Clinical Notes Flashcards
Emergency Airway
Cricothyroid ligament pay be pierced by a fine 1mm needle when a patient can’t breath
Eg - during anaphylactic shock
Goitre
An enlarged thyroid gland, often caused by Grave’s disease or iodine deficiency
If seen in a patient also check for Exopthalamos of the eye as this can also occur in Grave’s disease
Congestive Heart Failure
In this, EJV becomes distended and a bruit may be heard
Lymph Node Enlargement
When a lymph node is enlarged it indicates some form of pathology
If the lymph node is enlarged or tender, it implies infection, otherwise it may indicate a tumour
Temporal Arteritis
Also known as Horton’s disease, can affect any artery, however the Superficial Temporal is the most commonly affected
This is the inflammation of the artery which can lead to decreased Oxygen supply causing blindness and stroke
Scalp Blood Supply
The scalp has a very rich blood supply so if it is lacerated, there is likely to be a large amount of bleeding
It will however, heal very quickly
Paget’s Disease
A disease of the bone which causes thickening and disorganisation
It may affect different bones and the development of disease is slow
If the skull is affected, this can cause blindness or deafness, depending on how developed the disease is
Osteoma
A localised mass of bone which is a benign tumour
May be found on the skull, but it is slow growing with no symptoms
If necessary, it can be excised
Multiple Myeloma
A tumour of the bone marrow cells and may also affect the skull
Extradural Haemorrhage
The pterion is the weakest part of the skull and just behind the middle meningeal artery runs. If there is a fracture at the pterion, the middle meningeal is likely to rupture and cause extradural haemorrhage. The patients condition will deteriorate rapidly as blood gathers between the dura mater and the skull
Subdural haemorrhage
Will usually occur in elderly or alcoholics. The cerebral veins, which over years will deteriorate, may rupture after a minimal trauma. This causes blood build up between the dura mater and arachnoid mater. The patients condition will deteriorate over days or weeks and they will start to become confused and incontinent
Subarachnoid Haemorrhage
The is usually caused by a defect in an artery on the underside of the brain. The patient needs to get to hospital as soon as possible. Most common cause of middle aged death.
Berry Aneurysm
An outpouching of a cerebral artery which may rupture with a very high mortality rate
Broca’s Area (Motor Speech Cortex) and Wernicke’s Area (Language Cortex)
Both supplied by the middle cerebral artery and if there is a stroke occluding this vessel, it can lead to both no longer functioning
Cavernous Sinus Thrombosis
Bacteria from a third molar abscess may pass through the pterygoid venous plexus throughsphenoidal emissary veins to the cavernous sinus. The bacteria may then multiply due to the slow flow causing bacteraemia or thrombosis. Symptoms include high temperature and swollen eye as blood cannot drain from the eye through ophthalmic veins
Facial Nerve Palsy Causes
Ear infection in Mastoid Air Cells
Surgery to the parotid gland
IAN block
Bell’s Palsy
The unilateral paralysis of the Facial Nerve with no known cause
Stroke in the Internal Capsule
The two main CNs that will be affected are VII and XII because these will both only cross over and will not innervate the same side (apart from facial to the forehead) This means if a patient has a stoke in their right internal capsule, their left muscles innervated by CNVII will no longer work below the eye brows and when the patient sticks their tongue out, it will deviate to the left. Also below the head, all muscles will be paralysed on the left due to the Pyramidal Decussation
Osteophytes
Bony projections that grow on joints which may block arteries, veins and nerves causing pain when the head is turned
Horner’s Syndrome
Damage to the cervical sympathetic trunk leading to damage to the sympathetic functions of the face. These include loss of sweating, constricted pupils (miosis) and drooping of the eyelid (ptosis)
Parotid Gland Inflammation
The dense fascia around the gland will cause any form of inflammation in the gland to be painful. This will put pressure on CNIX supplying the gland
Trigeminal Neuralgia
Disease where patient has severe pain in face and no known cause. There will be a compression of the nerve around the foramen ovale through the mouth to cause necrosis or the removal of part of the nerve
Salivary Calculi
These may be formed in the submandibular duct, which is the most prone area to stones. These are formed by the uphill salivary flow in the duct and also by salivary components. May be excised through the FoM and on excision, there could be damage to the lingual nerve. These can be viewed pre-treatment via a Mandibular True Occlusal radiograph
Mandibular Third Molar Extractions
The lingual nerve will run by the third molars so may be damaged in the extraction of them
Pharyngeal Recess Neoplasm
A tumour may form in the pharyngeal recess of the nasopharynx. Difficult to visualise however and is often advanced before it is diagnosed. When taking a biopsy of the pharyngeal races, the ICA may be damaged as it lies just behind the recess.
