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ESA3 revision decks > Head and neck > Flashcards

Head and neck Flashcards

1
Q

anatomy of the eye

A
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2
Q

ways to differentiate causes of acute red eye

A
  • Vision- normal or reduced vision?
  • Painful or painless
  • Normal intraocular pressure or raised intraocular pressure
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3
Q

painful acute red eye

(vission N= normal , R = reduced)

A
  • conjunctivitis (N)
  • sceleritis (N/R)
  • keratitis (R)
  • corneal foreign body (N/R)
  • epsicleritis (N)
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4
Q

painless acute red eye

(vission N= normal , R = reduced)

A

subconjunctival haemorrhage (N)

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5
Q

reduced vision and red eye with normal intraocular pressure

A

corneal abrasion

keratitis

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6
Q

reduced vision and red eye with increased intraocular pressure

A

acute angle closure glaucoma

anterior uveitis

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7
Q

what is the likely diagnosis

A

orbital cellulitis

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8
Q

investigations required for orbital cellulitis

A
  • FBC
    • Raised WBC and CRP
  • Blood cultures
  • CT with contrast
    • Would show inflammation of orbital tissue deep to the septum
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9
Q

management of orbital cellulitis

A
  • Abx
  • Admit for IV antibiotics
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10
Q

how do we differentiate orbital cellulitis from periorbital cellulitis

A
  • Periorbital cellulitis- confined to tissues superficial to the orbital septum (and tarsal plates)
    • Secondary to infection e.g. bug bite
  • Orbital cellulitis- results of an infection affecting the fat and muscle posterior to the orbital septum, within the orbit but not involving the globe
    • Vision and movement affected
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11
Q

what is the likely diagnosis

A

acute closed angle glaucome

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12
Q

acute closed angle glaucome management

A
  • Drugs to reduce pressure
  • Surgical- use laser to make hole to allow flow of aqueous humour to the iris
  • opthalmological emergency
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13
Q

outline how acute angle closure gluacoma occurs

A
  • Drugs to reduce pressure
  • Surgical- use laser to make hole to allow flow of aqueous humour to the iris
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14
Q

likely diagnosis

A

Right oculomotor nerve palsy

  • Ptosis- LPS
  • Dilation of pupil- parasympathetic fibres lie on periphery
    • In diabetes usually not dilated (can receive blood supply from smaller blood vessels)
    • But with compression- pressure on parasympathetic fibres and the oculomotor nerve - dilation
  • Down and out
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15
Q

likely diagnosis

A

Horner’s syndrome

  • Sympathetic fibres traveling up from the thoracic region
    • Superior tarsal muscle
    • Sweat glands
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16
Q

likely diagnosis

A

right 4th nerve palsy (trochlear)

  • Superior oblique muscle affected
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17
Q

label these eye muscles

A
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18
Q

clinical testing of the extraocular eye muscle and their innervations

A

H in space for muscle isolation

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19
Q

most of the extraocular eye muscles are innervated by

A

CN3- oculomotor

  • inferior oblique
  • superior rectus
  • inferior rectus
  • medial rectus
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20
Q

which extraocular eye muscles are not innervated by the oculomotor nerve

A

Lateral rectus

Superior oblique

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21
Q

how to remember Lateral rectus and Superior oblique

A

LR6 SO4

all other CN III

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22
Q

lateral rectus innervated by the

A

CN6- abducens nerve

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23
Q

supeiror oblique innervated by

A

CN4- trochlear

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24
Q
A
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25
Q

muscle action of lateral rectus

A

abduction

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26
Q

muscle action of medial rectus

A

adduction

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27
Q

muscle action of superior rectus

A

elevation

minor muscle actions : intorsion and adduction

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28
Q

muscle action of inferior rectus

A

depression

minor muscle actions

  • extorsion
  • adduction
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29
Q

muscle action of inferior oblique

A

extorsion

minor muscle action

  • elevation
  • abduction
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30
Q

muscle action of supeirior oblique

A

intorsion

minor muscle movement

  • depression
  • abduction
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31
Q

