Clinical Review Flashcards
What is Bell’s Palsy?
Lower motor neuron disorder of CN VII
Facial paralysis, Drooling (buccinator) Inability to close eye
Loss of taste to anterior tongue, pain in or behind ear, hyperacousia
What can result from paralysis of the orbicularis oculi?
Patient is unable to close eye, which can result in damage to the cornea
In newborns, the eyelid can be sewn shut to prevent corneal damage
What results from paralysis of the buccinator muscle?
Patient is unable to hold food between teeth
Dificulty chewing, drooling
Cause is facial paralysis
Why does damage to VII result in hyperacousia?
Paralysis of the stapedius
How can infection spread from the face to the vein?
Low pressure and no valves in the venous system of the face
Facial and ophthalmic veins have extensive anastomoses
Ophthalmic veins drain to cavernous sinus
What is the clinical sign of a facial infection that spread to the brain?
Diplopia
*Infections lateral to the nose are particularly dangerous due to pterygoid venous plexus
What is cleft lip?
Failure of fusion of medial nasal process and maxillary process at the philtrum of the lip
Can be unilateral or bilateral and occur in combination with cleft palate
What part of the skull is a common place for fractures and what joint does in affect?
Zygomatic arch
Temporo-mandibular joint
What layer of the scalp can infection spread through?
Loose areolar tissue that is deep to the epicranial aponeurosis
Tumors in the orbit can also affect what cavity?
Nasal cavity
What is an obstructed nasolacrimal duct?
Failure of the duct to canalize during development
Can be opened surgically
What is a stye or horde’olum?
Obstruction or infection of the sebaceous gland in the subcutaneous layer of the eyelid
What is a chalazion?
Obstruction of a tarsal gland in the eyelid
What would cause an inability to produce tears?
Damage to the facial nerve
VII innervates the lacrimal gland via the pterygopalatine ganglion
What results from damage to the abducens nerve?
Medial strabismus due to paralysis of the lateral rectus
What results from damage to the trochlear nerve?
Patient cannot look down and out, causes difficulty walking down stairs
Eye is rotated laterally, patient tilts head to the opposite side
Normal eye ends up being rotated medially to compensate for the head tilt
What results from oculomotor nerve damage?
Lateral strabismus - medial rectus paralysis
Ptosis - paralysis of the levator palpabrae superioris
Mydriasis (dilated pupil) - pupillary constrictor paralysis
What occurs with damage to the short ciliary nerves?
Mydriasis
What is horner’s syndrome?
Lesions of the sympathetic nervous system
Symptoms: Miosis (pupillary constriction)
Ptosis (drooping eyelid)
Anhydrosis (lack of sweating)
What is torticollis?
Contracture of the sternocleidomastoid
Face turns to the opposite side
How do you test for accessory nerve damage?
Shrug shoulders
What is a retropharyngeal abscess?
Can be difficult to diagnose due to no external swelling; life-threatening as abscess can block airway
What is otitis media?
Middle ear infection that is common in children
Spreading of infection from respiratory system can damage auditory ossicles
Why can you lose taste if the tympanic membrane is pireced?
The chorda tympani crosses the middle ear
Branch of VII that provides taste sensation to the anterior 2/3 of the tongue
What can result from damage to the recurrent laryngeal nerve?
Paralysis of all laryngeal muscles on one side except the cricothyroid
Permanent hoarse voice
Why will anaphylactic shock cause suffocation?
The Deep cervical nodes lie above and below the vocal folds and the mucosa is tightly attached to the vocal folds
Anaphylactic shock will cause swelling of the vestibular folds
What is the procedure to restore air flow during anaphylactic shock?
Cricothyrotomy - insert a tube through the cricothyroid membrane
Will cause less bleeding than a tracheotomy
What are the two places that food (popcorn) can get stuck and feel like choking?
Vallecula in the oropharynx
Piriform recess in the laryngopharynx
