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HnN > Conditions Flashcards > Flashcards

Conditions Flashcards

1
Q

Retropharyngeal space infection

Cause?

Common group affected?

Key symptoms?

Where should you examine?

A

Secondary to URT infection

Children under 5

Reluctant to move neck
Difficulty swallowing
Stridor
Fever

Look at oropharync and you will notice bulge on inspection

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2
Q

Goitre

Why may it extend retrosternally?

Why stridor?
Why facial oedema?

A

Because the pre-tracheal fascia extends into thorax (base of skull -> fibrous pericardium)

Tracheal compression
Venous compression

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3
Q

Ipsilateral parotid enlargement + weakness of facial muscles - likely to be what?

Mumps typically associated with weakness?

A

Parotid cancer

No

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4
Q

What classification system is used to classify fractures of the mid face?

A

Le fort

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5
Q

Give 3 causes for injury to the occulomotor nerve.

When is IV palsy diplopia worst?

A

Raised ICP
Aneurysms
Cavernous sinus thrombosis

Vascular (diabetes or hypertension)

Reading, walking downstairs -

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6
Q

Why may you get loss of sensation in cheek and lower eye lid in orbital floor fracture?

Sensory supply of mental nerve?

A

Infra-orbital nerve damaged as it runs in the floor of the orbit.

Lower lip, gums and chin.

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7
Q

Why can VI be easily stretched in raised ICP?

A

Emerges anteriorly and runs upwards at the pontomedullary junction on the under surface of the pons.

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8
Q

What occurs when a pinna-haematoma goes untreated?

What is the relevance of the sigmoid shape of the external acoustic meatus?

Which organisms are typically associated with otitis externa?

A

FIbrosis and new asymmetrical cartilage development.

Ottoscope - back, up and out.

Staph aureus
Pseudomonas aeruginosa

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9
Q

Typical presentation of Cholestatoma?

Why can it be serious?1

A

Painless
Smelly ottorhea
+/- hearing loss

Erodes, ossicles, mastoid/ petrous bone, cochlea

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10
Q

Why is hearing affected in otitis media with effusion?

Treatment?

Why may Tx not be needed?

Two things seen on ottoscopy?
Differ from acute otitis media?

Give a complication.

A

Reduced motility of the ossicles and tympanic membrane.

Tympanostomy tube/ grommets

Resolve on its own in 2-3 months.

Retracted TM
Straw coloured fluid.

Red and bulging TM

Perforation

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11
Q

Two reasons why middle ear infections are more common in children.

Give some complications of acute otitis media.

Why mastoiditis?

What would you see on examination of mastoiditis?

A

shorter and more horizontal ET means
Easier passage of infection more nasopharynx to the middle ear.

Tube can block more easily compromising ventilation and drainage pre-disposing to infection.

Facial nerve involvement
TM perforation
Mastoiditis
Intracranial complications (brain abscess, sigmoid sinus thrombosis, meningitis)

Middle ear communicates with the mastoid air cells via the mastoid antrum (opening to which is called the aditus).

Ear is turned forward

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12
Q

Where are stereocilia found? How are vibrations converted to action potentials?

Which inner ear disease presents with a feeling of fullness in the ear?

Which can present with ACUTE vertigo and tinnitus and hearing loss.

Other symptoms fo labyrinthitis.

Give a common causer of hearing loss in young?

A

Cochlear duct specifically in the spiral organ of corti.
Vibrations - sterocilia move - K+ channels in cuticular plate close - depolarisation - Ca2+ influx - neurotransmitter release and signals in VIII occur.

Meniere’s disease

Labyrnthitis.

Severe acute onset vertigo, hearing loss, nystagmus, tinnitus

Otosclerosis

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13
Q

Main symptom for acoustic neuroma.

Other symptoms?

A

Unilateral sensorineural hearing loss

Facial numbness, weakness
Headaches
vertigo and disequilibrium (less common).

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14
Q

Why are sphenopalatine artery bleeds more serious?

Describe management of epistaxis.

A

Blood tends to be at a higher pressure and is posteriorly located so harder to reach/ more serious.