Piriform Fossa and Valecula
In both these areas, fish bones may stick
Tonsillectomy
Only indicated now if a patient has tonsillitis multiple times in a year. During and after the procedure there is likely to be a large amount of blood as the lymphoid tissue in the mouth and pharynx is very vascular. This is the main cause of mortality in Tonsillectomies
Serous Otitis Media
Disease where there will be blockage of the Eustachian Tube by the overgrowth of the Tubal Tonsils. This may be caused by recurrent infection. If this occurs, air cannot get into the middle ear so the air is no longer refreshed. Leads to the proliferation of goblet cells in the middle ear so large amount of mucus is secreted. Can be seen down an Auriscope as a mucus level on the Tympanic Membrane with air bubbles. This is treated by insertion of a Grommet into the Tympanic Membrane which will allow air into the middle ear. This will usually occur around the age of 5-7
Chronic Otitis Media
An infection of the middle ear, leading to Tympanic Membrane perforation which may cause pus to leak into the external acoustic meatus
Alternating Engorgement of the Nose
Blood supply to the nose will alternate sides causing more blood to flow to one side or the other. When one side is engorged the other will breathe more easily as it will be less swollen. This especially occurs at night where the side of the nose to the pillow will be engorged so the other will be breathing though
Small Toys in Nose
Children may insert toys into their nose and they will usually be lodged in the inferior meatus. This will cause a runny nose when crying or when it is cold
Naso-lacrimal Duct
This will drain tears from the Lacrimal Sac to the nose just under the Inferior Concha. This will cause a runny nose when crying or when it is cold
Sinusitis
Infection of the sinuses of the head. It is often difficult for the body to drain the sinuses in chronic persisting infection so the Caldwell-Luc technique is sometimes used to access the Maxillary Sinus and drain it. More often today, however and endoscope is used in Functional Endoscoping Sinus Surgery
Trans-Sphenoidal Approach
To reach the Pituitary Gland in surgery, often the Trans-Sphenoidal Approach is used. This will reach the Pituitary through the Sphenoidal Sinus walls
Ethmoid Sinus
If there is damage to the ethmoid sinuses in surgery, this can lead to CSF leakage and arterial bleeding
Oro-Antral Fistula
Tissue between Maxillary Sinus and first molar may be thin and upon extraction, can break leaving a communication between the oral cavity and maxillary sinus
Otosclerosis
In old age, the Annular Ligament which holds the Stapes in the Oval Window may gradually calcify restricting the movement of the Stapes. This leads to deafness. Surgery may free the Staped
Referred Pain from Toothache
There may be referred pain from toothache via CNV to the ear
Laceration of the Lacrimal Canaliculi
If the face is lacerated around the eye, the Lacrimal Canaliculi may need to be surgically reattached as they may be lacerated too
Atheroma of CCA
An atheroma can form near bifurcation of CCA. vascular surgery for removal can damage CNXII causing paralysis of one side of the tongue
Cerebral Arterial Blockage
Middle cerebral artery is more likely to become blocked than the anterior cerebral artery as it is more in line/continuous with the ICA
Blockage in the posterior cerebral artery can cause altered vision
Osteoarthritis
Caused by osteophtyes. Happens at small facet joints of cervical spine that connect vertebrae. If occur in neck, can cause dizzy turn when at certain angle or a drop attack
Venous line in subclavian vein
Access is between clavicle and first rib
Lip Cut
Superior and inferior Labial branches of facial artery of each side anastomose so can cause heavy bleeding
Zygomatic arch
Quite prominent and easily fractured
Buccinator Window Syndrome
Physiological obstruction of parotid duct due to narrowing where parodist duct passes through buccinator
Referred pain in ear
Auriculotemporal nerve runs into the TMJ. Common cause of referred pain in ear
Test digastric and mylohyoid
Forceful opening of mandible
Central Cyanosis
Failure to oxygenate tissues/lack of oxygen to tissues
Signs include blue tongue and lips
Chronic Sinus Infection
Infection in frontal sinus and likely in maxillary sinus too. Due to mucosa movement
Reflux Failure/Laryngeal Paralysis
If patient is in unusual position/unconsciousness, larynx is paralysed and reflexes may not work. Danger of food and fluid entering laryngeal airway
Hoarseness
Caused by vocal nodules and sometimes laryngeal carcinomas
Laryngoscopy
Used to visualise and protect vocal folds during anaesthetic intubation
Deafness
Most common cause is build up of wax blocking canal
Sensorineural Deafness
Due to degeneration of middle ear
Ganglion of Hayfever
Pterygopalatine ganglion known as this
When ganglion is stimulated patient experiences hayfever like symptoms
Radical treatment involves destroying the ganglion
Oculomotor Nerve Palsy
Signs include fixed, dilated pupil
This may also indicate malignancy in head/neck
