Clinical Relevance Questions Flashcards
What is the function in of the sympathetic trunk, what are the cervical ganglia and what would damage to the sympathetic trunk result in?
Allows transmission of nerve impulses to different levels of the spine from which they originated on.
Superior cervical ganglion at level of c1/2 - innervate head
Middle cervical ganglion c6, stellate ganglion c7 - innervate neck and upper thorax.
Damage results in horners syndrome
- miosis - pupil constriction
- ptosis - drooping eyelid
- apparent anhydrosis - decreased sweating
What is Bell’s palsy/facial palsy What are its clinical presentations? What may cause them?
Paralysis of some / all facial muscles on the same side caused by damage to the facial nerve
Affected area sags
Symptoms can include lack of lacrimal fluid in the eye, saliva drooling from side of the mouth, food accumulation in oral vestibule
Can be caused by herpes virus, Epstein Barr virus, mumps, injection into facial nerve
What is trigeminal neuralgia? What causes it? Symptoms?treatments?
Sensory disorder of sensory root of CNV - mostly in middle aged/elderly persons
Excruciating jabs of facial pain which can last 15 mins or more
Mostly CNV2, then V3, then V1
Often set off by touching thr face, brushing teeth, chewing or shaving.
Treatment - avulsion of nerve at infra orbital foramen
How can herpes infect the trigeminal ganglion? Presentations?
Virus cause lesion at the ganglion, any division of CNV may be affected, but mostly V1. Typical corneal ulceration occurs.
Bell’s palsy too
How do you test sensory function of CNV?
Closing the eyes, respond when types of touch are felt on skin of - cheek, forehead, face, and lower jaw.
Asked if one side feels different.
How may dislocation of the TMJ occur? Whats the most likely dislocation?
Most common is anterior dislocation - condylar head of mandible passes anteriorly to the articular tubercle
Can be caused by yawning or taking a large bite, excessive contraction of pterygoid muscles.
Can also be caused by a lateral blow to mandible while jaw is open.
How may arthritis of the TMJ occur / present?
Inflamed from degenerative arthritis causing clicking, abnormal function, issues with occlusion
How may genioglossus paralysis occur? How does it present?
Caused by lesion to hypoglossal nerve
Genioglossus paralysis causes tongue to fall backwards and can obstruct the airway as genioglossus function is to protrude tongue and prevent airway obstruction
Also tongue protrudes out and deviates to the side of muscle paralysis
How may damage to the hypoglossal occur? What would present?
Trauma - fractured mandible
Paralysis of one side of the tongue
Tongue diverts to paralysed side when protruded due to muscles not working on that side
Why would a submandibular gland excision be done? Any complications?
Due to calculus stone or tumour
Incision is made below mandible so marginal mandibular branch is not affected.
Lingual nerve damage must be avoided during excision of the duct too as nerve passes directly superior, then inferior to the duct
What is a submandibular sialogram? Why can’t it be done on sublingual gland?
Injection of contrast medium into the duct, then radiograph taken to see where blockage lies.
The radiograph taken with the medium in situ is called a sialogram
Sublingual cannot be done due to large number of small salivary ducts.
What typical foreign body may get caught in the laryngopharynx? What would it present?
Items such as chicken or fish bone can get stuck in the piriform fossa in the laryngopharynx
If object is sharp it can pierce the membrane and injure the internal laryngeal nerve
Also risk of injury during removal of the object
Injury would result in anaesthesia of laryngeal mucous membrane
What may cancer of the larynx present? What often causes it? How treated?
Often caused by smokers or by those who chew tobacco
Often causes persistent hoarseness, earache (otalgia), and difficulty swallowing (dysphagia), also swollen pretracheal or paratracheal lymph nodes
Removed via laryngectomy - complete or partial removal of larynx.
How may occlusion of dural sinuses occur? What risk does this pose? What presentations?
Thrombi (clots) or venous inflammation or tumours.
Usually from infections in the orbit, nasal sinuses and superior face due to ophthalmic facial vein draining to cavernous sinus (from danger triangle)
Can affect adbucent nerve as travels through cavernous sinus
So sharp headache, swelling and bulging of eye, double vision, severe eye pain.
What is an extradural haemorrhage and what symptoms?