Direct pressure (pinch soft part lean forward_
Simple cautery/ topical vasoconstrictors
Anterior packing
Posterior packing
SPA ligation refractory to everything else.

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15
Q

Complication of saddle nose deformity?

A

Septal abscess

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16
Q

Give some symptoms of nasal polyps.

A

Watery rhinorrhoea
Blocked nose
Post-nasal drip
Decreased smell and reduced taste

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17
Q

What sign is indicative of a forgein body?

A

Unilateral blocked nose with smelly discharge and blood stained.

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18
Q

Why can a dental abscess lead to maxillary sinusitis?

A

Roots of upper teeth sometimes project into the maxillary sinuses.

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19
Q

What are some signs of acute sinusitis?

Describe the Pathophysiology behind acute sinusitis.

Common bacteria?

Why can it lead to orbital cellulitis?

A

Recent URTI
Blocked nose and rhinorrhea +/- green/yellow discharge
Fever
Headache and facial pain worse on leaning forward.

Primary infection -> reduced ciliary function, nasal mucosal oedema and ostia oedema and increased nasal secretions lead to drainage from the sinus’ being impeded - stagnant secretions are breeding ground for bacteria-secondary infections.

SP, HI, MC

Ethmoidal sinuses lie in the medial wall of the orbit

20
Q

Some signs of IX/X lesion.

Two causes?

A

No gag reflex
Uvula deviation away from the lesion (LMN)
Dysphagia
Taste impairment in the posterior tongue
Loss of sensation in the oropharynx
Failure of the soft palate to rise on the ipsilateral side

Medulla infarct
Jugular foramen issue

21
Q

3 signs off LMN XII lesion.

A

Point to side of lesion tongue
Muscle wasting
Fasciculations

22
Q

Why may someone tilted their head in CN IV palsy?

Why diplopia on looking down and medially?

A

Compensate for the extortion of the eyeball.

SO is the main depressor of the eye when adducted.

23
Q

MOA of orbital blow out fractures.

Why might upward gaze be affected?

Why anaesthesia on upper teeth, cheeks and gums?

What infection could occur?

A

Sudden increase in intra-orbital pressure form retropulsion of the eyeball fracturing the floor of the orbit aka the maxilla

Prolapse into the maxillary sinus traps structures such as the extraocular muscles near the orbital floor.

Infra-orbital nerve affected.

Maxillary sinusitis

24
Q

Where do the superior and inferior ophthalmic veins pass through?

Maxillary nerve?

A

SOF and IOF respectively

25
Q

Give three functions of SCM.

Give two nerves found in the carotid triangle.

Clinical relevance of the submental triangle.

Give four things contained in the submandibular triangle.

What nerves are found in the posterior triangle?

Where do you inject for anaesthesia of the neck region?

Give two roles of the suprahyoids.
Give two roles of the infrahyoids.

A 
Lateral flexion (ipsilateral) 
Lateral rotation (contralateral) 
Neck flexion (both)

X and XII

Submental lymph nodes are found here (Hyoid, midline and anterior belly digastric)

Submanidublar glands
Lymph nodes
Facial artery
Facial vein

Cervical plexus
Trunks of the brachial plexus
Accessory nerve

Posterior border of SCM (superior and middle thirds) where the cutaneous branches of the cervical plexus emerge.

Depress the mandible
Elevate the hyoid

Depress the hyoid
Stabilise the hyoid

26
Q

Why do scalp lacerations have profuse bleeding - give 3 reasons?

Why does loss of scalp not lead to necrosis of bone?

Where do the ethmoidal arteries supplying the nasal septum come from?

A

Walls of arteries are tightly adherent to the CT - limiting vasoconstriction
Opposing pulls of occiptofrontalis muscle
Numerous anastomoses

Because MMA supplies the bone

Ophthalmic arteries from ICA

27
Q

Cavernous sinus thrombosis.

Main organism?

What nerve palsy is often associated?

What can the contralateral eye become swollen?

Why does exophthalmos occur?

