Clinical Flashcards
what is papiledema?
this is where there is a blurring of optic discs due to increased intracranial pressure
what is dysarthria?
difficulty speaking
what is rhinorroea?
this is where there is a leakage of CSF from the nose
what is anosmia?
loss of smell
what is the most fractured bone of the face?
the nasal
what is the second most common fracture of the face?
the mandible
what does ptosis result from?
CN III injury
which nerves decussate?
optic although not truely
trochlear is only true as it does it where it starts
what is lymphadenopathy?
enlargement of lymph nodes due to infection or malignancy
what do the lymph nodes feel like on palpation if enlarged due to infection?
tender
smooth
soft
on palpation, what do lymph nodes feel like if malignant?
hard
non tender
craggy
painless
what symptoms accompany EBV?
swollen node sore throat fatigue fever painful node
what are the majority of head and neck cancers?
squamous cell
what is head and neck cancer associated with?
hpv
alcohol
smoking
what symptoms present with head and neck cancer?
sore throat
dysphagia
hoarseness
lymphadenopathy
how do you diagnose head and neck cancer?
fine needle aspiration
biopsy
what is an extradural haematoma?
seperation of periosteum layer of dura matter from cranium and a torn blood vessel bleeds into this space
which vessel is an extradural haematoma most commonly associated with?
middle menangial artery
if there was a subdural haemotoma in a small baby, by which route would you aspirate and why?
between the partietal bones and frontal because they dont fuse until later on, insert a needle into the connective tissue separating them
why are cervical vertebrae prone to prolapse during whiplash injuries?
no horizontal alignment of vertebrae
why might a fracture of the lower mandible result in numbness of the lower lip?
may involve inferior alveolar nerve as it exits mental foramen
how does Paget’s disease affect the skull?
exaggerated reabsorption and replacement
thickening, swelling and increased vascularity
severe pain
jaw enlarged and teeth fuse with bone
what nerve may be damaged during a forceps delivery?
facial as it exits the stylomastoid foramen
how might a patient present with a damaged scm?
cannot flex or laterally flex
rotated neck
spasms
how can scm be damaged in childbirth?
may be stretched in delivery and tear
tight, fibrous tissue forms
what might a patient present with with an aneurysm of arch of aorta?
vomitting and nausea clammy high hr blood clots thoracic pain
if you were to feel for the pulse in the carotid triangle, what complication may arise?
syncope
why might an infection deep in the pterygoid region endanger the eye?
connected to cavernous sinus which is connected to eye via superior and inferior orbital veins
can increase icp
why does tongue become numb in inferior alveolar nerve block?
lingual is near and derives from the mandibular nerve as well
how can the tmj dislocate on yawning?
if there is excessive contraction of lat pterygoids while the other muscles are relaxed
What is bruxism?
Grinding of teeth when asleep
What is knacking?
Loud sounds when the jaw displaces (cracking)
What is mal occlusion syndrome?
Muscular pain
What is temperomandibular pain dysfunction?
Muscular pain not attributable to particular structure but tight and painful jaw
Why can metastasis occur in the infratemporal fossa?
Because it is a potential space
What can dislocation of TMJ be caused by?
Fractured mandible
Blow to open jaw
Yawning or a large bite
what are the common bacteria causing an ear infection?
strep pneumonia
viruses
moraxella catarrhalis
haemophillus influenza
how can osteosclerosis lead to impaired hearing?
osteosclerosis of stapes to oval window, resulting in dampened movement
what can Eustachian tube dysfunction result in?
negative pressure in middle ear and TM being drawn in, reducing function
what type of infection is otitis externa usually?
bacterial
what colour does the tympanic membrane turn in disease?
red or yellow
what would bulging of the tympanic membrane suggest?
fluid in the middle ear or pus
what would a retracted tympanic membrane indicate?
negative pressure in the middle ear
what is meniere syndrome?
blockage of cochlear aqueduct -> recurrent tinnitis hearing loss vertigo pressure in ear
what is otalgia?
ear pain due to infection or inflammation around ear
teeth, pharynx or cervical spine pain is usually referred to the ear
what is pruritus?
itching
name some congenital ear deformities..
pre auricular pit
pre auricular skin tag
pinna malformation
antihelix deformity
what are the two types of hearing loss?
conductive - due to blockage
sensorineural - defect in the pathway from cochlear to brain
what is ottorhea
discharge from the ear
indicates acute or chronic infection
blood or csf related to bone fractures
what causes motion sickness?
otoliths are embedded along hair cells - when hair cells bend, they stimulate the vestibular nerve and provides and indication of head in space
respond to quick tilting and motion sickness is a discordance between vestibular and visual stimulation
explain the formation of cauliflower ears
a haemotoma develops between the cartilage and skin and if the haematoma is not drained then it can cause scarring. it also compromises blood supply to the cartilage. so it occurs if the haemotoma is untreated
what is acute otitis externa?
