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ESA4 > Disorders of the Head and Neck > Flashcards

Disorders of the Head and Neck Flashcards

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1
Q

What does a CN III Nerve Palsy do?

Causes?

A

“Down and Out” Eyeball, Ptosis, Blown Pupil

Increase of intracranial pressure -> Compresses
Aneurysm
Cavernous Sinus Trauma

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2
Q

What does a CN IV Palsy do?

Causes?

A

Can’t look “Down and In”, Double Vision, Head Tilt

Congenital Palsy
Diabetic Neuropathy
Thrombophelbitis of Cavernous Sinus
Increase in intracranial pressure

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3
Q

What does a CN VI Palsy do?

Causes

A

Can’t look laterally, medially rotated eye and diplopia

Any increase in downwards pressure
ICA Atherosclerosis in CS

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4
Q

What are the Common Problems with the Orbit?

A 
Cranial Nerve Palsy
Fractures
Mass Lesions
Cellulitis
Thyroid Eye Disease
Glaucoma
Retinal Detachment and Abrasion
Cataracts
Papilloedema
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5
Q

What are the 2 Types of Orbital Fractures?

A

Rim - Fracture of a bone on the rim, happens at the suture join of the Maxilla, Zygomatic and Frontal bones

“Blowout” Fracture - Most common in Maxillary as it’s weak. Herniates into the Maxillary Sinus. Can be Medial or through the Floor

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6
Q

What does an Orbital Fracture Cause?

A

Increase intraorbital pressure
Exophthalmos
Haemorrhage into Sinuses (Blowout)

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7
Q

What are some symptoms of Orbital Fractures?

A 
Lid Swelling
Pain
Diplopia
Reduced Vision or Eye Movements
Trauma
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8
Q

What are the 2 Types of “Blowout” Fracture?

A

1) Medial - Ethmoid, Rarely Isolated, Horizontal Diplopia and Surgical Emphysema
2) Floor- Maxilla, Weak, Goes into the Sinus. Causes Vertical Diplopia

Can also get Lateral -> Zygomatic Arch

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9
Q

What is Thyroid Eye Disease?

Signs and Symptoms?

A

Organ-Specific Autoimmune disease

Symptoms: Redness, Irritation of Eye and Diplopia

Signs: Proptosis, Lid Retraction and Lag, Restrictive Myopathy, Optic Neuropathy

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10
Q

What is Orbital Cellulitis?

A

Inflammation of the Eyelids
Pain, Fever
Restricted Movement, Vision and Colour, RAPD
Sticky Discharge, Proptosis

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11
Q

What causes Orbital Mass Lesions?

A

Inflammation
Cysts
Vascular
Metastatic Mass

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12
Q

What is an Orbital Mass Lesion?

A

Any swelling in and around the orbit

Can present with pain, inflammation and diplopia

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13
Q

What is a Cataract?

Causes?

A

Lens becoming Opaque, develops slowly and with old age
Lens is flatter and harder so it can’t focus

Age, Diabetes, Smoking, Steroids

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14
Q

What is Open-Angle Glaucoma?

A

Increase in intraoccular pressure due to an increase in aqueous humour
Due to a blockage in the trabecular network
Increases the angle between the corneo and cris (pushes into vitreous humour)

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15
Q

What can Open-Angle Glaucoma cause?

A

Optic Nerve damage
Compression of Retinal Arteries
Lose Peripheral Vision

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16
Q

What is Papilloedema?

A

Swelling of the Optic Disc due to increased intracranial pressure
High Pressure -> No venous return = fluid retention = swollen disc
Compression -> Visual Impairment

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17
Q

What is Retinal Detachment?

A

Trauma to the eye causes the neural and pigmented layers to seperate

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18
Q

What is Corneal Abrasion?

A

Dirt/Particles cause Lacerations

If the sensory supply (V3) is damaged, the Patient may not notice the abrasion

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19
Q

What is Conjunctivitis?

A

Inflammation of the Conjunctiva (thin film on sclera)
Infection and Allergy
Contagious, “Red-Eye”, Dischange

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20
Q

What is a Meibomian Cyst?

A

Infection of Tarsal Glands
Non-painful swelling
Not Serious

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21
Q

What is a Sty?

