Head and neck symptoms and signs Flashcards
List three differentials for hoarseness
infective- acute laryngitis
benign e.g. nodules
irratative e.g. laryngeal reflux
malignant
post-surgical
List two benign causes of hoarseness
nodules
polyps
cysts
papillomas
List one irratative cause of hoarseness
laryngeal reflux
reinke’s oedema
List one post surgical causes of hoarseness
vocal cord surgery
recurrent laryngeal nerve palsy
Which is the strongest risk factor for reinke’s oedema
smoking- occurs exclusively in this population
If patient has problems swallowing solids but not liquids, what is the nature of the cause?
obstructive
If patient has problems swallowing liquids more than solids, what is the nature of the problem?
neurological
List three differentials for dysphagia
foreign body
neurological
tumour
stricture
iatrogenic
List a benign obstructive cause of dysphagia
pharyngeal pouch
List a malignant cause of dysphagia
oesophageal cancer
List two differentials for strictures causing dysphagia
GORD
congenital web
systemic sclerosis
List three differentials for throat pain
- Infective (lasting < 2 weeks with systemic upset)
- Malignant (lasting > 2 weeks, lateralising, radiating to ear, progressive)
G3. lobus pharyngeus (sensation in throat not pain as such – swallow not affected) - Laryngopharyngeal reflux – symptoms of heartburn / waterbrash
- Neuralgic – (rare) pharyngeal plexus (CN IX, X) – Eagle’s syndrome (overlong styloid process)
List three differentials for midline/para median neck lump
thyroid
thryoglossal cyst
dermoid cyst
lymph nodes
cutaneous lesions- sebaceous cysts, lipoma
List three airway noises
inspiratory stridor
stertor= snoring
biphasic stridor
wheeze= expiratory stridor
Where does wheeze suggest obstruction is?
tracheobronchial
Where does inspiratory stridor suggest problem is?
glottis/supraglottis
What is the site of problem with snoring?
oropharynx
List two congenital conditions that cause airway noise
laryngomalacia
subglottic stenosis
webs
subglottic cysts
haemangioma
List three causes of airway noise
tonsillitis
foreign body
haematoma
goitre
obstuctive sleep apnoea
angioedema
List two infective causes of airway noise
Tonsillitis, parapharyngeal abscess, epiglottitis, croup, respiratory papillomatosis
List two traumatic causes of airway noise
Foreign body, Intubation trauma, Vocal cord palsy, Laryngeal #, Haematoma
List two neoplastic causes of airway noise
Benign (goitre, cystic hygroma, haemangioma) – Malignant (SCC, Lymphoma)
What is stertor?
noisy breathing above larynx
What is stridor?
pathology within larynx itself
Differential diagnosis for airway problems
infective- tonsillitis, epiglottis
hypersensitivity- angioedema, allergy
trauma
neurological
malignancy
foreign body
big thyroid
Score for tonsillitis and deciding whether abx?
Centor-score
cough
body temp
cervical lymph nodes
tonsillar swelling or exudate
What centor score recommends antibiotics
4
Complications of tonsillitis?
peritonsillar abscess
rheumatic fever
post-strep glomerulonephritis
lemierre disease? = thrombosis of internal jugular vein, septic emboli- sepsis
Complications of tonsillectomy surgery?
oropharyngeal bleed
pain
Difference between tracheostomy and laryngectomy?
? important
layngectomy= only hole patient has to breathe so don’t occlude!!!
no tube for laryngectomy
tube mandatory for tracheostomy
Laryngectomy patient comes into A&E blue, where do you put the oxygen mask?
over the stoma/layngectomy
NOT over the mouth- oxygen goes to stomach
tracheo- still have communication between mouth and lungs, can put mask over trache as well