triangles of the neck

A
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32
Q

midline neck structures

A
  • thyroid
  • submental lymph nodes
  • hyoid bone
33
Q

Conditions could lead to neck lump in the midline

A
  • A cyst
    • Dermoid
    • Thyroglossal
  • Goitre
    • Hyper/hypothyroidisms
  • Thyroid malignancy
34
Q

structures in the anterior triangle

A
  • Anterior border of the SCM
  • Infrahyoid muscles
  • Lymph nodes
  • Anterior cervical chain
  • Submandibular glands
  • Carotid sheath
    • IJV
    • Carotid artery
    • Vagus nerve
35
Q

Conditions could lead to neck lump in the anterior triangle?

A
  • reactive lymphadenopathy
  • malignant lymphadenopathy
  • branchial cyst
  • carotid artery aneurysm
  • carotid body tumours
  • submandibular gland pathology
36
Q

structures in the posterior triangle

A
  • Trunk of the brachial plexus
  • Subclavian artery and veins
  • Pancoast tumour
  • Scalene , omohyoid inferior belly
  • Phrenic nerve
  • Lymph nodes
37
Q

Conditions could lead to neck lump in the posterior triangle?

A
  • Apical lung tumour
  • reactive lymphphadenopathy
  • malignant lymphphadenopathy
38
Q
A
39
Q

lumps which can occur anywhere in the neck

A
  • lipoma
  • sebaceous cyst
  • haemangiomas
  • skin malignancy
40
Q

Assessment of the lump

A
  • Movement
    • Mobile/immobile
    • On swallow
    • On sticking out tongue
  • Texture
    • Hard or soft
    • Regular/irregular
41
Q

lymph nodes feel

A

rubbery

42
Q

hot lymph nodes

A

inflammatory

43
Q

tender lymph node

A

not cancer

44
Q

Swallow and stick out tongue

A
  • Any lump related to thyroid will move on swallowing
  • If the lump moves when tongue being stuck out- thyroglossal
45
Q

why does the patient have enlarged lymph nodes

A

infection

lymphoma

46
Q

questions to narrow down lymph nodes

A

Onset

  • Acute- days
  • Chronic- week- months

Associated symptoms

  • Infection
    • Fever
    • Localising symptoms such as ear pain, cough or sore throat
  • Inflammation
    • Arthritis
  • Malignancy
    • Ref flag symptoms for all possible sites
      • May be a primary, local or distant metastasis
47
Q

red flag symptoms

A
  • age
  • weight loss
  • blood malignancy
    • symptoms such as night sweats and tiredness
  • local metastasis
    • persistant hoarse voice
    • difficulty swallowing
    • persisting sore throat
  • distant metastasis e.g. abdominal primary
48
Q

investigations of lymph nodes

A

blood tests

US

refer

49
Q

Describe what you see

A
  • Hutchinson’s sign
    • Hutchinson’s sign is the presence of vesicular lesions on the side or tip of the nose. It is classically associated with acute herpes zoster ophthalmicus, which may cause loss of vision, ocular inflammation, and debilitating pain.
      • Nasociliary nevre (branch of V1)
      • Infection extends to the tip of the nose- sight threatening
  • Unilateral
  • Va lesion- ophthalmic
50
Q

what other questions do you want to ask?

A
  • Onset/duration
  • Sensation
  • Pain
  • Immunocompromised
  • Contact with anyone with the same condition
51
Q

likely diagnosis

A
  • Varicella zoster infection causing ophthalmic shingles
    • Lies dormant in the trigeminal ganglion
  • Ophthalmic emergency- sight threatening
52
Q

key symptoms

A
  • Tinnitus- vestibulocochlear
  • Facial tingling
    • Facial nerve involvement
  • Progressive worsening
53
Q

differentials

A
  • Vestibulocochlear lesion
    • Schwannoma
    • Acoustic neuroma (vestibular schwannoma)
54
Q

Acoustic neuroma (vestibular schwannoma)

