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BBC Exam 3

What are some causes of cervical pain? Muscle strain, inflamed lymph nodes
What is most chronic cervical pain caused by? bony abnormalities or trauma
How do you fracture the hyoid bone? Being choked
What does paralysis of the platysma result from? Injury to cervical branch of the facial nerve
What does paralysis of the platysma cause? Skin to fall away from the neck in slack folds
What is dyphagia? Difficulty swallowing
What is dysarthria? Difficulty speaking
What is torticollis? A contraction or shortening of cervical muscles that produces twisting of the neck and slanting of the head
How does toricollis present? Like a SCM contraction: head tilts toward and face turns away from affected side
What is cervical dystonia? Abnormal tonicity of cervical muscles (spasmodic torticollis)
Where is a Sawn-Ganz catheter usually put in? Subclavian vein
How does the external jugular vein serve as an internal barometer? When the venous pressure is in the normal range, the EJV is usually visible above the clavicle for only a short distance. However, when pressure rises (heart failure), the vein is prominent throughout its course along the side of the neck
What happens when the EJV is severed along the posterior border of the SCM? Its lumen is held open by the tough investing layer of deep cervical fascia and the negative intrathroacic pressure air will suck air into the vein. This produces a churning noise in the thorax and cyanosis
How can CN XI be damaged? Penetrating trauma Surgical procedures in the lateral cervical region Tumors at the cranial base Cancerous cervical lymph nodes Fractures of the jugular foramen
How would a lesion of CN XI present? Weakness turning head to the opposite side against resistance Weakness and atrophy of trap
What does severance of the phrenic nerve result in? Paralysis of the corresponding half of the diaphragm
Where is a phrenic nerve block given? Anterior surface of middle third of anterior scalene
What does the carotid triangle provide access to? Internal jugular vein, vagus nerve, hypoglossal nerve, and cervical sympathetic trunk
What is a TIA? Transient ischemic attack: sudden focal loss of neurological function that disappears within 24 hours
What is a TIA caused by? Partial occlusion of the internal carotid
What is an endarterectomy? A procedure done to relieve carotid occlusion
What does the carotid artery lie between? Trachea and infrahyoid muscles
Where is the carotid pulse palpated? Just deep to anterior border of SCM at the level of the superior border of the thyroid cartilage
What can carotid sinus hypersensitivity cause? Slowing of the heart rate with pressure on the carotid sinus
What does a decrease in PO2 do? Activates aortic and carotid chemoreceptors, increasing alveolar ventilation
Where can the internal jugular pulse be observed? Beneath the SCM superior to the medial end of the clavicle
When are the internal jugular vein pulsations especially visible? Whne the person's head is inferior to the lower limbs (Trendelenburg position)
When might the internal jugular vein pulse increase? Mitral valve disease
Which internal jugular vein is usually examined? Why? Right IJV because it's larger and straighter
Where is the needle inserted for an IJV puncture? Just lateral to it at a 30 degree agnle, aiming at the apex of the triangle between the sternal and clavicular heads of the SCM, the lesser supraclavicular fossa
Why do facial lacerations tend to gape? Because the face has no distinct deep fascia and the subcutaneous tissue between the cutaneous attachments of the facial muscles is loose
Which way to wrinkles form? Perpendicular to the muscle fibers
Do incisions along the cleavage or wrinkle lines (Langer lines) of the face heal with minimal or excessive scarring? Minimal
Does the epicranial aponeurosis allow the scalp to gape with a supeficial wound? No
Why do deep scalp wounds gape widely when the epicranial aponeurosis is lacerated in the coronal plane? Because of the pull of the frontal and occipital bellies of the occipitofrontalis muscles in opposite directions
What is a dangerous area of the scalp and why? The loose connective tissue layer (layer 4) because pus or blood spreads easily into it and infection can also pass to the meninges
Can a scalp infection pass down into the neck? No because of the occipital bellies of the occipitofrontalis muscles attachment to the occipital bone and mastoid parts of the temporal bone
Can a scalp infection pass into the zygomatic arches? No because of the epicranial aponeurosis
