Head And Neck - History Taking Flashcards
What symptoms should be asked in a head and neck history?
Sore throat
Dysphonia- hoarseness
Dysphagia
Mouth/throat ulcer
Neck lump
What id a lifestyle factor to consider in history?
Smoking
Alcohol
What is another important aspect to history in head and neck?
Family history (thyroid problem)
Where should you examine for head and neck?
Neck
Oral cavity
Pharynx
Larynx
Nose/ears/salivary glands
What nodes are in level 1 of the neck nodes?
Submental
Submandibular
What nodes are in level 2, 3 and 4 of the neck nodes?
Nodes in the anterior edge of SCM
What nodes are in level 5 of the neck nodes?
Posterior triangle
Feel for posterior nodes
Include supraclavicular fossa
What nodes are in level 6 of the neck nodes?
Pretracheal
How should salivary glands be palpated?
Bimanual palpation
Feel gland and associated duct
What should you ausculatate for in head and neck?
Thyroid bruit (grave’s thyroiditis)
Carotid bruit (carotid stenosis)
What can be used for throat examination?
Indirect laryngoscopy
Fibre optic nasolaryngoscopy
Rigid larygoscopy
What investigations should be done for head and neck?
Fine needle aspiration cytology
CT/MRI/PET scan
Us scan
Plain X-ray
Contrast swallow
Endoscopy
What should be considered when a patient present with a neck lump?
How long?
Site?
Fluctuates?
Sore?
H&N symptoms?
B symptoms
Travel?
What should be examined for in neck lumps?
Site
Size
Shape
Sore
Skin
Stuck
Soft
What would a reactive lymph node feel like?
Oval
Soft
Smooth
Mobile
Tender
What can be causes of salivary gland swelling?
Tumour eg benign pleomorphic adenoma
Inflammation- parotitis
What should be asked in history of hoarseness?
How long?
Recent URTI?
Persistent or intermittent?
Pain?
Cough/ choking/ swallowing?
Asthma/ rhinosinusitis/ reflux?
Voice use?
Smoker?
Medication?
What are benign causes of hoarseness?
Nodules
Cysts
Vocal abuse
Laryngitis
Infection
Smoking
Reflux
What can be a non benign cause of hoarseness?
Laryngeal carcinoma
What should be asked with dysphagia?
What is difficult?
Persistent/ intermittent?
Pain?
Where?
What is a cause of dysphagia in the lumen?
Foreign body
What is a cause of dysphagia in the wall?
Tumour
Stricture
Neuromuscular
Pouch
What is a cause of dysphagia that is extra luminal?
Thyroid
Heart
Mediastinal mass
What can be used to investigate the cause of dysphagia?
Barium swallow
What is FOSIT?
Feeling of something in throat
Globus pharyngeus
Does FOSIT present with dysphagia?
No
Is FOSIT a red flag symptom?
No
What can FOSIT be caused by?
Acid reflux “silent” (laryngopharngeal reflux)
Stress/ anxiety
Where are common sites of head and neck cancer?
Oral cavity
Larynx
Oropharynx
Nasopharynx
Hypopharynx
What does a malignant neck node feel like?
Round
Firm
Irregular
Fixed
Non-tender
What is the symptom of airway obstruction?
Difficulty breathing
What are the signs of airway obstruction?
Stridor
-inspiratory = obst above vocal cord level)
- expiratory = wheeze
- biphasic = below vocal cords and above trachea
What are causes of airway obstruction?
Infection
Tumour
Foreign body
How should airway obstruction be treated?
ABC
Humidifies O2
Steroids
Adrenaline nebuliser
Secure the airway (intubate; FONA - cricothyroidotomy, tacheostomy)
How does bacterial tonsilitis present?
Pus covering
Neck nodes
Fever
No cough
When should tonsilectomy be offered?
6-7 attacks in 1 year
Disrupts daily activities
More than 1 quinsy
