Histories Flashcards
Causes of hyposmia / anosmia:
Most common:
- Sinonasal disease
- Post viral anosmia (Covid-19, rhinovirus, parainfluenzae)
- Head trauma
- Other: Neoplasia, Cushings, Kallmann’s, Turner’s
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Conductive - blocks odorants:
- Rhinitis, Polyps
- Sinonasal neoplasia
- Cystic fibrosis
Sensory - loss of receptor function
- Post viral damage to peripheral olfactory receptors
Neural - damage to periphral/ central neural pathways
- Head Trauma (damage nerves or olfactory cortx)
- Intracranial mass lesion or neoplasia
Idiopathic
Other:
- Autoimmune: Diabetes, Thyroid, MS/Neuroligcal conditions
- Dementia
- Drugs: Antihypertensives (ACE-I & Ca blockers), statins
- Syndromes: Kallmann’s, Turners
- Chemical e.g. nickel
Questions not to miss in hyposmia / anosmia history:
TRAUMA
Intra cranial lesions / raised ICP Q’s
Allergies / Pets / Hayfever etc.
Cystic Fibroosis
Autoimmune: DM, Thyroid
Neurological conditions e.g. MS
Dementia
Syndromes: Turner’s, Kallmann’s
Drugs: Antihypertensives, Statins
Chemical exposure - e.g. nickel
Epistaxis history - questions not to miss:
How much blood do you lose (e.g. eggcupfuls)
Required prev. hospital Rx for epistaxis?
Affect of epistaxis on pt life
Allergies -hayfever, animals etc
Use of nasal oxygen - dries mucosa
HTN / Coagulopathy / Liver disorders / bleeding disorders
Drugs: DOAC, warfarin, clopidogrel
Nasal drugs e.g. cocaine
Exposure to wood dust / heavy metals / occupation
FH - HHT / coagulopathies
Facial pain - causes:
Sinogenic
- Acute (rarely chronic) rhinosinusitis
Non sinogenic:
Neuropathic:
- Migraine
- Midfacial segment pain
- Tension headache
Cranial neuropathies:
- Trigeminal neuralgia (masses or microvascualr compromise can cause)
- Trigeminal autonomic cephalgias (unilateral trigeminal distribution pain occurring in association with ipsilateral cranial autonomic symptoms)
Dental pain
TMJ dysfunction
Myofascial pain
Facial pain - questions not to miss:
Impact on life
Autonomic symptoms (tearing, N&V)
Migraine symptoms (sensitivity light / sounds, aura etc.)
Mass lesion symptoms / fever / weight loss
Exacerbating factors - stress, caffeine, alcohol
Dental / Jaw problems / muscular problems
Medications ? intranasal steroids / decongestants / analgesia used etc
Hearing loss in child questions not to miss:
AOM soft signs: ear tugging / irritability / poor feeding
TRAUMA to the head?
OSA / Snoring / Breathing issues
TV volume / school / teachers
Developmental - delay / Down’s / Cleft palate
Birth / NICU / prematurity / perinatal
Maternal infections - TORCH
Routine vaccines
Smoking in household
FH syndromes / SNHL?
Child recurrent ear infections - questions not to miss:
AOM soft signs: ear tugging / irritability / poor feeding
OSA / Snoring / Breathing issues
Other infections / ? immunocompromise
School / development
Developmental - delay / Down’s / Cleft palate
Birth / NICU / prematurity / perinatal
Routine vaccines
Household smoking
Other siblings well? Similiar issues? FH…
Neck lumps - differentials
Congenital
- Thyroglossal cyst
- Branchial cyst
- Laryngocele
- Teratoma
- Dermoid cyst
- Cystic hygroma
Infective
- Reactive lymph node (viral or bacterial lymphadenopathy)
- Granulomatous disease (TB, Sarcoid)
Neoplastic
- Metastatic SCC
- Thyroid masses
- Salivary masses
- Lymphoma
Vascular
- Carotid aneurysm
- Carotid body tumour
- Paraganglioma (Glomus Jugulare / Glomus vagale)
Neck lump history - questions not to miss
Does the lump change when eating (salivary masses often do)
Lymphoma - night sweats, weight loss, rubbery nodes
Nose: Associated nasal blockage / symptoms
Ear: Associated otalgia / otological symptoms
Throat: Hoarseness / odynophagia / dysphagia
Trismus / TMJ
Salivary gland symptoms
CV disease (aneurysm) / Diabetes
Holidays abroad - TB
Work chemicals / animals (abattoir - rare infections e.g. brucellosis)
Dry mouth (Xerostomia) causes:
Medications
- Anticholinergics e.g. antidepressants
- Antihypertensives
Mouth breathing e.g. due to nasal blockage
Radiotherapy
Systemic disease
- Sjogrens syndrome / Autoimmune disease
- HIV
- Parkinsons
- DM
Pseudoxerostomia
Xerostomia history questions not to miss:
Bad breath / problems with teeth / oral infections (can all result from xerostomia)
Radiation exposure!
OSA / snoring / nasal blockage (mouth breathing)
Screen for malignancy / Red flags
Medications: antihypertensives, anticholinergics
FH and PMH autoimmune disease (Raynauds, Sjogrens)
Occupation - voice abuse, teacher /singer
Causes of Tinnitus:
**Objective **- heard by the clinician e.g. Bruit
- Dehiscent jugular bulb
- Carotid artery stenosis
- Dural venous fistula
Subjective
Otological:
- Noise trauma
- Presbycusis / SNHL
- Infective - AOM
- Wax impaction
- Vestibular schwannoma
- Ménière’s disease
- Skull base tumours e.g. glomus tympanicum, retrochoclear lesions
Medications:
- Aspirin, NSAIDs, gentamicin, cisplatin
- Antimalarials / Benzo’s / diuretics can = SNHL therefore tinnitus
Systemic diseases:
- Thyroid disease
- B12 deficiency
- Anaemia
Psychiatric: Anxiety / depression
Tinnitus history questions not to miss:
Uni / bilateral (unilateral ? retrocochlear lesions)
Worse with noise or without
Character - ringing / pulsatile / clicking
Casn you change the tinnitus (modulation - somatic tinnitus)
Associated: hearing loss, vertigo, aural fullness etc
Screen for intracranial lesions
Sleep disturbance / impact to patient
ICE! - Brain tumour
Medications - gentamicin / aspirin / NSAIDs / Cisplatin / antimalarials
Hoarse voice - causes:
Laryngitis: viral or local irritants e.g. smoking or LPR
Voice abuse
Local vocal cord disease (nodules, cysts, reinkes)
Neoplasia
Endocrine - DM, Thyroid
Haematological - leaukaemia, lymphoma
Hoarse voice - questions not to miss
Suffer with reflux
Worse when lying down?
Cattarh? Do you clear throat a lot?
Systemic things like: DM, Thyroid, neurological conditions
Voice abuse / teacher / singer etc