A

Staph aureus

CNVI palsy - lack of lateral gaze

Spread to adjacent cavernous sinus via intercavernous sinuses

Venous congestion and oedema lead to increased retrobulbar pressure leading to proptosis.

28
Q

Lymph nodes.

What are the superficial lymph nodes in the neck associated with?

What does jugulo-omohyoid drain?

What is the difference in drainage of the right and left supraclavicular nodes?

A

AJV and EJV

Thyroid, larynx, pharynx and posterior tongue.

Right - oesophagus and lungs (mid section chest)
Left - abdomen and thorax

29
Q

Give some differences between infant and adult skull.

How do bones of the calvaria differ from bones of the base of the skull in terms of development.

When do the anterior and posterior fontanelles fuse.

Give two complications of craniosyntosis.

What shape should the anterior fontanelles be in healthy baby? What two things can it be sued to assess?

What classfication is used to asses fractures of the midface?

A

Fontanelles present
Sinuses are incompletely formed
Frontal bone = two parts
Relatively large orbits

Calvaria from intramembranous ossification
Base form from endochrondrial ossification

Anterior 18m-2years
posterior 1-3 months

Raised ICP (papilloedema)
OSA (midface hypoplasia)
Jugular hypoplasia (increased blood in skull - raised ICP)
Neurobehavioural impairment

Slightly convex
Hydration and ICP

Le Fort classification

30
Q

Intracranial haemorrhage.

Which one is midline shift seen in?

Where do intraparenchymal haemorrhages commonly occur? Why?
What type of anuerysm pre-disposes?

Which one is associated with a lucid interval?

A

Sub-dural

Basal ganglia and internal capsule
Usually due to systemic hypertension
Charcot Bouchard aneurysms (typically in small arterioles - lenticulostriate vessels).

Epidural haemorrhage - initial confusion and decreased consciousness which improves for a period of time.

31
Q

What parts of which two bones form the hard palate?

How would you describe the location of the pterygopalatine fossa?

Name two holes that communicate with infratemporal fossa?

A

Palatine plates of the maxilla and horizontal plate of the palatine bones

Between the pterygoid plate of the sphenoid and the maxilla.

Infraorbital fissure
Foramen ovale

32
Q

Give three disorders of the TMJ.

What is the joint innervated by?

What does wide opening of the mouth require?

Why is the jaw fixed in a open position in TMJ dislocation?

In which direction should pressure be applied to reduce such a dislocation?

A

TMJ disorder
TMJ dislocation
Arthritis

Auriculotemporal

Rotational movement at the inferior joint capsule
Gliding in the superior joint capsule (protrusion due to lateral pterygoid muscle)

Due to anterior dislocation of the condylar process over the article tubercle.
The muscles of mastication then keep the joint locked into place.

Downwards direction - overcome the contraction of the muscles of mastication

33
Q

Why is lacrimation preserved in a lesion of the facial nerve below the geniculate ganglion?

How would a lesion at the cerebellopontine angle present?
Two causes of a lesion at this level?
How might a lesion at the level of the pons differ?

A

Because the greater petrosal nerve is given off at the geniculate ganglion which supplies the lacrimal gland.

Ipsilateral facial weakness
Lacrimation, salivation and taste intact because Nervus intermedius is spared

Acoustic neuroma
Meningitis
Lymphoma
Sarcoidosis

Pons - might have ipsilateral abducens nerve palsy

34
Q

What supplies parasympathetic to the head and neck? Sympathetic?

ICA dissection would spare which sympathetic function?

A

III VII IX and X.
T1 spinal cord via superior cervical ganglion

Sweating and vasoconstriction

35
Q

Why does cauliflower deformity result?

A

Due to fibrosis and asymmetrical cartilage development

36
Q

What is the posterior boundary of the oral cavity proper?

How does it communicate with the mouth proper?

Which muscle of the tongue has a different nerve supply and what is it?

Which muscles have opposing actions.

A

Oropharyngeal isthmus

Space behind the 3rd molar.

Palatoglossus - CN X as opposed to rest which are CNXII

genioglossus - depresses and protrudes styloglossus - elevates and retracts

37
Q

What is the main gland which is affected by sialolithiasis?

