frcem primary all in one notes pdf free download

frcem primary all in one notes pdf free download

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Moreover, the sutural ligaments begin to ossify during middle age. A severe, localized blow produces a local indentation, often accompanied by splintering of the bone. The petrous parts of the temporal bones and the occipital crests strongly reinforce the base of the skull and tend to deflect linear fractures.

The frontal air sinus may be involved, with hemorrhage into the nose. Once a fracture of the maxilla has been reduced, for example, prolonged fixation is not needed. However, in the case of the mandible, the strong muscles of mastication can create considerable displacement, requiring long periods of fixation. To fracture the maxillary bones and the supraorbital ridges of the frontal bones, an enormous force is required.

There is extensive facial swelling, midface mobility of the underlying bone on palpation, malocclusion of the teeth with anterior open bite, and possibly leakage of cerebrospinal fluid cerebrospinal rhinorrhoea secondary to fracture of the cribriform plate of the ethmoid bone.

Involvement of the infraorbital nerve with anaesthesia or paraesthesia of the skin of the cheek and upper gum may occur in fractures of the body of the maxilla. Nose bleeding may also occur in maxillary fractures. Blood enters the maxillary air sinus and then leaks into the nasal cavity. Although it can occur as an isolated fracture, as from a blow from a clenched fist, it may be associated with multiple other fractures of the face, as often seen in automobile accidents.

Patients are said to have an orbital personality. It is among the first functions to falter in Alzheimer's. AMYGDALA o Lying deep in the center of the limbic emotional brain, this powerful structure is constantly alert to the needs of basic survival including sex, emotional reactions such as anger and fear.

Consequently, it inspires aversive cues, such as sweaty palms, and has recently been associated with a range of mental conditions including depression to even autism.

THALAMUS o Located at the top of the brain stem, the thalamus acts as a two-way relay station, sorting, processing, and directing signals from the spinal cord and mid-brain structures up to the cerebrum, and, conversely, from the cerebrum down the spinal cord to the nervous system. The medulla oblongata joins the spinal cord at the foramen magnum. PONS o Superior to the medulla lies the pons, the ventral surface of which has a characteristic band of horizontal fibers.

The pons interacts with the cerebellum, motor control and respiration. Helps regular breathing. Between the cerebral peduncles, the third cranial nerve oculomotor can be seen exiting.

The fourth cranial nerve trochlear exits dorsally and is unique in this regard. The cerebellum consists of 2 hemispheres, connected by a midline structure called the vermis. There are 4 deep cerebellar nuclei: The Fastigial, Globose, Emboliform, and Dentate Nuclei, in sequence from medial to lateral.

The cerebellum contributes to the posterior wall of the IVth ventricle. The dendate nucleus is located within the deep white matter of each cerebellar hemisphere. Within the cranial cavity, the dura contains two connective tissue sheets: o Endosteal layer: Lines the inner surface of the bones of the cranium. It is the only layer present in the vertebral column. They are responsible for the venous vasculature of the cranium, draining into the internal jugular veins.

It is very thin, and tightly adhered to the surface of the brain and spinal cord. It is the only covering to follow the contours of the brain the gyri and fissures. Four varieties are considered here: extradural, subdural, subarachnoid, and cerebral. The most common artery to be damaged is the anterior division of the middle meningeal artery.

The arterial or venous injury is especially liable to occur if the artery and vein enter a bony canal in this region. The intracranial pressure rises, and the enlarging blood clot exerts local pressure on the underlying motor area in the precentral gyrus.

Blood may also pass outward through the fracture line to form a soft swelling under the temporalis muscle. This condition, which is much more common than middle meningeal hemorrhage, can be produced by a sudden minor blow. Once the vein is torn, blood under low pressure begins to accumulate in the potential space between the dura and the arachnoid.

For example, if the patient starts to vomit, the venous pressure will rise as a result of a rise in the intrathoracic pressure. In the chronic form, over a course of several months, the small blood clot will attract fluid by osmosis so that a haemorrhagic cyst is formed, which gradually expands and produces pressure symptoms.

In both forms, the blood clot must be removed through burr holes in the skull. The symptoms, which are sudden in onset, include severe headache, stiffness of the neck, and loss of consciousness. The diagnosis is established by withdrawing heavily blood-stained cerebrospinal fluid through a lumbar puncture spinal tap.

The patient immediately loses consciousness, and the paralysis is evident when consciousness is regained. Excessive anteroposterior compression of the head often tears the anterior attachment of the falx cerebri from the tentorium cerebelli. The brain may be likened to a log soaked with water floating submerged in water. The brain is floating in the cerebrospinal fluid in the subarachnoid space and is capable of a certain amount of anteroposterior movement, which is limited by the attachment of the superior cerebral veins to the superior sagittal sinus.