Can a scalp infection enter the eyelids or root of the nose? Yes because the frontalis muscle insets into the skin and not the bone
What is ecchymosis Purple patches (bruising)
T/F: True nasal breathers can flare their nostils distinctly while habitual mouth breathers have diminished ability to flare their nostrils True
How can mouth breathing affect children? Cause them to develop dental malocclusion (improper bite) because the alignment of the teeth is maintained to a large degree by normal periods of occlusion and labial closure
How can Bells Palsy cause corneal ulcerations which could cause scarring, impairing one's vision? Because the loss of tonus of the orbicularis oculi causes the inferior eyelid to evert and as a result, lacrimal fluid is not spread over the cornea, preventing adequate lubrication, hydration, and flushing of the surface of the cornea
What is the most common nontraumatic cause of facial paralysis? Inflammation of the facial nerve near the stylomastoid foramen, often a result of a viral infection
Where does the facial nerve emerge from? Stylomastoid foramen
What would a lesion of the zygomatic branch of CN VII cause? Paralysis, including loss of tonus of orbicularis oculi in the inferior eyelid
What would a lesion of the buccal branch of CN VII cause? Paralysis of buccinator and superior portion of the orbicularis oris and upper lip muscles
What would a lesion of the marginal mandibular branch of CN VII cause? Paralysis of the inferior portion of the orbicularis oris and lower lip muscles
Do arteries of the scalp retract when lacerated? Why or why not? No because they are help open by the dense connective tissue
Which lip does squamous cell carcinoma usually involve? Lower lip
What are some causes of lip cancer? Overexposure to sun, chronic irritation from pipe smoking
Where do about 80% of all salivary gland tumors occur? In the parotid gland
How would a blockage of the parotid duct be painful? By blocking the saliva produced
Where is a mandibular nerve block injected? Near the mandibular N where it enters the infratemporal fossa (Through mandibular notch)
What does a mandibular nerve block anesthetize? Auriculotemporal, inferior alveolar, lingual, and buccal branches of CN V3
What does an inferior alveolar nerve block anesthetize? Inferior alveolar N, a branch of CN V3
Where is the inferior alveolar nerve block injected? Around the mandibular foramen
Causes of TMJ dislocation During yawning, taking a large bite, excessive contraction of lateral pterygoids may cause head of mandible to dislocate anteriorly
What will a person with a TMJ dislocation not be able to do? Close their mouth
What is the clicking in TMJS thought to be a result of? Delayed anterior disc movements during mandibular depression and elevation
What is loss of smell frequently associated with? URI, sinus disease, head trauma
What is anosmia? Loss of smell
What does complete section of the optic N result in? Blindness in temporal and nasal visual fields of the ipsilateral eye
What does complete section of the optic chiasm result in? Reduces peripheral vision and results in bitemporal hemianopsia, the loss of vision of one half of the visual field of both eyes
What does compelte section of the R optic tract at the midline result in? Eliminates vision from the left temporal and R nasal visual fields
What is the most common form of visual field defects of patients with strokes? Loss of ipsilateral nasal field and contralateral temporal field
What does a lesion of CN III result in? Ipsilateral oculomotor palsy
What is the first sign of CN III compression? Ipsilateral slowness of the pupillary response to light
What would lesion of the trochlear N cause? Paralysis of the superior oblique and impair ability to turn affected eyeball inferomedially
What is the characteristic sign of trochlear N injury? Diplopia when looking down
Why does diplopia occur? Because the superior oblique normally assists the inferior rectus in depressing the pupil (directing downward gaze) and is the only muscle to do so when the pupil is adducted
What is tic douloureux? Trigeminal neuralgia: principal disease affecting the sensory root of CN V which produces excrusiating episodic pain that is usually restricted to the areas supplied by the maxillary and/or mandibular divisions of this nerve
Which nerve is readily accessable and is probably anesthetized more frequently than any other nerve? Inferior alveolar N
What happens to CN VI when there is intracranial pressure It gets stretched because it has a long intra-dural course
