Clinical app quiz 2

Dr. Dayna Miller at the University of Northern Iowa

Where does the mastoid process lie?

near the middle ear

What can children get with an upper respiratory infection?

middle ear infections

What tubes does infections travel through to get from the throat to the ear?

pharyngotympanic tubes OR Eustachian tubes OR auditory tubes

What is the function of pharyngotympanic tubes?

equalize the air pressure between the middle ear and atmosphere

mastoiditis

a middle ear infection that spreads to the mastoid process

meningitis

infection of meninges

meninges

the protective connective tissue covering around the brain

What are the functions of paranasal sinuses?

resonating chambers for the voice and to lighten the skull bones

What are paranasal sinuses lined with?

mucosal membranes

List the paranasal sinuses

frontal, sphenoid, ethmoid, and maxillary

sinusitis

infection of the sinuses

symptoms of sinusitis

pain, pressure, cough, fever, nasal discharge, inflammation, swelling

Pain in the upper jaw suggests what kind of infection?

sinusitis of the maxillary sinus

Pressure or pain in the eye region or down the sides of the nose suggests what kind of infection?

sinusitis of the ethmoid sinus

What do treatments of sinusitis try to do?

decrease swelling

promotes drainage of the sinuses

maintain open sinuses

rid the sinuses of microbes

List the treatments for sinusitis

antihistamines, decongestants, corticosteroids, antibiotics, antifungal medications, and surgery

What happens if sinusitis is left untreated?

it can develop into more serious conditions

Cleft lip

one or more splits or openings in the upper lip resulting from failure of tissues to fuse normally during fetal development

cleft palate

occurs when bones and/or tissues of the palate do not jain completely during fetal life

How common is it to have a cleft lip AND palate?

1 in 750 births

Are cleft lips/palates more common in males or females?

males

What are the causes of cleft lips/palates?

genetics, environmental factors, smoking, drinking, certain medications, and disorders in developments

If an individual with a cleft lip/palate has a child, are they at an increased, decreased, or same risk of having one too?

increased

What is the treatment for a cleft lip/palate?

surgery after birth, several surgical procedures over the course of several years, orthodontic procedures

What is TMJ disorder/TMD?

temporomandibular joint disorder, pain in the jaw joint

What are the symptoms of TMJ disorder?

clicking of the jaw

pain

ear pain

headaches

tenderness of nearby muscles

locked jaw

What causes TMD?

arthritis, wear and tear on the joint, misalignment of the teeth, accidental injury, and clenching/grinding of the teeth

Treatments of TMD

pain and anti inflammatory medications, limiting jaw movement, heat therapy, mouth guards, cortisone, dental treatments, and surgery to replace the joint

About what percent of TMD cases require surgery?

1%

Rhinoplasty

reshaping of the nose for medical or cosmetic purposes

Are rhinoplasties done for medical or cosmetic reasons more?

cosmetic

Why would someone need a rhinoplasty?

deviated septum, enlargement of the nasal conchae, misshapen bone healing

What happens in a rhinoplasty procedure?

surgeon enters through the nostrils and makes an incision into the nasal mucosa to gain access to the nasal cartilage and nasal bone, the bone and cartilage are cut/broken/reshaped/and rebuilt as needed

When was the first rhinoplasty done?

600 BC

Who did the first rhinoplasty?

Surgeon Sushruta

What can the anterior fontanelle tell doctors?

the state of health of an infant

What does a sunken fontanelle mean?

dehydration

What does a bulging fontanelle mean?

an increased intracranial pressure

Craniosynostosis

premature closure of the sutures

What causes craniosynostosis?

genetic defects but mostly it is UNKNOWN

How do you treat craniosynostosis?

surgery to separate the bones, helmet therapy, cosmetic surgery

What happens to the intervertebral discs as people age?

the annulus fibrosis loses moisture and becomes thinner and less flexible

What is a ruptured or herniated disc?

when the nucleus pulposus slips out of the annulus fibrosis

kyphosis

exaggerated thoracic curvature (humpback)

kyphosis is common in what demographic?

those with advanced cases of osteoporosis that result in loss of vertebral bone mass

lordosis

exaggerated lumbar curvature (swayback)

Scoliosis

lateral curvature of the spine

Spina bifida

when the spinous process fails to form properly during fetal development, causing the spinal cord to be uncovered by bone

What causes spinal bifida?

genetics, nutrition, environmental factors, lack of vitamin B, folic acid

What is the treatment for spinal bifida?

Surgery to move the spinal cord into the vertebrae, surgery in utero to repair the spinal column before birth

What is a lumbar puncture/spinal tap?

a procedure that allows the withdrawal of cerebrospinal fluid to check for infection, blood, etc or the addition of a medication or anesthetic to the CSF

Where does the spinal cord end?

