Glasgow look ups

Question 1

MOA of phenylephrine

Answer 1

alpha 1 agonist
causing vasoconstriction and increases in vascular resistance and increase in blood pressure

Question 2

frontal nasal duct location

Answer 2

opens into the anterior part of the middle meatus or directly into the anterior end of the infundibulum

Question 3

frontal sinus obliteration

Answer 3

Fractures of the floor of the sinus that involve the frontal recess and interfere with the drainage apparatus may render the sinus non functional. In this situation, frontal sinus obliteration may be required. This involves exposure of the entire sinus, fastidious removal of all sinus mucosa and obliteration of the sinus cavity with autologous tissue.

Question 4

list of autologous materials for sinus obliteration

Answer 4

fascica (usually the choice) , abdominal fat, muscle, pericramium, bone

Question 5

allograft

Answer 5

a tissue graft from a donor of same species as the recipient but not genetically identical vs autograft = tissue from own body.

allograft = human donor

Question 6

xenograft

Answer 6

tissue from one species to another
porcine -

bovine -

equine etc

Question 7

sinus obliteration

Answer 7

disruption of greater than 25% of the posterior table should be considered for cranialization. This involves exposure of the entire sinus, meticulous removal of all sinus mucosa, and removal of the posterior table bone. The anterior table bone is replaced to reconstitute the forehead contour.

Important: Complete removal of the posterior wall and obstruction of the sinus outflow tract is essential to create a “safe sinus”.

Question 8

mydriasis is performed through what muscle / nerve

Answer 8

stimulation of alpha 1 receprots of iris dilator muscle

Question 9

why would anesthesiologist be worried about mydriasis in patient?

Answer 9

impaired venous return from the head and neck

intracranial mass lesion
intracranial hemorrhage

Question 10

outflow in maxillary sinus

Answer 10

cilia move mucus towards sinus ostium (O)
then passes vis the infundibulum (I)
next to the hiatus semilunaris into the
middle meatus

Question 11

drainage of the frontal sinus

Answer 11

drains via a small outflow tract into the ethmoid sinus / nasal cavity
outflow tract is hour-glass shaped with

it communicates with the nasal cavity through the frontonasal duct (also known as the frontal recess), which opens into the middle meatus or the ethmoidal infundibulum

Question 12

frontal recess involvment with fracture?

Answer 12

a frontal recess injury involves the FLOOR of the frontal sinus and the outflow tract

Question 13

anterior, posterior, medial, and lateral walls of frontal recess

Answer 13

anterior = posterior wall of nasi air cell
posterior =ethmoid bulla
medial=middle turbinate
lateral = orbit

Question 14

indications for ORIF of frontal sinus

Answer 14

displaced fractures of anterior table WITHOUT involvment of nasofrontal recess

Question 15

frontal sinus obliteration / ablation

Answer 15

This entails the removal of all sinus mucosa, occlusion of the nasofrontal duct, and filling the sinus cavity with bone grafts or other materials.
Hydroxyapatite, pericranial flap obliteration, adipose tissue, calcium phosphate, and glass ionomer can also be used as grafting material.
A potential complication of this procedure is a mucocele secondary to incomplete removal of the mucosa during obliteration. If left untreated, mucocele growth can cause further bony destruction.

Question 16

what mediates the mydriasis? - which nerve?

Answer 16

long ciliary nerve - which is sympathetic –

Question 17

what happens with increased intracranial pressure? related to the eye?

Answer 17

rise in ICP can lead to pupil being dilated and unresponsive

Question 18

unknown cause of mydriasis concerncing for

Answer 18

problem within the brain head injury, tumor, stroke

Question 19

pupillary dilation pathway where is 1st 2nd and 3rd order neuron DETAILS

Answer 19

1st = CNS (hypothalamus)
2nd, 3rd = PNS
2nd = preganlgionic that go and synapse at superior ganglion
3rd order = postganglionic fibers that are in close proximity to the internal carotid artery

JOIN with nasocilliary nerve which is a branch of the trigemnial nerve (opthalmic) then travel through long ciliary nerves to the dilator pupillae

Question 20

compression of occulomotor nerve?

Answer 20

usually will constrict the pupil - but if it it cannot perform this then we have dilation

Question 21

pupil at baseline / when dead

Answer 21

dilated bc do not have innervation of the parasymptathetic occulomotore nerve

Question 22

landmark for gillies approach

Answer 22

2.5 cm superior and anterior to helix of ear3

Question 23

key features / classification of nasal fractures

Answer 23

open / closed
deviated / non deviated
comminuted

Question 24

4 main tx options for nasal fx

Answer 24

observe and treat w/ meds (NSAIDS/ antinflammatory)
manual manipulation and reduction
forceps reductions
open septorhinoplasty technique

Question 25

medial canthal tendon insertion ? superficial portion? deep portion?

Answer 25

superficial - frontal process of maxilla deep - posterior lacrimal crest and is known as horners muscle / par lacrimalis

Question 26

two external diagnostic tests to determine integrity og medial canthal tendon and how perform?

Answer 26

Bowstrings test - pull eyelid laterally while palpating MCT to detect movement of fracture segments furnas test - grasp skin overlying MCT with forceps. lack of creasing or resistance indicated underlying fracture likely