Clinical Correlations- Exam 2 Flashcards

1
Q

Scalp Laceration

A
  • Loss of structural support
  • Aponeurosis tone loss
  • Profuse bleeding
  • Staples used to close wound
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2
Q

Peri-Orbital Ecchymosis

(Scalp Infection)

A
  • Infection spread via Emissary Veins causing Meningitis (inflammation of intracranial structures)
  • Occipitofrontalis muscle inserts onto skin, allowing infection to enter eyelids and nose
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3
Q

Calvaria Fracture

A

Four types:

  1. Simple Linear (most common)
  2. Depressed
  3. Comminuted
  4. Basilar
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4
Q

Berry (Saccular) Aneurysm

A

Vessels are weakest at their branching points

  • Berry aneurysm at the Posterior Cerebral Artery can impinge CN III and affect pupillary constriction
  • Aneurysm may rupture causing a Subarachnoid bleed
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5
Q

Uncal Herniation

A

Epidural bleed increases intracranial pressure causing Uncus to be pushed through the Tentorium Cerebelli

-Affects CN III leading to a fixed, non-dilated pupil

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6
Q

Arnold-Chiari Malformation

A

Hernation of the Cerebellar Tonsil through the Foramen Magnum

  • Caused by a neural tube development disorder (Spina Bifida)
  • May cause Hydrocephalus by closing off the 4th Ventricle
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7
Q

Hydrocephalus

A

Excess CSF accumulation causing Ventricles to dilate

-Imbalance of reabsorption (or blockage) within the Ventricular system

Treated with a Ventriculoperitoneal Shunt to draw CSF out of Ventricles and into the abdomen

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8
Q

Papilledema

A

Swelling of CN II and the Optic Disc due to increased intracranial pressure from:

  • Hydrocephalus
  • Tumor
  • Trauma
  • Intracranial Hypertension

Symptoms:
-Headache, Vision Loss, Blindness

Treatment:
-Optic Nerve Sheath Fenestration

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9
Q

Middle Cerebral Artery (MCA) Stroke

A

-Most common stroke (approximately 50% of cases)

Complete MCA Syndrome:
Losing sensation/movement on the opposite side of the body from where the Brain was injured

  • Contralateral hemiplegia (paralysis)
  • Contralateral hemianesthesia (sensory)
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10
Q

Orbital Blowout Fracture

A

Anterior trauma to the Orbital Rim
-Involves Maxillary bone

Blowout occurs medially and inferiorly
-Causes Eye to drop down into maxillary sinus

Symptoms:

  • Double vision
  • Eye drooping
  • Protruding eye
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11
Q

Glaucoma

A

Leading cause of blindness in the world

Causes:

  • Obstruction to aqueous humor outflow
  • Build up of fluid in anterior chamber increases pressure on the Eye and CN II

Symptoms:

  • Blurry vision
  • Severe eye pain
  • Halo’s around the eyes

Can damage CN II and lead to permanent vision damage

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12
Q

H Test

Testing Individual Eye Muscles

A

Following movements of the examiners finger, the pupil is moved in H-patterns to test individual extraocular muscles and the integrity of their nerves

  • Only the actions of the medial and lateral rectus are tested starting from the primary position
  • Other muscles must be tested from an abducted or adducted position
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13
Q

Occulomotor Nerve Palsy

A

Injury to CN III
-Lateral Rectus and Superior Oblique unaffected, all other muscles are paralyzed

-Characterized by a dilated, non-reactive pupil that is fixed laterally (“Down and Out”)

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14
Q

Pupillary Light Reflex

A

Rapid contriction of the pupil due to light
-When light enters one eye, both pupils constrict

Pathway:

  1. CN II
  2. CN III
  3. Ciliary ganglia
  4. Short ciliary nerves
  5. Pupil constriction
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15
Q

Trochlear Nerve Lesion

A

Lesion of CN IV leads to paralysis of Superior Oblique causing the extorsion of the Eye

Symptoms:

  • Vertical diplopia
  • Weakened downward gaze

Treatment:
-Head tilted to opposite side of affected eye to compensate for extorsion

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16
Q

Abducent Nerve Lesion

A

A lesion to CN VI causes paralysis of the Lateral Rectus muscles

  • Affected eye cannot move laterally
  • Affected eye stays adducted at rest
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17
Q

Horner’s Syndrome

A

Interruption of the Cervical Sympathetic Trunk manifested by the absence of sympathetically stimulated functions on the same side of the face as the lesion (ipsilateral)

Can be caused by a Pancoast Tumor
-Tumor of the apex of the lung which compresses the Cervical Sympathetic Trunk

Symptoms:

  • Miosis (constricted pupil)
  • Ptosis (drooping eyelid)
  • Annhydrosis (absence of sweating)
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18
Q

Inferior Alveolar Nerve Block

A

Anesthetizes:

  1. Mandibular nerve
  2. Skin/mucous membrane of the lower lip
  3. Labial alveolar mucosa and gingiva
  4. Skin of the chin
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19
Q

Dens Fracture

A

Fracture of the Dens and/or part of the C2 vertebral body

-Caused by hyperextension of the cervical spine with the head of C1 forced backwards

Common in:

  • Elderly falls
  • Traumatic accidents

Type 1: Fracture of only the apex of the Dens
Type 2: Fracture of the Dens where it meets the vertebral body
Type 3: Fracture of the Dens that extends into the vertebral body

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20
Q

Hangman’s Fracture

A

Bilateral fracture of the Pars Interarticularis of C2 with C2/C3 subluxation (misalignment)

  • Hyperextension injury where the head is snapped upwards and backwards
  • Severe subluxation can impinge the upper cerivcal spinal cord leading to injury
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21
Q

Congenital Torticollis

A

Damage to the Sternocleidomastoid during gestation that leads to fibrosis (shortening) of the muscle

-Head tilts towards (and face tilts away from) the affected side

Treatments:

  • Gentle stretching
  • Infant stimulation to encourage movement
  • Torticollis collar
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22
Q

Erb’s Point (Cervical Plexus Block)

A

Site for regional anesthesia

-Located in the posterior triangle of the neck

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23
Q

Carotid Endarterectomy

A

Removal of atherosclerotic plaque from the Carotid Arteries (usually at bifurcation)

Nerves to protect during procedure:

  • CN IX
  • CN X (Superior Laryngeal Nerve branch)
  • CN XI
  • CN XII
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24
Q

Central Line Placement

A

Catheter placed into vein to administer medication/fluids or measure central venous pressure

Vein commonly used:

  • Internal Jugular Vein
  • Subclavian Vein
  • Femoral Vein

-Precautions must be taken to not pierce the Common Carotid Artery

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25
Q

Retropharyngeal Abcess

A

Swelling of retropharyngeal space due to spread of upper respiratory/oral infection

Symptoms:

  • Difficulty swallowing
  • Difficulty breathing

Treatment:

  • IV antibiotics
  • Intubation
  • Surgical abcess drainage
26
Q

Thyroidectomy

A

Surigcal removal of part or all of the Thyroid gland

Hypothyroidism:

  • Low energy
  • Weight gain
  • Feeling cold

Hypoparathyroidism:
-Low blood calcium leading to muscle spasms and tremors

Surgical complication:
-Injury to Recurrent Laryngeal Nerve leading to a monotone voice and trouble breathing

27
Q

Tracheotomy

A

Incision between the 3rd and 4th Tracheal rings to establish a long-term airway

Risks:
-Dependant on the size/position of Thyroid and its vasculature

28
Q

Cricothyrotomy

A

Incision through the Cricothyroid membrane to establish an emergency airway

29
Q

CSF Rhinorrhea

A

Fracture to the Cribiform plate may damage CN I

-Since CN I is covered by meninges, damage to it will cause a leak of CSF into the nose

Clinical presentation:
-Blood from the patient’s nose will have a “halo” around it indicating the presence of CSF

30
Q

Hypoglossal Nerve Lesion

A

Paralysis of the tongue muscles on the side of the lesion

  • Deviation of protruded tongue towards the affected side
  • “Lick you lesion”

Tongue will appear wrinkled and shrunken due to atrophy

31
Q

A. Cingulate (Subfalcine) Herniation

A

Intracranial pressure pushes Cingulate Gyrus underneath the Falx Cerebri

-Can impinge both Anterior Cerebral Arteries causing an infarction

32
Q

B. Uncal Herniation

A

Increased intracranial pressure pushes the Uncus through the Tentorial Notch

-Can impinge CN III and the Posterior Cerebral Artery

33
Q

C. Central Herniation

A

Increased intracranial pressure pushes the Temporal lobe down through the Tentorial Notch

-Can obstruct the Cerebral Aqueduct and cause Hydrocephalus

34
Q

Communicating Hydrocephalus

A

Issue with reabsorption at the Arachnoid Granulations

-CSF can flow through ventricles normally but cannot leave the skull

35
Q

Non-Communicating (Obstructive) Hydrocephalus

A

Issue with a blockage of CSF

36
Q

Corneal Reflex

A

Examiner tries to ellicit a blink by touching cotton to the Cornea

Afferent: Absence of reflex indicates a lesion to Nasociliary branch of CN V1

Efferent: Absence of reflex indicates a lesion to CN VII which innervates the Orbicularis Oculi

