Blue Box trivia Flashcards
What are some possible causes of cervical pain?
Inflamed lymph nodes, muscle strain, vertebral disc protrusion; most commonly bone abnormalities and trauma
What might enlarged cervical lymph nodes be a sign of?
Malignant head tumor
How do the facial layers of the neck help prevent the spread of infection?
- Infection btw the investing layer and muscular part of the pretracheal fascia will stop at manubrium; infection btw the investing layer and visceral part of the pretracheal fascia can spread to the thorax, prevertebral layer infections can spread to the posterior lateral neck and potentially the retropharyngeal space
What might enlarged cervical lymph nodes be a sign of?
Malignant head tumor
What fracture is likely to occur as a result of manual strangulation?
- Hyoid fracture
What must a surgeon be sure to do when performing neck surgery?
- Be careful not to sever the cervical branch of the facial nerve, be sure to suture the edges of the platysma as well as the skin during closing to ensure that the pieces move as one
What is torticollis?
- Shortening of the neck muscles causing twisting or slanting of the head
Where would a line be placed to monitor central venous pressure?
- Subclavian vein
What are the possible routes for right cardiac catheterization?
- IJV and subclavian; EJV may be necessary at times but is not ideal bc of the angle
What occurs when lesions form on the accessory nerve (CN XI)?
- Atrophy of trapezius, weakness turning head, inability to elevate and retract shoulder, difficulty raising upper extremity
How does the phrenic nerve innervate the diaphragm?
- The right and left branches each innervate half
What other nerve is usually affected by a cervical nerve block?
- Phrenic Nerve
Anatomically, where is the grove that the CCA lies in?
- between the trachea and the infrahyoid muscles; deep to the anterior border of the SCM
Why is the carotid triangle surgically significant?
- Access to the IJV, vagus, hypoglossal, and cervical sympathetic trunk
What occurs in carotid sinus hypersensitivity?
- External pressure causes decreased heart rate, drop in bp, cardiac ischemia, and ultimately a potential for syncope
What is the difference in time duration to clinically differentiate between TIA and CVA?
- TIA - symptoms visible for less than 24 hours; minor CVA - 24 hours to three weeks
In what situations would a person’s partial pressure of oxygen be decreased?
- high altitudes and pulmonary disease
What physiological effect does decreased PO2 cause when detected by the carotid sinus?
- activation of the aortic and carotid chemoreceptors to increase alveolar ventilation
What triggers do the carotid bodies respond to?
- decreased PO2, increased CO2 tension, free hydrogen ions; stimulation occurs -> message via glossopharyngeal nerve -> CNS -> message out to body -> increased depth and rate of breathing (along with HR and BP)
What might increased pulsations of the IJV be an indicator of?
- mitral valve disorder (increases pulmonary pressure)
What anatomical factor makes it possible for pulsations to be observed in the IJV as a result of R ventricular contraction?
- lack of one way valves in the brachiocephalic vein and superior vena cava
Why would a clinician choose the R IJV over the L IJV for an IJV puncture?
- because it is straighter and larger
What might a surgical resection of the large cervicothoracic ganglion be used to accomplish?
- resolution of excess vasoconstriction of the upper extremity
What is Horner syndrome characterized by and what is its cause?
- pupil contraction (miosis), drooping of the superior eyelid (ptosis), sinking in of the eye (enophthalmos), vasodilation with absence of sweating on the face and neck (anhydrosis); caused by a lesion on the cervical sympathetic trunk
What small, unpaired artery exists in approximately 10% of people which supplies both the thymus and trachea?
- thyroid ima artery
How do thyroglossal duct cysts form?
- during development the thyroid is attached to its origin point at the tongue by a thyroglossal duct, which disappear, but sometimes leave epithelium behind to form a cyst
What is another name for an ectopic thyroid gland?
- aberrant thyroid glandular tissue; usually found somewhere along the former path of the thyroglossal duct
What is an accessory thyroid gland?
- additional glandular thyroid tissue along the former track of the thyroglossal duct
What is a goiter?
- noninflammatory enlargement of the thyroid gland resulting from a lack of iodine; possible complications include compression of the trachea, esophagus, and recurrent laryngeal nerves
What is the surgical treatment for hyperthyroidism and why?
- near-total thyroidectomy, preserving the posterior portions of each lobe in order to protect the recurrent and superior laryngeal nerves and retain parathyroid glands
What may occur with unilateral injury to the recurrent pharyngeal nerve?
- hoarseness, temporary aphonia, speech disturbance, or laryngeal spasm
What is tetany?
- neurologic syndrome involving muscle twitches and cramps due to decreased serum Ca2+, resulting from atrophy or excision of the parathyroid glands; can be lethal due to laryngeal and respiratory muscle involvement
Can you fracture your larynx?
- yes; causes hoaarsness, submucous hemorrhage, edema, and temporary aphonia
What is the Valsalva maneuver?
- forced expiratory effort against a closed airway (sneeze, cough, strain); causes increased intra-abdominal and intrathoracic pressure
What structures would be important to know the location of in reference to the trachea when performing a tracheostomy?
- inferior thyroid veins, thyroid ima artery, left brachiocephalic vein, thymus, and the posterior wall in infants (esophagus also)
Stridor - high pitched, noisy breathing; caused by lack of ability to abduct the vocal folds
What protective mechanism is affected during paralysis of the superior laryngeal nerve?
