test 1 Flashcards
(120 cards)
1
Q
rhinorrhea, otorrhea are due to what type of fracture
A
Basilar fracture
2
Q
most frequent skull fracture
A
linear calivarial, occurs at POI, fracture lines radiate away in multiple directions
3
Q
life threatening skull fracture
A
Fracture of the pterion
4
Q
Extradural/epidural hemorrhage
A
rupture of the middle meningeal artery due to fracture of the pterion
5
Q
order of events of a Extradural/epidural hemorrhage
A
Brief concussion → lucid interval of some hours → drowsiness and coma
6
Q
Tearing of superior cerebral vein causes
A
Dural border/subdural hematoma
7
Q
order of events for a Dural border/subdural hematoma
A
Tearing of superior cerebral vein → blood leaks → hematoma splits open dural border cell layer → creates a space at the dura arachnoid junction
8
Q
Subarachnoid hemorrhage
A
Rupture of saccular aneurysm → Arterial blood escapes to subarachnoid space
9
Q
Meningeal irritation/headache/stiff neck/loss of consciousness
A
symptoms of Subarachnoid hemorrhage
10
Q
how do scalp injuries and infection enter the brain
A
Emissary veins pass through calvaria and reach intracranial structures such as the meninges
11
Q
limitations of the spread of scalp infections
A
Can NOT pass laterally beyond zygomatic arches, Can NOT pass through neck
12
Q
Ecchymoses
A
(purple patches) results of extravasation of blood into subcutaneous tissue and skin of eyelids and surrounding regions
13
Q
SCALP
A
skin, connective tissue, aponeurosis, loose connective tissue, perostium
14
Q
what nerves and vessels are in the cavernous sinus
A
occulomotor , trochlear, abducens, ophthalmic and maxillary. Internal Carotid Artery
15
Q
eyeball protrudes (exophthalmos) conjunctiva becomes engorged (chemosis) pulsating exophthalmos are cased by what?
A
Cranial base fracture tear in the internal carotid artery leading to Arteriovenous (AV) fistula within cavernous sinus
16
Q
thrombophlebitis of cavernous sinus and Arteriovenous (AV) fistula can affect what nerves
A
CN III, IV, V1, V2, VI
17
Q
what procedure can cause dural headache
A
lumbar spinal puncture
18
Q
pain due to distension of scalp or meningeal vessels
A
dural headache
19
Q
Bruising occurs due to impact of moving brain/cranium → loss of consciousness
A
cerebral contusion
20
Q
○ Brain trauma → pia stripped/torn from brain surface → blood enter subarachnoid space
A
cerebral contusion
21
Q
Associated w/ depressed cranial fractures/gunshot wounds
A
cerebral lasceration
22
Q
Ruptures of blood vessels and bleeding into brain and subarachnoid space → increased intracranial pressure and cerebral compression
A
cerebral lasceration
23
Q
Cerebral compression produced by
A
○ Intracranial collections of blood
○ Obstruction of CS circulation/absorption
○ Intracranial tumors/abscesses
○ Brain edema due to increased water/sodium
24
Q
Overproduction of CSF or an obstruction of flow/interference of absorption
A
hydrochephalus
25
(Otorrhea) and meninges superior to middle ear torn/tympanic membrane ruptured caused by
Fractures in floor of middle cranial fossa
26
(Rhinorrhea), Involves cribriform plate of ethmoid bone
fractures in the floor of the anterior cranial fossa
27
increase risk of meningitis due to
Rhinorrhea and otorrhea due to cranial floor fractures can cause Infection from ear/nose can transfer to the meninges
28
Sudden development of neurological deficits due to lack of blood to the brain
Ischemic stroke
29
common causes of Ischemic stroke
```
CVA (cerebrovascular accidents
■ Cerebral embolism
■ Cerebral thrombosis
■ Cerebral hemorrhage
■ Subarachnoid hemorrhage
```
30
Saccular aneurysm/Rupture of artery can cause
Hemorrhagic stroke
31
Most common saccular aneurysm
Berry aneurysm = saccular aneurysm near Circle of Willis
32
Over time and w/ high BP can cause
Berry aneurym
33
Mini stroke” temporary clot that will go away
Transient Ischemic Attacks (TIA)
34
why do facial injuries gape widely
very loose subQ connective tissue and no deep fascia
35
Central lower lip, floor of mouth, apex tongue drains to where?
