Head and Neck History Taking Flashcards
What are the common presentation of head and neck pathology?
–Sore Throat
–Dysphonia - Hoarseness
–Dysphagia
–Odynophagia
–Mouth/Throat Ulcer
–Neck Lump
History
- Smoking / alcohol
- Family history
What are the subdivisions of the pharynx?
- Nasopharynx
- Oropharynx
- Hypopharynx
What are the subdivisions of the larynx?
- Supraglottis
- Glottis (vocal cords)
- Subglottis
What does a doctor examine in the case of head and neck pathology?
Neck
Oral cavity
Pharynx
Larynx
Nose
Ears
Salivary Glands
What are the methods of throat examination?
Indirect laryngoscopy
Fibre optic nasolaryngoscopy
When might auscultation be used?
- Thyroid bruit (Grave’s thyroiditis)
- Carotid bruit (carotid stenosis)
What are the relevant head and neck investigations?
FNAC
CT/MRI/PET scan
US scan
Plain X-ray
Contrast Swallow
Endoscopy
What is the first line investigation for neck lump?
FNAC
When is FNAC contraindicated?
In pulsatile lumps
What are the relevant questions to ask about neck lumps?
- How long?
- Site?
- Fluctuates?
- Sore?
- H&N symptoms?
- B symptoms? Lymphoma
- Travel?
What should you examine in a neck lump?
- Site
- Size
- Shape
- Sore
- Skin
- Stuck
- Soft
What are the features of a reactive lymph node vs malignant neck node?
Ractive:
Oval
Soft
Smooth
Mobile
Tender
Malignant:
Round
Firm
Irregular
Fixed
Non-tender
When do you get enlarged salivary glands?
Tumour – e.g.Pleomorphic Adenoma
Inflammation - Parotitis
What is a common pathology of the submandibular gland?
Duct calculi
What might you ask a patient suffering from hoarseness?
- How long?
- Persistent or Intermittent?
- Pain?
- Cough/Choking/Swallowing?
- Voice use?
- Asthma/Rhinosinusitis/Reflux?
- Smoker?
- Medication?
INhalers can become irritating to volcal chords
What causes hoarseness?
- Nodules
- Cysts
- Vocal abuse
- Laryngitis
- Infection
- Smoking
- Reflux
Laryngeal cancer
Which nerve compression may result in hoarseness?
Recurrent laryngeal nerve
What questions are useful when the patient has dysphagia?
- What is difficult? food? water?
- Persistent/Intermittent?
- Pain?
- Where?
- Well Localised in Neck
- Poorly localised lower down.
What are the luminal causes of dysphagia?
Foreign body
What are the wall causes of dysphagia?
Tumour, stricture, neuromuscular, pouch
What are the mediastinal causes of dysphagia?
Thyroid, heart, mediastinal mass
What is the cause of dysphagia if food goes down but water doesn’t?
Neuromuscular
What is meant by FOSIT?
Feeling of something in throat
What causes FOSIT?
Globus pharyngeus,
Spasm of the ring of muscle associated with the cricoid cartilage (cricopharyngeus)
