Anterior Neck Swelling

Question 1

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.

Answer 1

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?
2. BIODATA:
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?

Question 2

Presenting complaints: swelling on her anterior neck

Answer 2

Presenting complaints: swelling on her anterior neck

Question 3

History of presenting complaints:

DOCTOR

Answer 3

: 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

Question 4

C) Causes:

Answer 4

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)

Question 5

Complications

Answer 5

1. Pressure effects
   Any pain/ difficulty during swallowing ( pressure on oesophagus)
   Any difficulty breathing (pressure on trachea)
   Any noisy breathing ( pressure on upper airways)
2. Any weight loss, diarrhea, awareness of heart beat ( thyrotoxicosis)
3. Any weight gain, cold intolerance, constipation, excessive menstrual bleeding ( hypothyroidism)
4. Any symptoms suggestive of metastasis

Any cough , chest pain, difficulty breathing (lung metastasis)

Any yellowish discoloration of eye, skin ( liver metastasis)

Any headache and seizure ( brain metastasis)

Any history of bone pain ( bone metastasis)

Question 6

CARE SO FAR

Question 7

PAST MEDICAL HISTORY

Question 8

FAMILY AND SOCIAL HISTORY

Question 9

REVIEW OF SYSTEM