submental lymph node
36
Lateral lower lip drain to
submandibular lymph nodes
37
Trigeminal Neuralgia (tic douloureux)
Disorder of CN V sensory root
| Sensitive “trigger zone”→ paroxysm (sudden sharp pain) that can last 15 min or more
38
a way to relieve Trigeminal Neuralgia
remove blood vessels that may be putting pressure on sensory part of CN V
39
```
Face (minus angle of mandible)
Cornea and conjunctiva
Anterior half of scalp
Mucous membranes of nose and paranasal sinus, mouth, anterior tongue
Paralysis of muscles of mastication
```
Legions (damage) of Trigeminal Nerve (CN V) cause wide spread anesthesia to.. (FCAMP)
40
Bells Palsy
injury to facial nerve and branches causing ○ Paralysis some/all facial muscles
41
○ Orbicularis oculi paralysis
■ Eversion of inferior eyelid → lacrimal fluid unable to lubricate/hydrate/flush cornea → infection/ulcer
■ Tears drip
Bells Palsy
42
○ Buccinator/ orbicularis oris paralysis
■ Food stuck in mouth/drooping of corner/saliva food drip
○ Lip muscle paralysis
■ Affect speech, can’t whistle/blow wind instrument
bells palsy
43
Mumps can cause infection of
parotid gland
44
Redness of parotid papillae where duct opens into the mouth opposite the second maxillary molar tooth
inflammation of partotid duct
45
makes up 80% of salivary gland tumors
parotid gland tumors
46
what is imbeded in partotid gland plexus
CN VII (Facial)
47
Intraorbital bleeding
exophthalmus
48
paralysis of levator palpebrae superioris, causes superior eyelid to droop (ptosis)
lesion of CN III
49
where can a Tumor in middle cranial fossa travel?
Enter orbital cavity through superior orbital fissure
50
damage to CN VII
paralysis of orbicularis oculi
| prevents eyelids from closing fully
51
Ducts of ciliary glands become obstructed
red pus producing sty on eyelid
52
Chalazia
cyst of sebaceous glands of the eyelids
53
seepage of fluid b/w neural and pigmented layers of retina
detached retinal
54
how does a detached retina effect vision
Straight lines will look wavy/crooked
55
Increase in Cerebral Spinal Fluid slows venous return from the retina and causes edema of retina
Papilledema
56
lenses become harder and flatter with age
presbyopia
57
cataracts
cloudiness/loss of transparency of lens from areas of opaqueness
58
Outflow of aqueous humor slower than aqueous is produced causing retinal compression
glaucoma
59
Sensory damage to CN V1
can damage corneal needing transplant
60
no corneal reflex are indicative of lesions on which CN?
lesion of CN V1 and CN VII
61
Sign of compression of the CN III
ipsilateral slowness of the pupillary light reflex
62
Eyelid can not be raised
Pupil dilated and nonreactive due to unopposed dilator pupillae
Down and out (abducted and depressed) due to unopposed LR6 SO4
symptoms of Oculomotor Nerve Palsy
63
Anesthetizes auriculotemporal, inferior alveolar, lingual, and buccal branches of mandibular nerve
Mandibular nerve block
64
All mandibular teeth are anesthetized, skin and mucous of lower lip, labial alveolar mucosa and gingiva and skin of chin as well since they are supplied by mental branch of this nerve
Inferior alveolar nerve block
65
head of mandible can dislocate anteriorly by passing anterior to the articular tubercles now unable to close mouth
Dislocation of Temporomandibular Joint
66
Malignant tumors of the posterior part of the tongue metastasize which lymph nodes
superior deep cervical lymph nodes
67
paralysis of this muscle causes complete relaxation of the tongue causing posterior shift which can cause suffocation
Paralysis of Genioglossus
68
Trauma to the hypoglossal nerve results in
paralysis and atrophy of one side of the tongue. Protrusion of the tongue will fall to paralyzed side.
69
Nerves involved in Gag Reflex
CN 9 (afferent and muscle) CN 10 (muscle contraction)
70
Infection from ear/nose can transfer to the meninges
Middle and Anterior Cranial fossa fractures
71
Epistaxis (nosebleed)
most cases due to trauma
comes from anterior third of nose (Kiesselbach)
are also associated with infections and hypertension
72
Deviation of nasal septum
may result from birth injury, or trauma during adolescence and adulthood
- in severe cases, the nasal septum contacts the lateral wall of nasal cavity
- obstructs breathing, exacerbates snoring
* corrected by surgery
73
Rhinitis
nasal mucosa is swollen and inflamed in severe upper resp. infections & allergic reactions
74
wryneck
Congenital torticollis, fibrous tissue tumor forms on SCM before or after birth
75
Muscular torticollis
head pull during birth tears fibers in SCM forming a hematoma
fibrous mass that forms traps CN XI denervation of the SCM
76
adulthood, abnormal tonicity, most commonly involves the SCM and trapezius
Spasmodic torticollis (cervical dystonia
77
Central line placement
R/L subclavian vein
78
External Jugular Vein
Internal Barometer, Protrusion of EJV signals heart Failure (Right EJV), distension, or obstruction of SVC, enlarged supraclavicular LN, or increased intrathoratic pressure.
79
Uncommon, drooping of shoulder, unable to elevate the shoulder
Lesions of CN XI Accessory nerve
80
Severance of the Phrenic nerve results in
paralysis of corresponding half of diaphragm. A nerve block in lung operation, trauma, surgery will cause temporary paralysis. Used in treatment of hiccups
81
anesthetic is injected on posterior edge of SCM for surgical procedures of neck or upper limb
Cervical plexus block
82
For anesthesia of upper limb inserted superior to midpoint of clavicle
Supraclavicular brachial plexus block
83
External Carotid artery ligation
Control bleeding from an inaccessible branch
| Descending occipital artery provides main collateral circulation and joins vertebral and deep cervical arteries.
