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BDS3 Head & Neck Anatomy > PPQ Clinical Relevance > Flashcards

PPQ Clinical Relevance Flashcards

1
Q

damage to what nerve would cause numbness in the pinna of the right ear

A

great auricular nerve

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2
Q

what areas does the great auricular innervate

A

pinna/auricle of the ear; surface over parotid gland and the angle of the mandible

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3
Q

surgery to the side of the neck has resulted in drooping eyelid and lack of sweating on the same side; what is damaged to have caused this?

A

damage to sympathetic cervical trunk

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4
Q

name the signs of Horner’s Syndrome

A

ptosis - drooping of eyelid
anhydrous - lack of sweating
miosis - constricted pupils

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5
Q

where does submandibular duct enter the mouth

A

at summit of small papilla at side of frenulum of tongue

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6
Q

if there is surgery to area where submandibular duct lies, what nerve could be damaged

A

lingual & hypoglossal nerves

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7
Q

what vessel causes excessive bleeding when the lip is lacerated

A

inferior labial branch of facial artery can be ruptured which is where the left and right side anastomose

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8
Q

what muscle is responsible for the majority of protraction movements of the TMJ

A

lateral pterygoid muscle

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9
Q

what muscle tendon inserts into coronoid process

A

temporalis tendon inserts into the coronoid process of the mandible

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10
Q

a stroke affecting the RHS will affect what 2 muscles and where

A

facial muscles of the left lower face and left side of the tongue will be paralysed

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11
Q

what nerves innervate motor supply of the tongue when testing motor innervation

A

hypoglossal nerve supplies motor function to tongue

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12
Q

what muscle is responsible for protrusion of the tongue

A

genioglossus is responsible for protrusion of the tongue

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13
Q

what is the name of a long standing ear ache

A

chronic otitis media which is an infection of the middle ear that is likely to cause perforation of the tympanic membrane, if pus is resent it may leak into external auditory meatus

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14
Q

what nerves are at risk of damage when there is an operation to the middle ear

A

facial nerve and chorda tympani

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15
Q

what is the carotid sinus

A

a dilated area at base of ICA just superior to the bifurcation area of CCA that contains baroreceptors that monitor blood pressure

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16
Q

which nerve innervates the carotid sinus

A

glossopharyngeal CN IX carries messages from the carotid sinus to the brain regarding blood pressure status

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17
Q

where do fishbones get stuck readily

A

piriform fossa and vallecula

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18
Q

what haemorrhage has occurred when someone comes to A&E with bruising to the side of the head

A

extradural haemorrhage as there is an enlarging haematoma on the side of the head

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19
Q

what blood vessel is damaged in an extradural haemorrhage

A

middle meningeal artery which results in blood accumulating in the epidural space. usually as a result of head trauma to area of pterion

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20
Q

what cranial nerve supplies the larynx

A

vagus nerve CN X

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21
Q

what epithelium covers the majority of the larynx and what covers the true vocal folds

A

pseudostratified columnar respiratory epithelium covers the majority of the larynx except from true vocal folds which are covered in stratified squamous epithelium

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22
Q

in full dentures, where should they extend in accordance with the mylohyoid line

A

they should be extended and finish above the mylohyoid line

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23
Q

where do nodes from the maxillary sinus drain to

A

drain to submandibular lymph nodes

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24
Q

what can occur when there is a difficult maxillary molar extraction with roots close to the maxillary sinus

A

oroantral fistula due to oroantral communication as when the roots are removed it can leave an opening between the maxillary sinus floor and oral cavity so fluid and food then can come out of the nose during swallowing

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25
Q

what does the vagus nerve supply

A

motor supply - pharynx, larynx, palate, thorax, GIT
sensory supply - tongue and external auditory meatus

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26
Q

what is the sentinel node and if infected what does it mean

A

it is the first node to be biopsied to check for infection of malignancy. it is it positive then the cancer is not localised

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27
Q

what are the 3 types of haemorrhage

A

extradural
subdural
subarachnoid

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28
Q

what is a cavernous sinus thrombosis and how does it occur

A

infection in the oral cavity or face where bacteria spread through the pterygoid venous plexus via sphenoid emissary veins to the cavernous sinus. slow flow in the veins means that bacteria can multiply and proliferate much faster leading to a thrombus. symptoms include: swollen eye as blood cannot drain from the eye via ophthalmic veins and a high temperature

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29
Q

what is the cause of sudden sharp unilateral facial pain

A

can be trigeminal neuralgia which has no known cause other than it may be caused by compression of the nerve around the foramen ovale. treatment is with carbamazepine, necrosis of nerve with alcohol or peripheral neurectomy

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30
Q

what may be damaged when there is a blow to the parietal lobe of the brain

A

broca’s area which controls motor speech
wernicke’s area which controls understanding of language

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31
Q

when there is damage to CN XII during a stroke, what occurs

A

paralysis of the opposite side of the tongue. the pyramid’s decussation in the lower medulla where the nerve passes from one side of the brain to innervate the other is no longer functional so paralysis of the opposite side of the body. however it depends on the lesion:
1. upper motor neuron lesion - will affect corticospinal pathway so tongue will curve away from damaged side
2. lower motor neuron lesion - direct damage to the specific nerve which will result in tongue deviating to weak side

