Clinical Correlates Flashcards
(101 cards)
1
Q
Median cleft of lower lip
A
failure of L and R mandibular prominences to fuse
2
Q
Median cleft of upper lip
A
failure of L and R medial nasal prominences to fuse
3
Q
Bilateral oblique facial cleft w/ complete bilateral cleft lip and exposed nasolacrimal duct
A
failure of maxillary prominences and med and lat nasal prominences to fuse
4
Q
Macrostomia (bilateral facial cleft)
A
failure of maxillary and mandibular prominences to fuse
5
Q
Complete unilateral cleft of upper lip and unilateral cleft of primary palate
A
failure of maxillary and medial nasal prominences to fuse
6
Q
Median cleft of secondary palate
A
failure of L and R palatine shelves to fuse
7
Q
Facial paralysis (Bell’s Palsy)
A
- -paralysis of some of the mm of facial expression on one side of the face
- -results from lesion (pathological discontinuity) of the facial n, often deep to parotid gland
- -asymmetrical face
- -lack of facial expression
- -may bite cheeks when chewing (paralysis of buccinator)
- -dry eyes (paralysis of orbicularis oculi)
8
Q
Thrombophlebitis
A
venous inflammation of facial v may lead to thrombophlebitis of transverse sinus
9
Q
Danger triangle
A
central area of face
infections can spread via facial vv to dural sinuses
10
Q
Tumor on nose…how would it be stitched
A
flap of skin from forehead perfused by supratrochlear a is used, otherwise skin would die
11
Q
Trigeminal neuralgia (tic doulereux)
A
causes short bouts of excruciating pain in one (unilateral) of the sensory fields of the trigeminal n upon the least stimulation (light wind, chewing)
–field of CN V2 affected
–so painful that pts refuse to eat or are driven to suicide
Treatment: ligation of sensory root of the n inside the braincase, leading to anesthesia of the involved side of the face
12
Q
Midface trauma can impact
A
mm, glands, neurovascular tissue, blindness
13
Q
Ptosis
A
drooping upper eyelid
levator palpebrae superioris
14
Q
Horner’s syndrome
A
lesion of sym trunk
pupillary constriction
partial ptosis
absence of sweating on ipsilateral side
15
Q
Thrombophlebitis of facial v
A
inflammation of facial v w/ secondary thrombus (clot) formation – pieces of infected clot may extend into the intracranial venous sys and produce thrombophlebitis of the cavernous sinus
- -can spread to other sinuses
- -can damage abducent n as traverses the cavernous sinus (innervates lat rectus – first sign of infection if eye mvmt problem)
16
Q
Dural venous sinuses that are most frequently thrombosed
A
transverse
cavernous
superior sagittal
17
Q
Facial vv make connections w/ cavernous sinus through what vv?
A
superior opthalmic vv
18
Q
Cavernous sinus thrombosis
A
results from infections in the orbit, nasal sinuses, and danger triangle
19
Q
Acute meningitis
A
due to septic thrombosis of the cavernous sinus
20
Q
Fracture of pterion
A
pterion overlays frontal branches of middle meningeal vessels which lie in grooves on the internal aspect of the lat wall of the calvaria
fracture of bones of pterion can rupture frontal branch of middle meningeal or the v crossing the pterion
21
Q
Dural origin of headaches
A
dura is sensitive to pain when related to dural venous sinuses and meningeal aa
pulling on aa at cranial base or vv near the vertex, wherer they pierce the dura causes pain
distension of scalp or meningeal vessels can cause headache
–headaches after removal of CSF (due to stimulation of sensory nerve endings in dura – brain sags when CSF removed, pulling on dura)
22
Q
Leptomeningitis
A
inflammation of arachnoid and pia (leptomeninges) due to microorganism
infection/ inflammation contained to subarachnoid space and arachnoid-pia
bacteria can enter via blood or from infection of viscera or fracture of nasal sinuses
23
Q
Innervation of dura from what CN?
