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96

Fracture-Dislocation right shoulder

This image shows a dislocated shoulder with a fracture through the surgical neck of humerus. The patient is at high risk of axillary nerve injury. The axillary nerve supplies deltoids but this is difficult to test in these conditions - luckily it also supplies an area of skin over the shoulder known as the regimental badge - this must be tested before and after any procedure involving the shoulder.  
Rhys Clement
about 9 years ago
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10
96

Hip Fracture

Left intracapsular neck of femur fracture. This is a common injury which it is important to recognise on imaging. It has a relatively poor prognosis and intracapsular fractures are particularly at risk of avascular necrosis of the hip. Early intervention is therefore important - consider which may be the appropriate treatment approaches in this case?  
Tim Ritzmann
about 9 years ago
2
2
50

Focus On: Meningitis - Beyond Fever, Stiff Neck, and Altered Mental Status

Acute bacterial meningitis is a significant source of patient morbidity and mortality even when appropriate antibiotic therapy is initiated.  
American College Of Emergency Medicine
over 8 years ago
10
5
81

Episode 4. Neck Lumps (Part 2 of 2)

The second part of the video podcast on neck lumps  
Saran Shantikumar
over 8 years ago
11
7
162

Episode 3. Neck Lumps (Part 1 of 2)

Video podcast on neck lumps, part 1  
Saran Shantikumar
over 8 years ago
29749
7
318