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32
Q

what does the pineal gland do

A

located behind 3rd ventricle under corpus callosum bathed in CSF. it controls melatonin secretion for modulating sleep patterns and also circadian rhythms

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33
Q

what is vertebral basilar ischaemia

A

compression of one of the vertebral arteries branching off the basilar artery in the circle of Willis. this can be caused by osteoarthritis where osteophytes (bony projections) compress the vessels or when you turn your head which blocks blood supply thus dizziness is a symptom

34
Q

what might exaggerated reflex’s suggest

A

common sign in stroke - usually an upper motor neuron lesion

35
Q

what is the Babinski effect

A

a plantar reflex and is when the sole of the foot is stimulated with a blunt instrument. normal results mean the big toe will go down but in positive results the big toe will go up and this is a sign of stroke due to damage to the pyramidal tracts of the CNS

36
Q

what nerve has been damaged when the pupils do not constrict

A

oculomotor CN III as constrictor papillae not functioning

37
Q

what are the functions of the muscles of mastication

A

temporalis - elevates and retrudes
masseter - elevates and retrudes
medial pterygoid - elevates and moves mandible laterally
lateral pterygoid - depresses, protrudes and moves mandible laterally

38
Q

what is glue ear

A

it is serious otitis media. occurs in infection of nasopharynx which causes overgrowth of tubular tonsils resulting in proliferation of goblet cells, thus increased mucous production. blocks auditory canal increasing pressure. treated with grommet insertion into tympanic membrane which allows air into middle ear

39
Q

what can occur when doing a biopsy of the pharyngeal recess

A

can be a common site for occult tumours which will require biopsy or surgery. ICA at risk of being damaged

40
Q

give the clinical name for a nosebleed, what artery causes it and how it is treated at the scene

A

epistaxis which is caused by the sphenopalatine artery. treatment includes ptx sitting upright to reduce venous pressure and pinching bridge of nose

41
Q

what causes a blockage of the auditory tube

A

otitis media

42
Q

what are the 3 common causes of deafness

A
  1. osteosclerosis - calcification of the annular ligament which connects the base of the stapes to the fenestra vestibula
  2. wax build up from cerumenous glands
  3. chronic otitis media
43
Q

explain referred pain in a heart attack

A

pain is felt in neck due to sympathetic fibres of cervical sympathetic trunk travelling up from the heart. can also be due to the homunculus model

44
Q

what emergency airway access can be carried out during anaphylactic shock

A

cricothyroidectomy - hole pierced using 1mm needle through cricothyroid ligament to bypass mouth and allow air to enter lungs

45
Q

why is a systolic bruit

A

medium to low pitched noise heard during systole. generated by turbulent blood flow through an artery due to partial obstruction (atherosclerosis) or a localised high rate of blood flow through an unobstructed artery. linked with peripheral vascular disease, stroke, carotid artery stenosis, aortic aneurysm

46
Q

what can cause a distended extended jugular vein

A

may bulge and pulsate due to heart disease or hypertension caused by smoking

47
Q

why does a laceration to the scalp bleed profusely

A

rich blood supply of connective tissue

48
Q

what is diplopia

A

double vision - can occur due to blow out fracture, sinusitis, MS, temporal arteritis which damages CN III, IV, VI. can be spotted by a squint

49
Q

what is Virchow’s node

A

supraclavicular node in the supraclavicular fossa located above the left clavicle. drains the thorax and abdomen and when it is hardened or inflamed it can be a sign of abdomen malignancy

50
Q

what does the parotid, mental, submandibular, jugulo-digastric, deep cervical, jugulo-omohyoid lymph nodes all drain

A

parotid - side of face above angle of mandible
mental - anterior tongue, lower lip, incisal teeth
submandibular - oral cavity, nasal cavity, maxillary sinus
jugulo-digastric - tonsils
jugulo-omohyoid - tongue
deep cervical - deep structures of head e.g. posterior tongue, middle ear, nasopharynx

51
Q

what is Hodgkin lymphoma compared with non Hodgkin lymphoma

A

hodgkin - malignancy of lymphatic system with multiple nodes affected. reed-sternerg cells found
non hodgkin - lymphocytes become abnormal

52
Q

what can cause inflammation of parotid gland

A

caused by mumps or LA into parotid gland. very painful as dense fascia puts pressure on glossopharyngeal & facial nerves

53
Q

what causes submandibular duct calcifications

A

stones due to upwards travel of saliva. can be removed but risk of damage to lingual nerve

54
Q

what is an oro-antral communication and when does it become a fistula

A

see other card. becomes a fistula when epithelium covers it

55
Q

what is sinusitis

A

sinus infection of mucous membrane. can result in maxillary or frontal sinuses. headaches and foul smelling discharge. cloudy mass on radiograph. usually when frontal sinus is infected so is the maxillary as they both open into the hiatus semilunaris

56
Q

what is the trans sphenoidal approach

A

used to reach pituitary tumours by entering the sphenoidal sinus

57
Q

what happens to excess tears when crying or when it is cold

A

excess tears drain through the nasolacrimal duct into vestibule of nose to cause a runny nose

58
Q

what is chronic rhinitis

A

inflammation of the nose which can be caused by allergies or irritants. results in nasal drip, cough, sore throat etc.

