test 2 Flashcards
fractures of the orbit can cause intraorbital bleeding. the pressure causes protrusion of the eyeball
exophthalmos
paralysis of levator palpebrae superioris, causes superior eyelid to droop (ptosis)
lesion of CN III
where can a Tumor in middle cranial fossa travel?
Enter orbital cavity through superior orbital fissure
damage to CN VII
paralysis of orbicularis oculi
prevents eyelids from closing fully
Ducts of ciliary glands become obstructed
red pus producing sty on eyelid
Chalazia
cyst of sebaceous glands of the eyelids
seepage of fluid b/w neural and pigmented layers of retina
detached retinal
how does a detached retina effect vision
Straight lines will look wavy/crooked
Increase in Cerebral Spinal Fluid slows venous return from the retina and causes edema of retina
Papilledema
lenses become harder and flatter with age
presbyopia
cataracts
cloudiness/loss of transparency of lens from areas of opaqueness
Outflow of aqueous humor slower than aqueous is produced causing retinal compression
glaucoma
Sensory damage to CN V1
loss of sensory feeling can damage corneal damage eventually needing transplant
no corneal reflex are indicative of lesions on which CN?
lesion of CN V1 and CN VII
Sign of compression of the CN III
ipsilateral slowness of the pupillary light reflex
Eyelid can not be raised
Pupil dilated and nonreactive due to unopposed dilator pupillae
Down and out (abducted and depressed) due to unopposed LR6 SO4
symptoms of Oculomotor Nerve Palsy
Anesthetizes auriculotemporal, inferior alveolar, lingual, and buccal branches of mandibular nerve
Mandibular nerve block
All mandibular teeth are anesthetized, skin and mucous of lower lip, labial alveolar mucosa and gingiva and skin of chin as well since they are supplied by mental branch of this nerve
Inferior alveolar nerve block
head of mandible can dislocate anteriorly by passing anterior to the articular tubercles now unable to close mouth
Dislocation of Temporomandibular Joint
Malignant tumors of the posterior part of the tongue metastasize which lymph nodes
superior deep cervical lymph nodes
paralysis of this muscle causes complete relaxation of the tongue causing posterior shift which can cause suffocation
Paralysis of Genioglossus
Trauma to the hypoglossal nerve results in
paralysis and atrophy of one side of the tongue. Protrusion of the tongue will fall to paralyzed side.
Nerves involved in Gag Reflex
CN 9 (afferent and muscle) CN 10 (muscle contraction)
Epistaxis (nosebleed)
most cases due to trauma
comes from anterior third of nose (Kiesselbach)
are also associated with infections and hypertension
Deviation of nasal septum
may result from birth injury, or trauma during adolescence and adulthood
- in severe cases, the nasal septum contacts the lateral wall of nasal cavity
- obstructs breathing, exacerbates snoring
- corrected by surgery
Rhinitis
nasal mucosa is swollen and inflamed in severe upper resp. infections & allergic reactions
wryneck
Congenital torticollis, fibrous tissue tumor forms on SCM before or after birth
Muscular torticollis
head pull during birth tears fibers in SCM forming a hematoma
fibrous mass that forms traps CN XI denervation of the SCM
adulthood, abnormal tonicity, most commonly involves the SCM and trapezius
Spasmodic torticollis (cervical dystonia
Central line placement
R/L subclavian vein
External Jugular Vein
Internal Barometer, Protrusion of EJV signals heart Failure (Right EJV), distension, or obstruction of SVC, enlarged supraclavicular LN, or increased intrathoratic pressure.
Uncommon, drooping of shoulder, unable to elevate the shoulder
Lesions of CN XI Accessory nerve
Severance of the Phrenic nerve results in
paralysis of corresponding half of diaphragm. A nerve block in lung operation, trauma, surgery will cause temporary paralysis. Used in treatment of hiccups
anesthetic is injected on posterior edge of SCM for surgical procedures of neck or upper limb
Cervical plexus block
For anesthesia of upper limb inserted superior to midpoint of clavicle
Supraclavicular brachial plexus block
External Carotid artery ligation
Control bleeding from an inaccessible branch
Descending occipital artery provides main collateral circulation and joins vertebral and deep cervical arteries.
