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GROUP 1 NMD 1C- ANATOMY CLINICAL CASES

1. Explain the following:


A. Why you feel pressure/ fullness in your ear during a plane ride?

This happens when the air pressure in your middle ear and the air pressure in the
environment are out of balance. Fast changes in altitude cause air pressure changes and
can trigger airplane ear.

air pressure on both sides of the tympanic membrane must be equal. The
Eustachian tube provides the means of the pressure equalization. It does this by opening for
short periods, with every 3rd or 4th swallow; if it were open all the time one would hear
one's own every breath. When an airplane climbs or descends, the air pressure in the
environment changes rapidly, and your eustachian tube often doesn't react quickly
enough.

Because the lining membrane of the middle ear is a respiratory membrane, it can
absorb some gases, so if the Eustachian tube is closed for too long it absorbs carbon dioxide
and oxygen from the air in the middle ear, thus producing a negative pressure. This may
produce pain (as experienced if the Eustachian tube is not unblocked during descent of an
aeroplane).

Additional info: The middle ear cavity itself is quite small and the mastoid air cells act as an air
reservoir cushioning the effects of pressure change. If negative pressure lasts too long, fluid is
secreted by the middle ear, producing a conductive hearing loss.
B. How an URTI may lead to complications?

Upper respiratory tract infections (URTIs) are infections that affect the nose, throat
and sinuses. It is highly prevalent in young children and often results in otitis media
(OM).
Viral upper respiratory tract infection (URI) has been shown to precede most cases
of AOM. Viral URI leads to Eustachian tube inflammation resulting in its dysfunction
and negative middle ear pressure permitting secretions containing the infecting virus
and pathogenic bacteria that colonize the nasopharynx to enter the middle
ear. Bacteria and virus cause inflammation of the middle ear, which results in
accumulation of the middle ear fluid (MEF) or pus.

2. Explain
A. How to locate the carotid pulse in the neck?
The convenient site to locate the carotid pulse is beneath the anterior border of
the sternocleidomastoid muscle at the level of the superior border of the thyroid
cartilage.

B. What happens if pressure is applied to the carotid vessels in the neck? Why?

Pressure on one or both carotid sinuses can cause excessive slowing of the heart
rate, a fall in blood pressure, and cerebral ischemia with fainting. We have what we
call the Carotid sinus located just before the bifurcation of the common carotid to
become the internal and external carotid arteries. The Carotid Sinus is a High-
pressure baroreceptor that sense changes in arterial pressure.

C. What can happen to a person who loves cholesterol-rich food in relation to the blood
flow in the carotid vessels?

The person will have high levels of cholesterol in his blood.

People who have high blood cholesterol have a greater chance of


getting coronary heart disease, also called coronary artery disease. Coronary heart
disease is a condition in which plaque builds up inside the coronary (heart) arteries.
Plaque is made up of cholesterol, fat, calcium, and other substances found in the blood.
When plaque builds up in the arteries, the condition is called atherosclerosis. It is
possible that the plaque will rupture and will stimulate inflammatory mediators that
will eventually cause blockade of the arteries and thus causing hypoxia to the organ
supplied by that specific vessel. This usually happen in large arteries especially the ones
supplying the heart.

3. Explain
A. How different tastes are sensed by the tongue? What innervates the tongue?
B. The dire consequences of a dental abscess
4. Explain
A. Presbyopia
-decreased elasticity and power of accommodation with age
B. Cataract
-loss of transparency, causes can be infections, metabolic, hereditary, trauma, UV
light
C. Color blindness
-The (normal) eye contains 3 types of cone cells, each containing a different
pigment:
The L-cone detecting long wavelength light (peaking in the yellows but also
responsible for reds).
The M-cone detecting medium wavelength light (peaking in the greens).
The S-cone which detects short wavelength light (peaking with blue).

-Color blindness occurs when one or more types of cones are either totally absent,
or has a limited spectral sensitivity. By far the most common is congenital
(hereditary) red green color blindness, meaning the L-cones and/or M-cones are
either damaged or absent.

D. Exophthalmos in Graves disease


-The etiology of the thyroid-related orbitopathy is an autoimmune-mediated
inflammatory process of the orbital tissues, predominantly affecting the fat and the
extraocular muscles. Lymphocytes, plasma, and mast cells are the cellular constituents
in this process. The deposition of glycosaminoglycans and the influx of water increase
the orbital contents. Over time, fibrosis can occur. Genetic factors have been
associated with Graves disease. Obstruction of the superior ophthalmic vein with
resultant diminished venous outflow also contributes to the orbital engorgement.
References:
4C
http://www.colour-blindness.com/general/how-it-works-science/
4D

Maheshwari R, Weis E. Thyroid associated orbitopathy. Indian J Ophthalmol. 2012


Mar-Apr. 60(2):87-93. [Medline]. [Full Text].

Ing E. Thyroid-Associated Orbitopathy. Medscape Reference. January 29,


2014. [Full Text].

Brix TH, Kyvik KO, Christensen K, Hegeds L. Evidence for a major role of heredity
in Graves' disease: a population-based study of two Danish twin cohorts. J Clin
Endocrinol Metab. 2001 Feb. 86(2):930-4. [Medline].