37
Q

Trigeminal Neuralgia (Tic Douloureux)

A

Sensory disorder of the sensory root of CN V due to demyelination

Symptoms:

  • Sudden attacks of excruciating, lightning-like jabs of facial pain
  • Initiated by touching a trigger point or by eating
  • Can be caused by pressure from an aberrant artery (artery pressing on Trigeminal ganglia)
  • CN V2 most affected, then CN V3, and least affected is CN V1
38
Q

Gag Reflex

A

Sensory (Afferent): CN XII
-General sensation to posterior 1/3 of the tongue, tonsils, oropharynx, soft palate

Motor (Efferent): CN X
-Triggers a reverse peristalsis to the central visceral tube, esophagus, stomach, and duodenum

39
Q

Transmucosal Absorption

A

-Quick drug administration

  • Nitroglycerin is a vasodilator
  • Treatment for Angina Pectoris

-Thin mucosa allows drug to enter Deep Lingual Veins in less than one minute

40
Q

Epistaxis (Nosebleeds)

A

Causes:

  • Infection
  • Hypertension
  • Dry mucosal membrane
  • Trauma to Kiesselbach area
41
Q

Fracture of the Cribiform Plate

(Lesion to CN I)

A
  • Anosmia (loss of smell)
  • CSF rhinorrhea
42
Q

Fracture involving Optic Canal

(Lesion to CN II)

A

-Loss of pupillary constriction

43
Q

Pressure on optic pathway

(Lesion to CN II)

A

Visual field defect

44
Q

Laceration or intercerebral clot in the Temporal, Parietal, or Occipital lobes of the Brain

(Lesion to CN II)

A

Visual field defects

45
Q

Pressure from Uncal Herniation

(Lesion to CN III)

A
  • Dilated pupils
  • Ptosis
  • Eyes turn “down and out”
  • Pupillary reflex on side of lesion is lost
46
Q

Fracture involving Cavernous Sinus

(Lesion to CN III)

A
  • Dilated pupils
  • Ptosis
  • Eyes turn “down and out”
  • Pupillary reflex on side of lesion is lost
47
Q

Stretching of nerve during its course around the Brainstem

(Lesion to CN IV)

A

Inability to look down while affected eye is adducted

48
Q

Fracture of the orbit

(Lesion to CN IV)

A

Inability to look down while the eye is adducted

49
Q

Injury to Trigeminal branches in the roof of the Maxillary Sinus

(Lesion to CN V)

A
  • Loss of pain and touch sensations
  • Paresthesia
  • Mandible deviation to side of lesion with gaping mouth
50
Q

Pathological processes affecting the Trigeminal Ganglia

(Lesion to CN V)

A
  • Loss of pain and touch sensations
  • Paresthesia
  • Mandible deviation to side of lesion with gaping mouth
51
Q

Fracture involving Cavernous Sinus/Orbit

(Lesion of CN VI)

A
  • Eye fails to move laterally
  • Diplopia on lateral gaze
52
Q

Laceration or contusion in Parotid region

(Lesion to CN VII)

A

Paralysis of facial muscles

53
Q

Fracture of Temporal bone

(Lesion to CN VII)

A
  • Paralysis of facial muscles
  • Dry cornea
  • Loss of taste
54
Q

Intracranial hematoma

(Lesion to CN VII)

A
  • Paralysis of facial muscles
  • Forehead wrinkles because of loss of innervation to Frontalis muscle
55
Q

Tumor of nerve

(Lesion to CN VIII)

A
  • Tinnitus
  • Progressive unilateral hearing loss
56
Q

Brainstem lesion

(Lesion to CN IX)

A
  • Loss of taste to posterior 2/3 of tongue
  • Loss of palate sensation on affected side
57
Q

Deep laceration of neck

(Lesion of CN IX)

A
  • Loss of taste to posterior 2/3 of tongue
  • Loss of palate sensation on affected side
58
Q

Brainstem lesion

(Lesion to CN X)

A
  • Sagging of soft palate
  • Uvula deviation
  • Paralysis of vocal cord (hoarse voice)
59
Q

Deep laceration to the neck

(Lesion to CN X)

A
  • Sagging of soft palate
  • Uvula deviation
  • Paralysis of vocal cord (hoarse voice)
60
Q

Laceration of the neck

(Lesion to CN XI)

A
  • Drooping of shoulder
  • Paralysis of Sternocleidomastoid
  • Paralysis of Trapezius
61
Q

Basal Skull fractures

(Lesion to CN XII)

A

Protruded tongue deviates toward the affected side