Clinical Relevance

Question 1

What is temporal arteritis?

Answer 1

Inflammation of arteries
Can affect any artery but most commonly superficial temporal
Risk of ophthalmic arteries becoming inflamed, leading to decreased oxygen supply causing blindness.

Question 2

What is trigeminal neuralgia? How can you treat trigeminal neuralgia?

Answer 2

Compression of CNV through the foramen ovale
Pt experiences severe facial pain with no known cause
Can be treated using Carbamazepine or an alcohol injection at foramen ovale to cause necrosis/remove part of nerve

Question 3

When may the external jugular vein become noticeably distended?

Answer 3

Congestive cardiac failure

Question 4

What is Horners syndrome?

Answer 4

Damage to sympathetic trunk in neck
Symptoms include:
-Dilator papillae muscle supplied by sympathetic nervous system (cervical trunk) is paralysed - pupil becomes constricted
-Ptosis - drooping eyelid
-Loss of sweating as sweat glands are also supplied by sympathetic nerves

Question 5

What is Parkinson’s disease?

Answer 5

Degeneration of neurons in the substantia nigra

Face becomes mask like as patient loses part of facial expression

Question 6

What happens if LA is injected into the parotid gland?

Answer 6

Patient will have temporary facial paralysis.
Tough fascia surrounding the parotid gland doesn’t allow LA to disperse
Facial nerve enters parotid gland and branches into 5 groups, therefore all branches become anaesthetised.

Question 7

What two places in the pharynx can fish bones commonly get stuck?

Answer 7

Piriform fossa or vallecula

Question 8

What is Ludwigs angina and what are the symptoms?

Answer 8

Lamina infection that occurs on floor of mouth underneath tongue, it’s a bacteria infection usually caused by a dental abscess or other mouth infection/injury
Symptoms include swelling of tongue, neck pain and breathing problems

Question 9

Where in the nasal cavity are small toys likely to get stuck? What symptoms would this present?

Answer 9

In the meatus below the inferior nasal concha.

Symptoms would be pus and a foul smell.

Question 10

What is an oro-antral communication? What signs will the patient present with? What will happen if this is left untreated?

Answer 10

Bone between the oral cavity and maxillary sinus can be thin - if a posterior tooth is extracted, this may create a communication (hole in bone)
Liquid will be coming through the nose
Oro-antral fistula - where gingival epithelium and mucosal epithelium join

Question 11

Where in the nasopharynx are tumours likely to occur? What are the risks of doing a biopsy in this area?

Answer 11

Pharyngeal recess

This area lies directly in front of the internal carotid artery, which can become damaged.

Question 12

What is Paget’s disease?

Answer 12

disease of the bone which causes thickening and disorganisation
can be seen in the skull, and if severe can cause blindness/deafness

Question 13

What is an extra-dural haemorrhage?

Answer 13

occurs outside the dura
commonly occurs at the pterion (weakest part of skull) where the middle meningeal a. runs underneath
if this ruptures, blood will gather between dura and skull causing pt to deteriorate rapidly

Question 14

What is a subdural haemorrhage?

Answer 14

occurs when cerebral veins rupture (these veins weaken with age) ie simple fall
pts may deteriorate rapidly or over several days/weeks, showing symptoms of confusion and incontinence
usually occurs in elderly/alcoholics

Question 15

What is a subarachnoid haemorrhage?

Answer 15

occurs when cerebral arteries rupture

Question 16

What is a berry aneurysm? What happens if these vessels rupture?

Answer 16

Swelling of cerebral arteries.

Causes subarachnoid haemorrhage if these rupture.

Question 17

What areas are affected if a stroke occurs from the anterior cerebral artery?

Answer 17

lower limb of opposite side will be affected

Question 18

What areas are affected by a blockage of middle cerebral a.?

Answer 18

Broca’s area (motor speech area) and Wernicke’s area (language cortex) are affected
Opposite side of lesion is affected -> upper limb, head and neck (mouth drooping), trunk

Question 19

What area will be affected if a stroke occurs from a posterior cerebral a.?

Answer 19

visual cortex will be affected

Question 20

What is Bell’s palsy?

Answer 20

facial paralysis of no known cause

Question 21

Which structures lie close to the optic nerve? What may happen if these swell?

