Clinical Cases 2

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Clinical Cases 2
2014-05-07 13:05:35

Clinical Cases 2
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  1. Loss of smell , crushed ethmoid bone , olfactory problems ?
  2. How can multiple sclerosis effect the eye ?
    it can demyelinate the optic nerve
  3. When  the oculomotor (CN III) , trochlear (CN IV) , and abducent (CN VI) are all compressed by muscles , logical diseases , tumors , aneurysms, etc . What is it called ?
    Ocular palsies
  4. What nerve causes Complete Palsy ?
    What condition can it cause ?
    • CN III 
    • Ptosis
  5. Explain Partial CN III Palsy ?
    it is slow intercranial pressure to the CN III
  6. what nerve is effected when diplopia is a symptom ?
    CN IV - Trochlear
  7. What nerve is effected when the eye can't look laterally ?
    CN VI
  8. -Paralyzed mastication muscles 
    -Deviation of mandible to side of lesion
    -loss of soft tactile , thermal , and painful sensations in the face.
    -Loss corneal reflex
    -Causes excruciating pain
    Trigeminal neuralgia ( Tic douloureux)
  9. -Paralysis of upper and lower face ipsilateral
    Bell's palsy -  Facial CN VII
  10. What two nerves may be troubled if the corneal reflex is no functioning ?
    Opthalmic (CN V1) Facial (CN VII)
  11. Tinnitus , ringing or buzzing in the ear 
    Vertigo , dizziness or loss of balance
    Vestibulocochlear (CN-VIII)
  12. What nerves can an Acoustic Neroma effect ?
    • CN VIII -vestibular ataxia 
    • CN VII , CN V - facial palsy and trigeminal sensory loss
    • CN IX
  13. -Absence of taste
    -Changes in swallowing 
    -Absent Gag reflex
    Glossopharyngeal - (CN-!X)
  14. -Dysphagia 
    -weak voice /dysphonia 
    possible injury to recurrent laryngeal nerve
    -Tachycardia (accelerated heartbeat )
    Vagus Nerve - (CN-X)
  15. - unable to shrug shoulders
    -loss of Neck resistance when turning left and right
    Spinal Accessory Nerve - (CN-XI)
  16. -Ipisilateral half of tongue paralyzed 
    -Tongue atrophies 
    -apex deviates to the paralyzed side
    Hypoglossal nerve - (CN-XII)
  17. Laceration of the Thoracic Duct
    -Cut during surgery or investigative procedures , enter the thorax causing “chylothorax”
  18. Collateral Veins to the heart
    -If the SVC is obstructed then blood can drain into the Azygos veins of the abdomen and be returned to the right atrium via the IVC and azygos system of veins
  19. Aneurysm of Ascending Aorta
    -the distal portion of the arch is weak and receives pressure from the left ventricle.
  20. Injury to Recurrent Laryngeal Nerves
    -Bronchial or esophageal carcinoma , enlargement of the mediastinal lymph nodes , or aneurysm of the arch of the aorta . Cause stretched or damaged laryngeal nerves affecting speech.
  21. Variations of Great Arteries
    -Arch may be more superior or inferior to the manubrium , may be a right arch of aorta , double arch of aorta , retro-esophageal right subclavian .
  22. Coarctation of Aorta
    -the descending aorta has a constriction (stenosis) near the ligamentum arteriosum.
  23. Age Changes in Thymus
    -Can contrict Trache at childhood , puberty it starts to become fatty , by adult hood it is pretty fatty, but still makes T-lymphocytes
  24. Spread of infection in the Neck
    -Deep cervical fascia helps contain pus and infection , Visceral fascia is bad , retropharyngeal space is detrimental , (retropharyngeal abscess , dysphagia , dysarthria , pneumomediastinum)
  25. Congenital Torticollis
    -congenital neck problems (wry neck) caused by tumor. Tearing causes a hematoma (muscular torticollis) entrapping CN XI. Cervical dystonia is abnormal neck muscle tonicity (spasmodic torticollis)
  26. Nerve Blocks in Lateral Cervical Region
    -Injections made at posterior border of the SCM ,
  27. UpperLimb
    – supraclavicular brachial plexus at midpoint to the clavicle
  28. Severance of Phrenic Nerve and Phrenic Nerve Block
    - Paralysis of corresponding lung , injected at scalene muscle
  29. Subclavian vein puncture
    -(alt =IVC and Femoral vein ) Venous nutritional injection , central lines
  30. Prominence of External Jugular Vein
    -shows pressure , normal pressure it can be seen superior to the clavicle for only a short distance (internal barometer)
  31. Ligation of External Carotid Artery
    -When a branch is inaccessible we ligate the external carotid
  32. Surgical Dissection of Carotid Triangle
    -Important access to carotid system of arteries , IJV , vagus and hypoglossal nerves , and cervical sympathetic trunk. Damage in this area can cause speech problems
  33. Carotid Occlusion and Endarterectomy
    -partial occlusion causes dizziness and disorientation , partial neurological function. Can cause a stroke . Endarterectomy can be used to remove arterial plaque , procedure can affect CN IX , CN XII, CN X.
