case 20 Flashcards
where is the retromandibular vein usually found?
behind the parotid gland
what is parosmia?
abnormality in the sense of smell
what is dysosmia?
abnormality in smell PERCEPTION
what is phantosmia?
smell that isn’t there
what is anosmia?
complete loss of sense of smell
what happens in locked-in syndrome?
patient is fully conscious, aware, and alert but they are paralysed. they can see, hear, and feel pain. often their eyes are unaffected so they may be able to communicate using movements of the eyes and eyelids.
what artery is most likely to be occluded in locked in syndrome and why?
basilar artery-has a number of branches that supply the pons and brainstem-damage to these areas would stop the brain from communicating with the rest of the body-especially the corticospinal tract-resulting in locked in syndrome
what happens in brainstem death?
loss of all brainstem function and reflexes. spontaneous respiratory effort in response to rising CO2 levels. if alive, deeply comatose and ventilator dependent.
what levels does the common carotid artery split at?
C4!!!
what is hydrocephalus?
abnormal buildup of fluid in the ventricles of the brain. this excess fluid causes the ventricles to widen, putting pressure on the brain’s tissues.
what are neutral lipids?
hydrophobic molecules lacking charge groups
TAGs and choleterol esters (steryl esters and wax esters)
what drug interactions can happen with statins?
drugs that also are metabolised by CYP3A4 pathways.
what is the site of action of statins?
the liver
which brainstem nucleus do carotid sinus afferents synapse with?
solitary nucleus
what is an vital gene in HDL formation?
ABCA1. this makes the ABCA1 protein, or the CERP (cholesterol/phospholipid efflux regulator protein) which is vital in the formation of HDL.
why do people with anorexia develop high cholesterol?
no stimulus to release insulin-insulin switches on different lipases in the body-dysregulation of system
what is the sensory role of the spinal trigeminal nucleus?
general sensation (pain/pressure/temp)
what is the sensory role of the nucleus solitarius?
taste
what is hemoparesis?
weakness on one entire side of the body.
what fissures do the anterior cerebral artery and middle cerebral artery travel in?
ACA-longitudinal fissure
MCA-lateral fissure
what type of fibre is the golgi tendon organ?
1b
what are the stages involved in production of speech?
exhalation, phonation, articulation
what structures does the trigeminal nerve originate from?
four brainstem nuclei (3 sensory and 1 motor)
which cell type gives rise to parallel fibres in the cerebellar cortex?
granule cell
which region of the brainstem do the pyramides decussate?
caudal medulla
which drug therapy should be used as secondary prevention after a TIA?
antiplatelet therapy-aspirin
what function would be affected by a unilateral lesion of the cerebellum?
ipsilateral motor function
what are the absolute contraindications to alteplase?
it being a bleed/SAH history of intracranial haemorrhage known intracranial arteriovenous malformation, neoplasm, or aneurysm active internal bleeding known bleeding diathesis neurosurgery, head trauma, or stroke in past 3 months suspected/confirmed endocarditis abnormal blood glucose uncontrolled hypertension (>185/110)
what’s the main function of vWf?
binds platelets to the subendothelium.
what is carotid artery dissection?
condition where the layers of the carotid artery are spontaneously separated
potentially compromises blood flow to certain areas of the brain and can lead to a stroke
can occur extracranially or intracranially and can lead to subarachnoid hemorrhage or brain ischemia
most common cause of strokes in younger patients
what is tachypnoea?
rapid breathing
which artery goes through the internal accoustic meatus?
labyrinthine artery
how does the brain regulate cerebral blood pressure?
the pressure in the vessels themselves causes their muscular walls to contract or expand to keep the pressure optimal (myogenic autoregulation). this can only happen within their limits of 60-160 mmHg; outside this the BP is dependent on mean arterial pressure in a linear fashion.
what are the symptoms of dental abscess?
intense throbbing pain in affected tooth or gum
can spread to ear, jaw, and neck on same side
worse lying down
what are the symptoms of otitis media?
earache (ear pain) fever nausea fatigue previous urti
what are the features of otitis externa?
ear pain itching tenderness canal redness and swelling hearing loss/ears feeling 'plugged'
what are the symptoms of TMJ disorder?
pain in the TMJ and muscles of mastication, and in the pre-auricular region, which may radiate to other structures (ear, temple, teeth, cheek, jaw)
what are the symptoms of mastoiditis (infection of the mastoid bone)?
redness, tenderness, swelling, pain behind ear
discharge from ear
high temp
hearing loss in affected ear
what is the most common symptom of mumps?
swelling in the parotid gland
what are the symptoms of salivatory calculi?
(salivatory gland stones) dull pain in mouth and intense during mealtimes dry mouth swelling in mouth visible stone
what are the symptoms of trigeminal neuralgia?
pain in region of 1 or more division of trigeminal nerve (around 90% due to nerve compression, usually vascular cause)
episodic, severe, sharp, shock-like pain, lasts mins/secs.
what is myositis?
damage to skeletal muscles that over time can cause rhabdomyolysis
what is rhabdomyolisis?
breakdown of skeletal muscle tissue, can be fatal
what are the adverse effects of statins?
transient and mild: headache, myalgia, nausea, insomnia
rare and serious: rhabdomyolysis, rashes, angioedema
what is a key contraindication of statins?
pregnancy-they are teratogenic.
what are the non pharmacological interventions for dyslipidaemias?
1-cardioprotective diet 2-weight loss 3-physical activity 4-reduce alcohol consumption 5-smoking cessation
how long does it take fibrinolytic drugs eg alteplase to have an effect?
instant affect (administered IV)
what is enoxiparin an example of?
low molecular weight heparin
is heparin safe in pregnancy?
yes-does not cross placenta
is warfarin safe in pregnancy?
no-crosses placenta
how is warfarin metabolised?
CYP450 enzymes-possible drug interactions.
how do measure heparin and warfarin actions?
heparin-APTT-intrinsic pathway
warfarin-INR-extrinsic pathway
what is the antidote for direct factor Xa inhibitors?
andaxanet alfa or prothrombin complex concentrate (PCC)
what is the antidote for dabigatran (direct thrombin inhibitor)?
idarucizumab
what is one issue with streptokinase?
it’s synthesised from streptococci-people who’ve previously had a strep infection might have antibodies against the streptokinase
what is vocalisation?
the sound made by the vibration of vocal folds modified by the resonance of the vocal tract
what is articulation?
using the speech sounds for intelligible and meaningful speech via the movement and positioning of the lips, soft palate, tongue, teeth, alveolar ridge, and hard palate.
what is phonation?
the process by which the vocal folds produce certain sounds through periodic vibration. it occurs due to the actions of the laryngeal muscles.
what does phonation require?
adduction of the vocal folds so that they’re in the airstream generated by respiration.
what are the 3 adductors of the vocal folds?
lateral cricoarytenoids
transverse arytenoid
oblique arytenoid
which muscles allow for adjustments in pitch?
cricothyroid, thyroarytenoid, vocalis -these change the frequency of the vocal fold vibration.
what muscle is the only abductor of the vocal cords?
posterior cricoarytenoid muscle
what do you find at the precentral gyrus?
primary motor cortex
where are tendon xanthomas most commonly found?
achilles tendon
what happens in haemophilia A?
deficiency in factor VIII.