The tentorium cerebelli and the falx cerebelli also restrict displacement of the brain. The terms concussion, contusion, and laceration are used clinically to describe the degrees of brain injury. They do not supply any branches to the face or neck.

Anterior and posterior spinal arteries: supplies the spinal cord, spanning its entire length. Posterior inferior cerebellar artery: supplies the cerebellum.

After this, the two vertebral arteries converge to form the Basilar Artery. Several branches from the basilar artery originate here, and go onto supply the cerebellum and pons. The basilar artery terminates by bifurcating into the Posterior Cerebral Arteries. The Middle Cerebral Arteries are situated laterally, supplying the majority of the lateral part of the brain.

The Posterior Cerebral Arteries supply both the medial and lateral parts of the posterior cerebrum. The volume of the lateral ventricles increases with age. Here the CSF is reabsorbed back into the circulation. For example, a kg male has a circulating blood volume of approximately 5 L. Bleeding patients need blood! In uncomplicated situations, minimal tachycardia occurs. These agents produce an increase in peripheral vascular tone and resistance. Some patients in this category may eventually require blood transfusion, but most are stabilized initially with crystalloid solutions.

The blood loss with class III hemorrhage approximately — mL in an adult can be devastating. Patients almost always present with the classic signs of inadequate perfusion, including marked tachycardia and tachypnoea, significant changes in mental status, and a measurable fall in systolic pressure.

Patients with this degree of blood loss almost always require transfusion. However, the priority of initial management is to stop the hemorrhage, by emergency operation or embolization if necessary. The skin is cold and pale. It is responsible for transmitting the special sensory information for sight. It is one of two nerves that do not join with the brainstem the other being the olfactory nerve, CN I. Thus, the entirety of the nerve can be considered part of the central nervous system and as a consequence, examining the optic nerve usually performed via ophthalmoscopy enables an assessment of intra-cranial health to be made.

Due to its unique anatomical relation to the brain, the optic nerve is surrounded by cranial meninges not by epi-, peri- and endoneurium like most other nerves. It travels through the parietal lobe to reach the visual cortex. Within the middle cranial fossa, the pituitary gland lies in close proximity to the optic chiasm. This produces visual defect affecting the peripheral vision in both eyes, known as a bitemporal hemianopia.

To access the gland, the surgeon uses a transspehenoidal approach, accessing the gland via the sphenoidal sinus. Parietal lobe Lower Homonymous Quadrantanopsia: Homonymous defect, denser inferiorly Parietal lobe Gerstmann syndrome and a homonymous defect, denser inferiorly Not well-localized Complete homonymous hemianopsia Occipital lobe lower Homonymous upper bank quadrantanopsia with macular sparing Occipital lobe upper Homonymous lower bank quadrantanopsia with macular sparing Occipital lobe Isolated homonymous defect macular sparing without other neurologic findings Bilateral occipital lobe Anton syndrome cortical lesions blindness Bilateral Balint syndrome occipitoparietal lesions Left occipital lobe and Alexia without agraphia angular gyrus Bilateral occipitotemporal Central achromatopsia lesions Anatomy Physiology Pharmaco.

This condition results in the loss of vasomotor tone and in sympathetic innervation to the heart. Neurogenic shock is rare in spinal cord injury below the level of T6; if shock is present in these patients, an alternative source should be strongly suspected.

Loss of sympathetic innervation to the heart may cause the development of bradycardia or at least a failure of tachycardia in response to hypovolemia. In this condition, the blood pressure may not be restored by fluid infusion alone, and massive fluid resuscitation may result in fluid overload and pulmonary edema.

The blood pressure may often be restored by the judicious use of vasopressors after moderate volume replacement. Atropine may be used to counteract hemodynamically significant bradycardia. The duration of this state is variable. Spinal cord anatomy Anatomy Physiology Pharmaco. This syndrome has the poorest prognosis of the incomplete injuries.

Although this syndrome is rarely seen, variations on the classic picture are not uncommon. These patterns should be recognized so they do not confuse the examiner. Usually this syndrome occurs after a hyperextension injury in a patient with preexisting cervical canal stenosis often due to degenerative osteoarthritic changes , and the history is commonly that of a forward fall that resulted in a facial impact.

This artery supplies the central portions of the cord. Recovery usually follows a characteristic pattern, with the lower extremities recovering strength first, bladder function next, and the proximal upper extremities and hands last. This is most often due to traumatic injury, and involves both the anterolateral system and the DCML pathway: o DCML pathway: ipsilateral loss of tactile sensation and proprioception o Anterolateral system: contralateral loss of pain and temperature sensation.

It is the body's attempt to maintain a constant internal environment. When body temperature rises, receptors in the skin and the hypothalamus sense a change, triggering a command from the brain. This command, in turn, effects the correct response, in this case a decrease in body temperature. Published on Dec 6, SlideShare Explore Search You.

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