COA Clinical Stuff

Question 1

Why does severe pain occur in parotitis?

Answer 1

Severe pain occurs because the parotidsheath limits swelling.

Question 2

What cause viral parotitis?

Answer 2

Mumps

Question 3

Where does parotid gland disease cause pain?

Answer 3

Auricle, EAM, temporal region and TMJ

Question 4

What blocks parotid duct?

Answer 4

Sialolith

Question 5

What is painful in blockage of parotid duct?

Answer 5

Sucking a lemon

Question 6

What is aneathatised in inferior alveolar nerve block?

Answer 6

all mandibular teeth areanesthetized to the median plane. The skin and mucous mem-braneof the lower lip, the labial alveolar mucosa and gingi-vae, and the skin of the chin are also anesthetized becausethey are supplied by the mental nerve, a branch of the infe-rior alveolar nerve

Question 7

What resists posterior dislocation of TMJ?

Answer 7

Postglenoid tubercle and strong lateral ligaments

Question 8

What nerves can be affected in TMJ surgery?

Answer 8

Branches of facial nerve and articular branch of auricullotemporal nerve.

Question 9

What is the point of yawning?

Answer 9

To reverse atelactasis, collapse of the lung, before bed

Question 10

What is a cough and what causes it?

Answer 10

Coughing is important for ridding the tracheobronchial tree of inhaled foreign substances. There is probably no single class of “cough receptors.” The tickling sensation that is relieved by a cough is analogous to the cutaneous itch and is probably mediated by C-fiber receptors. Thus, a cough is a respiratory scratch.
When lower airway receptors trigger a cough, it begins with a small inspiration that increases the coughing force. Mechanosensitive and irritant receptors in the larynx can trigger either coughing or apnea. When they trigger a cough, the inspiration is absent, minimizing the chances that the offending foreign body will be pulled deeper into the lungs. In either case, a forced expiratory effort against a closed glottis raises intrathoracic and intra-abdominal pressures to very high levels. The glottis then opens suddenly, and the pressure inside the larynx falls almost instantaneously to near-atmospheric levels. This sudden drop in luminal pressure produces dramatic increases in the axial (alveolus to trachea) pressure gradient that drives airflow. In the trachea, this pressure drop also decreases the radial transmural pressure difference across the tracheal wall, thereby collapsing the trachea, especially the membranous (i.e., noncartilaginous) part of the trachea. (See Chapter 27.) As a result, tracheal cross-sectional area may fall to as little as one-sixth its original value. The net effect is a brief but violent rush of air out of the trachea at velocities near 800 km/hr (∼65% of the speed of sound) that loosens mucus or foreign bodies and moves them upward. Protracted bouts of severe coughing can lead to syncope (lightheadedness) because the high intrathoracic pressure decreases venous return and reduces cardiac output (see Chapter 23).

Question 11

What is a sneeze?

Answer 11

Sensors in the nose detect irritants and can evoke a sneeze. Curiously, these same receptors are probably also responsible for apnea in response to water applied to the face or nose, which is part of the diving reflex that evolved in diving mammals such as the seal to prevent aspiration during submersion. A sneeze differs from a cough in that a sneeze is almost always preceded by a deep inspiration. Like a cough, a sneeze involves an initial buildup of intrathoracic pressure behind a closed glottis. Unlike a cough, a sneeze involves pharyngeal constriction during the buildup phase and an explosive forced expiration through the nose as well as the mouth. This expiration is accompanied by contraction of facial and nasal muscles, so that the effect is to dislodge foreign bodies from the nasal mucosa.