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C21 Phase 1 > Case 13 - Head Injury > Flashcards

Case 13 - Head Injury Flashcards

1
Q

3 regions of the nasal cavity

A

vestibule
respiratory
olfactory

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2
Q

Blood supply to vessels in the nasal cavity and implication of this

A

Internal and external carotid

Makes it harder to stop nose bleeds

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3
Q

What are the projections in the nasal cavity to increase surface area known as

A

Conchae/turbinates

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4
Q

What are the spaces between turbinates known as

A

Meati

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5
Q

What are the different paranasal air sinus’

A

Sphenoidal
Ethmoidal (anterior + posterior)
frontal
maxillary

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6
Q

Features of the oral cavity

A

Teeth, tongue, hard and soft palette, uvula, palatoglossal arches

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7
Q

Where is a laryngoscope placed to give a view of the larynx

A

Valleculae

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8
Q

Muscles of the pharynx and their role

A

inner longitudinal - elevator muscles

outer circular - constrictor muscles

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9
Q

Regions of the pharynx

A

Nasopharynx
oropharynx
laryngohypopharynx

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10
Q

What is located laterally to the pharynx

A

Carotid sheath containing common carotid artery, internal jugular vein, vagus nerve

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11
Q

What is located posteriorly to the pharynx

A

retropharyngeal space

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12
Q

Features of the nasopharynx

A

Auditory tube

Pharyngeal tonsil

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13
Q

Features of the oropharynx

A

Palatine tonsils

Palatopharyngeal arches

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14
Q

Features of the hypopharynx

A

Laryngeal inlet

Piriform fossa

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15
Q

What are the laryngeal cartilages

A

thyroid cartilage
cricoid cartilage
arytenoid cartilage
epiglottic cartilage

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16
Q

What are the laryngeal membranes

A

thyrohyoid membranes

cricothyroid membranes

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17
Q

Vocal folds and the function

A 
Vestibular folds
True folds (sound generating)
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18
Q

What are the intrinsic muscles of the larynx and their action

A

Interarytenoid = adducts vocal folds
lateral cricoarytenoid = adducts vocal folds
posterior cricoarytenoid = abducts vocal folds
cricothyroid = tenses vocal folds

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19
Q

What is the arterial blood supply to the brainstem

A

pontine branches of the basilar artery as well as partial supply from cerebellar vessels

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20
Q

Features of brainstem strokes

A

Often cause catastrophic damage - 85% fatality rate

Wide range of symptoms depending on where the infarction has occurred

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21
Q

How does axonal regeneration work in the PNS

A

Phagocytosis of damaged neuron

Schwann cells regress to early neuron to help promote axonal growth

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22
Q

How is scar tissue formed in the CNS

A

Oligodendrocytes divide and hypertrophy
Astrocytes form a barrier around the legion
Meningeal cells may invade and form a plug

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23
Q

Why is axonal regeneration not possible in the CNS

A

Physically blocked by scar formation

Chemically blocked by inhibitory molecules

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24
Q

What is a diffuse axonal injury

A

Caused by sudden jerking to the head and neck it causes axons to twist and shear/rupture

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25
Q

What is a coup and contracoup injury

A

Head injury where the brain is ricocheted to the opposite side of the skull, causing brain damage in two areas

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26
Q

Consequences of necrotic breakdown in CNS

A

Glutamate released which can overexcite neurons and cause cell death

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27
Q

What do different GCS scores mean

A 
14-15 = mild
9-13 = moderate
3-8 = severe (coma)
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28
Q

Causes of coma

A 
Infection
Fits
Stroke
Overdose
Metabolic
Neoplasm
Oxygen Deficiency
Low temp/blood pressure
Endocrine
Narcotics
Trauma
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29
Q

Features of Cushing’s triad

A

hypertension
bradycardia
respiratory depression

30
Q

Signs of raised intracranial pressure

A 
Headache
Nausea
Vomiting
Nerve palsies
Altered consciousness
Papillodaemia
31
Q

What is a lucid interval

A

Period of wakefulness following a period of unconsciousness after a head injury

32
Q

Features and treatment for extradural haemorrhage

A

Lemon shaped bleed on CT at the skull line
Reasonably good prognosis
Usually caused by traumatic injury
Craniotomy as treatment

33
Q

Features for subdural haemorrhage

A

Banana shaped bleed on CT at the skull line
Caused by ruptured bridging veins
Common in the elderly
Can have an insidious onset

34
Q

Features of a subarachnoid haemorrhage and treatment

A

Thunder clap headache
Due to rupture of berry aneurysm
Treated with rest and surgical clipping of aneurysm

35
Q

Features of intracerebral haemorrhage and treatment

A

Bleed within brain tissue on CT
Control hypertension
Stop blood thinning medication
Surgery can be an option for large superficial haematomas