- the ability of the superior laryngeal mucosa to keep foreign bodies out of the larynx
What procedure does a superior laryngeal nerve block usually go hand-in-hand with?
- Endotracheal intubation of conscious patients
How does laryngeal cancer present?
- hoarsness, potentially earache (otalgia), and difficulty swallowing (dysphagia)
Which nerves may be damaged by large or sharp foreign objects being lodged in the laryngopharynx?
- the superior and internal laryngeal nerves
What is an uncommon source of recurring thyroiditis?
- occurance of a sinus from the piriform fossa, along the former tract of the hypoglossal duct to the thyroid
Which structures are vulnerable during a tonsillectomy?
- the glossopharyngeal nerve and potentially the ICA
What is a fistula?
- an abnormal canal with an internal and external opening
Which structures are vulnerable during excision of a branchial cyst?
- hypoglossal nerve, glossopharyngeal nerve, spinal accessory nerves
What is esophageal atresia?
- when the esophagus doesn’t go straight through and ends in a pouch without leading to the stomach
What is a tracheo-esophageal fistula (TEF)?
- most common esophageal birth defect; communication between trachea and esophagus; often associated with esophageal atresia
What are the zones of penetrating neck trauma?
- Zone I : clavicles/manubrium to cricoid cartilage; Zone II : cricoid cartilage to angles of mandible; Zone III : superior to angles of mandible; zones I and III = greatest morbidity, zone II = most common
What is the most common symptom of a head injury?
- Altered Level of Consciousness/ Mental Status
What are neuralgias characterized by?
- severe throbbing or stabbing pain along a nerve caused by a demyelinating lesion
What might an injury to the superciliary arches cause?
- the superciliary arches are the bony prominences where you would find the eyebrows; injury in this region is likely to cause a black eye due to fluid accumulation and tissue aggravation surrounding the eye and at the upper lid
What was the zygomatic bone once known as?
- malar bone
What is malar flush?
- redness of the cheeks; associated with increased temperature and dz’s such as TB and Systemic Lupus Erythematosus Disease
How are fractures to the maxilla classified?
- Le Fort I: various horizontal maxillary fractures in the area between the alveolar processes and the zygomatic bone (may include the septum/ethmoid and sphenoid); Le Fort II: inclusive of the areas in Le Fort type I fractures, extending up the bridge of the nose (nasal bone) and essentially including the central portion of the face - results in separation of the central face from the cranium; Le Fort III: inclusive of the areas in Le Fort I and II, extends through the greater wings of the sphenoid and frontozygomatic sutures and zygomatic arches - causes separation of the maxillae and zygomatic bones from the rest of the cranium
What is key about mandibular fractures?
- if there is a fracture on one side there is usually one on the opposite side as well, with the exception of the coronoid process
What occurs when a tooth is removed from the maxilla vs. the mandible?
- The alveolar socket is eventually filled with bone when a tooth is removed from the maxilla, where as in the mandible bone is resorbed causing the mental foramina to become progressively more superior on the anterior border of the mandible (this can eventually cause complete exposure of the mental nerves); loss of all teeth can cause mandibular prognathism
What feature allows the calvaria to distribute force from a blow to the head?
- convexity (however hard blows are likely to yield a depressed skull fracture)
What is a countrecoup fracture?
- when no fracture occurs at the site of impact, but fracture is observed on the opposite side of the cranium
What is indicative of the healing of bone flaps caused by fracture or surgery?
- poor osteogenic properties are observed, therefore not much regeneration occurs (most success is observed when the bone retains its own blood supply)
What does palpation of the fontanelles allow a physician to determine?
- frontal and parietal growth, hydration, intracranial pressure
What does the anterior fontanelle eventually become?
- bregma
What is it called when the frontal suture does not disappear in the course of normal development (by the age of 8)?
- metopic suture (8% of population)
What does the posterior fontanelle eventually turn into?
- lambda
What are the paranasal sinuses important for?
- face shape and voice resonance
What does it mean when an older person has gray gelatinous material in the diploe?
- loss of blood cells and fat in the bone marrow
What can primary craniosynostosis (premature cranial suture closure) result in?
- scaphoncephaly: long, narrow, wedge-shaped cranium resulting from premature closure of the sagittal suture; plagiocephaly: twisted, asymmetrical cranium resulting from premature closure of the coronal or lambdoid suture; oxycephaly and turricephaly: high, tower-like cranium resulting from premature coronal suture closure; more prevalent in males and usually associated with other osseous abnormalities
What is the scalp proper?
- first three layers of the scalp
Why is the epicranial aponeurosis clinically significant?
- the strength of the aponeurosis prevents superficial head wounds from gaping, where as a deep wound (especially a coronal laceration) gapes due to laceration of the aponeurosis in conjunction with opposing forces of the occipitofrontalis
What is another term for black eyes?
- periorbital eccymosis
What does a cephalhematoma result from?
- difficult birth process, usually benign and affecting the periosteal arteries
What is diagnostically useful about a person’s ability to flare their nostrils?
- chronic mouth breathers (due to nasal obstruction) can lose the ability or have diminished ability to flare their nostrils