What would a lesion to CN VI cause? Paralysis of lateral rectus, causing medial deviation of the affected eye due to the unopposed action of the medial rectus
What is the most frequently paralyzed of all the CN? Facial
What would a lesion of CN VII near its origin result in? Loss of motor (to superior and inferior parts of ipsilateral face), gustatory (taste) and autonomic functions
What would a central lesion of CN CII (lesion of the CNS) result in? Paralysis of muscles in the inferior face on the contralateral side
What is Bells Palsy? Unilateral facial paralysis of sudden onset resulting from a lesion of CN VII
What might lesions of CN VIII cause? Tinnitus (ringing or buzzing in ears), vertigo, and impairment or loss of hearing
What do central lesions of CN VIII involve? Either the cochlear or vestibular division
What are the two kinds of deafness? Conductive deafness: involving external or middle ear Sensorineural deafness: results from disease in the cochlea or in the pathway from the cochlea to the brain
What is an acoustic neuroma? Slow growing benign tumor of the neurolemma (Schwann) cells
What is an early sign of an acoustic neuroma? Hearing loss
What is vertigo? Hallucination of movement involving the person or the environment
Does a lesion of CN IX result in disability? No
What would a lesion of CN IX cause? Absence of taste on posterior 1/3 of tongue, absence of ipsilateral gag reflex, and ipsilateral weakness which may produce a noticeable change in swallowing
What is jugular foramen syndrome? Tumor in the region of the jugular foramen which affects CN IX, X, and XI
What would an injury to the pharyngeal branches of CN X result in? dysphagia (difficulty in swallowing)
What would injury to CN XII result in? Paralysis of the ipsilateral half of the tongue
What is otitis externa? Inflammation of the external acoustic meatus
S/S of otitis externa? Itching and pain in external ear
What increases pain when you have otitis externa? Pulling the auricle or applying pressure on the tragus
What is otitis media? Infection of the middle ear
What is otitis media usually caused by? URI
S/S of otitis media Earache, bulging red tympanic membrane which indicates pus or fluid in middle ear
What is one cause of middle ear deafness? Ruptured tympanic membrane
What is hyperacusis? Paralysis of stapedius which is associated with excessive acuteness of hearing. Results from uninhibited movements of the stapes.
What does motion sickness result from? Discordance between vestibular and visual stimulation
What are the three major symptoms of injuries to the peripheral auditory system? Hearing loss, vertigo, and tinnitus
What is conductive hearing loss a result of? Anything in the external or middle ear that interferes with conduction of sound or movement of the oval or round windows
S/S of people with conductive hearing loss Will speak with a soft voice because, to them, their own voices sound louder than background sounds
What is sensorineural hearing loss a result of? Defects in the pathway from cochlea to brain
What is included in Zone 1 of penetrating neck trauma? Includes root of neck and extends from the clavicles and manubrium to cricoid cartilage
What structures are included in Zone 1 of penetrating neck trauma? Cervical pleurae, apices of lungs, thyroid, and parathyroid glands, trachea, esophagus, CCA, EJV, IJV, and cervical regions of vertebral column
What is included in Zone 2 of penetrating neck trauma? Extends from cricoid cartilage to angle of mandible
What structures are included in Zone 2 of penetrating neck trauma? thyroid gland, thyroid, cricoid cartilages, larynz, laryngopharynz, carotid arteries, IJV, EJV, esophaguys, cervical regions of vertebral column
What is included in Zone 3 of penetrating neck trauma? Angle of mandible and superiorly
What structures are included in Zone 3 of penetrating neck trauma? Salivary glands, oral and nasal cavities, oropharynx, and nasopharynx
What nerves are responsible for the actual gagging when you touch the posterior part of your tongue? CN IX and X
What nerve is responsible for the afferent limb of the gag reflex? Branches of glossopharyngeal
What happens with paralysis of the genioglossus? Tongue falls posteriorly, obstructing the airway and presenting the risk of suffocation
Why does the tongue deviate to the side of the hypoglossal lesion with protrusion? Because of the action of the unaffected genioglossus muscle on the other side
What is rhinitis? Nasal mucosa becomes swollen and inflamed during server URI and allergic reactions
What is another word for nosebleed? Epistaxis