Cranial Nerve Examination - Abnormal

Cranial Nerve 1- Olfaction This patient has difficulty identifying the smells presented. Loss of smell is anosmia. The most common cause is a cold (as in this patient) or nasal allergies. Other causes include trauma or a meningioma affecting the olfactory tracts. Anosmia is also seen in Kallman syndrome because of agenesis of the olfactory bulbs. Cranial Nerve 2- Visual acuity This patientâs visual acuity is being tested with a Rosenbaum chart. First the left eye is tested, then the right eye. He is tested with his glasses on so this represents corrected visual acuity. He has 20/70 vision in the left eye and 20/40 in the right. His decreased visual acuity is from optic nerve damage. Cranial Nerve II- Visual field The patient's visual fields are being tested with gross confrontation. A right sided visual field deficit for both eyes is shown. This is a right hemianopia from a lesion behind the optic chiasm involving the left optic tract, radiation or striate cortex. Cranial Nerve II- Fundoscopy The first photograph is of a fundus showing papilledema. The findings of papilledema include 1. Loss of venous pulsation 2. Swelling of the optic nerve head so there is loss of the disc margin 3. Venous engorgement 4. Disc hyperemi 5. Loss of the physiologic cup an 6. Flame shaped hemorrhages. This photograph shows all the signs except the hemorrhages and loss of venous pulsations. The second photograph shows optic atrophy, which is pallor of the optic disc resulting form damage to the optic nerve from pressure, ischemia, or demyelination. Images Courtesy Dr. Kathleen Digre, University of Uta Cranial Nerves 2 & 3- Pupillary Light Refle The swinging flashlight test is used to show a relative afferent pupillary defect or a Marcus Gunn pupil of the left eye. The left eye has perceived less light stimulus (a defect in the sensory or afferent pathway) then the opposite eye so the pupil dilates with the same light stimulus that caused constriction when the normal eye was stimulated. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Inspection & Ocular Alignmen This patient with ocular myasthenia gravis has bilateral ptosis, left greater than right. There is also ocular misalignment because of weakness of the eye muscles especially of the left eye. Note the reflection of the light source doesn't fall on the same location of each eyeball. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Versions • The first patient shown has incomplete abduction of her left eye from a 6th nerve palsy. • The second patient has a left 3rd nerve palsy resulting in ptosis, dilated pupil, limited adduction, elevation, and depression of the left eye. Second Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Duction Each eye is examined with the other covered (this is called ductions). The patient is unable to adduct either the left or the right eye. If you watch closely you can see nystagmus upon abduction of each eye. When both eyes are tested together (testing versions) you can see the bilateral adduction defect with nystagmus of the abducting eye. This is bilateral internuclear ophthalmoplegia often caused by a demyelinating lesion effecting the MLF bilaterally. The adduction defect occurs because there is disruption of the MLF (internuclear) connections between the abducens nucleus and the lower motor neurons in the oculomotor nucleus that innervate the medial rectus muscle. Saccades Smooth Pursui The patient shown has progressive supranuclear palsy. As part of this disease there is disruption of fixation by square wave jerks and impairment of smooth pursuit movements. Saccadic eye movements are also impaired. Although not shown in this video, vertical saccadic eye movements are usually the initial deficit in this disorder. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Utah Optokinetic Nystagmu This patient has poor optokinetic nystagmus when the tape is moved to the right or left. The patient lacks the input from the parietal-occipital gaze centers to initiate smooth pursuit movements therefore her visual tracking of the objects on the tape is inconsistent and erratic. Patients who have a lesion of the parietal-occipital gaze center will have absent optokinetic nystagmus when the tape is moved toward the side of the lesion. Vestibulo-ocular refle The vestibulo-ocular reflex should be present in a comatose patient with intact brainstem function. This is called intact "Doll’s eyes" because in the old fashion dolls the eyes were weighted with lead so when the head was turned one way the eyes turned in the opposite direction. Absent "Doll’s eyes" or vestibulo-ocular reflex indicates brainstem dysfunction at the midbrain-pontine level. Vergenc Light-near dissociation occurs when the pupils don't react to light but constrict with convergence as part of the near reflex. This is what happens in the Argyll-Robertson pupil (usually seen with neurosyphilis) where there is a pretectal lesion affecting the retinomesencephalic afferents controlling the light reflex but sparing the occipitomesencephalic pathways for the near reflex. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerve 5- Sensor There is a sensory deficit for both light touch and pain on the left side of the face for all divisions of the 5th nerve. Note that the deficit is first recognized just to the left of the midline and not exactly at the midline. Patients with psychogenic sensory loss often identify the sensory change as beginning right at the midline. Cranial Nerves 5 & 7 - Corneal refle A patient with an absent corneal reflex either has a CN 5 sensory deficit or a CN 7 motor deficit. The corneal reflex is particularly helpful in assessing brainstem function in the unconscious patient. An absent corneal reflex in this setting would indicate brainstem dysfunction. Cranial Nerve 5- Motor • The first patient shown has weakness of the pterygoids and the jaw deviates towards the side of the weakness. • The second patient shown has a positive jaw jerk which indicates an upper motor lesion affecting the 5th cranial nerve. First Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 7- Motor • The first patient has weakness of all the muscles of facial expression on the right side of the face indicating a lesion of the facial nucleus or the peripheral 7th nerve. • The second patient has weakness of the lower half of his left face including the orbicularis oculi muscle but sparing the forehead. This is consistent with a central 7th or upper motor neuron lesion. Video Courtesy of Alejandro Stern, Stern Foundatio Cranial Nerve 7- Sensory, Tast The patient has difficulty correctly identifying taste on the right side of the tongue indicating a lesion of the sensory limb of the 7th nerve. Cranial Nerve 8- Auditory Acuity, Weber & Rinne Test This patient has decreased hearing acuity of the right ear. The Weber test lateralizes to the right ear and bone conduction is greater than air conduction on the right. He has a conductive hearing loss. Cranial Nerve 8- Vestibula Patients with vestibular disease typically complain of vertigo – the illusion of a spinning movement. Nystagmus is the principle finding in vestibular disease. It is horizontal and torsional with the slow phase of the nystagmus toward the abnormal side in peripheral vestibular nerve disease. Visual fixation can suppress the nystagmus. In central causes of vertigo (located in the brainstem) the nystagmus can be horizontal, upbeat, downbeat, or torsional and is not suppressed by visual fixation. Cranial Nerve 9 & 10- Moto When the patient says "ah" there is excessive nasal air escape. The palate elevates more on the left side and the uvula deviates toward the left side because the right side is weak. This patient has a deficit of the right 9th & 10th cranial nerves. Video Courtesy of Alejandro Stern, Stern Foundatio Cranial Nerve 9 & 10- Sensory and Motor: Gag Refle Using a tongue blade, the left side of the patient's palate is touched which results in a gag reflex with the left side of the palate elevating more then the right and the uvula deviating to the left consistent with a right CN 9 & 10 deficit. Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 11- Moto When the patient contracts the muscles of the neck the left sternocleidomastoid muscle is easily seen but the right is absent. Looking at the back of the patient, the left trapezius muscle is outlined and present but the right is atrophic and hard to identify. These findings indicate a lesion of the right 11th cranial nerve. Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 12- Moto Notice the atrophy and fasciculation of the right side of this patient's tongue. The tongue deviates to the right as well because of weakness of the right intrinsic tongue muscles. These findings are present because of a lesion of the right 12th cranial nerve.  
Neurologic Exam
almost 8 years ago
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895