2 risk factors?

Tonisilitis viral or bacterial more common?

How can you differentiate peritonsillar abscess from tonisiltis?

A

Submandibular glands

Dehydration
Reduced salivary flow

Viral

Lymph node swelling

38
Q

Zenker’s diverticulum.

Symptoms.

Between what muscles?

Which muscle is the pharyngeal muscle mainly on?

A

Choking of fluids
Dysphagia
Bad breath
Regurgitation

Inferior constrictor - divided into cricopharyngeus and thyropharyngeus - weakness - UOS does not relax - higher pressure in laryngopharynx - outpouching occurs.

Middle constrictor muscles - consists of vagus, glossopharyngeal and cervical sympathetically.

39
Q

Which cranial nerve out of four three and six is most commonly affected due to raised ICP?

Which palsy is associated with diplopia on down and medially?
How else may the patient present?

Why is pupillary dilation in CNIII palsy a cause for concern?

A

SIX

Trochlear
Will tilt their head away from side of lesion

Indicates hearmorhage, tumour or another cause for raised ICP

40
Q

Two roles of the aqueous humour.

Treatment for acute closed angle glaucoma.

Give two groups of people at increased risk of this.

Why are outer injuries of the cornea heal?

A

Supporting shape of the eye (with the vitreous humour)
Nourishment to the lens and cornea - do not have their own blood supply

Pilocarpine
Acetazolamide (muscarinic eye drops)
Iridotomy

Long sighted 
Elderly people (shallow anterior chambers)

Outer layers of the cornea undergoing mitosis so easily regenerates if damaged.

41
Q

Peri-orbital cellulitis?

Cause? Children?

How can you differentiate from orbital cellulitis?
Two complications of this?

Route of infection to cause cavernous sinus thrombosis?

A

Superficial skin infections due to bites and wounds
Children - bacterial sinusitis in the frontoethmoidal sinuses in children.

reduced visual acuity (retrobulbar pressure leads to optic nerve compression)
Reduced eye movements
Painful to move the eye

Meningitis
Cavernous sinus thrombosis

Superior opthalmic vein - SOF - cavernous sinus

42
Q

Difference between myopia and hypermetropia?

What needs to happen for the lens to because more biconvex?

What is presbyopia?

What light levels are cones active at?

A 
Myopia = short-sightedness = eye ball too long 
Hypermetropia = long sightedness = eye ball too short

Ciliary muscles contracts

Age related inability to focus near objects

High light levels (colour vision of high acuity)

43
Q

Give some refractive conditions.
How can you test?

What is astigmatism?

What is the most common cause of adult blindness in the UK?
Pathophysiology?

A

Astigmatism
Hypermetropia
Myopia
Presbyopia

Pin hole testing will cause improval in acuit because light is travelling perpeniduclar to the cornea and lens and therefore does not need to be refracted.

Irregular corneal surface

Age related macular degeneration

Build up of deposits (drusen) in the macula of the retina between the RPE and the choroid layer

44
Q

What is sellicks manoeuvre?

What is there function of the saccule?

What epithelium lines the vocal cords?

What does contraction of the aryepiglottic muscles do?

Why may oesophageal cancer lead to hoarseness of voice?
Why may hoarseness resolve in time?

A

Cricoid pressure

Contains mucous glands that keep the vocal folds moist

Stratified squamous

Pull down epiglottis
narrow laryngeal inlet

Because the recurrent laryngeal nerve runs in the tracheo-oesophageal groove

Because the unaffected vocal cord will cross the midline to meet the vocal cord on the affected side.

45
Q

Give three conditions that can cause laryngeal swelling and oedema and therefore threaten the airway.

Give some symptoms of epiglottitis. Common organism?
Give another cause of stridor.

A

Croup
Epiglottitis
Laryngeal oedema

Tripod position 
Drooling 
Pain and redness over anterior neck 
Stridor 
Cyanosis 
Dysphagia 
Dysphonia

HI

Croup

HnN (23 decks)

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