Arterial, rupture of meningeal artery, typically anterior underneath Pterion
Brief concussion, later is drowsiness and possible coma
What causes a ‘subdural’ hematoma?
There is no actual subdural space, however usually venous in nature and caused by rupture of the bridging veins (superior cerebral vein) leaving the saggital sinus. Usually caused by a strong blow which jerks the brain forward in the skull e.g. hitting head on windscreen
What causes a subarachinoid hematoma? Symptoms?
Usually arterial, often aneurysm of internal carotid artery or rupture of cerebral artery or veins within the subarachinoid layer. Results in meningeal irritation, severe headache, stiff neck and often loss of consciousness
What two types of strokes are there? What causes them?
Ischemic - impaired cerebral blood flow
- occlusive atherosclerotic disease
- thrombi within a vessel
Haemorhhagic - due to bleeding
- leakage or rupture of cerebral artery due to aneurysm or trauma
What does middle cerebral artery occlusion cause?
Contralateral hemiparesis and hemisensory loss in face and arm
Aphasia - difficulty to comprehend language
What does an anterior cerebral artery occlusion cause?
Contralateral hemiparesis and hemisensory loss of the leg and foot
Visual agnosia - Inability to identify objects correctly
What does a posterior cerebral artery occlusion cause?
Contralateral homonymous hemianopia
Visual agnosia - poor object recognition
Memory impairment
What occurs in a laryngeal skeleton fracture? How may it occur?
Often caused by a blow to larynx from something such a sick boxing, ice hockey goalkeepers or from seatbelt in a car.
Symptoms include sumbucous haemorrhage and oedema, hoarseness, sometimes temporary inability to speak.
How may the inside of the larynx be viewed?
Laryngoscopy
Anterior tongue pulled slightly out of mouth so posterior tongue covers the laryngeal inlet less
What is the Valsalva manoeuvre? What is it used for?
Pinch nose and close mouth then try to breathe out forcefully
Helps to trigger heart to go back to sinus rhythm
What occurs in aspiration of foreign bodies?
Foreign body enters airway and sits above vocal folds as rima glottidis is small
Causes laryngeal muscles to go into spasm, tensing vocal folds, can completely block airway
Coughing will occur as the mucosa of vocal folds are sensitive to foreign objects.
How can aspiration of foreign bodies be helped?
Heimlich manoeuvre
Closed fist and base of palm facing inwards placed below the sternum, other hand grasps and forcefully thrusts inwards and superiorly, forcing diagram superiorly creating an artificial cough
What is a cricothyrotomy and why is it Performed
Used for severe airway obstruction or major facial/cervical trauma where intubation not possible
Large bore needle inserted through cricothyroid ligament to permit fast entry to airway
What is a tracheostomy and why performed?
Incision made between 1st and 2nd tracheal ring.
Infrahyoid muscles retracted laterally
Isthmus of thryoid is divided or retracted superiorly.
What is an OAC? What is usually felt?
Communication where maxillary molar removed exposing the maxillary sinus, causing a sinus infection
Toothache session often felt due to the sinus and maxillary molar teeth both being innervated by the superior alveolar nerve
What is an OAF?
Oro-antral fistula
Where an OAC does not spontaneously close and is left open for 48-72 hours
The communication becomes epithelialised by migration of oral epithelium
Results in osteitis
What types of pituitary tumour are there?
Functioning - can be small but releases enough hormones to affect pituitary function
Non-functioning - can be large but does not release enough hormones, but does press/impede surrounding structures through siz
Signs and symptoms of a functioning tumour
Acromegaly (adults) or gigantism (in children and teens) from increased growth hormone
Cushings from excess cortisol (weight gain, excess back fat, more hair, decreased libido)
Breast growth in men and milk production
Irregular heartbeat, shaking and dizziness
Signs and symptoms of a non-functioning tumour
Macular sparing
Issues with eye movement
Headaches
Facial numbness or pain
Diabetes from decreasing pituitary hormone ADH
What is temporal arteritis? What does it cause?
Inflammation of artery on side of head - typically superficial temporal artery
Severe headaches, loss of vision in one or both eyes
Idiopathic
What. Is occulomotor palsy?
Damage to occulomotor nerve resulting in palsy of eye muscles
Results in drooping eyelid (ptosis), loss of constriction to the eye (mydriasis), and a downwards and outwards turned eye as superior oblique and lateral rectus intact
