Head and Neck Clinical Flashcards
What may present in a head and neck history?
Sore throat Dysphonia Odynophagia Moth/ throat ulcer Neck lump
Smoking/ Alcohol
Family History
What is important to remember about a full head and neck examination?
It includes an examination of the pharynx and larynx.
If you suspect problems then refer to ENT. They have the equipment to do this:
- Laryngoscopy
- Nasolaryngoscopy
What is bifid uvula an early manifestation of?
Cleft palate
What is the appearance of normal healthy vocal cords?
“Pearly white”
How should you prepare a patient for a head and neck examination?
Patient sitting in chair
Glass of water nearly - be prepared to examine the thyroid in full
Expose the neck down to the clavicles - undo the top buttons of a shirt
Ask the patient to remove any jewellery
How do you carry out an inspection in head and neck examination?
Lump: site, size, skin changes
Scars
Does the lump move?
- Tongue protrussion: thyroglossal cyst
- Swallowing: place glass of water in patients hands, hold in mouth then swallow
Describe the palpation in the head and neck examination
From front:
-Check the trachea
From back:
- Be gentle, watch for discomfort
- Use fingertips to elicit physical signs
Palpate the triangles (Z)
- Anterior triangle
- Posterior triangle
Determine lump characteristics
Examine thyroid in full
How do you examine the neck using the Z technique?
- Palpate from the chin backwards to below the ears
- Palpate down the anterior border of sternocleidomastoid to clavicle
- Move laterally along the clavicle and then up the posterior border of sternocleidomastoid
- Finish by palpating the back of the scalp for occipital lymph nodes
What can a thyroid bruit indicate?
Grave’s disease
What are the head and neck examinations?
FNAC CT/MRI/PET scan US scan Plain X-ray Contrast swallow Endoscopy
Explain FNAC in head and neck
With any lumps this is great.
If you find a lump on examination imaging is only going to tell you what you already know.
FNAC will tell you what exactly the lump is
What are the characteristics of a reactive lymph node?
Oval Soft Smooth Mobile Tender
What does a brachial cyst present like?
Usually young patients
Soft and non tender
Upper sternocleidomastoid
How do you identify a thyroglossal cyst?
Moves out with tongue
How would a patient present with duct calculi?
Pain and pressure when they are about to eat or are eating (pressure builds up as fluid produced but nowhere to go)
Will settle a while after eating