Head and Neck History Taking Flashcards
List some of the most common symptoms in presenting complaint of an ENT patient.
Sore throat
Dysphonia- hoarseness
Dysphagia
Odynophagia
Mouth/throat ulcer
Neck lump
In which issues is family history particularly important?
Thyroid issues
Name the three major salivary glands
Parotid
Sublingual
Submandibular
Auscultation is rare in head and neck examination but when might this be done?
Thyroid bruits
Carotid bruits
In which condition would there be a thyroid bruits?
Grave’s thyroiditis
In which condition would there be a carotid bruits?
Carotid stenosis
What happens if you look in someone’s mouth and they have two uvula?
Don’t panic! Strange to see but no clinical significance.
But gal, this could be something they throw in an OSCE to see if you notice ig so be aware!
What is used in examination of the throat?
Flexible or rigid laryngoscope
What colour are normal vocal cords?
Pearly white
If a patient presents with a lump in their neck, which investigation will be carried out?
FNAC
Fine needle aspirate cytology
Which scan is useful for seeing areas of increased metabolic activity?
PET scan
->areas of increased metabolic activity may be tumours as require more blood and nutrients to grow.
Which questions will need to be asked if a patient presents with a lump in the neck?
How long has it been there?
Site?
Fluctuates in size?
Sore?
Associated head and neck symptoms.
Recent travel?
Upon examination of a neck lump, what should be checked?
Seven S’s
Site
Size
Shape
Soft or hard?
Sore
Skin over the lump
Stuck or fixed to any adjacent structures?
Describe the features of a reactive lymph node.
Oval
Soft
Smooth
Mobile
Tender
If a child has reactive lymph nodes, what may the child have?
Ear infection
Posterior nasal infection
What may salivary gland swellings be related to?
Tumours
Inflammation
What other problems can occur within the salivary glands?
Salivary stones
In someone with salivary stones, when will their salivary glands swell?
In relation to meals- as soon as they try to salivate, the gland will swell up
Which investigation can be used to find salivary stones and why?
X-ray as they as usually radio-opaque because of high calcium content
If a patient presents with hoarseness, what would you want to ask of in past medical history?
Recent UTRI?
What other questions may you ask regarding hoarseness?
How long?
Persistent or intermittent?
Pain?
Cough/swallowing/choking?
Asthma/rhinitis/reflux causing irritation to throat?
How much do they use their voice e.g. teacher or singer?
Smoke?
Medication?
What are some benign causes of hoarseness?
Nodules
Cysts
Vocal abuse
Laryngitis
Smoking
Reflux
Infection
What is a more worrying cause of hoarseness?
Laryngeal carcinoma
What is the treatment for a laryngeal carcinoma?
Removal of voice box (larynx)
Could get a laryngectomy stoma where larynx is removed and trachea is stitched to the skin at the front of the neck.
Which other cancer may present with hoarseness and why?
Lung cancer
May metastase to hilum of lung and compress recurrent laryngeal nerve
List some questions to ask a patient presenting with dysphagia.
How long?
What is difficult to swallow?
Persistent or intermittent?
Pain?
Where do they feel food sticking?
What could be an issue with the lumen of the oesophagus causing dysphagia?
Foreign body
What could be an issue with the wall of the oesophagus causing dysphagia?
Stricture
Tumour
Pouch
Neuromuscular
What could be an extra-luminal issue of the oesophagus causing dysphagia?
Thyroid
Heart
Mediastinal mass
Which investigation may be carried out in someone with difficulty swallowing?
Barium swallow (contrast)
What is Globus phartyngeus?
Feeling like there is something stuck in the throat when there isn’t anything there
What is the cause of Globus phartyngeus?
Spasm of the Cricopharyngeus muscle
What can trigger spasm of the Cricopharyngeus muscle and therefore cause Globus Phartyngeus?
Reflex
Recent infection
Postnasal drip
Anxiety/stress
What is the most common type of malignancy in head and neck?
Squamous cell carcinoma
List some common sites for cancer of the head and neck.
Oral cavity
Larynx
Oropharynx
Nasopharynx
Hypopharynx
If someone has a nasopharynx cancer, what other related symptoms may they get?
Fluid in ear
Describe what would be felt in a malignant node of the neck.
Firm
Round
Irregular
Fixed
Non-tender
What is the symptom for airway obstruction?
Difficulty breathing
What is a clinical sign of airway obstruction?
Stridor
What are some of the causes of airway obstruction?
Tumours, foreign bodies, infection
How would an airway obstruction be treated?
ABC
humidified oxygen, steroids, adrenaline nebuliser
Secure airway, may involve surgery
Which surgery may be involved in the treatment of airway obstruction in cases of tumours?
Cricothyroidotomy or tracheostomy.
What is a complication of tonsillitis?
Quinsy (abscess)
When may a patient be offered tonsillectomy?
Bacterial tonsillitis
6-7 attacks in one year
Disrupting daily activities
More than one quinsy
