Head and Neck history taking Flashcards
what are common head and neck symptoms to cover in history taking?
sore throat
Dysphonia -Hoarseness
Dysphagia
Odynophagia
Mouth/Throat Ulcer
Neck Lump
smoker/alcohol intake
family history
what sites are important to cover in examination?
Neck
Oral cavity
Pharynx
Nasopharynx
Oropharynx
Hypopharynx
Larynx
Supraglottis
Glottis (vocal cords)
Subglottis
Nose/Ears/Salivary Glands
how many levels of the neck are there?
six commonly described levels in the neck
what is level one of the neck?
submental and submandibular area
what are levels two, three and four?
They follow the sternocleidomastoid and sit under the anterior edge of that muscle
what is examined within levels two, three and four?
deep cervical lymph nodes
what is felt for in posterior triangle/level 5?
posterior nodes
five also includes supraclavicular fossa
what is level 6 and when is it relevant in patients?
pretracheal, and it’s relevant in patients who might have thyroid conditions such as thyroid cancer
what major salivary glands are palpated for?
parotid gland, submandibular gland and the sublingual gland
how are salivary glands felt for?
the use of by manual palpation where one places the hand both inside and outside the patient’s mouth to palpate the glands and the associated ducts.
Just in case we might feel any swelling’s or indeed any stones or calculi within the ducts that drain these salivary glands.
note location of major salivary glands
what would cause a thyroid bruit?
A thyroid bruit is described as a continuous sound that is heard over the thyroid mass. (If you only hear something during systolic, think about a carotid bruit or radiating cardiac murmur.) A thyroid bruit is seen in Grave’s disease from a proliferation of the blood supply when the thyroid enlarges.
when would you perform auscultation?
Thyroid bruit (Grave’s thyroiditis)
Carotid bruit (carotid stenosis)
what would cause a carotid bruit?
A carotid bruit is a vascular sound usually heard with a stethoscope over the carotid artery because of turbulent, non-laminar blood flow through a stenotic area
what do these images show?
minor cleft palate, tonsillitis, mid tongue abscess following piercing
what are these images all examples of?
early oral cavity cancer, including lip cancer
what are different methods of throat examination?
Fibreoptic Nasolaryngoscopy
Indirect Laryngoscopy
(Obsolete)
Rigid laryngoscopy
what does this image show?
“Pearly white” normal vocal cords
what are some possible head and neck investigations?
FNAC
CT/MRI/PET scan
US scan
Plain X-ray
Contrast Swallow
Endoscopy
what is the most important test for a lump in neck?
Fine Needle Aspiration Cytology “FNAC”
what do all these images show?
All these images, in fact, show evidence of tumours in the larynx or around the back of the tongue throat area.
left=ct scan
middle=mri
right-PET
what history questions do you ask a patient presenting with a lump in their neck?
How long?
Site?
Fluctuates?
Sore?
H&N symptoms?
B symptoms?
Travel?
what do you examine in a patient with a lump in their neck?
Site
Size
Shape
Sore
Skin
Stuck
Soft
what are some different types of benign neck lumps?
branchial cyst, lipoma, thyroglossal cyst and a child with a reactive lymph node.
how would a benign neck lump be characterised?
oval in shape. It’s going to be soft, smooth, mobile - may be tender
what may salivary Gand swelling relate to?
Tumour eg. benign Pleomorphic Adenoma
Inflammation - Parotitis
what is parotitis
Parotitis is an inflammation of one or both parotid glands, the major salivary glands located on either side of the face
what else may affect the salivary glands?
stones blocking the flow of saliva so that the gland will swell in relation to meals.
X-ray these and often find the stone is radio-opaque because of its calcium content.
In a patient presenting with hoarseness what questions should you ask?
How long?
Recent URTI?
Persistent or Intermittent?
Pain?
Cough/Choking/Swallowing?
Asthma/Rhinosinusitis/Reflux?
Voice use?
Smoker?
Medication?
what are some benign causes of hoarseness?
Nodules
Cysts
Vocal abuse
Laryngitis
Infection
Smoking
Reflux
what is a malignant cause of hoarseness?
early and advanced laryngeal cancer
recurrent laryngeal nerves (esspecially on left) affected
lung cancer
what questions would you ask a patient presenting with dysphagia?
What is difficult?
Persistent/Intermittent?
Pain?
Where?
Well Localised in Neck
Poorly localised lower down.
what may cause dysphagia in the lumen?
foreign body
what may cause dysphagia in the wall?
tumour, stricture, neuromuscular, pouch
what may cause dysphagia in the extra luminal?
Thyroid, Heart, Mediastinal mass
what type of investigation do these images show?
barium swallow
when may a barium swallow be considered?
someone with difficulty swallowing.
what is globus pharyngeus?
painless sensation of a lump in the throat and may be described as a foreign body sensation, a tightening or choking feeling. It is often associated with persistent clearing of the throat, chronic cough, hoarseness, and catarrh.
why do people with globes pharyngeus feel a sensation of choking?
they’re feeling is spasm of this muscle here, one of the pharyngeal muscles -
Cricopharyngeus, forms a ring of muscle above which is the pharynx and below which is the oesophagus.
this muscle can be irritated by a number of factors, such as reflux.postnatal drip, recent infection. And sometimes, can also be affected by anxiety and stress,
which can cause the muscle to go tight and present us with that typical lump in the throat feeling.
what are common sites for malignant cancer in head and neck?
Oral cavity
Larynx
Oropharynx
Nasopharynx
Hypopharynx
what type of cancer is 90% of malignant cancers in head and neck?
squamous carcinoma
what are the characteristics of a malignant neck node?
round
Firm
Irregular
Fixed
Non-tender
what are the signs of airway obstruction?
Symptom: Difficulty breathing
Sign: Stridor = Noisy Breathing: Inspiratory/Expiratory/Biphasic
when is a Tracheostomy/Cricothyroidotomy performed?
Cricothyrotomy and tracheostomy are medical procedures that help people with airway obstruction. Cricothyrotomy is an emergency procedure that provides immediate access to the airway. Tracheostomy is a surgical procedure performed to help with long-term breathing issues.
how do you treat an airway obstruction?
“ABC” Humidified O2 , Steroids, Adrenaline nebuliser.
Secure the airway
e.g. Intubate; FONA (cricothyroidotomy, tracheostomy)
when is a tonsillectomy offered?
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