A
CN V
24
Q
Extradural (epidural) hematoma
A
arterial origin tear in middle meningeal a blood collects b/w dura (external periosteal layer) and cranium after blow to head compresses brain
25
Dural border hematoma (subdural hematoma)
venous origin
splitting open of dural border cell layer
superior cerebral v tear
after blow to head that jerks the brain inside the cranium and injures it
26
Subarachnoid hemorrhage
usually arterial origin
subarachnoid space
due to aneurysm (int carotid)
or due to cranial fractures and cerbral lacerations
27
Ischemic stroke
embolism of major cerbral a
cerebral arterial circle is important for collateral circulation if one of the major aa of the circle is gradully occluded
sudden occlusion results in neurological deficits
in older people, circle is not enough if large a is occluded
Causes
--spontaneous cerebrovascular accidents (cerebral thrmobosis, cerebral hemorrhage, cerebral embolism, subarachnoid hemorrhage)
28
Hemorrhagic stroke
follows rupture of a (saccular aneurysm)
due to hypertension
blood enters subarachnoid space
29
Berry aneurysm
occurs in vessels of or near cerebral arterial circle and medium aa at base of brain
30
Sources of blood coming out of the ear
tympanic membrane ruptures easily
| cracks in Tegmen tympani (part of skull) may cause blood and CSF to leak into middle ear or directly into outer ear
31
Paralysis of inner ear mm
middle ear mm dampen strong vibrations, so paralysis leads to hypersensitivity of the ear (loud sounds will hurt)
32
Otitis media
| adult vs child
middle ear infections
--more common in children b/c have shorter, more horiz aud tube
--impairs draining of infection into throat
--easier entry of bacteria to middle ear from nasopharynx
Swelling of adenoids can block aud tubes -- inc ear infections
33
Mastoiditis
mastoid antrum and aircells filled w/ fluid (rather than air)
swollen external ear
epidural abscess that degrades the bone and projects into cranial cavity
34
Detached retina
Flashes of light
Tear --> fluids inc tearing
Tear b/w layers 1 and 2 b/c poorly attached
Detached retina unable to regenerate pigment (function of pigment ep is to regenerate rhodopsin)
Die b/c blood supply is gone
35
Treatment for detached retina
Pneumatic retinopexy
1. inject gas bubble into vitreous
2. position pt so gas bubble pushes detached retina back in place
3. use laser to re-attach retina
36
Glaucoma
aq humor does NOT drain b/c canal of Schlemm is plugged
inc intraocular pressure
(hard globe, pain)
pressure pushes on retina, central a of retina --> less blood to retina --> lose vision
nn and mm of iris compressed -- inhibit pupillary dilation and constriction
37
Presbyopia
loss of ability to focus on near things
- -due to hardening of lens
- -starts around age 40
- -lens not able to change shape as well -- more rounded
38
Damage to hair cells in certain region of cochlea
leads to deafness of specific freq
39
Hair cells overstimulated by exposure to loud sounds:
short term
long term
short term: lose sensitivity temporarily
| Multiple/long exposures: deafness
40
Cochlear implants
spiral electrodes that are guided up the cochlea
41
Congenital cataracts
German measles in pregnant female puts fetus at risk for congenital cataracts
lens forms mostly b/f week 7 and is affected if measles occur during pregnancy
if contract measles later, hearing damage b/c ear develops after eye
42
Colomba iridis
cleft in iris, connecting pupil to sclera
due to persistence of choroid fissure
can be asymptomatic or can result in blindness
43
Detached retina (embryo)
external and internal layer of optic cup are not fused -- there is a space b/w them
detached retina results due to poor attachment b/w rods/cones layer and pigmented layer
44
Strands of CT suspended ant to lens due to
persistence of iridiopupillary membrane
45
Congenital deformations of auricle
do not interfere w/ function
social stigma
can alert dr of presence of malformations that do not appear externally
46
Congenital dehiscence of semicircular canals
if petrous bone does not fully ossify around semicircular canals or if it erodes after formation, memebranous lining of canals touches meninges
vibrations of the fluid in the vestibule will also cause fluids of semicircular canals to vibrate -- get dizzy when hear loud sounds
occlude affected canal surgically
47
Symptoms of congenital dehiscence of the semicircular canals in children
```
hearing loss at early age
delayed walking
inability to do gymnastics
autophony (loud hearing of own voice)
vertigo (sense that environment spins/moves)
```
48
Thyroid surgery complications
Damage other neural structures (especially recurrent laryngeal)
49
Cervical cyst/fistula
```
Persistent cervical sinus
Cyst is fluid filled
Fistula
--external: connected to outside
--internal: connected to pharynx
```
50
Treacher-Collin's Syndrome
```
First Arch Syndrome
affects all structures formed by first arch to diff degrees
maxilla hypoplastic/absent
mandible hypoplastic/absent
eyes downslanted (palpebral fissures)
secondary palate divided (cannot nurse)
difficulty breathing (malformed oral/nasal cavity and pharynx)
external ear absent
middle ear deformed (hearing loss)
```
51
DiGeorge syndrome
```
affects regulation of branchial arches (1st and 2nd)
deletion on chromosome 22
affects other organ sys too
thymus and parathyroids absent/severely deformed
cleft palate
low set ears
wide-set eyes
no philtrum
long face
learning disabilities
delayed speech
```
52
Ankyloglossia
tongue not fully released from floor of mouth by extension of the frenulum (midline flap connecting floor to underside of tongue)
frenulum stretches after birth so no need for surgery
53
Thyroglossal cysts
remnants of thyroglossal duct
near midline
liable to same diseases as thyroid gland itself
54
Parathyroid unusual location
if do not complete migration, located above thyroid gland near bifurcation of carotids
55
Thymic tissue found in abnormal location
can be found as small accessory thymic glands in neck
56
Ear tubes -- what nerve to be careful of?
