History Taking, Examination & Investigation

Question 1

what are the common presenting symptoms in head and neck cases?

Answer 1

sore throat
dysphagia 
dysphonia 
odynophagia 
mouth/throat ulcer 
neck lump

Question 2

what are 2 investigations used to examine the throat/mouth?

Answer 2

indirect laryngoscopy

fibre optic nasolaryngoscopy

Question 3

what would you auscultate in someone with head/neck symptoms?

Answer 3

thyroid bruit (graves disease)
carotid bruit (carotid stenosis)

Question 4

what are the different neck levels?

Answer 4

divide neck into anterior and posterior by the sternocleidomatid 
divide SCM into 3
under the chin = I
SCM divided into II, III, IV
posterior to SCM = V
glottis = VI

Question 5

what are the salivary glands and their nerve innervation?

Answer 5

parotid - glossopharyngeal nerve XI

submandibular and sublingual = facial V3 (mandibular branch)

Question 6

list some of the head and neck investigations.

Answer 6

fine needle aspiration cytology
USS
CT/MRI/PET
indirect laryngoscopy
nasolaryngoscopy 
plain x-ray
contrast barium swallow 
endoscopy

Question 7

what do you have to ask in the history of someone with a neck lump?

Answer 7

how long?
site?
fluctuates?
sore?
H&N symptoms?
B symptoms?
travel?

Question 8

what do you have to examine for in a neck lump?

Answer 8

7 s's
site
size
shape 
sore
skin 
stuck 
soft

Question 9

what are the characteristics of a neck lump which makes it most likely to be a reactive lymph node?

Answer 9

oval 
soft
smooth
mobile
tender

Question 10

what is the most common salivary gland tumour?

Answer 10

pleomorphic adenoma

Question 11

what is a common condition of the submandibular gland and how does this occur?

Answer 11

duct calculus

high chance of developing stones as the gland secretions run against gravity

Question 12

why is laryngeal cancer usually picked up earlier than hypo pharyngeal cancers?

Answer 12

laryngeal cancer is at the level of the vocal cords so present with symptoms such as hoarseness earlier on than hypo pharyngeal cancers which are further away

Question 13

what are the most common causes of dysphonia?

Answer 13

nodules
cysts
vocal abuse 
laryngitis 
infection 
smoking reflux 
laryngeal cancer

Question 14

what are the characteristics of malignant neck tumour?

Answer 14

round
firm 
irregular
fixed 
non-tender

Question 15

what is the emergency treatment for stridor?

Answer 15

airway management
02
nebuliser adrenaline
iv dexamethasone

Question 16

when is someone referred for a tonsillectomy?

Answer 16

6-7 attacks in 1 year
5 attacks /year for 2 years
3 attacks/year for 3 yrs
disrupts quality of life
more than 1 quinsy