What is the area in the anterior 1/3 of the nose called? Kiesselbach area
What is inflammation of multiple sinuses known as? Pansinusitis
What is another name for a maxillary fracture? Le Fort fracture
Which type of Le Fort fracture passes superior to the maxillary alveolar processes and crosses the bony nasal septum? Le Fort I
What type of Le Fort fracture passes from the posterolateral parts of the maxillary sinuses through the infra-orbital foramina, lacrimals, or ethmoids to the bridge of the nose? Le Fort II
What type of Le Fort fracture passes through the superior orbital fissures and ethmoid and nasal bones and extends laterally through the greater wing of the sphenoid and the frontozygomatic sutures? Le Fort III
What are fractures of the neck of the mandible usually associated with? Fracture of its body in the region of the opposite canine tooth and dislocation of ipsilateral TMJ
What do palpations of the fontanelles enable physicians to determine? Progress of growth of the frontal and parietal bones Degree of hydration (depressed fontanelle) Level of intracranial pressure (bulging fontanelle)
When and where does obliteration of the cranial sutures begin? Between 30-40 y/o at bregma
What structure is two fingers superior to the zygomatic arch and one thumb posterior to the frontal process of zygomatic bone? Pterion
Why is a fracture of the pterion life threatening? Because it overlies the anterior branches of the middle meningeal vessels
How can a patient help to reduce a headache after having a lumbar spinal puncture to remove CSF and why? Keep head down because after removal of CSF, brain sags slightly, pulling on dura, so this minimizes the pull
How does an extradural or epidural hematoma typically present? Brief concussion followed by a lucid interval of some hours. Later, drowsiness and coma
What is a dural border hematoma classically called? Why is this a misnomer? Subdural hematoma: Because there is no naturally occuring space at the dura-acrachnoid junction. Hematomas at this junction are usually caused by exravasated blood that splits open the dural border cell layer.
Where does blood collect in a subdural hematoma? Does not collect within a pre-existing space but rather, creates a space at the dura-arachnoid junction
Which type of brain hemorrhage is arterial in origin? Which artery is usually involved? Extradural or epidural hemorrhage: Branches of middle meningeal A
Which type of brain hemorrhage is venous in origin? Which vein is usually involved? Subdural hemorrhage: Superior cerebral vein
What is a subarachnoid hemorrhage? Extravasation of blood, usually arterial in to the subarachnoid space
S/S of subarachnoid hemmorrhage? Meningeal irritation, severe headache, stiff neck, and often LOC
What is an ischemic stroke usually caused by? An embolism in a major cerebral artery
What is a "blowout" fracture? Indirect traumatic injury that displaces the orbital walls
What is exophthalmos? Protrusion of the eyeball
What is the first sign of compression of the oculomotor nerve in regards to the eye? Ipsilateral slowness of the pupillary response to light
What does a detached retina usually result from? Seepage of fluid between the neural and pigment cell layers of the retina
S/S of retinal detachment? Flashes of light or specks floating in front of the eye
What is presbyopia? Condition seen with age that causes the lens to become harder and more flattened
What is cataracts? Loss of transparency (cloudiness) of the lens from areas of opaqueness
What is glaucoma? When pressure builds uup in the anterior and posterior chambers of the eye due to a decrease in outflow because outflow pathway is blocked
What nerve supplies sensor innervation to the cornea? CN V1
What CN is responsible for the pupillary light reflex? CN II - afferent limb CN III - efferent limb
What CN is responsible for the corneal reflex? CN V1
How is the corneal reflex tested and how can you get a false positive test? Touch cornea with wisp of cotton. Can get a false positive if you have a lesion to CN VII (motor nerve to orbicularis oculi) and you don't actually touch the cornea
What would complete oculomotor nerve palsy result in? Superior eyelid drooping (unopposed orbiularis oculi), dilated and non-reactive pupil (unopposed dilator pupillae), abducted and depressed pupil (unopposed lateral rectus and superior oblique: CN IV)
What would complete abducent nerve palsy result in? Adducted pupil (unopposed pull of medial rectus)
Created by: 1185240090



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