Anterior Neck Swelling Flashcards
Case: A 37 year old woman presented to the surgery outpatient clinic with complaints of a swelling on her anterior neck. Take a focused history from her.
- Greet examiner: Good afternoon sir/ma, my name is ***,can I go ahead sir/ma?
Greet Patient: GRIP
G=Greet: Good afternoon sir
R=Rapport: How are you doing today sir?
I=Introduce: My name is **, a candidate of the MDCN exam.
P=Permission: For the purpose of this exam, I will like to take a focused history from you. Can I go ahead?
Bio data
NASOMART: Name, Age, Sex, Occupation, Marital Status, Address, Religion, Tribe.
If woman,
Reproductive profile: First day of your Last menstrual period, Gravidity- Have you ever been pregnant? Parity: Do you have any children? Last child birth?
Presenting complaints:
- swelling on her anterior neck
History of presenting complaints:
5 C’s (complaints, course, cause, complications, care so far)
A,b) complaints and course analysis: DOCTOR
Duration: When was it first noticed?
Onset: How did it start? Sudden or gradual?
Character: Single or multiple? Has it been increasing in size since onset? Rapid or slowly?
Course: Worsening or improving?
Timing: Any changes in size during menses, pregnancy or lactation?
Other symptoms: Painful? Voice changes, stridor (noisy breathing)
Related Phenomenon: Fever, poor appetite, awareness of heartbeat
Causes
Hx of trauma to the neck? r/o hematoma
Hx of excessive heat, weight loss despite good appetite (r/o hyperthyroidism)
Hx of ingestion of excessive cabbage, poorly processed cassava? Do you use iodized salt/ (r/o goitrogens)
Do you live in mountainous regions? (r/o endemic goitre)
Hx of similar swelling among members of her community?
Hx of similar swelling among family members (r/o endemic goitre)
What is your source of drinking water?
Do you take anti-TB, DM medications or COCP? (sulphynylureas, chlorpropamide, tolbutamine) - (r/o drug induced)
Have you undergone radiation?
Hx of easy fatigue, weight loss, bone pain (r/o thyroid carcinoma)
Hx of contact with adult who has chronic cough or drenching night sweats (r/o TB adenitis)
Hx of excessive cold, weight gain despite poor appetite (r/o hypothyroidism)
Complications
d):
1. Pressure effects
Any pain/difficulty during swallowing (r/o pressure on the oesophagus)
Any difficulty breathing (r/o pressure on the trachea)
Any noisy breathing (r/o pressure on the upper airway)
2. Hx of weight loss, diarrhea, awareness of heartbeat (r/o thyrotoxicosis)
3. Hx of weight gain, cold intolerance, constipation, excessive menstrual bleed (r/o hypothyroidism)
4. Symptoms suggestive of metastasis
Hx of cough, chest pain, difficulty breathing, (r/o lung metastasis)
Hx of yellowish discoloration of eyes (r/o liver metastasis)
Hx of headaches and seizure (r/o brain metastasis)
Hx of bone pain (r/o bone metastasis)
Care so far:
What have you done so far? E.g herbal concoction, over the counter medications etc?
Hospitals visited?
What investigations was done?
Treatment received?
Past medical history
Have you had similar symptoms in the past
Do you have any chronic liness lIke hypertension, epilepsy, asthma, diabetes or sickle cell disease . HEADS
Have you have any surgery. hospitalization or blood transtusion
in the past
Family and social history
Any history of similar condition in the family
Any history or nypertension, eplepsy. asthma, alabetes of sickle disease . HEADS
Do you smoke or drink alcohol?
Any allergies to medication?
Drug history
Are you on any long term medication
Are you on any current medication
Do you have any drug allergies
Review of system
Reviewof systems : Head to foe
Kindly answer Yes Or no to the following questions
Head :Headache,loss Consciousness, dizziness
Eye: Blurry vision, double vision
Nose: Nasal beading
Mouth: Sores, gum bleed
Neck: neck swelling, Excessive cold or heat
chest: Pain, Cough, difficulty breathing , Palpitation?
Abdomen:Abdominal Pain, diarrhea,
vomiting, constipation etc
Pelvic : vaginal discharge or bleeding , urinary frequency,
Urgency, Panful urination
skin: rashes, discoloration, dryness
Upper Limb: limb weakness, joint
Pain, swelling, bone pain
Lower limb: leg swelling, difficulty walking
