Head and Neck History Taking

Question 1

What are the methods of throat examination?

Answer 1

Indirect laryngoscopy

Fibre optic nasolaryngoscopy

Question 2

When might auscultation be used?

Answer 2

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

Question 3

What are the relevant head and neck investigations?

Answer 3

FNAC

CT/MRI/PET scan

US scan

Plain X-ray

Contrast Swallow

Endoscopy

Question 4

What is the first line investigation for neck lump?

Answer 4

FNAC

Question 5

When is FNAC contraindicated?

Answer 5

In pulsatile lumps

Question 6

When do you get enlarged salivary glands?

Answer 6

Tumour – e.g.Pleomorphic Adenoma

Inflammation - Parotitis

Question 7

What is a common pathology of the submandibular gland?

Answer 7

Duct calculi

Question 8

What might you ask a patient suffering from hoarseness?

Answer 8

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

INhalers can become irritating to volcal chords

Question 9

What causes hoarseness?

Answer 9

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

Laryngeal cancer

Question 10

Which nerve compression may result in hoarseness?

Answer 10

Recurrent laryngeal nerve

Question 11

What questions are useful when the patient has dysphagia?

Answer 11

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

Question 12

What are the luminal causes of dysphagia?

Answer 12

Foreign body

Question 13

What are the wall causes of dysphagia?

Answer 13

Tumour, stricture, neuromuscular, pouch

Question 14

What are the mediastinal causes of dysphagia?

Answer 14

Thyroid, heart, mediastinal mass

Question 15

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

Answer 15

Neuromuscular

Question 16

What is meant by FOSIT?

Answer 16

Feeling of something in throat

Question 17

What causes FOSIT?

Answer 17

Globus pharyngeus,

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

Question 18

What causes globus pharyngeus?

Answer 18

Acid reflux

Anxiety, stress

Question 19

Does Globus pharyngeus cause dysphagia?

Answer 19

NO - easier with food

Not a red flag symptom

Question 20

What are the benign and malignant H and N disorders?

Answer 20

Question 21

What is treatment for head and neck cancer?

Answer 21

Surgery

Radiotherapy

Chemotherapy

Pallation

Question 22

What are causes of airway obstruction?

Answer 22

Infection

Tumour

Foreign body

Question 23

How do you treat with ABC for airway obstruction?

Answer 23

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

Question 24

Where is a cricothyroidotomy made?

Answer 24

Question 25

What is defined as bacterial tonsilitis?

Answer 25

• 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.