SEN SE S

EMER ITA C . M EN DO ZA , R .N., M. D.

External Anatomy of the Eye

TERMS TO REMEMBER: EYE
1. 2. 3. 4. 5. 6. 7. 8. 9.

Pupil Conjunctiva Cornea Sclera Choroid Iris Ciliary body Lens aqueous chamber

aqueous humor

10. vitreous chamber 11. vitreous humor 12. Retina 13. rods & cones 14. optic nerve 15. optic disc 16. macula 17. fovea centralis

Pupils
the black spot or opening in the center of the circular muscles of the iris bright light: the circular ms of the iris contracts,  pupil size dim light:  pupil size

Conjunctiva

a moist mucous membrane that extends as a continuous lining of the inner layer of the eyelids clear & colorless except when blood vessels are dilated  bloodshot eyes

Cornea

the transparent, avascular layer that covers the iris & the pupil at the front of the eye frequently referred to as the window of the eye function: to bend, or refract the rays of the light

Sclera

the white of the eye tough, fibrous, connective tissue that extends from the cornea on the anterior surface of the eyeball to the optic nerve

Choroid

a layer inside the sclera made of black pigment cells that absorb light rays so that they are not reflected back rich in blood vessels that supply nutrients to the eye

Iris

the colored portion of the eye that surrounds the pupil smooth ms constrict the pupil in bright light & vice-versa color is determined by the amount of pigment present (blue has the least, brown has the most)

Ciliary Body And Lens

located on each side of the lens, contains ms that can adjust the shape & thickness of the lens lens is a clear, crystalline body that may be thinned or flattened for distant vision & thickened for close vision refractive power of the lens is called accommodation

Anterior & Vitreous Chamber

the lens lies at the rear of the anterior chamber filled with a fluid called aqueous humor that maintains shape & nourishes the structures within behind the lens is the vitreous chamber that is filled with a soft, jelly-like material, the vitreous humor

Retina
 

the thin, delicate, and sensitive nerve layer of the eye contains specialized sensory cells, the rods & cones
 

rods: 120M, for vision in dim light or darkness & peripheral vision cones: 6.5M, for vision in bright light, color vision, & central vision

cones are most concentrated in the fovea centralis and is the region of sharpest vision

Optic Nerve & Disc

light energy, when focused on the retina, causes a chemical change in the rods & cones  nerve impulses travel to the brain via optic nerve region where optic nerve meets the retina is called optic disc ( also known as blind spot due to absence of rods & cones)

Visual Pathway

Ganglion cells of the retina exit thru the optic disc  converge to form the optic nerve  pass thru the optic chiasm: 1) fibers from the nasal part crossover to the opposite side & 2) fibers from the temporal side go on the same side optic tract  thalamus & midbrain (pupillary reflexes & eye movements)

Eye Vs Camera

The eye can be compared to a camera in many ways. It has an adjustable lens and a variable aperture system [pupil]. The retina can be compared to the lightsensitive film used in a camera. Because of the ability of the eye to accommodate to different distances, the image is clearly focused on the retina unless there is some error in accommodation. The choroid layer absorbs light rays like the interior dark surface of a camera.

Extraocular muscles of the Eye

Accommodation
Accommodation. How the lens changes in distant and near vision: (a) Relaxation of the ciliary muscles causes the suspensory ligament to draw the lens into a flattened shape suitable for distant vision. (b) Contraction of the ciliary muscle relieves the tension on the suspensory ligaments, allowing the lens to

TERMS TO REMEMBER: Charts, Diopters, Lens
 

All require lens correction:  Myopic: nearsighted -> concave lens  Hyperopic: farsighted -> convex lens  Emmetropic: normal -> no  correction Astigmatism: irregular lens -> depends on area affected

diopter: refractive power of a lens at 1m Snellen: to test nearsightedness e.g., 20/50 OD or + 0.50 OD = Jaeger: to test farsightedness

EARS, NOSE AND THROAT
EMERITA C. MENDOZA, R.N., M.D.

EAR
organ of hearing and balance divided into:

1. The external ear -sound-collecting visible portion (auricle or pinna), the outer ear canal (external auditory meatus), and the outer surface of the eardrum (tympanum). 2. The middle ear- the inner surface of the eardrum, the ossicular chain (malleus, incus, and stapes), the eustachian tube, and the outer surface of the oval and round windows, and the cochlea. 3. The inner earvestibule, the semi-circular canals, the inner surface of the oval and round

The EAR

external & middle ear function for sound conduction; inner ear receives sound waves & relays them to the brain

External Ear:

Structures of the Ear

pinna or auricle -the projecting part, or flap, of the ear Function: to collect sound waves & funnel them to the canal -cartilage & fat; covered with skin that continues into the ear canal

External Auditory Meatus

also called auditory canal with ceruminous glands which secrete cerumen (earwax) that helps lubricate & protect the epithelial lining from infection

