B Wright Clinical Correlations Flashcards
What is an Epidural Hematoma?
If you hit your head and fracture the skull, and manage to break the Middle Meningeal A., you can bleed into the Epidural space (outside dura mater)
Blood fills up and compresses the brain away from the bleed.
What happens to vertebral artery when you turn your head?
It stretches.
Specifically, the effect of rotation causes the vertebral artery to stretch forwards
What is Vertebrobasilar Insufficiency?
Syncope, vertigo, dizziness, double vision, loss of vision, numbness or weakness in hands or feet, slurred speech, nausea and vomiting, loss of coordination
All due to Athersclerosis of the Basilar A. OR Rotation/Extension of the Head
Risk Factors:
- Smoking
- Hypertension
- Diabetes/obesity
- Over 50 years old
- Family history
What is Subclavian Steal Syndrome?
Occlusion of the Subclavian causes reverse blood flow through the vertebral artery of the affected side, to supply blood to the upper extremity
Causes a decrease in blood flow to the brain
Symptoms:
- Presyncope/Syncope
- Different blood pressures in Upper Extremities
- Neurologic Deficits/memory problems
Causes:
- Athersclerosis
- Cervical Rib (extra rib)
- Baseball Pitchers hypertrophy Anterior Scalene, which blocks subclavian a.
Why do cuts to scalp bleed profusely?
Dense connective tissue of the scalp holds the damaged arteries open, causing excessive bleeding
What layer of the scalp, if infected, can allow for spread of infection quickly?
Loose Connective Tissue layer
What is a gaping wound?
When a wound cuts through the aponeurosis layer, the muscles pull the wound open
Mumps in the Parotid Gland
Mumps is more painful in the cheek region because of the Parotid Gland is infected
Does not swell because it is covered in fascia
Structures that travel through the parotid gland:
- Facial N. (does not innervate)
- External Carotid A.
- Retromandibular V.
Parotid Gland has parasympathetic innervation from CN IX (glossopharyngeal N.)
Sensory Innervation from Auriculotemporal and Great Auricular N.
What nerve is responsible for opening the eye, which one closes it?
CN III (Occulomotor N.) opens eye
CN VII (Facial N.) closes eye
(Orbicularis Oculi M.)
What nerve innervates the Muscles of Mastication?
CN V3 (Mandibular Branch of Trigeminal N.)
Branches of the Motor Root of the Facial N.
Tiny Zebra Bit My Cheek
Temporal Branches Zygomatic Branches Buccal Branches Mandibular Branches Cervical Branches
What does the Chorda Tympani do?
Chorda Tympani is a branch off the Facial N.
Taste, anterior 2/3 of tongue
Also carries Parasympathetics to the Sublingual and Submandibular Glands
What does the Greater Petrosal N. do?
Parasympathetic Innervation of the Lacrimal Gland
What is Bell’s Palsy?
Damage to the Facial N.
- Cannot wrinkle the forehead
- Cannot Smile
- Cannot close eye
- Cannot spread tears across the cornea, eye dries out.
Symptoms depend on site of lesion
In severe cases, eye lid is sutured closed until resolved
What presentation would you see of Bell’s Palsy where the lesion is just after the Facial N. exits the Stylomastoid Foramen?
All facial expression muscles would be paralyzed on affected side.
- Cannot close eyes
- Cannot Smile
- Cannot wrinkle forehead
What presentation would you see of Bell’s Palsy where the lesion is in the Facial Canal, before the Chorda Tympani branches?
All facial expression muscles paralyzed on affected side.
- Cannot close eyes
- Cannot smile
- Cannot wrinkle forehead
Cannot sense taste on anterior 2/3 of tongue on affected side
Cannot secrete saliva from Submental and Submandibular glands on affected side
Taste and saliva loss will not be noticed, as the normal side will continue to function normally
What presentation would you see of Bell’s Palsy where the lesion in the Facial Canal, before the nerve to the Stapedius M. branches?
All facial expression muscles paralyzed on affected side.
- Cannot close eyes
- Cannot smile
- Cannot wrinkle forehead
Cannot sense taste on anterior 2/3 of tongue on affected side
Cannot secrete saliva from Submental and Submandibular glands on affected side
Cannot dampen loud sounds in ear of affected side - Stepdius M. dampens loud sounds
What presentation would you see of Bell’s Palsy where the lesion is at the Internal Acoustic Meatus?
All facial expression muscles paralyzed on affected side.
- Cannot close eyes
- Cannot smile
- Cannot wrinkle forehead
Cannot sense taste on anterior 2/3 of tongue on affected side
Cannot secrete saliva from Submental and Submandibular glands on affected side
Cannot dampen loud sounds in ear of affected side - Stepdius M. dampens loud sounds
Cannot secrete tears from Lacrimal Gland of affected side
What is Herpes Zoster?
Shingles (AKA Chicken Pox)
Stays in sensory ganglia for life (dormant virus)
Why is plastic surgery so successful in healing?
Anastemoses in the face and scalp
What is Tic Douloreux?
Trigeminal Neuralgia
Impingement/compression on a trigeminal nerve causing brief episodes of sharp pain over area of face innervated by either the CN V1, CN V2, CN V3
What is Auricular Hematoma?
Trauma to ear can cause bleeding
Blood accumulates in the space between the cartilage and the Perichondrium
Causes ear to swell
If blood is not drained, abnormal cartilage forms and you get CAULIFLOWER EAR
What is Otitis Externa?
Swimmer’s Ear
Infection of External Acoustic Meatus
Risk Factors:
- Excessive moisture
- Trauma (excessve cleaning/scratching)
- Devices that occlude the ear canal
- Dermatologic conditions
- Prior Radiation Therapy
What is Otitis Media?
Infection of the Middle Ear
Inflammation and swelling of mucous membrane of tympanic cavity may block pharyngotympanic tube
Tympanic membrane is red and bulges