84
Thickening of intima of internal carotid artery
Atherosclerosis of the artery resulting in stenosis and decreased blood flow. This can cause TIA or stroke
85
carotid endarterectomy
removes the plaque relieving the stenosis
86
What nerves can be injured during surgery of the internal carotid artery
CN- IX, X (OR SUPERIOR LARYNGEAL), XI, XII
87
Internal jugular artery
pulsation visible in Trendelenburg position
88
Increased internal jugular pulse is caused by
mitral valve disease which increases pressure in the right side of the heart and pulmonary circulation
89
relieves vascular spasm of brain and upper limb, surgery for patient with excessive vasoconstriction of ipsilateral limb
Cervico-thoracic ganglion block
90
Horner syndrome
(lesion of the cervical sympathetic trunk)
91
Horner syndrome symptoms
• Results in Pupillary constriction
• Ptosis (drooping of upper eyelid)
• Enophthalmos (sinking in of eyeball)
vasodilation and anhidrosis- absence of sweating on face and neck, caused by lack of sympathetic nerve supply to blood vessels and sweat glands
92
vasodilation and anhidrosis- absence of sweating on face and neck, caused by
lack of sympathetic nerve supply to blood vessels and sweat glands
93
Tetany
is a sever convulsive disorder that occurs when the parathyroid is accidentally removed during surgery.
94
treatment for Tetany
Needs calcium replacement
95
Subtotal thyroidectomy
most posterior part of thyroid is preserved. usually prevents removal of parathyroid
96
paralysis of vocal fold causing no adduction for phonation, or abduction for increased respiration causing stridor ( high pitch noisy respiration)
Inferior laryngeal nerve injury
97
monotonous voice
injury to superior laryngeal nerve
98
Fractures of laryngeal skeleton
sub mucous hemorrhage, edema, respiratory obstruction, hoarseness, no speech
99
foreign body aspiration
trapped superior to vestibular folds, rima glottidis close, no air in, asphyxiation in 5 min if no intervention
100
tracheostomy
Upper airway obstruction, respiratory failure
| 1-2 or 2-4 tracheal rings, transverse incision
101
Radical neck dissection
1. Usually done to remove cancer
2. deep cervical lymph nodes and tissue removed
3. cervical sentinel lymph nodes are often enlarged as first clue to cancer
4. cutaneous branches of cervical plexus removed
102
Adenoiditis
1. Inflammation of pharyngeal tonsils
Causes obstruction of airways, nasal obstruction, hearing due to blockage of pharyngotympanic membrane, also infection can spread to middle ear- otitis media
103
Tonsillectomy
removal of palantine tonsil
| Surgeon needs to be careful of bleeding due to location of CN IX, internal carotid artery. and external palantine vein
104
Zones of Penetrating Trauma
Zone 1,2,3. Zones 1 and 3 have increased risk of mortality, zone 2 easier to treat.
105
Zone 1
Clavicles and manubrium to inferior cricoid cartilage
106
zone 2
Cricoid cartilage to angle of mandible
107
zone 3
angle of mandible up to top of head
108
Emmetropia
Normal eyesight.
Far images are in focus without lens accommodation. (relaxed ciliary muscles)
Near images are in focus with lens accommodation (flexed ciliary muscles)
109
myopia
Near sighted
Far images are in front of retina without accommodation (looks blurry)
Near images are in focus without accommodation
Need concave lens to focus far image on retina
Eyeball long or lens is too strong
110
hyperopia
Far sighted
Far images are focused on retina with accommodation
Near images are blurring with accommodation (focused behind retina)
Need convex lenses to focus near image
Eyeball is short or weak lens
111
Diplopia, treatment and causes
double vision
1st they put a prism onto of the lens step. After adapted they will merge the prism with the glass
usually caused by unsynchronized muscle contraction
112
astygmatism
Misshapen lens causes multiple focal points for light
measured in degrees
blurry vision
113
Ethmoidal Cells Infection
infection can cause fracture to the fragile medial wall of the orbit
close to optic canal causing blindness
optic neuritis inflammation of optic nerve
114
Pansinitus
Multiple sinuses are inflamed due to infection
115
Most commonly infected sinus due to small ostia
Maxillary sinus
116
Causes of blockage to maxillary ostia
mucous membrane congestion
high location on medial wall makes it impossible to drain until full
Medially located ostia requires rolling to opposite side to drain
Close to molars, concern during teeth extraction
117
Acute otitis externa
inflammation of external acoustic meatus due to bacterial infection
causes itching and pain, which increases by pulling on tragus
commonly called swimmers ear
118
Otitis Media
earache, bulging tympanic membrane due to pus or fluid in middle ear.
Leads to blockage of pharyngotympanic tube
Ear popping
Amber colored blood fluid
Lead to scaring of auditory vesicles
119
Myringotomy
incision to release pus from middle ear abscess
| incision is made postero-inferiorly through the tympanic membrane because the superior is so vascularized
120
Tympano Stome/ Pressure equalization (PE) tube
enables drainage and equalizes pressure from chronic middle ear infections