chorda tympani
| if damage, no taste
57
Inf alveolar and lingual nerve block
```
Inf alveolar:
--mandibular teeth on that side
--supporting bone and periodontium
--mental n areas (terminal branches)
Lingual n
--ant 2/3 tongue
--floor of mouth
--lingual gingivae
```
58
Bloody nose from what a
Sphenopalatine (terminal branch of 3rd part of maxillary a)
59
Dislocation of TMJ
| ant
excessive contraction of lat pterygoids --> heads of mandible dislocate ANT
--mandible remains open, cannot close
60
Dislocation of TMJ
| lat
sideways blow to chin when mouth is open
61
Why is post dislocation of TMJ uncommon?
resisted by postglenoid tubercle and strong intrinisic lat lig
62
nn at risk of damage during TMJ repair
```
facial n
auriculotemporal n (damage can lead to laxity and instability of TMJ)
```
63
Temporomandibular joint disorder
```
degenerative changes (TMJ arthritis)
damage to disk/articular surfaces (internal derangement)
trauma, developmental defects, RA
```
64
Myofascial pain dysfunction
```
unbalanced muscle mechanics (coordination)
oral habits (grinding teeth--bruxism)
```
65
Aspiration of food
Lungs are aseptic
Mouth has bacteria
If food gets into lungs--bacterial pneumonia
66
Inflammation/enlargement of tonsils can lead to...
problems w/ respiration, feeding, speech
67
Synthetic oxytocin/pitocin
inc risk of ADHD in children
Pitocin: 57/85 ADHD
No pitosin: 31/87
RR = 1.88 ADHD diagnosis if pitocin administered
68
Pituitary adenoma
Ant pit
GNAS I mutation
--mutation in gene that encodes G protein
--alpha subunit loses GTPase activity --> continuous activation of cAMP/PLC --> mitosis
Most common type of cell w/ GNAS I mutation are somatotrophs (b/c release GH)
69
Dwarfism
Gigantism
Acromegaly
Dwarfism: hyposecreting pituitary adenoma involving somatotrophs
Gigantism: hypersecreting tumor (b/f growth plates close)
Acromegaly: hypersecreting tumor (after growth plates close--middle age)
--thickening of digits, mandible, frontal bone, cranium
--surgical removal of tumor or somatostatin analogs or dopamine agonists
--more bony matrix deposition (appositional growth)
70
BPA
```
Bisphenol A
Endocrine disruptor
Similar cyclic ring to those of steroid hormone synthesis proteins
BPA binds to ERR - gamma
CYP at position 19 affected
```
71
Pineoblastoma
```
malignant tumor of embryonic pinealocytes
ages 1-3
Symptoms
--hydrocephalus
--upward gaze disorders
--precocious puberty (high levels melatonin --> inc GnRH and GH)
Treatment
--surgery
--chemo w/ radiation
```
72
Grave's Disease
HYPERthyroidism (hyperplasia)
Ab to TSH receptor
Stimulates thyroid regardless of blood TSH levels (high T3/T4)
Young women
Anxiety, wt loss, exophtalmos (excess energy converted to adipose behind eyes -- bulge)
Goiter
Inc HR
Skin blisters, swollen finger tips, separation of nail beds from skin
73
Hashimoto's disease
```
Ab to thyroid peroxidase or thyroglobulin
Low T3/T4
Fatigue
Wt gain
Constipation
Dry skin
Destruction of thyroid gland
Nonpitting adema (accumulation of GAGs)
```
74
Hypoparathyroidism
muscle spasms
| arrhythmias
75
Hyperparathyroidism
bones, stones, groans, and psychic overtones
76
Addison's disease
autoimmune disease of adrenal glands
LOW levels adrenal steroid hormones (inappropriate cleavage of POMC --> no ATCH --> no cortisol --> cannot regulate Na+ in blood/filtrate -- BP problem
Low BP and darkening of skin due to POMC
When cleave POMC, MSH is one of the fragments -- induces melanin
Treatment: hormone replacement
77
Cushing's DISEASE
hypothalamic tumor or tumor of ant pit
excess CRH or ACTH
Excess cortisol
78
Cushing's SYNDROME
suprarenal gland -- cortical hyperplasia
| Excess cortisol
79
Symptoms of Cushing's disease and syndrome
```
wt gain
high BP
poor short-term memory
irritability
excess hair growth (women)
red, ruddy face
extra fat in neck
round face
fatigue
poor concentration
menstrual irregularities
```
80
Laceration or contusion in parotid region (CN VII lesion)
Paralysis of facial mm
Eye remains open
Angle of mouth droops
Forehead does not wrinkle
81
Fracture of temporal bone (CN VII lesion)
```
Damage chorda tympani
--dry cornea
--loss of taste on ant 2/3 of tongue
and
Paralysis of facial mm
Eye remains open
Angle of mouth droops
Forehead does not wrinkle
```
82
Intracranial hematoma (stroke) CN VII lesion
Forehead wrinkles due to bilateral innervation of teh frontalis mm
Paralysis of contralateral facial mm
83
Brainstem lesion or deep laceration of neck -- damage to CN X
sagging soft palate
deviation of uvula to normal side
hoarseness due to paralysis of vocal cofd
84
Neck laceration, basal skull fractures -- damage to CN XII
```
protruded tongue deviates toward affected side
moderate dysarthria (disturbance of articulation)
```
85
What nn do surgeons have to be careful of during tooth extraction?