A

Infection of the Ciliary Glands
Normally caused by Staphyloccus
Can be Severe, Antibiotics

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22
Q

What happens in Central Vessel Occlusion?
Artery
Vein

A

Artery- Retina is pale, Macula dark

  • Occurs in Old, usually due to embolus
  • Instant and Total Blindness

Vein - Slow, Painless loss of Sight

  • Caused by Thrombophlebitis, dehydration
  • See “Stormy Sunsets” of Engorged Veins
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23
Q

Describe Otitis Media

A

Infection of the Middle Ear, could be from the Eustachian Tube
Forces the Tympanic Membrane to retract so cannot see outline of Malleus any more

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24
Q

Describe Otitis Media with Effusion

A

Draws Transudate into the Middle Ear
“Glue Ear”
Fix with Grommits
Problem with Eustachian tube = Negative Pressure

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25
What is BPPV?
Benign Positional Paradoxical Vertigo | There is Otolith which is displaced and keeps moving after the head has stopped so vertigo symptoms
26
What is Mastoiditis?
Inflammation of the Mastoid Air Cells/Cavity Due to increased back pressure Swelling behind the ear, lose creases of pinna Can spread to Middle Cranial Fossa and cause Meningitis Death!
27
Describe Perforation of the Tympanic Membrane
Central or Subtotal Can be 2ndary to Infection (Pressure Necrosis) Trauma
28
What are some congenital defects that you can get of the Pinna?
Pre-auricular Skin Tags Pinna Malform (Microtia) Antihelix Deformity
29
Describe Cholesteatoma
When there is Negative Middle Ear Pressure = Pockets/Recesses Collection of Necrotic Epithelial Cells Can erode Ossicles/Ear from lytic enzymes
30
What is a Pinnal Haematoma
When blood accumulates between the cartilage and perichondrium of the bone It strips the layers away from each other Causes pressure necrosis
31
What is Cauliflower Ear
Due to Haematoma Not Drained Necrosis causes Cauliflower Shape
32
Describe Otitis Externa
``` Cellulitis of External Ear Inflamed, Red, Swollen "Swimmers Ear" Staph aureus or Pseudomonas a. Candida albicans, Aspergillus ```
33
What can cause a retraction of the tympanic membrane? General and Specific Conditions
Otitis Media (+ Effusion) Infections Ruptured Membrane Eustachian Tube Dysfunction Generally: Weak Membrane or Negative Pressure
34
What can cause damage to the Facial Nerve?
Any Middle Ear Disease | Compression of Facial Canal
35
How would you notice a problem with the Chorda tympani?
Loss of taste of 2/3 of the anterior tongue
36
What can cause a fracture of the Ossicles?
Trauma Loud Noise (Blast Injuries) Cholesteatoma Causes sudden hearing loss
37
What is Menier's Disease?
Low Pitch Tinnitus Vertigo Hearing Loss Endolymphatic Hydrops distend the ducts High Pressure damages ear membranes
38
What are the regions most succeptible to Epistaxis?
Kiesselbachs Plexus | Sphenopalatine (lots of blood lost)
39
What can cause Anosmia?
Damage/Inflammation in Cribriform Plate Tumour in the Olfactory Groove Tumour in Frontal Lobe/Meninges/ACF can compress the bulb Olfactory Nerve Damage Infection Neurodegenerative Disease
40
What is a Septal Haematoma?
When there is a haematoma between the septal cartilage and pericondrium
41
Why is the nose so succeptable to fracture?
As it sticks out from the face (it's prominent) | Trauma often in Sport
42
Sinusitis
inflammation of the mucosal lining of the sinuses, which is continuous with the vestibule of the nose
43
How can infection of the Frontal Sinus spread to the Maxillary Sinus?
As they both open up at the hiatus semilunaris | Frontal is above Maxillary so fluid can go down it
44
What is a Saddle deformity
When damage causes the septum (cartilage or bone) to collapse as structural support is lost
45
What is Rhinitis?
Inflammation of the mucosal lining of the nasal cavity Allergic Viral Bacterial
46
What are Polyps?