L2

Where are lumbar punctures done?

between L4 and L5

What is the danger of an inward Xiphoid process?

a blow to the chest can force the xiphoid process into the heart

Whiplash

when the head is thrown suddenly and forcefully backward and then forward

What can whiplash do to cervical vertebrae?

fractures, ruptured discs, muscle/tendon/ligament injury, compression of the spinal cord or spinal nerves

Symptoms of whiplash

neck pain, headaches at the base of the skull, dizziness, ringing in the ears, blurred vision, memory loss, difficulty concentrating, and irritability

What is the treatment for whiplash?

physical therapy, medications to decrease pain/inflammation/muscle tension

How long can whiplash last?

months

What is shaken baby syndrome/infant whiplash?

when a child is forcefully shaken that may result in permanent brain injury or death

Symptoms of shaken baby syndrome

brain swelling/bruising/bleeding, increased intracranial pressure, decreased blood supply to cells, spinal cord and neck damage, vertebral damage, breathing problems, poor eating, vomiting, extreme irritability, tremors/seizures, extreme sleepiness, blue/pale skin, paralysis, coma

What ages are at risk for shaken baby syndrome?

under 2 but up to 5 years have been reported

What should you do if you suspect a child has shaken baby syndrome?

take to the hospital IMMEDIATELY

How many children with shaken baby syndrome die?

50%

What lifelong conditions result from shaken baby syndrome?

cognitive impairment, blindness, hearing loss, cerebral palsy, seizure disorders, and developmental delays

What are the risk factors for shaken baby syndrome?

domestic violence in the home, history of child abuse, stress, substance abuse, isolations, depression, and unrealistic expectation of infants and toddlers

Who is more likely to shake a baby?

men

How to prevent shaken baby syndrome?

treat infants and children gently, parenting classes, outside assistance (friends/family/mental health professional)

How long does it take to cause severe shaken baby syndrome?

a few seconds

What is the most commonly dislocated bone in the body?

the humerus (shoulder joint)

How is the humerus dislocated in most cases?

the humerus is forced anterior to the glenoid cavity

Where are deltoid intramuscular injections?

2 to 5 cm below the acromion process

What is used as a landmark to place a deltoid IM injection?

the acromion process of the scapula

What 3 structures should be in alignment in the forearm?

the medial epicondyle of the humerus, the olecranon process of the ulna, and the lateral epicondyle of the humerus

If the olecranon process is not in line with the epicondyles, that indicates a...

ulnar dislocation

Colles fracture

a fracture of the distal end of the radius (wrist fracture)

McBurney's point

the location on the anterior abdominal wall that lies directly superficial to the appendix

How do you locate McBurney's Point?

Draw an imaginary line between the umbilical region and the anterior superior iliac spine, about 2/3 of the way from the umbilical region is McBurney's Point

Rebound pain

pain that intensifies when the pressure is released

What is McBurney's Point used for?

a diagnostic tool for appendicitis and an incision point for appendectomy

inguinal ligament

a ligament that travels from the anterior superior iliac spine to the pubis (forms a V line above the pubic region)

What does the inguinal ligament form?

part of the inguinal canal

Inguinal canal

an opening between the abdominopelvic cavity and the external genitalia; any structures that travel from the abdominopelvic cavity to the external genitalia must pass through

Is the inguinal canal larger in males or females?

males

hernia

a weakened area in a muscle wall through which internal organs protrude

What is the most common location of a hernia?

inguinal canal

What is a hernia in the inguinal canal called?

inguinal hernia

What is a hernia in the umbilical region called?

an umbilical hernia

What are "broken hips" really?

breaks in the femur at the femoral neck or just below

How are hip fractures treated?

surgical repair

What does it mean if the baby is "breeched"?

coming out feet or butt first

What does a baby's "station" mean?

position in the birth canal

What station is the baby at when the top of the baby's head is even with the ischial spines?

zero station

How are stations counted when the baby's head is above or below the ischial spines?

the centimeters away from the ischial spines the head is (positive if the baby's head is below the ischial spines, negative if it is above the ischial spines)

What is the largest nerve in the body?

sciatic nerves

Where is a common gluteal injection site?

the ventral gluteal muscle

How do you find the ventral gluteal muscle?

place the heel of the hand on the greater trochanters and the index finger just posterior to the anterior superior iliac spine

move the other fingers posteriorly

the injection should be placed in the v shaped area between the index and middle fingers

If giving a dorsogluteal injection, where should the injection site be?

above an imaginary line going from the greater trochanter of the femur to the posterior superior iliac spine