Answer 21

Pituitary gland and carotid arteries

If these swell, they can compress the chiasma and alter vision

Question 22

Where is an emergency airway usually placed?

Answer 22

within cricothyroid ligament, between the cricoid and thyroid cartilages (cricothyroidotomy)

Question 23

The maxillary sinus can undergo metaplastic changes into malignant epithelium. How does this usually present? What are the risk factors?

Answer 23

epithelium undergoes metaplasia from pseudostratified columnar epithelium to squamous cell carcinoma
half of pts present with facial pain, other half present with floor of sinus eroded through to gingival margin
risk factors include smoking, alcohol, poor oral hygiene

Question 24

What is a blow out fracture?

Answer 24

damage to infraorbital n.

can cause double vision, orbital contents drop downwards, squint

Question 25

What is the importance of the carotid sinus?

Answer 25

outpouching of the internal carotid a. just above the bifurcation
arterial walls contain baroreceptors which detect any changes in blood gas levels (as brain is highly sensitive to any changes)

Question 26

What is the importance of the Circle of Willis?

Answer 26

equalises pressure of blood flow to the brain

if one part becomes narrowed/blocked, blood flow from other vessels is usually enough to prevent ischaemia

Question 27

What are arachnoid granulations?

Answer 27

clusters of arachnoid villi -> these absorb CSF

can be seen as imprints on the inner side of the vault of the skull

Question 28

How can cavernous sinus thrombosis be caused?

Answer 28

bacteria can travel to cavernous sinus via sphenoidal emissary veins from the pterygoid venous plexus

Question 29

What is vertebrobasilar ischaemia?

Answer 29

caused by atherosclerosis, results in poor blood flow to posterior of brain as vertebral/basilar arteries are narrowed

Question 30

What is the clinical relevance of osteophytes?

Answer 30

These are bony projections that can grow on the vertebrae -> can cause pressure on vertebral arteries + other vessels + nerves

Question 31

Which salivary duct is the most common place for calculi stones to form? What is the risks of doing surgery in this duct?

Answer 31

submandibular duct

risk of damaging lingual n. as this lies very close by

Question 32

What is the clinical relevance of Waldeyer’s ring of tonsillar tissue?

Answer 32

includes adenoids, tubal tonsils, palatine tonsils, lingual tonsil
these are a crypt of protective lymphoid tissue to trap microorganisms + promote immune response + lymphocyte circulation

Question 33

If the frontal sinus is infected, which other sinus is likely to be infected too? Why is this?

Answer 33

maxillary sinus

the two are connected by the hiatus semilunaris

Question 34

What is the clinical relevance of a tumour in the vocal folds?

Answer 34

causes hoarseness therefore is easily detectable

Question 35

When may swallowing be less effective?

Answer 35

When pt is anaesthetised or in supine position

Question 36

What is the clinical name of an infection of the external ear?

Answer 36

otitis externa

Question 37

What is the clinical relevance of otitis media?

Answer 37

can be acute/chronic
pts with chronic condition tend to have piece of cotton wool in ear as the tympanic membrane often perforates causing pus leakage from middle ear

Question 38

What is the clinical relevance of Glue Ear? How can this be treated?

Answer 38

seen on tympanic membrane as bubble
common in children who have recurrent throat infections -> this causes hypertrophy of tubal tonsil (which surround auditory tube) therefore blocking it -> new air cannot enter middle ear cavity therefore goblet cells in mucosa produce excess mucous
treated with a grommet (ventilation tube) which is inserted through tympanic membrane allowing entry of new air (DOESN’T DRAIN PUS)

Question 39

What are three most common causes of deathness? How can these be treated?

Answer 39

build up of cerumin -> treat by syringing ears
glue ear -> treat with grommet
otosclerosis -> use artificial ligament

Question 40

What is the clinical relevance of otosclerosis?

Answer 40

calcification of annular ligament surrounding stapes
causes deathness as sounds cannot be conducted as movement of stapes into fenestra vestibuli is less effective
treated by artificial ligament

Question 41

What is the clinical relevance of lacrimal canaliculi? When can this be damaged?

Answer 41

drains excess tears into nasal cavity -> on a cold day, excess tears cause a runny nose
can be damaged in facial trauma, therefore will need to be repaired microsurgically