Session 8 Flashcards
(38 cards)
The image below is a coronal section through the primary motor cortex. Which area of the primary motor cortex is responsible for conscious control of left half of the face and arm?
slide 2 lec 1
panopto
A 52 year old man presents to the Emergency Department with a unilateral facial droop which he noted on first waking. He is concerned that he is having a stroke. The doctor takes a brief history before examining him and reassures him that his symptoms are not due to a stroke. The doctor diagnoses a facial nerve palsy What muscle(s) is affected to account for the appearance here? What muscle(s) is affected to account for the appearance here? slide 4 lec 1
panopto
Muscles of facial expression are innervated by the facial nerve. What other functions are carried by this nerve?
panopto
What might the doctor have asked the patient to do to test the integrity of the facial nerve?
panopto
Why might the doctor examine the parotid gland in a patient presenting with a facial nerve palsy?
panopto
What are the three branches of the facial nerve that arise within the petrous temporal bone?
panop
Why might a patient with a facial nerve lesion complain of sensitivity to loud noises (hyperacusis)?
pan
Give two reasons why the patient’s eye might be at risk of drying and injury as a result of a facial nerve lesion? How could this be managed?
lecture
What is the corneal reflex? Describe the afferent and efferent limb of this reflex.
slide 10 lec 1
g
Why might the doctor also want to examine the ear more closely? after looking at the corneal reflex
csdns
A 65 year old man attends the GP with a 1 month history of ear pain (otalgia). He describes it as an ache. He has no symptoms suggestive of recent infection, and his hearing remains unchanged. The doctor examines the ear, including otoscopic examination, which is normal
Name three conditions involving structures or areas of the ear that can present with otolagia (i.e. otological causes of ear pain)
po
A 65 year old man attends the GP with a 1 month history of ear pain (otalgia). He describes it as an ache. He has no symptoms suggestive of recent infection, and his hearing remains unchanged. The doctor examines the ear, including otoscopic examination, which is normal.
The doctor is concerned that the otalgia may be non-otological given examination of the ear is normal; that is the pain is referred pain to the ear due to pathology somewhere else.
Which nerves are involved in innervating structures of the external and middle ear (those carrying general sensory afferents)?
p
A 65 year old man attends the GP with a 1 month history of ear pain (otalgia). He describes it as an ache. He has no symptoms suggestive of recent infection, and his hearing remains unchanged. The doctor examines the ear, including otoscopic examination, which is normal.
The doctor is concerned that the otalgia may be non-otological given examination of the ear is normal; that is the pain is referred pain to the ear due to pathology somewhere else.
To explore a potential cause for referred pain to the ear the presence of pathology in which other areas of the head and neck should be determined (through history and examination)?
lec
A 65 year old man attends the GP with a 1 month history of ear pain (otalgia). He describes it as an ache. He has no symptoms suggestive of recent infection, and his hearing remains unchanged. The doctor examines the ear, including otoscopic examination, which is normal.
The doctor is concerned that the otalgia may be non-otological given examination of the ear is normal; that is the pain is referred pain to the ear due to pathology somewhere else.
The doctor enquires about the presence of ‘red flags’ and also examines the oropharynx and palpates for cervical lymphadenopathy.
What are ‘red flags’ and what might these have been in this patient’s case?
lo
A 65 year old man attends the GP with a 1 month history of ear pain (otalgia). He describes it as an ache. He has no symptoms suggestive of recent infection, and his hearing remains unchanged. The doctor examines the ear, including otoscopic examination, which is normal.
The doctor is concerned that the otalgia may be non-otological given examination of the ear is normal; that is the pain is referred pain to the ear due to pathology somewhere else.
The doctor enquires about the presence of ‘red flags’ and also examines the oropharynx and palpates for cervical lymphadenopathy.
Why did the doctor examine the oropharynx and palpate for cervical lymphadenopathy?
l
A 65 year old man attends the GP with a 1 month history of ear pain (otalgia). He describes it as an ache. He has no symptoms suggestive of recent infection, and his hearing remains unchanged. The doctor examines the ear, including otoscopic examination, which is normal.
The doctor is concerned that the otalgia may be non-otological given examination of the ear is normal; that is the pain is referred pain to the ear due to pathology somewhere else.
The doctor enquires about the presence of ‘red flags’ and also examines the oropharynx and palpates for cervical lymphadenopathy.
On examination of the cervical lymph nodes the doctor palpates and enlarged deep cervical lymph node. The features from palpation of the enlarged node are indicative of likely metastatic involvement.
What features on palpation of a lymph node would be indicative of metastatic involvement?
lectur
A 65 year old man attends the GP with a 1 month history of ear pain (otalgia). He describes it as an ache. He has no symptoms suggestive of recent infection, and his hearing remains unchanged. The doctor examines the ear, including otoscopic examination, which is normal.
The doctor is concerned that the otalgia may be non-otological given examination of the ear is normal; that is the pain is referred pain to the ear due to pathology somewhere else.
The doctor enquires about the presence of ‘red flags’ and also examines the oropharynx and palpates for cervical lymphadenopathy.
On examination of the cervical lymph nodes the doctor palpates and enlarged deep cervical lymph node. The features from palpation of the enlarged node are indicative of likely metastatic involvement.
What do you think could be the underlying diagnosis and what would be the appropriate next step for the GP to take in managing this patient?
k
A 3 year old girl is brought to her GP by her dad. Her dad is concerned that his daughter is unwell. Over the last few days she has been running a high fever, has had a runny nose and yesterday started pulling at her ear and complaining that it was sore. On otoscopic examination, the doctor sees the following.
insert image from slide 18 lec 1
1.What is the likely diagnosis?
2. What features in the girl’s history and examination of the tympanic membrane led you to your diagnosis?
3. Why is this condition more common in young children than in adults (your answer should refer to the anatomy of the ear)?
4. What are the most common pathogens involved in causing this type of infection?
pani
A 3 year old girl is brought to her GP by her dad. Her dad is concerned that his daughter is unwell. Over the last few days she has been running a high fever, has had a runny nose and yesterday started pulling at her ear and complaining that it was sore. On otoscopic examination, the doctor sees the following.
insert image from slide 18
Two days later the dad returns to the GP concerned that his daughter is more unwell, and seems quite lethargic. On examination the doctor notes that the right ear now appears pushed forward and the area behind the ear is red, swollen and tender. insert slide 21
5. What condition has now developed?
6. Explain, with reference to the anatomy of the ear, how the original infection was able to spread leading to the condition seen in the above image?
7. How should the GP manage the girl?
8. Name two other anatomical structures within the skull, which can (in any patient) be affected by the spread of infection from the middle ear.
pan
Motor function of tongue
Intrinsic muscles • 4 paired muscles • Motor innervation (hypoglossal nerve)
Extrinsic muscles • Genioglossus • Hypoglossus • Styloglossus • Motor innervation (hypoglossal nerve) • Palatoglossus • Motor innervation (Vagus nerve)
insert slide 4 lc 2
sensory function of tongue
Divide tongue into • Anterior 2/3 • Sensation –trigeminal (V3) • Taste -facial • Posterior 1/3 • Sensation and taste- glossopharyngeal
slide 5 lec 2
Salivary glands submandibular
slide 6 lec 2
Salivary glands -Parotid
slide 7 lec 2
Salivary glands -Sublingual
Only produce 3-5% of saliva • Smallest and most diffuse of the major salivary glands • 8-20 excretory ducts per gland
slide 8 lec 2