Polypoidal masses from the Mucosa | Non-Tender and Moveable
47
How can infection spread from the nasal cavity to the middle ear?
Via the Eustachian Tube
48
How can infection spread from the nasal cavity to the Middle Cranial Fossa?
Via the Frontal Sinus (as the posterior wall is very thin)
49
What is Treacher Collins Syndrome?
Rare, Autosomal Dominant Disorder Failure of Neural Crest Cells to invade the 1st Arch Results in Hypoplasia of Maxilla, Mandible and Zygomatic arches Ear and Palate developmental defects
50
What is DiGeorge Syndrome? | CATCH 22?
``` Failure of the development of the Pharyngeal Pouches 3 and 4 Cardiac Problems Abnormal Facies Thymic Aplasia Cleft Palate Hypocalcaemia (Chromosome) 22 Deletion ```
51
What is Bell's Palsy?
Palsy of Facial Nerve, From Swelling of the Nerve Usually Unilateral Paralysis of Facial Muscles of Expression If Extra-cranial, only Motor is affected If Intracranial, can also affect salivation, taste, hearing and tear production
52
What is Harlequin Syndrome?
Asymmetric sweating and flushing of the chest, face and neck Caused by damage to pre-ganglionic sympathetic neurons of the Ciliary Ganglion, at the level of the thoracic cord
53
What is Trigeminal Neuralgia?
A Chronic Pain Disorder, where the Trigeminal Nerve is extremely sensitive, thought to be due to compression by enlarged nearby blood vessel Normally affects V2 and V3 Gives episodes of extreme pain
54
How can a Varicella Zoster infection affect the Head and Neck?
As it remains dormant in the dorsal root ganglia, and also most commonly affects the Trigeminal Nerve, especially CN V1 Produces a Rash, Conjunctivitis, Optic Nerve Palsy/Vision Loss, Pain and Inflammation
55
How can Herpes affect the Head and Neck?
Can cause Bell's Palsy
56
What is Horner's Syndrome?
Damage to the Sympathetic Trunk | Get decreased sweating (anhydrosis), miosis, ptosis and sunken eyeball on the same side as the lesion
57
What does RAPD mean? | When does it appear?
Relative Afferent Pupillary Defect | When Pupil constricts less when a bright light is shone from unaffected eye to the affected eye
58
Give some Inflammatory examples of Orbital Mass Lesions | Describe them briefly:
Wegener's Granulomatosis - Vasculitis Dacryoadenitis - Inflammation of the Lacrimal Glands Pseudotumour- Idiopathic Condition, involving extra-ocular muscles Rapid Onset, Unilateral, Painful Proptosis and Diplopia
59
Give some Vascular examples of Orbital Mass Lesions | Describe them briefly:
``` Capillary Haemangioma: Infants, most common orbital tumour of infancy It is a Neoplasm Subcutaneous Mass Known as a "strawberry haemangioma" ``` Cavernous Haemangioma: Most Common Vascular Lesion in Adults Slow Flow Venous Malformations Normally results in Proptosis, Can have Diplopia and Visual Field Defects
60
What is Fetal Alcohol Syndrome? Signs? Incidence?
When the development of a foetus has been affected by maternal drinking during pregnancy It affects brain development and neural crest cell migration It occurs in 1/100 births Flat Midface Less prominent Philtrum and Thin Upper Lip Small Nose and Nasal Bridge Small Palpebral Fissure
61
What are the types of Cleft Lip and Palate?
Unilateral Cleft Lip (can involve primary palate) Bilateral Cleft Lip Isolated Cleft Palate Combined Cleft Lip and Palate
62
What is a Branchial Cyst?
When the 2nd Pharyngeal Cleft fails to grow over the other Pharyngeal Arches
63
What isn't usually affected by Bell's Palsy?
The Forehead Muscles | As it has Bilateral Innervation
64
What are some causes of Bell's Palsy? | Bilateral?
Intracranial: Middle Ear Pathology ``` Extracranial: Parotid Gland Pathology Nerve Infection (Herpes Virus) Forceps Delivery Idiopathic ``` Parkinsons
65
What is Epistaxis?
A Nose Bleed
66
Where does Epistaxis occur?
90% in Kiesselbachs Plexus, where the arteries anastomose on the septum, also known as Little's Area 10% Other areas, more problematic as they tend to be harder to reach areas Sphenopalatine (Problems with Warfarin, High Pressure)