  34. Carotid pulse
    -Neck pulse. Checked during cardiopulmonary resuscitation (CPR) no pulse =cardiac arrest.
  35. Internal Jugular Pulse
    -Seen in the Trendelenburg positon ( head lower than feet) , No valves so can here vibrations , pressure increases when there is mitral valve disease.
  36. Internal Jugular Vein Puncture
    -use right IJV it is larger and straight , they look for common carotid first and then inserts needle to the IJV
  37. Cervicothoracic Ganglion Block
    -Blocks transmission , used in relief of vascular spasms of brain and upper limb. Also can be used if there is excess vasoconstriction of the ipsilateral limb.
  38. Lesion of Cervical Sympathetic Trunk
    -Horner syndrome , sympathetic disturbance , papillary constriction , ptosis (eyelid droop) , sinking of eyeball orbitalis and enophthalmos , Vasodilation (absence of sweating on the face.
  39. Thyroidectomy
    -Parathyroid glands can be cut , if they are inadvertently removed the patient will have tetany (convulsion disorder) due to calcium regulation. If subtotal thyroidectomy is performed then parathyroid will be safe since only the anterior portion is removed.
  40. Accessory Thyroid Tissue
    -Extra thyroid tissue coming from the hyoid bone. Made from the thyroglossal duct
  41. Injury to Laryngeal Nerves
    -Injured during thyroidectomy . Loss of voice and some respiration
  42. Fractures of Laryngeal Skeleton
    -Can cause submucous hemorrhage and edema , respiratory obstruction , hoarsness, loss of speech. Most thyroid related cartilage is ossified by 25 yrs.
  43. Aspiration of Foreign Bodies
    -Foreign body in superior vestibule folds can cause death in 5 minutes. Heimlich maneuver is required.
  44. Tracheostomy
    -Used if can’t breath ,between 1st and 2nd ring is cut , or 2nd through 4th rings
  45. Laryngoscopy
    -used to examine larynx
  46. Radical Neck Dissections
    -Cancer present, remove tissue that contains lymph nodes in one piece , cervical sentinel lymph nodes.
  47. Adenoiditis
    -inflammation of the pharyngeal tonsils(adenoiditis) , can block the nasal cavities making it hard to breath, infection can travel to ear and cause otitis media , loss of hearing.
  48. Foreign Bodies in Laryngopharynx
    -stuff can be lodge into the piriform plate , things can puncture mucous membrane and damage the internal laryngeal nerve. Removed with Pharyngscope.
  49. Tonsillectomy
    -removal of the palatine tonsils . tonsillar artery , glossopharyngeal nerve , and internal carotid are vulnerable.
  50. Zones of Penetrating Trauma
    • -Neck trauma zones . Zones III and ! have the highest morbidity and mortality. Zone II physicians can apply pressure to vessels and can better visualize the area.
    • Zone 1 – cervical pleurae , apices of lung , thyroid and parathyroid glands , trachea, esophagus , common carotid arteries , jugular veins , cervical region of vertebral column.
    • Zone2-thyroid gland , larynx , thyroid and cricoid cartilage , laryngopharynx , carotid arteries, jugular veins, esophagus , cervical region of vertebral column.
    • Zone3-salivary glands , oral and nasal cavities , oropharynx , and nasopharynx.
  51. Commituated fractures
    – bone depressed inward
  52. Linear calvarial fractures
    – fracture lines go away from hardened area
  53. Countercoup (counterblow) fracture
    – fracture occurs on opposite side
  54. Basilar fractures
    – bones forming the base of the calvaria , CSF leak , ,blood vessel injury
  55. Fracture of Pterion
    - deep meningeal branches rupture , epidural hemtoma , can cause death in a few hours
  56. Loose connective tissue layer of scalp
    - infection cross into emissary veins , to meninges , black eye
  57. Occlusion of cerebral veins and Dural venous sinuses
    -blocked veins in the face by thrombi , thrombophlebetis , or tumors .
  58. Metastasis of Tumor cells to Dural sinuses
    - coughing can push venous blood , pus , and tumor cells to the vertebrae or the brain.
  59. Fractures of the Cranial Base
    – internal carotid busts and causes arteriovenous fistula , then pulsating eyeballs , leaking CSF
  60. Dural headaches
    – dura senses pain and sags after CSF is removed from the lumbar region.
  61. Epidural hematoma
    – blood in external layer
  62. Subdural hematoma -
  63. Subarachnoid hematoma –
  64. Cerebral injuires –
  65. Hydrocephalus
    – too much CSF
  66. Strokes
    – ischemic stroke
  67. Transient stroke
    – use MRI to find
  68. Femoral fractures
    –happen at the neck mostly
  69. Coxa Vara and Coxa Valga –