Clinical Applications Flashcards
emergency airway / cricothyrotomy
The Cricothyroid Ligament maybe pierced by a fine 1mm needle when a patient cannot breathe
what is goitre and what are the causes
This is an enlarged Thyroid Gland, often caused by Grave’s Disease or Iodine Deficiency. If this is seen in a patient, also
check for Exopthalmos of the eye as this can occur in Grave’s Disease
congestive cardiac failure
EJV becomes distended and a bruit may be heard
lymph node enlargement
indicates pathology
enlarged and tender = infection
hard and not sore = tumour
temporal arteritis / Horton’s disease
can affect any artery but mainly superficial temporal
inflammation of the artery = decreased oxygen supply causing blindness and stroke
scalp blood supply
scalp has a rich blood supply so if it is lacerated there is likely to be a lot of bleeding
it does heal quickly tho
paget’s disease
disease of the bone which causes thickening and disorganisation
develops slowly
if skull is affected it can cause blindness or deafness
osteoma
localised mass of bone which is a benign tumour
slow growing with no symptoms and can be excised if neccessary
multiple myeloma
tumour of bone marrow cells and can also affect the skull
extradural haemorrhage
pterion is the weakest point of the skull, and the middle meningeal nerve runs deep to it
if there is a fracture at the pterion the middle meningeal artery is likely to rupture and cause an extradural haemorrhage
ptx condition will deteriorate rapidly as blood gathers between dura mater and skull
subdural haemorrhage
usually occurs in elderly or alcoholics
the cerebral veins deteriorate over the years may rupture after a minimal trauma which causes blood to build up between dura and arachnoid
ptx condition will deteriorate over days or weeks and they become confused and incontinent
subarachnoid haemorrhage
usually caused by a defect in an artery on the underside of the brain
ptx should go to hospital ASAP
berry aneurysm
a type of sub-arachnoid haemorrhage outpouching of the border of the posterior cerebral and basilar arteries
may rupture
high mortality rate
stroke (occlusion) affecting middle cerebral artery
Broca’s area - motor speech cortex
and Wernicke’s area language cortex both stop functioning
cavernous sinus thrombosis
cause and symptoms
bacteria from a third molar abscess passes through pterygoid venous plexus and through sphenoidal emissary veins to the cavernous sinus
the bacteria then multiply as due to slow flow through cavernous sinus causing bacteraemia or thrombosis
ptx symptoms are high temperature and swollen eye as blood cannot drain from eye through ophthalmic veins
facial nerve palsy
CAUSES
ear infection = mastoiditis and this effects facial nerve as it runs past the mastoid process
parotid gland surgery accidently cutting the nerve as it runs through middle
temporarily paralysed in IDB if clinician doesn’t hit bone and LA drains into parotid. doesn’t drain quickly due to the dense fascial capsule so lasts prolonged time
ptx advised sensation will return within a few hours and to wear and eyepatch
EFFECTS
facial muscles on one side become paralysed
sounds become louder as stapedius muscle in ear can no longer contract to dampen sound
bell’s palsy
unilateral paralysis of facial nerve with no known cause
which CN are affected by a stroke in internal capsule and explain
CN affected - hypoglossal and facial
because these both will only cross over and not innervate the same side (bar facial to forehead)
this means stoke in right internal capsule their left muscles affected by the facial nerve will no longer work below eye brows and tongue will deviate to the right when they stick it out
osteocytes
and effect
bony projections which grow on joints which might block arteries/veins/nerves causing pain when head is turned
horner’s sydrome
damage to the cervical sympathetic trunk causing :
ptosis - dropping of eyelid
miosis - pupil constricted
anhidrosis
parotid gland inflammation
dense fascial capsule makes any inflammation of gland painful
puts pressure on glossopharyngeal nerve supplying gland
caused by mumps / tumour
trigeminal neuralgia
and tx
severe pain in face with no known cause
compression of nerve around foramen ovale
tx - carbamazepine - alcohol injection into foramen ovale through mouth causing necrosis or removal of nerve
salivary calculi and what structure can be effects by their excision
submandibular duct commonly
stones formed by the upward salivary flow in the duct and salivary components
can be excised through floor of mouth and this can cause damage to lingual nerve
can be viewed pre-treatment by a mandibular true occlusal radiograph
mandibular third molar extractions affect which structure
lingual nerve runs by and could be damaged