A
  • Compression of other structures
    • Facial nerve
    • Trigeminal nerve
    • Cerebellum
  • Very slow growing tumour
55
Q

positive rinnes test

A

AC>BC

Normal response or sensineural hearing loss on tested side

56
Q

negative rinnes test

A

BC >AC

conductive hearing loss on tested side

57
Q

what does Rinnes test compare

A

compares BC to AC at each ear

58
Q

what does webers test compare

A

compared BC bilaterally

59
Q

normal webers test

A

sound heard in both ears equally

60
Q

how will sound lateralise in sensinoural hearing loss in a Webers test

A

sounds lateralises to unaffected side

61
Q

ow will sound laterlase with conductive hearing loss in webeers test

A

lateralised to affected side

62
Q
  • Vid shows tongue pointing to the right-likely diagnosis?
A
  • Right hypoglossal nerve palsy - the tongue never lies
63
Q
A
64
Q
A

C- MIDDLE EAR (grey part on diagram)

Explanation:

  • Right sided facial droop
    • Juice falling out of the mouth- orbicularis muscle weak
  • Crying- greater petrosal intact
  • Chorda tympani not functioning
  • Sensitivity to loud noises- nerve to stapedius not working

Think about this

  • If you have a lesion before the internal acoustic meatus- all functions affected
  • Once we get to the geniculate ganglion- first branch of facial nerve leavesà (1)greater petrosal nerve- parasympathetics to a number of glands
  • 2 more intrapetrous branch
    • Nerve to stapedius (2)
    • Chordae tympani – special sensory taste and parasympathetic (3)
  • Once leaving stylomastoid foramen- motor to muscles of facial expression
65
Q
A

A

B

C

D

66
Q

Facial nerve lesion where the lesion is related to the Geniculate ganglion

A

- Ramsay hunt syndrome

  • Look for vesicular rash on the ear
67
Q

inflammation of the supraglottis (including epiglottis

A

epiglottitis

  • rare but airway threatening
  • 2-6 years
  • stridor, drooling, unwell, sniffling position
  • H . infuenzae but also strep pneumoniae
68
Q

examples of conditions which would caused impaired actions of vocal cords

A
  1. inflammation of cords (laryngitis), nodule cancer
  2. paralysis of muscles moving vocal cords
69
Q

paralysis of muscles moving vocal cords

A
  • injury to external branch of superir laryngeal enrve
  • laryngospasm
  • laryngeal odema
70
Q

inflammation of the larynx, trachea and bronchi

A
  • croup
  • parainfluenza virus
  • 6 months - 3 years
  • seal like bark (sometimes stirdor, increased resp efffort)
71
Q

innervation of the pharynnx

A

maxillary division of the trigeminal nerve (V)- sensory

72
Q

innervation of the Oropharynx

*

A
  • Sit behind oral cavity
  • Includes posterior third of tongue
  • Glossopharyngeal (IX)- sensory and special sensory taste, some motor contribution (stylopharyngeus)
    • Glosso- tongue
    • O- oropharynx
    • Pharangeal-pharynx
73
Q

innervation of the laryngopharynx and laryx

A
  • Vagus (CN X)
    • Motor
      • Laryngopharynx
      • Larynx
    • Sensory
      • Laryngopharynx
  • Most important for swallowing
74
Q

Glossopharyngeal also innervates

A
  • Middle ear and ET
  • Carotid sinus and bodies (carotid massage)
  • Parasympathetic to the parotid gland
75
Q

Vagus also innervates

A
  • Soft palette
  • External ear
  • Parasympathetic
76
Q
A
  • B vagus (Q tip shouldn’t be able to get in to the middle ear)
77
Q

both CNIX and CNX have some sensory function relating to the

A

ear, but different parts

  • IX- eustachian tube and middle ear
  • X- external ear (part) and external suface TM (part)
78
Q

how do we clinically examine CN IX and X

A
  • Speech
  • Swallow
  • Cough
  • Gag reflex
  • Uvula deviation
79
Q
A

ESA3 revision decks (12 decks)

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