67
What are some Risks for Epistaxis
``` Trauma Coagulation Defects Vascular Abnormalities NSAIDs - Ibuprofen, Asprin Warfarin Tumours Granulomas Mucosal Drying EToH (Alcohol) Infections ```
68
How do you Manage Epistaxis? | The 5 steps and the last resorts
1) Compression and Hypocratic Position for 20 mins 2) Try Again 3) Cautery (Silver Nitrate or Electo) 4) Anterior Packing + Bolster (24-48 hours) 5) Posterior Packing Surgical Ligation - Sphenopalatine, Maxillary or ECA Radiological Embolism
69
What tests do you do when investigating an Epistaxis?
Blood Test- Coagulation, Hb Count, INR (Clotting Time) Blood Pressure Heart Rate Capillary Refill (Shock)
70
What is 1st arch syndrome?
Failure of Neural Crest Cells to migrate into the 1st arch | Can cause facial anomolies
71
What is CHARGE syndrome?
Mtuation of Chromosome 7 Affects NCC production ``` Coloboma Heart Defects Atresia of Choana Retardation Genital Hypoplasia Ear Defects ```
72
Describe Adenoid Hypertrophy
Hypertrophy of the Adenoid Tonsils Can block the Eustachian tube- deafness and infections Can obstruct the nasal cavity
73
Describe Tonsillitis
Inflammation of the Palatine Tonsils Most common viral and bacterial (Streptococcus) Fever, Pain, Chills, Headaches
74
What is a Pharyngeal Pouch?
A true diverticulum | Part of the pharynx herniates through Killian's dehiscence
75
What can happen in the Piriform Fossa?
Malignancy | Foreign Bodies
76
What kind of cancers occur in the Larynx?
Most squamous cell carcinoma | Poorer Prognosis the further you go down
77
What kind of cancers occur in the laryngopharynx?
Piriform Fossa
78
Describe Ectopic Thyroid Tissue
Can occur anywhere on path of descent Tongue is the most common site (lingual thyroid) May be functional Gives dyspnoea, dysphagia and dysphonia
79
What is a thyroglossal cyst?
A remnant of the thryoglossal duct
80
What is CSF Rhinorrhoea?
Damage to the cribriform plate, causes tearing of the meningeal layers, causing CSF to leak from the nose
81
What can affect the Optic Nerve? | Think brain and nearby structures
Demyelination by CNS Dieases e.g. Multiple Sclerosis Pituitary Tumours
82
What can cause damage to CN III?
Compression Increase in intracranial pressure, compresses against petrous part (affects ANS first) Aneurysm of the Superior/Posterior Cerebral Artery Cavernous Sinus Infection
83
Why can the trochlear nerve be affected easily?
As it has a very long course can be damaged in head injuries But is rarely affected on its own General increase in intracranial pressure Goes through the cavernous sinus
84
What can go wrong with the Vestibulocochlear nerve?
Sensorineural Deafness - Cochlear disease of anywhere in its path to the brain Vertigo Acoustic Neuroma
85
What is Acoustic Neuroma? | What does it cause?
A neurofibroma- a slow growing tumour of Schwann cells Occurs to CNVIII in the IAM or the cerebellopontine angle so it also affects the facial nerve Get hearing loss, tinnitus etc
86
What can damage to CN X cause?
``` Dysphagia - injure pharyngeal branches Superior Laryngeal - Upper anaesthetic, weak voice Recurrent Laryngeal: One-side- hard to speak, hoarse Two-sided- lose voice, stridor ```
87
What can damage the recurrent laryngeal nerve?
Aneurysm of the Arch of the Aorta Neck Operations Malignancy of Larynx, Thryoid Apical Lung Tumour
88
Why can bleeding from the scalp track into the orbit and cause a black eye? Why not go into neck or laterally?
As the aponeurosis of the scalp of occipitofrontalis only connects into the skin and connective tissue and not the bone, as it does in other directions, anteriorly Occipital --> Occipital bone and mastoid process (not into neck) Epicranial Aponeurosis is continuous with temporal fascia (lateral) Therefore bleeding in the loose connective tissue layer/under the aponeurosis can go into the nasal bridge and around the orbit

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