Clinical Applications of Anatomy

Question 1

What is the indications for cricothyrotomy ?

Answer 1

Emergency airway e.g. anaphylaxis.

Question 2

What is a cricothyrotomy ?

Answer 2

Cricothyroid ligament pierced with fine 1mm needle when occluded airway.

Question 3

What is a goitre ? And what conditions is it commonly associated with ?

Answer 3

Enlarged thyroid gland. Commonly seen with Grave’s disease and iodine deficiency.

Question 4

What is another symptom of Grave’s disease ?

Answer 4

Exopthalmos of the eye, also known as ocular proptosis.

Question 5

What is congestive cardiac failure ?

Answer 5

EJV distension.

Question 6

What is temporal arteritis (also known as Horton’s disease) ?

Answer 6

Inflammation of artery (most commonly superficial temporal), leading to reduced oxygenated supply.

Question 7

What are the symptoms of Horton’s disease (temporal arteritis) ?

Answer 7

Blindness and stroke.

Question 8

What is Paget’s disease ?

Answer 8

Disease of bone causing thickening and disorganisation of skull.

Question 9

What are the clinical implications of Paget’s disease ?

Answer 9

Blindness and deafness.

Question 10

Tumour of the bone marrow cells - what is the name of this malignancy ?

Answer 10

Multiple myeloma.

Question 11

Where is the most common site and vessel for extra-dural haemorrhage ?

Answer 11

Pterion and middle meningeal artery.

Question 12

What two main cranial nerves are affected by a stroke in the internal capsule ?

Answer 12

Facial (CNVII) and hypoglossal (CNXII).

Question 13

Why are the facial and hypoglossal cranial nerve affected most by a stroke ?

Answer 13

Both cross over and do not innervate the same side (apart from facial nerve to forehead). Results in contralateral facial and hypoglossal symptoms.

Question 14

What is Horner’s syndrome ?

Answer 14

Damage of cervical sympathetic trunk leading to damage of sympathetic functions of the face.

Question 15

What are the symptoms of Horner’s syndrome ?

Answer 15

Loss of sweating on one side of face, constricted pupil and drooping of eyelid.

Question 16

What nerve can be affected by swelling of the parotid gland ?

Answer 16

Glossopharyngeal (CNIX), due to pressure on nerve supplying the gland.

Question 17

What is the name of the condition where a patient suffers severe pain in their face for no known cause ?

Answer 17

Trigeminal neuralgia.

Question 18

What are the treatment options of trigeminal neuralgia ?

Answer 18

Carbamazepine, alcohol injection to foramen oval through mouth to cause necrosis and removal of part of the nerve.

Question 19

What is anatomically significant about mandibular third molar extractions ?

Answer 19

Proximity to lingual nerve behind third molar.

Question 20

When is a tonsillectomy indicated ?

Answer 20

Recurrent tonsillar infections in one year.

Question 21

What is chronic otitis media ?

Answer 21

Infection of middle ear leading to tympanic membrane perforation. Pus can leak into external auditory meatus.

Question 22

What are the symptoms if a posterior cerebral artery is affected by a stroke ?

Answer 22

• Contralateral homogenous hemianopia with macular sparing (visual field loss).
• Visual agnosia (recognition of objects) more commonly if left affected.
• Memory impairment (due to medial aspect of temporal lobe affected).

Question 23

What are the symptoms if a middle cerebral artery is affected by a stroke ?

Answer 23

• Contralateral hemiparesis and sensory impairment, face and arm (as pre and post-central gyri supplied, pre and post motor cortex).
• Contralateral homogenous hemianopia (visual field loss).
• Aphasia (more commonly if left affected, hypoglossal no colateral).
• Anosognosia - impaired ability to understand illness (more commonly if right affected).

Question 24

What are the symptoms if a anterior cerebral artery is affected by stroke ?

Answer 24

• Contralateral hemiparesis and hemisensory loss, leg and foot (paracentral lobule of cortex).
• Inability to identify objects.
• Apathy.
• Personality changes.

Question 25

Where does bleeding occur in an extradural cranial haemorrhage ?

Answer 25

Between periosteum and dura.

Question 26

What blood vessel is most commonly affected in extradural cranial haemorrhage ?

Answer 26

Middle meningeal.

Question 27

How quickly to symptoms appear in extradural cranial haemorrhage ?

Answer 27

Within 24 hours.

Question 28

What is the most common cause of extradural cranial haemorrhage ?

Answer 28

Trauma.

Question 29

What are the symptoms of extradural cranial haemorrhage ?

Answer 29

Loss of consciousness.
Confusion.
Dilated pupil of contralateral eye.
Headache.
Nausea.

Question 30

Where does bleeding occur in a subarachnoid cranial haemorrhage ?

Answer 30

Between pia and subarachnoid i.e. subarachnoid space.

Question 31

What blood vessels are most commonly affected by subarachnoid cranial haemorrhage ?

Answer 31

Cerebral arteries.

Question 32

How quickly do symptoms arise in subarachnoid cranial haemorrhage ?

Answer 32

Within minutes.

Question 33

What is the most common cause of subarachnoid cranial haemorrhage ?

Answer 33

Berry aneurysm - out pouching of cerebral artery causing weakness to wall and ultimately rupture.

Question 34

What are the common symptoms of subarachnoid cranial haemorrhage ?

Answer 34

Severe headache.
Stroke like symptoms - weakness, facial palsy, slurred speech.
Photophobia.
Nausea.
Double vision.

Question 35

What blood vessel is most commonly affected in subdural cranial haemorrhage ?

Answer 35

Bridging cerebral veins and rupture in weakened dura.

Question 36

Where does a subdural cranial haemorrhage occur ?

Answer 36

Between meningeal dura and subarachnoid layer.

Question 37

How quickly do symptoms arise in subdural cranial haemorrhage ?

Answer 37

Very slowly.

Question 38

Who is most affected by subdural cranial haemorrhage ?

Answer 38

Elderly - small trauma or weakening blood vessels due to age.

Question 39

What are the most common symptoms of subdural cranial haemorrhage ?

Answer 39

Personality change.
Headache.
Confusion.