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OSCE > Head and Neck History Taking > Flashcards

Head and Neck History Taking Flashcards

1
Q

What are the common presentation of head and neck pathology?

A

–Sore Throat

–Dysphonia - Hoarseness

–Dysphagia

–Odynophagia

–Mouth/Throat Ulcer

–Neck Lump

History

  • Smoking / alcohol
  • Family history
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2
Q

What are the subdivisions of the pharynx?

A
  • Nasopharynx
  • Oropharynx
  • Hypopharynx
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3
Q

What are the subdivisions of the larynx?

A
  • Supraglottis
  • Glottis (vocal cords)
  • Subglottis
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4
Q

What does a doctor examine in the case of head and neck pathology?

A

Neck

Oral cavity

Pharynx

Larynx

Nose

Ears

Salivary Glands

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5
Q

What are the methods of throat examination?

A

Indirect laryngoscopy

Fibre optic nasolaryngoscopy

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6
Q

When might auscultation be used?

A
  • Thyroid bruit (Grave’s thyroiditis)
  • Carotid bruit (carotid stenosis)
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7
Q

What are the relevant head and neck investigations?

A

FNAC

CT/MRI/PET scan

US scan

Plain X-ray

Contrast Swallow

Endoscopy

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8
Q

What is the first line investigation for neck lump?

A

FNAC

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9
Q

When is FNAC contraindicated?

A

In pulsatile lumps

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10
Q

What are the relevant questions to ask about neck lumps?

A
  • How long?
  • Site?
  • Fluctuates?
  • Sore?
  • H&N symptoms?
  • B symptoms? Lymphoma
  • Travel?
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11
Q

What should you examine in a neck lump?

A
  • Site
  • Size
  • Shape
  • Sore
  • Skin
  • Stuck
  • Soft
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12
Q

What are the features of a reactive lymph node vs malignant neck node?

A

Ractive:

Oval

Soft

Smooth

Mobile

Tender

Malignant:

Round

Firm

Irregular

Fixed

Non-tender

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13
Q

When do you get enlarged salivary glands?

A

Tumour – e.g.Pleomorphic Adenoma

Inflammation - Parotitis

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14
Q

What is a common pathology of the submandibular gland?

A

Duct calculi

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15
Q

What might you ask a patient suffering from hoarseness?

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

INhalers can become irritating to volcal chords

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16
Q

What causes hoarseness?

A
  • Nodules
  • Cysts
  • Vocal abuse
  • Laryngitis
  • Infection
  • Smoking
  • Reflux

Laryngeal cancer

17
Q

Which nerve compression may result in hoarseness?

A

Recurrent laryngeal nerve

18
Q

What questions are useful when the patient has dysphagia?

A
  • What is difficult? food? water?
  • Persistent/Intermittent?
  • Pain?
  • Where?
  • Well Localised in Neck
  • Poorly localised lower down.
19
Q

What are the luminal causes of dysphagia?

A

Foreign body

20
Q

What are the wall causes of dysphagia?

A

Tumour, stricture, neuromuscular, pouch

21
Q

What are the mediastinal causes of dysphagia?

A

Thyroid, heart, mediastinal mass

22
Q

What is the cause of dysphagia if food goes down but water doesn’t?

A

Neuromuscular

23
Q

What is meant by FOSIT?

A

Feeling of something in throat

24
Q

What causes FOSIT?

A

Globus pharyngeus,

Spasm of the ring of muscle associated with the cricoid cartilage (cricopharyngeus)

25
Q

What causes globus pharyngeus?

A

Acid reflux

Anxiety, stress

26
Q

Does Globus pharyngeus cause dysphagia?

A

NO - easier with food

Not a red flag symptom

27
Q

What are the benign and malignant H and N disorders?

A
28
Q

What is treatment for head and neck cancer?

A

Surgery

Radiotherapy

Chemotherapy

Pallation

29
Q

What are causes of airway obstruction?

A

Infection

Tumour

Foreign body

30
Q

How do you treat with ABC for airway obstruction?

A

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

31
Q

Where is a cricothyroidotomy made?

A
32
Q

What is defined as bacterial tonsilitis?

A
  • Bacterial Tonsillitis: (pus covering, neck nodes, fever, no cough)
  • 6-7 attacks in 1 year (5 per year over two years, 3 per year over three years)
  • Disrupting daily activities
  • More than 1 quinsy

Quinsy: inflammation of the throat, especially an abscess in the region of the tonsils.

OSCE (45 decks)

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