Thickening of intima of internal carotid artery
Atherosclerosis of the artery resulting in stenosis and decreased blood flow. This can cause TIA or stroke
carotid endarterectomy
removes the plaque relieving the stenosis
What nerves can be injured during surgery of the internal carotid artery
CN- IX, X (OR SUPERIOR LARYNGEAL), XI, XII
Internal jugular artery
pulsation visible in Trendelenburg position
Increased internal jugular pulse is caused by
mitral valve disease which increases pressure in the right side of the heart and pulmonary circulation
relieves vascular spasm of brain and upper limb, surgery for patient with excessive vasoconstriction of ipsilateral limb
Cervico-thoracic ganglion block
Horner syndrome
(lesion of the cervical sympathetic trunk)
Horner syndrome symptoms
• Results in Pupillary constriction
• Ptosis (drooping of upper eyelid)
• Enophthalmos (sinking in of eyeball)
vasodilation and anhidrosis- absence of sweating on face and neck, caused by lack of sympathetic nerve supply to blood vessels and sweat glands
vasodilation and anhidrosis- absence of sweating on face and neck, caused by
lack of sympathetic nerve supply to blood vessels and sweat glands
Tetany
is a sever convulsive disorder that occurs when the parathyroid is accidentally removed during surgery.
treatment for Tetany
Needs calcium replacement
Subtotal thyroidectomy
most posterior part of thyroid is preserved. usually prevents removal of parathyroid
paralysis of vocal fold causing no adduction for phonation, or abduction for increased respiration causing stridor ( high pitch noisy respiration)
Inferior laryngeal nerve injury
monotonous voice
injury to superior laryngeal nerve
Fractures of laryngeal skeleton
sub mucous hemorrhage, edema, respiratory obstruction, hoarseness, no speech
foreign body aspiration
trapped superior to vestibular folds, rima glottidis close, no air in, asphyxiation in 5 min if no intervention
tracheostomy
Upper airway obstruction, respiratory failure
1-2 or 2-4 tracheal rings, transverse incision
Radical neck dissection
- Usually done to remove cancer
- deep cervical lymph nodes and tissue removed
- cervical sentinel lymph nodes are often enlarged as first clue to cancer
- cutaneous branches of cervical plexus removed
Adenoiditis
- Inflammation of pharyngeal tonsils
Causes obstruction of airways, nasal obstruction, hearing due to blockage of pharyngotympanic membrane, also infection can spread to middle ear- otitis media
Tonsillectomy
removal of palantine tonsil
Surgeon needs to be careful of bleeding due to location of CN IX, internal carotid artery. and external palantine vein
Zones of Penetrating Trauma
Zone 1,2,3. Zones 1 and 3 have increased risk of mortality, zone 2 easier to treat.
Zone 1
Clavicles and manubrium to inferior cricoid cartilage
zone 2
Cricoid cartilage to angle of mandible
zone 3
angle of mandible up to top of head
Emmetropia
Normal eyesight.
Far images are in focus without lens accommodation. (relaxed ciliary muscles)
Near images are in focus with lens accommodation (flexed ciliary muscles)
myopia
Near sighted
Far images are in front of retina without accommodation (looks blurry)
Near images are in focus without accommodation
Need concave lens to focus far image on retina
Eyeball long or lens is too strong
hyperopia
Far sighted
Far images are focused on retina with accommodation
Near images are blurring with accommodation (focused behind retina)
Need convex lenses to focus near image
Eyeball is short or weak lens
Diplopia, treatment and causes
double vision
1st they put a prism onto of the lens step. After adapted they will merge the prism with the glass
usually caused by unsynchronized muscle contraction
astygmatism
Misshapen lens causes multiple focal points for light
measured in degrees
blurry vision
Ethmoidal Cells Infection
infection can cause fracture to the fragile medial wall of the orbit
close to optic canal causing blindness
optic neuritis inflammation of optic nerve
Pansinitus
Multiple sinuses are inflamed due to infection
Most commonly infected sinus due to small ostia
Maxillary sinus
Causes of blockage to maxillary ostia
mucous membrane congestion
high location on medial wall makes it impossible to drain until full
Medially located ostia requires rolling to opposite side to drain
Close to molars, concern during teeth extraction
Acute otitis externa
inflammation of external acoustic meatus due to bacterial infection
causes itching and pain, which increases by pulling on tragus
commonly called swimmers ear
Otitis Media
earache, bulging tympanic membrane due to pus or fluid in middle ear.
Leads to blockage of pharyngotympanic tube
Ear popping
Amber colored blood fluid
Lead to scaring of auditory vesicles
Myringotomy
incision to release pus from middle ear abscess
incision is made postero-inferiorly through the tympanic membrane because the superior is so vascularized
Tympano Stome/ Pressure equalization (PE) tube
enables drainage and equalizes pressure from chronic middle ear infections
