History Taking, Examination and Investigation

Question 1

What symptoms should be discussed?

Answer 1

• Sore throat
• Dysphonia (hoarseness)
• Dysphagia
• Odynophagia
• Mouth/throat ulcers
• Neck lumps

Question 2

What are the 3 components of the pharynx?

Answer 2

• Nasopharynx
• Oropharynx
• Hypopharynx

Question 3

What are the 3 components of the larynx?

Answer 3

• Supraglottis
• Glottis
• Subglottis

Question 4

How should neck node levels be examined?

Answer 4

• Trace a Z

- Count to 5

Question 5

What may you want to auscultate for?

Answer 5

• Thyroid bruit indicative of Grave’s thyroiditis

- Carotid bruits indicative of carotid stenosis

Question 6

What are the key investigations for head and neck?

Answer 6

• FNAC
• CT/MRI/PET
• US
• Plain X-ray
• Contrast swallow
• Endoscopy

Question 7

What should you ask about in the history of a neck lump?

Answer 7

• How long?
• Site?
• Fluctuates?
• Sore?
• H and N symptoms?
• B symptoms? (related to lymphomas)
• Travel?

Question 8

What are the 7 Ss you are interested in when examining a neck lump?

Answer 8

• Site
• Size
• Shape
• Sore
• Skin
• Stuck
• Soft

Question 9

What are the characteristics of a reactive lymph node?

Answer 9

• Oval
• Soft
• Smooth
• Mobile
• Tender

Question 10

What do you want to ask about when it comes to someone who presents with hoarseness?

Answer 10

• How long?
• Persistent or intermittent?
• Pain?
• Cough/choking/swallowing?
• Voice use?
• Asthma, rhino sinusitis/reflux?
• Smoker?
• Medication?

Question 11

What may hoarseness be due to?

Answer 11

• Nodules
• Cysts
• Vocal abuse
• Laryngitis
• Infection
• Smoking
• Reflux
• Laryngeal cancer

Question 12

What do you want to know about the patient who presents with dysphagia?

Answer 12

-What is difficult?
-Persistent/intermittent?
-Pain?
-Where?
-

Question 13

What may be the cause of dysphagia in the lumen?

Answer 13

Foreign body

Question 14

What may be the cause of dysphagia in the wall?

Answer 14

• Tumour
• Stricture
• Neuromuscular
• Pouch

Question 15

What may be the cause of dysphagia in the extra luminal space?

Answer 15

• Thyroid
• Heart
• Mediastinal mass

Question 16

How is globus pharyngeus otherwise referred to?

Answer 16

FOSIT

-Feeling of something in throat

Question 17

What are the characteristic of cricopharygeus?

Answer 17

• Acid reflux
• Strees/anxiety
• No dysphagia
• Not a red flag symptom

Question 18

What can cause benign head and neck disorders?

Answer 18

• Congenital
• infective
• Inflammatory
• Trauma
• Neoplasia

Question 19

What are the majority of cancers in head and neck?

Answer 19

Squamous carcinomas

Question 20

What are the treatment options for head and neck cancers?

Answer 20

• Surgery
• Radiotherapy
• Chemotherapy
• Palliation

Question 21

What are the characteristics of malignant neck nodes?

Answer 21

• Round
• Firm
• Irregular
• Fixed
• Non-tender

Question 22

What is the main symptom of airway obstruction?

Answer 22

Difficulty breathing

Question 23

What is the main sign of airway obstruction?

Answer 23

Stridor (noisy breathing)

Question 24

What can cause airway obstruction?

Answer 24

• Infection
• Trauma
• Foreign body

Question 25

How is airway obstruction managed?

Answer 25

• ABC approach
• Secure airway
• Humidified O2
• Steroids
• Adrenaline nebuliser

Question 26

What are the SIGN guidelines on when tonsillectomy’s should be offered?

Answer 26

• Bacterial tonsillitis
• 6-7 attack in 1 year (5 per year over 2 years, 3 per year for 3 years)
• Disrupting daily activities
• More than 1 quinsy