Head and neck history and examinations

Question 1

What are the sections of head and neck exam?

Answer 1

inspection
palpation
percussion
auscultation

Question 2

List five things in inspection

Answer 2

scars and deformities
sinuses
lumps
skin lesions
appliances e.g. tracheostomy

Question 3

What are the areas to assess in palpation

Answer 3

parotids
anterior triangle
posterior triangle
inferior neck midline for thyroid mass whilst swallowing and tongue protrusion

Question 4

What are you assessing for when you ask patient to stick out tongue and feel midline inferior neck?

Answer 4

thyroglossal cyst

Question 5

Why do you percuss?

Answer 5

to detect goitre- retrosternal extent

Question 6

Why do you auscultate?

Answer 6

assess for bruit in vascular lesions e.g. carotid body tumour

Question 7

List two imaging investigations you would do following findings in head and neck exam

Answer 7

USS for neck lumps + FNAC/core biopsy
MRI for soft tissue detail and CT for bone detail

Question 8

List three blood tests that would be appropriate following head and neck exam

Answer 8

FBC
CRP
Thyroid profile if thyroid lump suspected
Autoimmune screen

Question 9

Which blood test for sarcoid

Answer 9

ACE

Question 10

Which blood test for wegners granulomatosis

Answer 10

cANCA

Question 11

Which blood test for sjorgens syndrome?

Answer 11

SS-A and SS-B

Question 12

List two features of Sjorgens syndrome

Answer 12

parotid swelling, dry mouth and eyes

Question 13

Which three areas of the mouth would you inspect in mouth exam?

Answer 13

oral cavity
buccal cavity
oropharynx

Question 14

What would you palpate in the mouth examination?

Answer 14

parotid duct
floor of mouth and submandibular duct
tongue base
temporomandibular joint
neck- cervical lymphadenopathy

Question 15

What imaging could you offer following mouth exam?

Answer 15

USS for salivary gland architecture/stones
silaography for stones/sticture

Question 16

List three red flag symptoms for head and neck history

Answer 16

hoarseness
dysphagia
lump
pain-neck, ear (otalgia), on swallowing (odynophagia)
(smoking- not symptom but strong aetiological link)

Question 17

List four risk factors for head and neck cancers

Answer 17

smoking
male
age >40 years
HPV infection
wood workers

Question 18

Which HPV infections are risk factors for head and neck cancers

Answer 18

16-18

Question 19

Name a cancer that wood workers are at risk of developing

Answer 19

sino-nasal tumour- adenocarcinoma

Question 20

List three differentials for salivary glands swellings

Answer 20

stones
infection
ranula??
benign neoplasia
malignant neoplasia

Question 21

Name the salivary glands

Answer 21

parotid
submandibular
sublingual x2

Question 22

What is ranula?

Answer 22

A ranula is a spit-filled cyst that forms under your tongue. It can result from a blocked salivary gland.