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Flashcards in Head and Neck Clinical Deck (33)
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1

What may present in a head and neck history?

Sore throat
Dysphonia
Odynophagia
Moth/ throat ulcer
Neck lump

Smoking/ Alcohol
Family History

2

What is important to remember about a full head and neck examination?

It includes an examination of the pharynx and larynx.

If you suspect problems then refer to ENT. They have the equipment to do this:
-Laryngoscopy
-Nasolaryngoscopy

3

What is bifid uvula an early manifestation of?

Cleft palate

4

What is the appearance of normal healthy vocal cords?

"Pearly white"

5

How should you prepare a patient for a head and neck examination?

Patient sitting in chair

Glass of water nearly - be prepared to examine the thyroid in full

Expose the neck down to the clavicles - undo the top buttons of a shirt

Ask the patient to remove any jewellery

6

How do you carry out an inspection in head and neck examination?

Lump: site, size, skin changes

Scars

Does the lump move?
-Tongue protrussion: thyroglossal cyst
-Swallowing: place glass of water in patients hands, hold in mouth then swallow

7

Describe the palpation in the head and neck examination

From front:
-Check the trachea

From back:
-Be gentle, watch for discomfort
-Use fingertips to elicit physical signs

Palpate the triangles (Z)
-Anterior triangle
-Posterior triangle

Determine lump characteristics

Examine thyroid in full

8

How do you examine the neck using the Z technique?

-Palpate from the chin backwards to below the ears
-Palpate down the anterior border of sternocleidomastoid to clavicle
-Move laterally along the clavicle and then up the posterior border of sternocleidomastoid
-Finish by palpating the back of the scalp for occipital lymph nodes

9

What can a thyroid bruit indicate?

Grave's disease

10

What are the head and neck examinations?

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

11

Explain FNAC in head and neck

With any lumps this is great.
If you find a lump on examination imaging is only going to tell you what you already know.
FNAC will tell you what exactly the lump is

12

What are the characteristics of a reactive lymph node?

Oval
Soft
Smooth
Mobile
Tender

13

What does a brachial cyst present like?

Usually young patients
Soft and non tender
Upper sternocleidomastoid

14

How do you identify a thyroglossal cyst?

Moves out with tongue

15

How would a patient present with duct calculi?

Pain and pressure when they are about to eat or are eating (pressure builds up as fluid produced but nowhere to go)

Will settle a while after eating

16

Should you worry about a pleomorphic adenoma?

They are benign

Can become malignant over the space of years so if the patient is young you may consider removal

17

Someone presents with hoarseness.
What questions should you ask them?

How long?
Persistant or intermittent?
Pain?
Cough/Choking/Swallowing?
Voice use? (do they sing etc)
Asthma/Rhinosinusitis/Reflux?
Smoker?
Medication (inhalers etc may irritate)

18

What can cause hoarseness?

Nodules
-Will be present on both cords
-Singers with poor technique

Cysts
-Traumatic cyst or vocal cord polyp

Laryngitis
Smoking
Reflux

Laryngeal or lung cancer

19

What are the two most common treatment plans for laryngeal carcinoma?

Chemoradiotherapy - try to save the larynx

Laryngectomy - remove larynx and bring trachea up as stoma
(will breath through tube for test of life)

20

How would you suspect lung cancer in someone with hoarseness?

The larynx will look normal

Get them to speak

One cord (usually left) won't be able to move.

Lung cancer nodes in the mediastinum are pressing on recurrent laryngeal nerve causing palsy

Nodes in mediastinum means cancer is inoperable

21

What kind of questions should you ask someone presenting wit dysphagia?

-What is difficult? (solids or liquids)
-Persistent or intermittent
-Getting worse?
-Pain?
-Where?
---Neck better at localising obstruction
---Lower down poorly localised, may be referred slightly

22

What can cause dysphagia?

Lumen = foreign body

Wall = Tumour, stricture, neuromuscular, pouch

Extra Luminal = Thyroid, Heart, Mediastinal mass

23

What is FOSIT?

"Feeling Of Something In Throat"
aka Globus Pharyngeus

Due to spasm of cricopharyngeus

Acid reflux
Stress/ anxiety
No dysphagia ("easier with food")

24

What are the most common cancers of the head and neck?

90% squamous

25

What are the characteristics of a malignant neck node?

Round
Firm
Irregular
Fixed
Non-tender

26

What is stridor?

Noisy breathing

Inspiratory stridor comes from the level of vocal cords or above (emergency)
-Possible tracheostomy

Expiratory stridor = wheeze
-From lower down

Biphasic stridor = both inspiratory and expiratory

27

What infections may become an emergency?

Quinsy/ Peritonillar abscess

Infectious Mononucleosis (Glandular Fever)
-Possibly cannot swallow at all

Neck space infections

28

Why should you do an ultrasound after a FNAC of a thyroglossal cyst?

To check if the thyroid is present where it should be or if the whole thing is in the cyst

Don't want to remove the thyroid if its in the cyst -> hypothyroidism

29

What is the operation for a thyroglossal cyst?

Sistruck's operation

take cyst out along with central portion of hyoid bone and tracts of cyst

This prevents it returning

30

What is the embryological origin of a thyroglossal cyst?

Foramen caecum