Clinical - Mouth, Throat, Neck

Question 1

Which lymph nodes are located in each of the clinical levels of the neck?

Answer 1

I - submental and submandibular nodes
II - upper deep cervical nodes
III - mid deep cervical nodes
IV - lower deep cervical nodes
V - posterior triangle
VI - pre-trachial nodes

Question 2

Name the lymph nodes of the cervical region

Answer 2

Submental
Submandibular
Tonsillar
Parotid
Pre-auricular
Posterior auricular
Occipital
Superficial cervical
Deep cervical
Posterior cervical
Supraclavicular

Question 3

What should you look at when inspecting the mouth?

Answer 3

Lips
Inside of the oral cavity - dentition, floor, palates, inside of cheeks, parotid duct opening
Oropharynx, uvula, tonsillar folds and tonsils
Tongue - dorsal surface and lateral borders
Underside of tongue, frenulum, submandibular duct and opening
Bite - ask patient to gently bite teeth together

Question 4

What’s the best way to inspect the tonsils?

Answer 4

Ask the patient to stick their tongue out and move it from side to side

Question 5

What pathologies might be seen when inspecting the lips?

Answer 5

Cyanosis,
Angular stomatitis
Other lesions e.g. BCC

Question 6

What pathologies might be seen when inspecting the tongue?

Answer 6

Dryness
Fasciculation
Wasting

Question 7

What’s the best way to inspect the patient’s bite?

Answer 7

Use two tongue depressors to hold the cheeks and lips away from the teeth, and ask patient to open their mouth and then bite down gently

Question 8

What pathologies might be seen when inspecting the neck?

Answer 8

Scars
Swelling
Lump - observe size, site, skin changes
   Movement with tongue protrusion 
   Movement with swallowing

Question 9

Describe how you would palpate the neck

Answer 9

Check position of the trachea from front, then examine the patient in more detail from the back:

Palpate the whole neck in a Z shape looking for swellings, including lymph nodes

Question 10

How would you assess a swelling in the neck?

Answer 10

Determine if the swelling is:
- mobile
- vascular (pulsable)
- cystic (compressible)
- nodular (hard)
Note position (midline or lateral)
- if lateral is it in the anterior or posterior triangle?
- if midline is it a thyroid swelling or thyroglossal cyst?
If a node then describe clinical level I - V

Question 11

Describe how you would palpate the mouth

Answer 11

Bimanual palpation
Wear gloves
Explain the examination to the patient
Ask patient to open their mouth
Dentures need to be removed

Question 12

Which areas of the mouth should be palpated?

Answer 12

Along the floor, under the tongue
Inside of cheeks
Salivary glands
Substance of tongue

Question 13

What pathologies might be encountered when palpating the mouth?

Answer 13

Cystic swellings
Irregular roughened areas (suggestive of malignancy)
Stones in the parotid duct

Question 14

Describe how you would palpate the parotid gland

Answer 14

1. Palpate from zygoma to the angle of the jaw with the superficial part overlying the masseter muscle
2. Palpate at angle of jaw and over the masseter and the “tail” of the parotid (just below the earlobe and behind the angle of the jaw)

Question 15

Describe how you would palpate the submandibular gland

Answer 15

Palpate with one hand under the mandible, feeling towards the midline and one finger under the tongue inside the mouth

Question 16

When would you percuss the neck?

Answer 16

If there is palpable thyroid swelling consider percussion for retrosternal thyroid

Question 17

Which parts of the neck should be auscultated?

Answer 17

Carotid artery: listening for a carotid artery bruit (indicative of carotid artery stenosis)
Thyroid: listen over an enlarged thyroid, over both lobes, for a thyroid bruit (indicative of Graves’ disease)

Question 18

List the common symptoms in ENT disease

Answer 18

Sore throat
Dysphonia (hoarseness)
Dysphagia
Odynophagia
Neck swelling/lump
Mouth ulcer (non-healing)