History Taking, Examination + Investigations

Question 1

What are general symptoms of head and neck problems?

Answer 1

Sore throat
Dysphonia (hoarseness)
Dysphagia
Odynophagia
Mouth/throat ulcer
Neck lump

Question 2

What needs to be examined?

Answer 2

Neck
Oral cavity
Pharynx (3 parts)
Larynx (3 parts)
Nose/ears/salivary glands

Question 3

How is the throat examined?

Answer 3

Indirect laryngoscopy

Fibre optic nasolaryngoscopy

Question 4

What are the neck node levels?

Answer 4

Areas of the neck split up 1-6
1-5 (z shape starting from under chin)
6 lies at front of neck

Question 5

What is listened for in auscultation of the neck?

Answer 5

Thyroid bruit (Grave's thyroiditis)
Carotid bruit (carotid stenosis)

Question 6

What are the investigations for head and neck?

Answer 6

FNAC
CT/MRI/PET scan
USS
Plain x-ray
Contrast swallow
Endoscopy

Question 7

What history needs to be taken with the presentation of a neck lump?

Answer 7

How long
Site
Fluctuation
Pain
Other head and neck symptoms
B symptoms
Travel

Question 8

What needs to be examined with the presentation of a neck lump?

Answer 8

Site
Size
Shape
Sore
Skin
Stuck
Soft

Question 9

What are the indications of a reactive lymph node?

Answer 9

Oval
Soft
Smooth
Mobile 
Tender

Question 10

What history needs to be taken with presentation of hoarseness?

Answer 10

How long
Persistent or intermittent
Pain
Cough/choking/swallowing
Voice use
Asthma/rhinosinusitis/reflux
Smoking
Medication

Question 11

What needs to be looked for in examination of hoarseness?

Answer 11

Nodules
Cysts
Vocal abuse
Laryngitis
Infection
Smoking
Reflux
Cancer

Question 12

What history needs to be asked with presentation of dysphagia?

Answer 12

What is difficult
Persistent or intermittent
Pain
SIte

Question 13

What does a mass in the lumen suggest?

Answer 13

Foreign body

Question 14

What does a mass in the wall suggest?

Answer 14

Tumour
Stricture
Neuromuscular problems
Pouch

Question 15

What does a mass in the extra luminal space suggest?

Answer 15

Thyroid problems
Heart problems
Mediastinal mass

Question 16

What are the signs of globus pharyngeus?

Answer 16

Acid reflux ‘silent’
Stress/anxiety
No dysphagia
No red flag symptoms

Question 17

What are some benign presentations of head and neck disorders?

Answer 17

Congenital
Infective
Inflammatory
Trauma
Neoplasia

Question 18

What is the treatment for head and neck cancer?

Answer 18

Surgery
Radiotherapy
Chemotherapy
Palliation

Question 19

What are the indications of a malignant neck node?

Answer 19

Round
Firm
Irregular
FIxed
Non-tender

Question 20

What is the main symptom of airway obstruction?

Answer 20

Difficulty breathing

Question 21

What is the main sign of airway obstruction?

Answer 21

Stridor

Inspiratory/expiratory/biphasic

Question 22

What are the causes of airway obstruction?

Answer 22

Infection
Tumour
Foreign body

Question 23

How is airway obstruction treated?

Answer 23

ABC

intubation? tracheostomy, humidified O2, steroids, adrenaline nebuliser

Question 24

What are the SIGN guidelines for a tonsillectomy?

Answer 24

Bacterial tonsiliitis
6-7 attacks in 1 year
5 attacks over 2 years
3 attacks over 3 years
Disruption of daily activities
More than 1 quinsy