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Questions and Answers
A patient involved in a motor vehicle accident is brought to the emergency department. During the initial assessment, which of the following actions is MOST crucial regarding potential cervical spine injuries?
A patient involved in a motor vehicle accident is brought to the emergency department. During the initial assessment, which of the following actions is MOST crucial regarding potential cervical spine injuries?
- Immediately immobilizing the cervical spine and employing a jaw-thrust maneuver to open the airway. (correct)
- Checking the patient's pupillary response to assess neurological function.
- Performing a head-tilt/chin-lift maneuver to open the airway.
- Applying direct pressure to any visible bleeding on the head or neck before addressing the airway.
An individual with long-standing diabetes presents with complaints of blurred vision. Fundoscopy reveals changes in the retinal blood vessels. Which of the following is the MOST likely cause of these changes?
An individual with long-standing diabetes presents with complaints of blurred vision. Fundoscopy reveals changes in the retinal blood vessels. Which of the following is the MOST likely cause of these changes?
- Hyperkeratosis of the conjunctiva constricting the retinal blood vessels.
- Elevated lipid levels causing direct mechanical damage to the vessel walls.
- Cataract formation obstructing clear visualization of retinal vessels.
- Damage to blood vessels due to elevated blood sugar levels. (correct)
What are the qualifications needed to practice Oral and Maxillofacial Surgery (OMFS)?
What are the qualifications needed to practice Oral and Maxillofacial Surgery (OMFS)?
- A medical degree and completion of a plastic surgery residency program.
- A registrable dental degree, medical degree, surgical diplomas from the Royal College of Surgeons, and registration with the General Medical Council. (correct)
- A registrable dental degree, surgical diplomas from the Royal College of Surgeons, and specialist registration with the General Dental Council.
- A registrable dental degree and completion of an oral surgery residency program.
A patient's visual acuity is recorded as 20/40. What does this indicate?
A patient's visual acuity is recorded as 20/40. What does this indicate?
In the context of airway management for a trauma patient, which of the following best describes the primary concern when deciding between a head-tilt/chin-lift maneuver and a jaw-thrust maneuver?
In the context of airway management for a trauma patient, which of the following best describes the primary concern when deciding between a head-tilt/chin-lift maneuver and a jaw-thrust maneuver?
A patient presents with diplopia and numbness in the cheek following a blunt trauma to the face. Which of the following is the most likely underlying mechanism causing the diplopia in this scenario?
A patient presents with diplopia and numbness in the cheek following a blunt trauma to the face. Which of the following is the most likely underlying mechanism causing the diplopia in this scenario?
Following a motor vehicle accident, a patient is diagnosed with an orbital floor fracture. Besides diplopia, which of the following clinical signs would strongly suggest herniation of orbital contents into the maxillary sinus?
Following a motor vehicle accident, a patient is diagnosed with an orbital floor fracture. Besides diplopia, which of the following clinical signs would strongly suggest herniation of orbital contents into the maxillary sinus?
A patient reports a gradual decline in their vision, describing it as a blurring that affects both near and distance vision. They also mention increased glare, especially at night. Which condition is most consistent with these symptoms?
A patient reports a gradual decline in their vision, describing it as a blurring that affects both near and distance vision. They also mention increased glare, especially at night. Which condition is most consistent with these symptoms?
A patient presents with a red, painful eye, significantly reduced visual acuity, and a dilated pupil. They also report nausea and vomiting. Which of the following is the most likely diagnosis?
A patient presents with a red, painful eye, significantly reduced visual acuity, and a dilated pupil. They also report nausea and vomiting. Which of the following is the most likely diagnosis?
An elderly patient reports a gradual loss of central vision in both eyes but maintains good peripheral vision. What condition is most likely causing this presentation?
An elderly patient reports a gradual loss of central vision in both eyes but maintains good peripheral vision. What condition is most likely causing this presentation?
A 70-year-old woman presents with recent onset headaches, scalp tenderness, and jaw pain when chewing. She also reports vision loss in one eye. What is the most likely underlying condition?
A 70-year-old woman presents with recent onset headaches, scalp tenderness, and jaw pain when chewing. She also reports vision loss in one eye. What is the most likely underlying condition?
A patient is diagnosed with orbital cellulitis. Which of the following signs or symptoms would be most concerning and necessitate immediate intervention to prevent potential complications?
A patient is diagnosed with orbital cellulitis. Which of the following signs or symptoms would be most concerning and necessitate immediate intervention to prevent potential complications?
A patient with macular degeneration is being considered for treatment. Which form of macular degeneration benefits most from treatments aimed at reducing blood vessel leakage?
A patient with macular degeneration is being considered for treatment. Which form of macular degeneration benefits most from treatments aimed at reducing blood vessel leakage?
A patient with a suspected orbital floor fracture complains of numbness in the cheek and upper lip on the affected side. Which nerve is most likely affected by this fracture?
A patient with a suspected orbital floor fracture complains of numbness in the cheek and upper lip on the affected side. Which nerve is most likely affected by this fracture?
What is the primary mechanism by which phacoemulsification improves vision in patients with cataracts?
What is the primary mechanism by which phacoemulsification improves vision in patients with cataracts?
Flashcards
OMFS
OMFS
Surgical specialty involving the mouth, jaws, face, and skull, regulated by the General Medical Council.
OMFS Scope
OMFS Scope
Trauma surgery, cancer surgery (including skin), facial deformity, cleft lip and palate, salivary gland surgery, major dento-alveolar surgery, cranio-facial surgery, aesthetic facial surgery, emergency airway management and teaching.
