Week 2.1 - Head and Neck History Taking

Question 1

What are common symptoms in head and neck?

Answer 1

• dysphonia
• dysphagia
• odynophagia
• mouth/throat ulcer
• neck lump

Question 2

What history is relevant for head and neck?

Answer 2

• symptoms
• smoking/alcohol/family history

Question 3

What do we consider when dealing with head and neck issues?

Answer 3

benign - inflammatory, infective, neoplastic, traumatic, hereditary
malignant - squamous carcinoma

Question 4

How do we assess the neck nodes?

Answer 4

• 6 levels - make z shape and then check posterior for level 6
• looking for submental and submandibular glands, deep cervical lymph nodes, posterior nodes and thyroid

Question 5

How do we palpate for major salivary glands?

Answer 5

inside mouth and outside mouth to palpate glands, ducts, for swelling, stones

Question 6

Which bruits do we check for and what do these indicate?

Answer 6

• thyroid bruit may indicate graves thyroiditis
• carotid bruit may indicate carotid stenosis

Question 7

What do we look for inside the mouth?

Answer 7

cleft palate, tonsils, tongue, any lesions which may be cancer

Question 8

What do we look for inside the throat and how?

Answer 8

use fibreoptic nanolaryngectomy - look at back of tongue, down to hypophayrnx and vocal cords. ask patient to make sounds

Question 9

How do we further investigate head and neck issues with scans?

Answer 9

• FNAC for abscesses
• CT/MRI/PET
• US
• Xray
• Contrast swallow
• endoscopy

Question 10

How do we manage a neck lump?

Answer 10

• FNAC
• history - how long, pain , fluctuate, travel
• examine - shape, size, site, sore, stuck, soft/hard

Question 11

What are features of a reactive lymph node vs an invaded lymph node?

Answer 11

• reactive lymph node - soft, tender, oval, smooth, mobile
• invaded lymph node - firm, irregular, round, fixed, non-tender

Question 12

What are salivary gland stones?

Answer 12

stone in gland, high calcium content so may be seen on xray and feel with hands

Question 13

How do we take history of hoarseness?

Answer 13

• history - how long, intermittent or persistent, cough/choke? smoke? pain?

Question 14

What may be causes of hoarseness?

Answer 14

• nodules/cysts/tumour in vocal cords
• pink vocal cords due to laryngitis, smoker, chronic reflux
• malignancy on left recurrent laryngeal nerve near lung hilum

Question 15

How do we take history of dysphagia?

Answer 15

• what is it? fluid may be neuromuscular and solid may be obstruction/mechanical issue
• persistent or intermittent?
• localise the area? if high up well localisation, if lower down not so well

Question 16

What may be the cause of dysphagia?

Answer 16

• foreign body in lumen
• wall tumour, stricture, neuromusculas, pouch
• extraluminar compression

Question 17

How do we investigate dysphagia?

Answer 17

barium swallow

Question 18

What is globus pharyngeus and its cause?

Answer 18

• sensation of something in throat
• cause is muscle spasms by cricopharyngeus. triggererd by reflux, infection, stress/anxiety

Question 19

What are the common sites of malignancy?

Answer 19

oral cavity, larynx, oropharynx, nasopharynx, hypopharynx

Question 20

What is the morbidity of head and neck malignancy?

Answer 20

generally curative and palliative. use CT, RT, surgery.

Question 21

What are some acute airway issues?

Answer 21

• obstruction - choking
• acute tonsilitis

Question 22

What are the causes of stridor?

Answer 22

• inhalation - above vocal cord
• expiration - in lungs
• both - biphasic stridor - below vocal cord in upper trachea
• infection, tumour, foreign body

Question 23

How do you treat stridor?

Answer 23

• ABC - emergency
• oxygen, adrenaline and steroids for swelling. may intubate by FONA - cricothyroidotomy or tracheostomy