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Flashcards in FINAL - Clinical Scenarios Deck (23)
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A 16 year old male presents to his physician’s office with an elongated cranial vault, narrow palate, and crowded teeth. The doctor orders a plain film radiograph. What common genetic condition is likely at fault?

no fucking clue


The health care facility where you work has recently had several cases of methicillin- resistant staph infections (MRSA). Your chief of operations insists that everyone on staff be screened. Where is this infection known to live dormant and how is testing accomplished?

Sphenoidal sinus. Giant Q-tip passed into sphenoidal sinus through nose.


Clinical Significance of Pterion

Weakest part of the skull.
Clinically, the pterion is relevant because the anterior division of the middle meningeal artery runs beneath it, on the inner side of the skull, which is quite thin at this point. The combination of both a vital artery in this area and the relatively thin bone structure has lent itself to the name "God's little joke" by some physicians.
A blow to the pterion (e.g. in boxing) may rupture the artery causing an extradural haematoma. The pterion may also fracture indirectly. Blows to the top or back of the head may not cause fracture at the site of impact, but may place sufficient force on the skull that its weakest part, the pterion, will fracture.


What is the blue bone at asterion?

no idea


A 9 year old girl’s teeth impact another girl’s skull during an aggressive game of tag, knocking out the 9 year old’s central left maxillary incisor. Which tooth did she lose?



A healthy, physically active, 37 year-old WU professor, Brian Kraatz (Department of Anatomy, COMP), was in the UAE in January, 2011, doing fieldwork (mammal paleontology). On the afternoon of the 14th, he and some colleagues climbed an 8-foot fence and hiked a ½ mile to a new locality. On the way back to their vehicle, Dr. Kraatz reported a sudden, sharp headache in the left frontal region. He then became unable to walk in a straight line, instead deviating to the left. His colleagues took him to the local ER, where as the evening progressed, he became nauseated, developed vertigo and lost the ability to stand unsupported. He also developed a visual impairment that left him unable to read without becoming dizzy and nauseated. He had no previous medical conditions and reported only a persistent and localized neck pain in the two previous weeks high up in his neck on the left side.

Subdural hematoma?????????????????


A young child presents to the ER with bruised eyes. What might explain the origin of the bruising? Where might you go next with this knowledge?



The leader of your study group shows up for a small group session and the left half of his face appears paralyzed. His smile is asymmetrical and his lower eyelid is drooping to the point his eye is incompletely closing. What common condition is he suffering from? What causes it? And how long does it last?




High vascularization of the mucosa. Especially inf. nasal concha.
Symptoms: stuff/runny nose/ postnasal drip
Triggers: environment, viral, alcohol, NSAIDs, high BP meds, sedatives, antidepressants, making babies control, decongestant nasal sprays, hormone changes.
Complications: nasal polyps, chronic sinusitis, middle ear infections
Treatments: nasal rinses, humidifiers, oral decongestants, saline or antibistamine or corticosteroid nasal sprays.



Acute: cold becoming bacterial infection, resolves within a month.
Chronic: allergies, pollutants, injuries, biofilms
Symptoms: Purulent rhinorrhea, nasal congestion, facial pain on palpation, fever, feeling of facial "fullness", aching teeth, halitosis, core throat/laryngitis (postnasal drip), ear pain
Treatment: anti-inflammatories, antibiotics, surgery
Complications: can be life-threatening.


Functional Endoscopic Sinus Surgery (FESS)

to correct chronic sinusitis. Enlarge natural drainage channels.


Transnasal Transsphenoidal surgery (TNTS)

Preferred method of removing pituitary tumors or cysts. Approach through sphenoid sinus = least traumatic route to hypophyseal (fossa), avoid brain retraction, provides excellent visualization of pituitary gland.


Acute Otitis Media

Infection with inflammation and effusion. Fluid builds up in middle ear, pressure on tympanic membrane.

Causes: viral, adenoid, OME (otitis media with effusion)

Symptoms: pain, fever, headache, clear fluid draining from external ear, dizziness, temporary hearing loss.

Treatment: antibiotics, myringotomy

Complications: ear drum rupture, hearing loss, mastoiditis, permanent damage to tympanic membrane.


Coalescent mastoiditis

Acute, with AOM association
Persistent mastoiditis --> rarifying osteitis; abscess forms

Causes: incompletely antibiotic treatment of AOM

Symptoms: pain behind ear, protrusion of ear, fever

Treatment: Mastoidectomy

Complications: Sigmoid sinus thrombosis; meningitis, abscesses, intratemporal involvement of VII and/or labyrinth (sensineuronal hearing loss).


VI lesion

loss of lateral rectus m. (out).

Symptoms: eye turned medially, diplopia (double vision).


IV lesion

loss of sup oblique m. (down & out).

Symptoms: affected eye is higher and deviated medially, very subtle, may also see head tilt away from affected side to counteract extorsion (from IO), diplopia.


III Lesion

oculomotor palsy.

loss of all but lateral rectus and sup oblique mm. (as well as sphincter pupillae and ciliary m).

Symptoms: eye directed downward and laterally, ptosis, pupilary dilation*, poor near focus*.


Blowout Fracture

(“blow out” orbital floor medial wall) most common, from impact with large, low velocity object.

Causes: blunt or penetrating trauma (sports, fights, or car accidents).

Symptoms: swelling, bruising, ocular trauma, diplopia (double vision), decreased movement of the eye (entrapment of extraocular mm), enophthalmos. Occasionally: pressure in orbit when blowing nose (communication with sinuses), facial anesthesia (impingement of infraorbital n).

Treatment: wait for swelling to subside, surgery for complex fractures, significant enophthalmos or entrapment of muscles.


Acute Angle-closure glaucoma

Causes: iris bulges forward through the sudden dilation of the pupils (darkness, stress, medication)

Symptoms: severe, sudden eye pain, nausea and vomiting, halos, blurred vision.

Treatments: medications, iridotomy (laser surgery creates a hole in the iris to allow drainage of aqueous)


Secondary glaucoma --> results in either of the types of glaucoma described:

Causes: eye injury, inflammation, tumor, diabetes, cataracts, steroids.


Lesion at III

Dilated pupil/near focus problems = absence of pupil constriction


Lesion: SCG (short ciliary ganglion?)

Constricted pupil (miosis) = absence of pupil dilation


Lesion: V1

Loss of corneal touch reflex.