MIDDLE EAR
tympanic membrane or eardrum malleus incus Stapes oval window auditory/ eustachian

Eustachian Tube

connects the middle ear & the external environment through the throat equalizes the pressure on the two sides of the eardrum susceptible to bacterial infection  middle ear infection

Tympanic Membrane

separates the middle & external ear flexible membrane vibrates as incoming sound waves move through the canal

Ossicles

small moist cavity in the temporal bone containing air malleus, incus, & stapes attached to the oval window leading to the inner ear amplify sound waves

Inner Ear or Labyrinth

contains the mechanism for converting sound waves to nerve impulses cochlea – a bony, snail-shaped structure that contains perilymph & endolymph that carry the vibrations through the system organ of Corti – the sound receptor, with hair cells that transmit sound waves to the

Inner Ear or Labyrinth: cochlea perilymph endolymph organ of Corti auditory nerve fibers Structures for equilibrium: vestibule 3 semicircular canals: saccule & utricle endolymph

Equilibrium
 

vestibular apparatus detects sensations regarding body position and equilibrium It includes the three semicircular canals and two small chambers, the saccule and utricle, which connect them to the vestibule. Within it are sensory hair cells that transmit information about the position of the body, mainly the head. The response of the hair cells is produced by the flow of endolymph within the semicircular canals as the position of one's head is changed. These responses in turn are transmitted to the vestibular nerve, which joins the cochlear nerve to form the

SMELL

Olfactory information is transmitted by receptor cells in the olfactory epithelium at the upper part of the nasal cavity. In contrast to the taste buds, it is estimated that the olfactory epithelium may be able to discriminate among as many as 50 different smells. Smells discerned by the olfactory epithelium are transmitted to the olfactory center in the brain through the olfactory nerve (CN I). Olfactory cells are not replaced, therefore once damaged, our sense of smell is impaired. Both smell and taste are important in stimulating appetite and digestive juices.

Location & structure of the olfactory epithelium

What is the throat?

a ring-like muscular tube that acts as the passageway for air, food, and liquid. The throat also helps in forming speech. Consists of: larynx - also known as the voice box, the larynx is a cylindrical grouping of cartilage, muscles, and soft tissue which contains the vocal cords. The vocal cords are the upper opening into the windpipe (trachea), the passageway to the lungs. epiglottis - a flap of soft tissue located just above the vocal cords. The epiglottis folds down over the vocal cords to prevent food and irritants from entering the lungs. tonsils and adenoids - made up of lymph tissue and are located at the back and the sides of

Epiglottis

Thin leaf-shaped cartilage, covered with mucous membrane, at the root of the tongue, which folds back over the entrance to the larynx, covering it during the act of swallowing

Tonsils

pair of prominent masses of lymphoid tissue that are located opposite each other in the throat between the anterior and posterior pillars of the fauces

TASTE

The sense of taste is perceived through the taste buds on the tongue and in various parts of the mouth. average of 10,000 taste buds in the normal adult mouth. As an individual gets older the number of taste buds gradually decreases. The taste buds are able to discriminate among four primary tastes: sweet, sour, salty, and bitter. Both the facial (CN VII) and the glossopharyngeal (CN IX) nerves transmit the sensory input to the brain.

THE SENSE OF TASTE. Location of taste buds within the tongue.

TACTILE SENSATION

Types of similar receptors referred to as respond to pressure, touch, and vibration. Located in various layers of the skin, in the fingertips and toes, and in the tip of the tongue.

Meissner's corpuscles are fine-touch receptors.  If you close your eyes and have a

friend place an object in the open palm of your hand, chances are good you will be able to detect the object but you will not be able to identify it, shape, texture, & density, information your brain uses to identify the object.

Pacinian corpuscle or pressure receptors
located deeper in the skin that enable you to detect the object due to its weight, specialized bulblike nerve ending located in the subcutaneous tissue of the skin; occurs abundantly in the skin of palms and soles and joints and genitals

Ruffini Corpuscles
- thermoreceptor for warm temperature

Krause Corpuscles

PAIN
 

sensory mechanism that is protective for the body. Pain receptors are sensory nerve endings found in the skin and certain internal tissues. in experiencing pain, it may be felt in an area considerably distant from the primary area of pain REFERRED PAIN

or position sense, helps us maintain the position of the body and its parts. The receptors performing this function are widely spread sensory organs known as proprioceptors. They are located within muscles, tendons, and joints. The brain coordinates the information from the proprioceptors with the information from the vestibular

PROPRIOCEPTION

Proprioception  1. A sense of position

For example, we can 'feel' that our feet are in first position or that our arms are in second position, without having to look to check.

2. A sense of movement

We can accurately feel the speed and direction of movement of our limbs. This allows us to coordinate our limbs when they are moving.

3. A sense of force This is about the amount of effort a muscle needs to make to produce an accurate movement, and this is particularly important when lifting.