PBL - Patient With Facial Incised Wound

Question 1

What are the main vessels which supply the face?

Answer 1

Facial artery

Superficial temporal artery

Question 2

Where does the facial artery arise from?

Answer 2

External carotid

Question 3

Where does the facial artery cross onto the face?

Answer 3

Crosses lower border of mandible 2.5cm in front of the angle of the mandible.

Question 4

Where in the face are the best facial artery anastomoses?

Answer 4

By the superior and inferior labile branches - makes a vascular ring within the tissues of the lips

Question 5

Where does the superficial temporal artery arise from?

Answer 5

The maxillary branch of the external carotid

Question 6

What is the path of the superficial temporal artery?

Answer 6

Runs upwards from the neck, immediately in front of the tragus of the ear, where is can be felt

Question 7

Describe the venous drainage of the face.

Answer 7

Main veins are paired with arteries and drain to the internal jugular vein

Question 8

Which salivary gland is the largest?

Answer 8

Parotid gland

Question 9

Which important vessels are found within the parotid gland?

Answer 9

Facial nerve and branches
Where the external carotid artery branches to superficial temporal artey
Reteromandibular vein

Question 10

How long it the parotid duct?

Answer 10

5cm long

Question 11

What is the nervous supply of the parotid gland?

Answer 11

Parasympathetic nerves stimulate secretion

Effected by impulses that run in the CNXI, and then the CNVIII branch

Question 12

Where is the submandibular gland located?

Answer 12

Between the lower surface of the mandible and myohyoid muscle

Question 13

Where does the submandibular duct open in the mouth?

Answer 13

Beside the frenulum of the tongue

Question 14

Which gland is the closest to the oral cavity?

Answer 14

Sublingual gland

Question 15

How does the sublingual gland pass its secretions into the mouth?

Answer 15

Through a dozen minute ducts

• some open straight into the floor
• others open into submandibular duct

Question 16

What kind of cells are found in the acinus of the salivary glands?

Answer 16

Serous cells

Mucous cells

Question 17

What kind of cells have processes that extend over the outer surface of the acini?

Answer 17

Myoepthielial cells?

Question 18

List functions of saliva.

Answer 18

Facilitates swallowing
Helps speech
Contains alpha-amylase 
Contains IgA
Contains lysozyme

Question 19

How much of total secretions from the salivary glands does each one provide?

Answer 19

Parotid - 25%
Submandibular - 70%
Sublingual - 5%

Question 20

How is the isotonic fluid (the primary secretion) formed in the acinar cells of the salivary glands?

Answer 20

Active transport of electrolytes followed by passive movement of water

Question 21

What aquaporin channels are found in salivary acinar cells?

Answer 21

AQ5

Question 22

How does secondary modification of salivary fluid occur?

Answer 22

Ion transport pumps are in the epithelial cells lining the ducts.
Sodium and chloride are reabsorbed and potassium and bicarbonate are secreted

Question 23

What osmolality is the final salivary secretion compared to plasma?

Answer 23

Hypotonic

Question 24

If flow rate of secretion increases, what happens to the ionic concentration of sailiva?

Answer 24

It increases in sodium, chloride and bicarbonate concentration, and decreases in potassium.

Question 25

What can form is the parotid duct is damaged?

Answer 25

Salivary mucocele | - a collection of salivary leaked from a damaged salivary duct or gland

Question 26

What does a salivary mucocele look like?

Answer 26

A blue/transleuent swelling just under the lining of the mouth

Question 27

Where does the facial nerve originate?

Answer 27

Between the pons and the medulla

Question 28

What is the intermediate nerve of the facial nerve?

Answer 28

Contains special afferent fibres for taste

Question 29

Where does the facial nerve leave the cranial fossa?

Answer 29

The internal acoustic meatus

Question 30

Where do the two facial nerve roots fuse?

Answer 30

Petrous part of the temporal bone

Question 31

Which nerve is given off from the facial at the geniculate ganglion?

Answer 31

Greater petrosal nerve - carries mainly preganglionic parasympathetic fibres

Question 32

Which other nerves does the facial nerve give off before it exits the stylomastoid foramen?

Answer 32

Stapedius nerve | Chorda tympani

Question 33

What are the five terminal groups of branches of the facial nerve?

Answer 33

``` Temporal Zygomatic Buccal Marginal mandibular Cervical ```

Question 34

How is the facial nerve tested for clinically?

Answer 34

Ask patient to smile - check symmetry Ask patient to screw up eyes, and you gently try to pull them open - should resist Ask patient to raise eyebrows - check symmetry

Question 35

What are the three theoretical models of the violence reduction unit?

Answer 35

Typology of Violence Public heath approach Ecological framework

Question 36

In which four modes can violence be inflicted?

Answer 36

Physical Sexual Psychological attack Deprivation

Question 37

Physical violence can be broken down into three sub-types.

Answer 37

Self-directed harm Intrapersonal violence Collective violence

Question 38

Intrapersonal violence can be broken down into two more subtypes.

Answer 38

``` Family - child - partner - elder Community - acquaintance - stranger ```

Question 39

How is the public health approach to violence started?

Answer 39

Addressing the underlying risk factors that increase risk of someone becoming a victim or perpetrator of harm

Question 40

What are the four steps of the public heath approach to violence?

Answer 40

Define problem Establish why violence occurs using research Find out what works to prevent violence Implement effective and promising interventions

Question 41

What are possible reasons on an individual level for someone to perpetrate violence?

Answer 41

``` Personal history Biological factors Victim of child maltreatment Psychological disorders Alcohol/substance abuse History of violence ```

Question 42

What are possible reasons on a societal level for someone to perpetrate violence?

Answer 42

``` Economic policies Weapon availability Social and cultural norms - dominance over women - dominance over children - endorsement of violence ```