59
Q

what can occur with a blowout fracture to the zygomatic bone

A

orbit floor can fracture and spill into maxillary sinus causing double vision and possible infraorbital nerve damage

60
Q

what happens when the cheek is fractured

A

infraorbital nerve can be damaged at infraorbital foramen and other vessels ruptured

61
Q

what is trismus

A

reduced opening of the jaw caused by injection of LA into medial pterygoid

62
Q

what are osteophytes

A

bony projections that grown on joints where they can then press on nerves and vessels

63
Q

what can be seen in substantia nigra of a parkinson’s patient

A

death of dopamine generating cells in substantial nigra - black substance around the cerebral peduncle. results in tremors and lack of expression. generally a patient will be given dopamine replacement

64
Q

what is meningitis

A

viral or bacterial infection of the meninges. causes severe headache, nausea and vomiting. bacterial is life threatening and requires treatment ASAP

65
Q

what is an occult tumour in the pharyngeal recess

A

deep pocket in the fossa of rosenmuller which is the most common site for nasopharyngeal carcinomas. located posterior to the auditory tube where the ICA lies close to. requires treatment and diagnosis early as it progresses quickly. hoarseness is a common sign of this type of tumour

66
Q

what artery is at risk of rupture during tonsillectomy

A

ascending pharyngeal and facial artery branches

67
Q

what is waldeyer’s ring and what is its function

A

ring of lymphoid tissue in pharynx including the pharyngeal, palatine, lingual and tubular tonsils. serves to protect the respiratory system from infections

68
Q

what is the function of the 2 muscles found in the middle ear

A

tensor tympani - supplied by CN V which pulls the malleus to reduce movement and thus sound
stapedius of triangle - supplied by CN VII which contracts and reflexes the stapes which dampens sound and reduces movement

69
Q

what is osteosclerosis

A

most common cause of progressive deafness. fibrous annular ligament forms a band around the base of the stapes and fenestra vestibuli becomes calcified and held in this window meaning it lacks movement and thus restricts movement of stapes into the cochlea

70
Q

what is otitis externa

A

swimmer’s ear - when there is a inflammation of external acoustic meatus resulting in ear ache, pus discharge and temporary hearing loss

71
Q

what causes goitre

A

when thyroid gland becomes enlarged. generally caused by autoimmune e.g. Grave’s in hyperthyroidism or by iodine deficiency in hypothyroidism

72
Q

what is facial palsy

A

LA injected into parotid anaesthetising muscles of facial expression. can also be caused by haemorrhage, stroke, MS, tumours. unable to move eyebrows

73
Q

what is Bell’s palsy

A

facial palsy with unknown cause affecting the whole excitability of the facial nerve. unilateral paralysis including eyebrows

74
Q

what is hydrocephalus

A

accumulation of fluid in brain, usually CSF. caused by tumour in cerebral aqueduct so CSF cannot drain through to 4th ventricle so pressure increases in cranium

75
Q

what can occur when toys are lodged in the nose

A

foul smelling breath and neutrophils and pus begin to gather

76
Q

what is plunging ranula

A

an extravasation of saliva from sublingual gland due to trauma or obstruction of duct. results in slow growing, soft moveable mass located on floor of mouth

77
Q

what is temporal arteritis

A

form of vasculitis - can affect superficial temporal artery which causes inflammation to arterial branches of head. results in inadequate oxygen supply to head leading to blindness and stroke. can be treated with steroids

78
Q

what is paget’s disease

A

caused by excessive breakdown and formation of bone, followed by disorganised thickening of bone. can case blindness and deafness - effect on ossicles and pressure on vestibulocochlear nerve

79
Q

what occurs when there is damage to the ethmoid sinus in surgery

A

CSF leakage and arterial bleeding

80
Q

extra dural haemorrhage

A
  • rupture to middle meningeal artery due to skull fracture or blow to head
  • causes enlarging haematoma
  • 24hr deterioration as blood gathers in epidural space
  • haemorrhage looks like lens shape on scan
81
Q

subdural haemorrhage

A
  • usually occurs in older generation when a fall knocks the head
  • results in perforation / laceration / rupture of cerebral vein
  • causes blood to form in subdural space which can take days / weeks to deteriorate
  • haemorrhage looks like sickle shape on scan
82
Q

subarachnoid haemorrhage

A
  • usually occurs in middle aged patients
  • affects one of the cerebral arteries
  • cause of berry aneurysm which is an out-pouching of one of the cerebral arteries which can rupture spontaneously
  • high mortality rate and high deterioration rate
  • haemorrhage conforms to shape on sulci on scan

BDS3 Head & Neck Anatomy (25 decks)

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