History Taking, Examination + Investigations Flashcards
What are general symptoms of head and neck problems?
Sore throat Dysphonia (hoarseness) Dysphagia Odynophagia Mouth/throat ulcer Neck lump
What needs to be examined?
Neck Oral cavity Pharynx (3 parts) Larynx (3 parts) Nose/ears/salivary glands
How is the throat examined?
Indirect laryngoscopy
Fibre optic nasolaryngoscopy
What are the neck node levels?
Areas of the neck split up 1-6
1-5 (z shape starting from under chin)
6 lies at front of neck
What is listened for in auscultation of the neck?
Thyroid bruit (Grave's thyroiditis) Carotid bruit (carotid stenosis)
What are the investigations for head and neck?
FNAC CT/MRI/PET scan USS Plain x-ray Contrast swallow Endoscopy
What history needs to be taken with the presentation of a neck lump?
How long Site Fluctuation Pain Other head and neck symptoms B symptoms Travel
What needs to be examined with the presentation of a neck lump?
Site Size Shape Sore Skin Stuck Soft
What are the indications of a reactive lymph node?
Oval Soft Smooth Mobile Tender
What history needs to be taken with presentation of hoarseness?
How long Persistent or intermittent Pain Cough/choking/swallowing Voice use Asthma/rhinosinusitis/reflux Smoking Medication
What needs to be looked for in examination of hoarseness?
Nodules Cysts Vocal abuse Laryngitis Infection Smoking Reflux Cancer
What history needs to be asked with presentation of dysphagia?
What is difficult
Persistent or intermittent
Pain
SIte
What does a mass in the lumen suggest?
Foreign body
What does a mass in the wall suggest?
Tumour
Stricture
Neuromuscular problems
Pouch
What does a mass in the extra luminal space suggest?
Thyroid problems
Heart problems
Mediastinal mass
What are the signs of globus pharyngeus?
Acid reflux ‘silent’
Stress/anxiety
No dysphagia
No red flag symptoms
What are some benign presentations of head and neck disorders?
Congenital Infective Inflammatory Trauma Neoplasia
What is the treatment for head and neck cancer?
Surgery
Radiotherapy
Chemotherapy
Palliation
What are the indications of a malignant neck node?
Round Firm Irregular FIxed Non-tender
What is the main symptom of airway obstruction?
Difficulty breathing
What is the main sign of airway obstruction?
Stridor
Inspiratory/expiratory/biphasic
What are the causes of airway obstruction?
Infection
Tumour
Foreign body
How is airway obstruction treated?
ABC
intubation? tracheostomy, humidified O2, steroids, adrenaline nebuliser
What are the SIGN guidelines for a tonsillectomy?
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