inf alveolar nn (from V3)
86
Teeth and the maxillary sinus
if root of molar is fractured and retrieval done incorrectly, piece of root driven up into maxillary sinus
- -infection
- -superior alveolar nn supply (V2) both maxillary teeth and mucous membrane of maxillary sinus (toothache sensation)
87
Neglected dental caries lead to...
inflammation of pump cavity --> infection
causes toothache
small vessels in root may die from pressure of swollen tissue
abscess in alveolar bone
--pus can extend to nasal cavity or maxillary sinus
88
Gingivitis
food and bacterial deposits in tooth and gingival crevices
inflammation of gingivae
can spread to alveolar bone (periodontitis)
Dento-alveolar abscesses may drain to oral cavity and lips
89
Scurvy
vit C deficiency --> ab collagen
Periodontal lig and Sharpey's fibers affected
Teeth loosen
Bleeding gums
90
Tonsillectomy
palatine tonsil removal
| due to: repeated infections (more than 5 in one year) or obstruction of oropharynx and airway
91
Adenoiditis
obstruct passage of air from nasal cavities --> choanae --> nasopharynx
infection can spread to tubal tonsils (closes aud tubes -- impair hearing)
92
Xerostomia
```
inability to produce saliva (dry mouth)
--drug induced
--n injury
Symptoms
--pain in salivary glands
--problems eating, swallowing, speaking, tasting
--fissuring of tongue and lips
--dental caries (saliva is protection)
--susceptibility to fungal infections
```
93
Mumps
```
inflammation of parotid gland due to myxovirus
spread via saliva
Symptoms
--swelling of parotid gland
--fever
--loss of appetite
--headache/earache
Can spread to other organs
--orchiditis
--pancreatisitis
--encephalitis
```
94
Cleft palate
```
congenital fissure b/w L and R sides of palate in midline
1/700 births
associated w/ cleft lip
difficulty suckling
inc risk of ear infections
```
95
Deviation of nasal septum
SEVERE: septum comes in contact w/ lateral wall of nasal cavity and obstructs breathing/ exacerbates snoring
--can be corrected surgically
96
Rhinitis
nasal mucosa becomes swollen and inflamed during I URI and allergic reactions
--swelling due to vascularity
97
Infections of nasal cavity can spread to...
```
ant cranial fossa via cribiform plate
nasopharynx and retropharyngeal soft tissues
middle ear via aud tube
paranasal sinuses
lacrimal apparatus and conjunctiva
```
98
Epistaxis
```
nosebleed
usually at Kiesselbach's area
associated w/ infection, hypertension, trauma
spurting: rupture of aa
mild: tear vv in vestibule
```
99
Sinusitis
infection spreads from nasal cavity --> paranasal sinuses
(panisinusitis -- many sinuses inflamed)
swollen mucosa may block openings of sinuses into nasal cavities
100
Infection of maxillary sinuses
Most commonly infected
Sinuses cannot drain until they are full if head is erect
Ostia of R and L sinuses on medial sides -- when lying on one side, only upper sinus drains
--tossing and turning to keep sinuses drained
101
Infection of ethmoidal cells
if nasal drainage blocked, infections of ethmoid cells can break through medial wall of orbit
- -blindness (near optic canal)
- -can affect dural nerve sheath of optic n --> optic neuritis