Thyroid Cancer & Differential Diagnosis of Lumps in Neck for Medical Students and Foundation Doctors

A complete guide to the diagnosis and managment of thyroid cancer and how to clinically differentiate lumps in the neck. This resource is aimed at medical students in clinical years and foundation doctors.  
Adam Beebeejaun
over 7 years ago
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12
109

ENT - Neck Examination.mp4

This video - produced by students at Oxford University Medical School in conjunction with the ENT faculty - demonstrates how to perform an examination of the neck. It also demonstrates the lymph node regions of the neck.  
Hussam Rostom
over 6 years ago
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6
205

Penetrating Neck Trauma 01: Anatomy

Before we go into how we treat penetrating neck trauma, we need to know what's in there.  
YouTube
almost 5 years ago
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8
215

Penetrating Neck Trauma

Here we look at how to manage a neck injury and some of the more recent changes.  
YouTube
almost 5 years ago
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9
184

Duke Embryology - Craniofacial Development

Click here to launch the Simbryo Head & Neck Development animation (and some really trippy music -you'll understand once the window opens...)  
web.duke.edu
over 4 years ago
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0
7

A pain in the neck

Medical Protection Society Website  
medicalprotection.org
over 4 years ago
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1
50

Cholecystitis

Acute Cholecystitis This is caused by a blockage in the cystic duct or neck of the gallbladder (95% of cases are gallstones or gallstone precursor ‘sludge’) It is unlikely to be infection, and more likely to be local inflammation. You can also get associated peritonitis.  
almostadoctor.com - free medical student revision notes
over 4 years ago
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1
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MedClip - Estimating Jugular Venous Pressure Heywood

Estimating Jugular Venous Pressure Heywood: Using neck veins to estimate central venous pressure. Created by J Thomas Heywood, special thanks to the Weaver family  
medclip.com
over 4 years ago
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1
10

Neck and Thyroid Exam

Introduction Wash hands, check right patient, introduce yourself, get permission Ask the patient to sit up straight in a chair, and expose their neck down to the shoulders. You could ask them to look up a little bit. Remove any jewellery.   InspectionInspect the hands Hypothyroidism Lethargic, disinterested Bradycardia (radial pulse)  
almostadoctor.com - free medical student revision notes
over 4 years ago
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3
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Larynx Anatomy (3 of 5): Cartilages and Membranes (Part 3) - Head and Neck Anatomy 101

We've had a great response to our last set of videos so far, so we're thrilled that some of you are finding them helpful! One of the first year dental studen...  
YouTube
over 4 years ago
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2
41

Larynx Anatomy (2 of 5): Cartilages and Membranes (Part 2) - Head and Neck Anatomy 101

We've had a great response to our last set of videos so far, so we're thrilled that some of you are finding them helpful! One of the first year dental studen...  
YouTube
over 4 years ago
Preview
2
19

Larynx Anatomy (5 of 5): Vessels, Nerves & Basic Clinical Anatomy - Head and Neck Anatomy 101

We've had a great response to our last set of videos so far, so we're thrilled that some of you are finding them helpful! One of the first year dental studen...  
YouTube
over 4 years ago
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3
48

Larynx Anatomy (4 of 5): Muscles - Head and Neck Anatomy 101

We've had a great response to our last set of videos so far, so we're thrilled that some of you are finding them helpful! One of the first year dental studen...  
YouTube
over 4 years ago