inflammation of the external acoustic meatus
often develops in swimmers who dont dry their ears
itching and pain
what is otitis media
an infection within the middle ear and causes a bulging tympanic membrane
can cause blockage of the Eustachian tube
can lead to impaired hearing and scar ossicles
common due to strep pneumonia
what is glue ear?
absorption of water and oxygen
adherence of tympanic membrane to ossicles
bacteria thrive anaerobically so you use gromets to relieve the pressure and let air in
can spread to the brain
what is horners syndrome?
partial ptosis
fixed pupil
constricted pupil
may have: anihydrosis, flushing on affected side
due to a sympathetic supply being damaged
what is anihydrosis
failure to sweat on one side
what is harlequin syndrome?
patchy coloured face, hemifacial sweating, hemifacial flushing
doesnt neccessarily involve the eye
what does partial ptosis result from?
loss of innervation of smooth muscle of eyelid
what does paralysis of levator palpebrae superioris result in?
drooping of the eyelid - almost shut
why might the eye be partially open if the levator palpebrae superioris is damaged?
smooth muscle of eyelid may still be working
what does a paralysis of the orbicularis oculi result in?
failure to close the eye therefore cannot blink, fluid builds up, stagnation, infection of eye
how is blinking initiated?
touching cornea irritation to cornea foreign body to cornea sight of something coming toward eye drying of cornea
how might a lesion to the abducens nerve present?
paralysis of the lateral rectus muscle
inability to abduct the eye
how is abducens nerve palsy caused?
fracture of orbit or cavernous sinus
how does trochlear nerve palsy present?
paralysis of superior oblique muscle
unable to look down when eye is adducted
how is trochlear nerve palsy caused?
orbital fractures
stretching around the brainstem
how is occulomotor nerve palsy caused?
loss of innervation to all eye muscles bar the SO and LR
ptosis
down and out
dilated and non reactive pupil
how is an occulomotor nerve palsy caused?
involving cavernous sinus
aneurysm
what can an increased icp lead to?
blindness
papiloedema
what can a bloodshot eye result from?
infection
trauma
allergy
icp increased
name 3 causes of exopthalmos
Graves’ disease
haematoma
aneurysm
what is miosis?
constriction of pupil due to PS spinchter activation or loss of sympathetic
what is hyphema?
haemorrage within the anterior chamber of the eyeball
due to trauma
what is coloboma?
a loss of a section of the iris
congenital
injury
surgery
what is presbyopia?
this is where the lens becomes harder and flattened with age leading to a decreased focus of lens
what is cateracts?
cloudiness, harder lens, less focused
areas of opaquness
how might a blow to the eye affect the retina?
may cause it to detach
complain of flashes of specks across the eye
what is mydriasis?
dilation of pupil
due to underactivity of PSNS or over SNS
can be due to increased ICP
what is gluacoma?
when there is an increase in pressure between the anterior and posterior chambers of the eye, because it is not being balanced as blood is not being removed and delivered at the same rate
what muscles are paralysed during a stroke
facial muscles apart from the orbicularis oris and occipitofrontalis because there is bilateral innervation
what muscles are paralysed during Bell’s palsy?
all muscles of facial expression
what are the causes of facial nerve palsy?
idiopathic
iatrogenic
traumatic
non traumatic
what are the non traumatic causes of facial nerve palsy?
inflammation
infection e.g. viral or parotitis
compression
what are the traumatic causes if facial nerve palsy?
fractures
gunshots
stabbing
forceps delivery
if facial nerve palsy is due to idiopathic causes, what is it called?
Bell’s palsy
if the chorda tympani were damaged, what would present?
reduced salivation and loss of taste on illipsilateral 2/3 tongue
if the nerve to stapedius was damaged, what would be affected?
hyperacusius
if the greater petrosal nerve was damaged, how would it present?
ipsilateral reduced lacrimal fliud production
what pathology in what bodily part can affect the facial nerve most commonly?
middle ear pathology e.g. tumour or infection
parotid gland pathology
if there was an extracranial lesion of the facial nerve, what would be affected?
motor innervation affected
why is there forehead sparing in a stroke?
because there is bilateral innervation of the orbicularis occuli and occipitofrontalis
if there was an occulomotor palsy, proximal to ciliary ganglion, how would this present?
down and out
ptosis
dilation of pupil
loss of accomodation
if there was a complete occulomotor palsy distal to the ciliary ganglion, how would this present?
down and out
ptosis
pupils equal
PUPIL SPARING
if the ciliary portion of CN III was damaged but anatomical spared, how would this present?
loss of accomodation
dilated pupil unilateral
normal occulomotion
how is CN III commonly damaged?
DM
hypertension
tumour
how does herpes zoster present?
rash on ONE dermatome
