Head and Neck History and Exam

Question 1

Red flags in H&N history

Answer 1

-Hoarseness >2 weeks
-Neck lump >2 weeks
-Throat pain >2 weeks
-Swallowing problems
-Smoking history
-Weight loss
-Cough (10% of HNSCC lung disease)

-PMH previous malignancy, radiotherapy
-Alcohol

Question 2

Describe hoarseness

Answer 2

-Vocal cord pathology presentation
=Mucosal lesion
=Paralysis
=Age related

-Sinister if > 2 weeks, progressive
-Risk factors
=Smoking
=Alcohol excess is a potentiating factor
=HPV (16/18) infection
-Constant / variable
-History of surgery / intubation

Question 3

Features to assess neck lump

Answer 3

-Site
-Size
-Surface
-Skin changes/ discharge
-Fixation
-Fluctuance
-Mobility
-Duration

Question 4

Features of throat pain

Answer 4

-Duration
-Constant/ variable
-Site
-Character
-Exacerbating factors
-Relieving factors
-Radiation

Question 5

Features of swallowing problems (dysphagia)

Answer 5

-Liquids
-Solids
-Constant/ variable
-Sudden onset
-Progressive
-Regurgitation
-Weight loss
-Odynophagia= pain on swallowing

Question 6

History summary

Answer 6

-Pain – site, duration, radiation (especially ear), character
-Hoarseness – onset, duration, variation
-Swallowing – pain, what textures, regurgitation, weight loss
-Lump – onset, duration, discharge, systemic upset
-Past Medical History – operations, radiotherapy
-Drug history
-Social history – work, smoking, drinking, social support

Question 7

Features of listening examination

Answer 7

-Is the breathing noisy?

-Stertor
=Noise due to partial obstruction above larynx
=Snoring

-Stridor
=Noise due to partial obstruction at level/ below larynx
=Requires assessment and appropriate intervention

Question 8

Features of inspection examination

Answer 8

-Scars
-Lumps
-Ulcers, discharge
-Holes
-Appliances/ tubes
-Signs of distress
=Cyanosis, accessory muscles

Question 9

Inspection of the mouth

Answer 9

-Buccal cavity
=Gingiva
=Parotid ducts
=Retromolar trigone

-Oral cavity
=Tongue all surfaces
=Submandibular ducts
=Palate

-Oropharynx
=Tonsils

Question 10

How to palpate the neck

Answer 10

-From behind
-Ask if painful
-Ant + Post triangle
-Systematically
-Bimanual if needed
-Special manoeuvres
-No tickling

Question 11

Investigation in H&N

Answer 11

Fibre-optic nasolaryngoscopy

Question 12

Difference between laryngoscopy and tracheostomy

Answer 12

-L: the ONLY air way
-T: can have the nasopharyngeal airway, irreversible airway obstruction (fenestrated= speak)