History, Examination and Investigation

Question 1

Common presenting symptoms in head and neck

Answer 1

Sore throat 
Dysphonia 
Dysphagia 
Odonophagia 
Mouth/throat ulcer 
Neck lump

Question 2

Common way to examine the oral cavity

Answer 2

Use pen torch and tongue depressor - ask patient to open mouth and say “ah”

Question 3

Ways to examine the throat

Answer 3

Indirect laryngoscopy

Fibreoptic nasolaryngoscopy

Question 4

Things that might be identified on auscultation of the neck

Answer 4

Thyroid bruit
Carotid bruit
Pseudo-aneurysm

Question 5

Methods of investigation of head and neck

Answer 5

Fibre-optic nasolaryngoscopy 
Laryngoscopy 
Fine needle aspiration cytology 
CT/MRI/PET
Ultrasound 
Plain x-ray 
Contrast swallow
Endoscopy

Question 6

Histological type of 90% of head and neck malignancies

Answer 6

Squamous cell carcinoma

Question 7

Treatment options for head and neck cancer

Answer 7

Surgery
Radiotherapy
Chemotherapy
Palliative Care

Question 8

Surgical options for head and neck cancer

Answer 8

Neck dissection and flap reconstruction
Tracheostomy
Cricothyroidotomy
Laryngectomy

Question 9

When might neck dissection and flap reconstruction be used

Answer 9

Malignant neck node with following qualities;
round 
firm 
irregular 
fixed 
non-tender

Question 10

Major salivary glands

Answer 10

Parotid
Submandibular
Sublingual

Question 11

How are the salivary glands examined?

Answer 11

Bimanual palpation

Question 12

Salivary gland conditions

Answer 12

Tumour e.g. pleomorphic adenoma (benign)
Parotitis
Duct calculus

Question 13

Features of bacterial tonsillitis

Answer 13

Exudates on tonsils
Enlarged neck nodes
Fever
No cough

Question 14

Treatment of viral tonsillitis

Answer 14

Analgesia

Question 15

Treatment of bacterial tonsillitis

Answer 15

Analgesia and antibiotics - penicillin V

Question 16

Criteria for patient to be considered for tonsillectomy

Answer 16

6-7 episodes of bacterial tonsillitis in one year
5 episodes per year over two years
3 episodes per year over 3 years

Question 17

Questions to ask when assessing a hoarse patient

Answer 17

How long hoarseness has lasted 
Whether hoarseness is persistent or intermittent 
Any pain 
Cough, choking or dysphagia
Is voice use normal 
PMH of asthma, rhinosinusitis or reflux
If they smoke 
Drug history

Question 18

Conditions to consider in a patient with hoarseness (differential diagnoses)

Answer 18

Nodules 
Cysts 
Vocal abuse 
Laryngitis 
Infection 
Caused by smoking/reflux 
Laryngeal cancer 
Recurrent laryngeal nerve problem

Question 19

Questions to ask a patient with dysphagia

Answer 19

What is difficult to swallow - liquids or solids 
Persistent or intermittent 
Any pain 
Where they feel food/liquid stick
Assess lumen for foreign body

Question 20

What does dysphagia with solids but not liquids suggest

Answer 20

Mechanical disruption

Question 21

What does dysphagia with liquids but not solids suggest

Answer 21

Neuromuscular problem

Question 22

Questions to ask when taking history of a patient with a neck lump

Answer 22

How long they have had the lump 
Site 
Whether size fluctuates
Pain 
Head and neck symptoms 
Recent travel

Question 23

Aspects of a neck lump important to determine on examination

Answer 23

Site 
Size 
Shape 
Sore to touch 
Surrounding skin - bruised, rash, bleeding etc.
Soft or hard 
Fixed or mobile