36
Q

Obstructive causes of hydrocephalus

A

Tumours
Abscess
cyst
Congenital aqueduct stenosis

37
Q

Non-obstructive causes of hydrocephalus

A

Intracranial haemorrhage
infection
meningitis

38
Q

Examples of intracranial infections

A

intracerebral abscess

Subdural/extradural empyema

39
Q

Causes of intracranial infections

A 
paranasal sinus infection
dental abscess
middle ear/mastoid infection
head trauma
post-operative
40
Q

Causes of cauda equina syndrome and treatment

A

herniated lumbar disc
degenerative spinal stenosis
tumour
trauma

urgent MRI and lumbar decompression and discectomy

41
Q

Causes of acute spinal cord compression

A 
Disc herniation
Tumour
Haematoma
Empyema
Vertebral body fracture
42
Q

Type of infection crossing the blood brain barrier

A

Encephalitis

43
Q

Type of infection crossing the blood brain CSF barrier

A

Meningitis

44
Q

Risk factors for meningitis

A 
Babies
Prison populations
College campus'
Travel
Occupational hazard
45
Q

Symptoms of meningitis

A 
Fever
Rash
Stiff neck
Photophobia
Seizures/convulsions
Rapid breathing
Muscle pain
Headaches
46
Q

CSF findings with bacterial infection

A

Increased: neutrophils, protein
Decreased: glucose

47
Q

CSF findings with viral infection

A

Increased: lymphocytes

48
Q

CSF findings with TB infection

A

Increased: lymphocytes
Decreased: glucose

49
Q

CSF findings with fungal infection

A

Increased: lymphocytes

All others variable

50
Q

Treatment of meningitis

A

Antibiotics (cetotaxamine, amoxicillin, vancomycin)

Steroids

51
Q

Causes of viral encephalitis

A 
HSV
varicella-zoster
cytomegalovirus
mumps
poliovirus
rabies
HIV
52
Q

Ways to diagnose encephalitis

A

Lumbar puncture with CSF culture
CT head
EEG

53
Q

Treatment for encephalitis

A

Antiviral, eg, Acyclovir

54
Q

Features, methods of diagnosis and treatment of cerebral abscess

A

Symptoms associated with increasing intracranial mass
Diagnosed by CT with contrast, blood culture, lumbar puncture is CONTRAINDICATED

Treatment: antibiotics, surgical debridement

55
Q

Bones of the skull

A

Cranium - temporal, occipital, frontal, parietal

Jaw - Maxilla, mandible

Facial - zygomatic, lacrimal, nasal, ethmoid, sphenoid

56
Q

Indications for a CT head with contrast

A

Meningeal enhancement

Better view of infection

57
Q

Indications for a CT head without contrast

A

Stroke
headache
trauma

58
Q

Types of brain herniation

A 
Uncal
Central
Cingulate
Transcalvarial
Upward
Tonsillar
59
Q

Types of hydrocephalus

A 
Acquired
Congenital
Non-communicating
Communicating
Normal pressure
ex-vacuo
60
Q

Symptoms of a stroke

A
  • A weakness or numbness in the face, arm, or leg
  • A change in the vision of one or both eyes that occur suddenly with no known cause
  • A severe sudden headache that cannot be explained by any injury or other cause
  • A quick onset of dizziness, loss of coordination/balance, or other problems walking
  • A sudden problem talking or expressing thoughts and words
61
Q

What is carotid artery dissection

A

Arterial dissection of the carotid arteries occurs when a small tear forms in the innermost lining of the arterial wall (known as the tunica intima). Blood is then able to enter the space between the inner and outer layers of the vessel, causing narrowing (stenosis) or complete occlusion. The stenosis that occurs in the early stages of arterial dissection is a dynamic process and some occlusions can return to stenosis very quickly.

62
Q

What is the common cause of carotid artery dissection

A

Carotid artery dissection is thought to be more commonly caused by severe violent trauma to the head and/or neck

63
Q

Complications of carotid artery dissection

A

blood clots form and break off from the site of the tear, they form emboli, which can travel through the arteries to the brain and block the blood supply to the brain, resulting in an ischaemic stroke, otherwise known as a cerebral infarction. Blood clots, or emboli, originating from the dissection are thought to be the cause of infarction in the majority of cases of stroke in the presence of carotid artery dissection.

64
Q

Types of skull fracture

A

Comminuted/depressed
Basilar
Linear

65
Q

Descending spinal tracts

A

Lateral corticospinal tract

Ventral corticospinal tract

66
Q

Ascending spinal tracts

A

Dorsal column
Lateral spinothalamic tract
Ventral spinothalamic tract

67
Q

Actions of the lateral corticospinal tract

A

Voluntary motor neurons

68
Q

Actions of the ventral corticospinal tract

A

Voluntary motor neurons

69
Q

Actions of the Dorsal column

A

Deep touch
Proprioception
Vibration

70
Q

Action of the lateral spinothalamic tract

A

Pain and temperature

71
Q

Action of the ventral spinothalamic tract

A

Light touch

C21 Phase 1 (45 decks)

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