Airway Opening in Trauma
Airway Opening in Trauma
To avoid dislocation of the vertebrae/damage nerves, use jaw thrust.
Visual Acuity (VA)
Visual Acuity (VA)
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Visual Acuity Measurement
Visual Acuity Measurement
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Normal Visual Acuity (VA)
Normal Visual Acuity (VA)
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Orbital Blowout Fractures
Orbital Blowout Fractures
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Glaucoma
Glaucoma
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Cataracts
Cataracts
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Macular Degeneration (AMD/ARMD)
Macular Degeneration (AMD/ARMD)
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Orbital Cellulitis
Orbital Cellulitis
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Enophthalmos
Enophthalmos
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Diplopia
Diplopia
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Phacoemulsification
Phacoemulsification
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Scotoma
Scotoma
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Study Notes
Oral and Maxillofacial Surgery (OMFS)
- OMFS is a surgical specialty regulated by the General Medical Council
- Oral Surgery is a dental specialty regulated by the GDC
- OMFS requires registrable dental and medical degrees, plus 3 surgical diplomas from RCS
Scope of Practice for OMFS
- Includes trauma surgery
- Includes surgery for cancer, including skin cancer
- Includes surgery for facial deformity
- Includes surgery for cleft lip and palate
- Includes surgery for salivary gland
- Includes major dento-alveolar surgery
- Includes cranio-facial surgery
- Includes aesthetic facial surgery
- Includes emergency airway management
- Includes teaching
- Does not include plastic surgery, though overlaps may occur
Cervical Spine Trauma Considerations
- Always check trauma patients for head and neck trauma
- Check all 7 vertebrae
- Employ a jaw thrust to open the airway, avoiding dislocation of vertebrae or nerve damage
Ophthalmology
- Key parts of the eye include:
- Sclera
- Iris
- Cornea
- Pupil
- Lens
- Conjunctiva
- Vitreous
- Choroid
- Optic nerve
- Macula
- Retina
Cataracts
- The clouding of the lens
- Progresses slowly
- Associated risk factors include age, trauma, and UVB exposure
- Can be treated surgically, including phacoemulsification and plastic lenses
Visual Acuity Measurement
- Visual acuity is measured to assess visual function
- Measurement is important for driving and occupational requirements
- Measurement assists in making a diagnosis
- Measurement helps to assess the impact of eye diseases
- Measurement helps to monitor the effectiveness of treatment
- VA refers to angular measurement of the ability to resolve the minimal separation of two objects
- 20/20 acuity means from 20 feet, one can see 20 rows of the letter chart
- Visual Acuity can be recorded as 6/12 (meters) or 20/40 (feet)
- With 6/12, 6 is the distance from the testing chart; 12 is the distance where a normal person can see
- A normal person should have a visual acuity of 6/6 or better, assessed one eye at a time, with glasses if needed
Orbital Blowout Fractures
- Orbital blowout fractures can cause diplopia due to the inability to move both eyes together
Orbital Injuries
- Blowout fractures are internal orbital fractures
- Signs and symptoms include
- Tethering
- Diplopia
- Numbness
- Enophthalmos
Reconstruction of the Orbital Floor
- Typically involves titanium mesh
- In the longer term, it sometimes involves a calvarial bone graft
Glaucoma
- Causes damage to the optic nerve
- It is associated with increased intra-eye pressure
- Open angle glaucoma is painless
- Closed angle glaucoma is painful
Differential Diagnosis of Red Eye
- Conjunctivitis typically presents with normal visual acuity, not severe pain, normal pupils, no photophobia, and sticky eyes
- Acute Glaucoma typically presents with decreased visual acuity, severe pain, dilated pupils, photophobia, and vomiting
- Uveitis typically presents with normal or decreased visual acuity, moderate pain, normal or constricted pupils, photophobia, and adhesions between iris and lens
- Corneal Ulcer typically presents with decreased visual acuity, severe pain, normal or constricted pupils, photophobia, and corneal opacity/stain
Macular Degeneration (AMD/ARMD)
- Dry or wet, depending on exudates
- Results in loss of central vision (scotoma)
- Wet form involves blood vessels from the choroid that leak exudate and cause hemorrhage
- Risk factors include age and family history
- May be variable and tends to be managed medically
- A relatively recent (2015) tried stem cells
Case Study
- A 70-year-old woman presents with a one-month history of headaches
- She feels unwell and lost vision in her right eye just yesterday
- Key questions include:
- Headaches fronto-temporal and present all the time?
- Is the scalp tender to the touch?
- Has she lost weight?
- Is there pain in the jaw on prolonged chewing of food?
- Do the shoulders ache, with difficulty raising arms overhead?
- On Examination
- She cannot read any letters on a chart, only count fingers
- Eye movements are normal
- Raised ESR
- Treatment includes:
- Admittance to the hospital
- Administration of 500mg IV methylprednisolone daily for 3 days
- Followed by tapering doses of oral steroids for 2 years
- Prophylaxis for peptic ulcer and osteoporosis
- Monitoring for diabetes and hypertension
- Outcome
- Rapid resolution of headaches and jaw pain
- Weight gain
- She remained blind in the right eye
- Retained vision in the left eye
Orbital Cellulitis - Signs and Symptoms
- Patients may be unwell
- May be pyrexial
- May have proptosis, restricted eye movements, and a pupil affected
- Increased WCC
Orbital Cellulitis - Treatment
- IV antibiotics
- Surgical drainage
Summary
- Working knowledge is required
- Overlaps with OMFS/OS/Oral Medicine
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