w/aging
(presbycusis), hypertension, atherosclerosis, head
injury, cochlear infection/inflammation
Meniere’s disease – balance/equilibrium disturbed
-> severe vertigo, sensorineural hearing loss,
tinnitus; r/t overproduction/ dec absorption
endolymph -> degeneration vestibular & cochlear
hair cells -> hearing loss
Labyrinthitis – inflammation of labyrinth of inner ear;
precipitates severe vertigo & sensorieneural hearing loss
27. Identify common signs and symptoms of somatosensory disorders:
Fibromyalgia:
-Fatigue
-Pain in neck, shoulders, upper back, elbows, lower back, and hips
-Sleep disorders
-Depression-though it’s unclear if it is a cause or response to Fibromyalgia
Diagnostic Criteria:
-3 Months chronic musculoskeletal pain
-11 of 18 tender point sites
Migraine Headache:
-Unilateral, pulsing, throbbing headache
-Sensitivity to noise and light
-Aura (presence of visual disturbance)
-Nausea and vomiting (in some cases)
-1-2 Days before migraine: increased energy, sweet cravings, fatigue, irritability
Diagnostic Criteria:
-Hard to diagnose
-Review of history and physical exam
-Computed Tomography or MRI to rule out other pathology

28 Physiology of Pain: Nociception (pain sensation) involves stimulated free nerve endings, interpreted as pain.
0 Transduction of noxious stimuli into nerve impulses stimulates conduction of sensory impulse. Electrical impulse promotes
release of algesic substances including:
0 substance P
1 hydrogen
2 potassium ions
3 serotonin
4 histamine
5 prostaglandins
6 bradykinin
1 Transmission of nerve impulses from tissues to the CNS occurs along type A and type C fibers. Response delivered back to
 original site of stimulation.
0 Rapidly conducting Type A fibers
0 produce sharp, stinging, pin-prick local sensations
1 induced by mechanical or thermal stimuli
0 Type C fibers
0 produce dull ache or burning response
1 induced by chemical stimuli
0 Modulation occurs during transmission. Substances like serotonin, norepinephrine, and endorphins released in response to
pain and inhibit pain transmission by slowing nociceptive neurotransmitters.
0
0 Perception
0 involves sensory, emotional, and subjective reactions to stimuli.
1 varies among individuals based on
0 pain threshold: intensity of pain required for response
1 perceptual dominance: existence of pain at another location given more attention
2 pain tolerance: degree to which pain is endured before response
0
1
Specificity Theory: sensations of touch, warmth, cold, and pain involve specific receptors and pathways.

Gate Control Theory: gray matter in the posterior horn of the spinal cord regulates the transmission of pain impulses.

Mechanism of acute pain: nociceptor impulse-->dorsal horn of spinal cord-->synapse with second order neurons-->cross and ascend
spinothalmic pathway-->reticular activating system and thalamus-->perception occurs in somatosensory cortex.