Clinical Review

Question 1

What is Bell’s Palsy?

Answer 1

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

Question 2

What can result from paralysis of the orbicularis oculi?

Answer 2

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

Question 3

What results from paralysis of the buccinator muscle?

Answer 3

Patient is unable to hold food between teeth

Dificulty chewing, drooling

Cause is facial paralysis

Question 4

Why does damage to VII result in hyperacousia?

Answer 4

Paralysis of the stapedius

Question 5

How can infection spread from the face to the vein?

Answer 5

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

Question 6

What is the clinical sign of a facial infection that spread to the brain?

Answer 6

Diplopia

*Infections lateral to the nose are particularly dangerous due to pterygoid venous plexus

Question 7

What is cleft lip?

Answer 7

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

Question 8

What part of the skull is a common place for fractures and what joint does in affect?

Answer 8

Zygomatic arch

Temporo-mandibular joint

Question 9

What layer of the scalp can infection spread through?

Answer 9

Loose areolar tissue that is deep to the epicranial aponeurosis

Question 10

Tumors in the orbit can also affect what cavity?

Answer 10

Nasal cavity

Question 11

What is an obstructed nasolacrimal duct?

Answer 11

Failure of the duct to canalize during development

Can be opened surgically

Question 12

What is a stye or horde’olum?

Answer 12

Obstruction or infection of the sebaceous gland in the subcutaneous layer of the eyelid

Question 13

What is a chalazion?

Answer 13

Obstruction of a tarsal gland in the eyelid

Question 14

What would cause an inability to produce tears?

Answer 14

Damage to the facial nerve

VII innervates the lacrimal gland via the pterygopalatine ganglion

Question 15

What results from damage to the abducens nerve?

Answer 15

Medial strabismus due to paralysis of the lateral rectus

Question 16

What results from damage to the trochlear nerve?

Answer 16

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

Question 17

What results from oculomotor nerve damage?

Answer 17

Lateral strabismus - medial rectus paralysis

Ptosis - paralysis of the levator palpabrae superioris

Mydriasis (dilated pupil) - pupillary constrictor paralysis

Question 18

What occurs with damage to the short ciliary nerves?

Answer 18

Mydriasis

Question 19

What is horner’s syndrome?

Answer 19

Lesions of the sympathetic nervous system

Symptoms: Miosis (pupillary constriction)
Ptosis (drooping eyelid)
Anhydrosis (lack of sweating)

Question 20

What is torticollis?

Answer 20

Contracture of the sternocleidomastoid

Face turns to the opposite side

Question 21

How do you test for accessory nerve damage?

Answer 21

Shrug shoulders

Question 22

What is a retropharyngeal abscess?

Answer 22

Can be difficult to diagnose due to no external swelling; life-threatening as abscess can block airway

Question 23

What is otitis media?

Answer 23

Middle ear infection that is common in children

Spreading of infection from respiratory system can damage auditory ossicles

Question 24

Why can you lose taste if the tympanic membrane is pireced?

Answer 24

The chorda tympani crosses the middle ear

Branch of VII that provides taste sensation to the anterior 2/3 of the tongue

Question 25

What can result from damage to the recurrent laryngeal nerve?

Answer 25

Paralysis of all laryngeal muscles on one side except the cricothyroid

Permanent hoarse voice

Question 26

Why will anaphylactic shock cause suffocation?

Answer 26

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

Question 27

What is the procedure to restore air flow during anaphylactic shock?

Answer 27

Cricothyrotomy - insert a tube through the cricothyroid membrane

Will cause less bleeding than a tracheotomy

Question 28

What are the two places that food (popcorn) can get stuck and feel like choking?

Answer 28

Vallecula in the oropharynx

Piriform recess in the laryngopharynx