Head and Neck Clinical

Question 1

What are some of the commonly seen symptoms with head and neck?

Answer 1

Sore Throat
Dysphonia - Hoarseness
Dysphagia
Odynophagia
Mouth/Throat Ulcer
Neck Lump

Question 2

What are some of the common risk factors of neck symptoms (particularly mouth/throat)?

Answer 2

Smoking/Alcohol
Family history ( thyroid particularly)

Question 3

What are the various parts of the examination?

Answer 3

Neck

Oral cavity

Pharynx (Nasopharynx, Oropharynx, Hypopharynx)
Larynx (Supraglotti, Glottis (vocal cords), Subglottis)

Nose/Ears/Salivary Glands

Question 4

What is the method through which the throat can be examined?

Answer 4

Fibre optic nasolaryngoscopy

Question 5

How are the nodes roughly examined?

Answer 5

Trace a Z from the neck nodes (from the chin, down SCM and then along clavicle)

Question 6

How are the Major salivary glands examined?

Answer 6

Put on a glove and feel inside and out.

Question 7

What is auscultation of the throat used to look for?

Answer 7

Thyroid bruit (Grave's thyroiditis)
Carotid bruit (carotid stenosis)

Question 8

What are the investigations used in Head and Neck?

Answer 8

FNAC (fine needle aspiration cytology)

CT/MRI/PET scan

US scan

Plain X-ray

Contrast Swallow

Endoscopy

Question 9

What are some of the history questions that should be asked if there is a neck lump?

Answer 9

How long?
Site?
Fluctuates?
Sore?
H&N symptoms?
B symptoms (lymphoma)?
Travel?

Question 10

When examining a Neck Lump what should be noted?

Answer 10

Site
Size
Shape
Sore
Skin
Stuck
Soft

Question 11

What questions should be asked when a patient presents with hoarseness?

Answer 11

How long?
Persistent or Intermittent?
Pain?
Cough/Choking/Swallowing?
Voice use?
Asthma/Rhinosinusitis/Reflux?
Smoker?
Medication?

Question 12

What are some of the causes of hoarseness?

Answer 12

Nodules
Cysts
Vocal abuse
Laryngitis
Infection
Smoking
Reflux
Laryngeal Carcinoma

Question 13

What are some of the questions that should be asked when the patient has dysphagia?

Answer 13

What is difficult?
Persistent/Intermittent?
Pain?
Where?( Well Localised in Neck, Poorly localised lower down.)

Question 14

What are some of the causes of Dysphagia in terms of:

a) lumen
b) wall
c) extra luminal

Answer 14

a) Foreign body
b) tumour, stricture, neuromuscular, pouch
c) Thyroid, Heart, Mediastinal mass

Question 15

What is Globus Pharyngeal?

Answer 15

FOSIT (Feeling of Lump in Throat)
Due to the cricopharyngeus, this goes into spasm.
Can be due to:
- Acid Reflux “silent” (Laryngopharyngeal reflux)
- Stress/Anxiety

No Dysphagia (“Easier with food”)
Not a Red Flag symptom.

Question 16

What are the characteristics of a malignant neck node?

Answer 16

Round
Firm
Irregular
Fixed
Non-tender

Question 17

What is the obvious symptom of airway obstruction?

Answer 17

Difficulty breathing

Question 18

What are the clinical signs of Airway obstruction?

Answer 18

Stridor = Noisy Breathing

Question 19

What are some of the causes of airway obstruction?

Answer 19

Infection/Tumour/Foreign body

Question 20

How is airway obstruction treated?

Answer 20

ABC”
Secure the airway e.g. Intubate; ?Tracheostomy
Humidified O2 , Steroids, Adrenaline nebuliser.