Head and Neck History Taking

Question 1

List some of the most common symptoms in presenting complaint of an ENT patient.

Answer 1

Sore throat
Dysphonia- hoarseness
Dysphagia
Odynophagia
Mouth/throat ulcer
Neck lump

Question 2

In which issues is family history particularly important?

Answer 2

Thyroid issues

Question 3

Name the three major salivary glands

Answer 3

Parotid
Sublingual
Submandibular

Question 4

Auscultation is rare in head and neck examination but when might this be done?

Answer 4

Thyroid bruits
Carotid bruits

Question 5

In which condition would there be a thyroid bruits?

Answer 5

Grave’s thyroiditis

Question 6

In which condition would there be a carotid bruits?

Answer 6

Carotid stenosis

Question 7

What happens if you look in someone’s mouth and they have two uvula?

Answer 7

Don’t panic! Strange to see but no clinical significance.

But gal, this could be something they throw in an OSCE to see if you notice ig so be aware!

Question 8

What is used in examination of the throat?

Answer 8

Flexible or rigid laryngoscope

Question 9

What colour are normal vocal cords?

Answer 9

Pearly white

Question 10

If a patient presents with a lump in their neck, which investigation will be carried out?

Answer 10

FNAC
Fine needle aspirate cytology

Question 11

Which scan is useful for seeing areas of increased metabolic activity?

Answer 11

PET scan

->areas of increased metabolic activity may be tumours as require more blood and nutrients to grow.

Question 12

Which questions will need to be asked if a patient presents with a lump in the neck?

Answer 12

How long has it been there?
Site?
Fluctuates in size?
Sore?
Associated head and neck symptoms.
Recent travel?

Question 13

Upon examination of a neck lump, what should be checked?

Answer 13

Seven S’s

Site
Size
Shape
Soft or hard?
Sore
Skin over the lump
Stuck or fixed to any adjacent structures?

Question 14

Describe the features of a reactive lymph node.

Answer 14

Oval
Soft
Smooth
Mobile
Tender

Question 15

If a child has reactive lymph nodes, what may the child have?

Answer 15

Ear infection
Posterior nasal infection

Question 16

What may salivary gland swellings be related to?

Answer 16

Tumours
Inflammation

Question 17

What other problems can occur within the salivary glands?

Answer 17

Salivary stones

Question 18

In someone with salivary stones, when will their salivary glands swell?

Answer 18

In relation to meals- as soon as they try to salivate, the gland will swell up

Question 19

Which investigation can be used to find salivary stones and why?

Answer 19

X-ray as they as usually radio-opaque because of high calcium content

Question 20

If a patient presents with hoarseness, what would you want to ask of in past medical history?

Answer 20

Recent UTRI?

Question 21

What other questions may you ask regarding hoarseness?

Answer 21

How long?
Persistent or intermittent?
Pain?
Cough/swallowing/choking?
Asthma/rhinitis/reflux causing irritation to throat?
How much do they use their voice e.g. teacher or singer?
Smoke?
Medication?

Question 22

What are some benign causes of hoarseness?

Answer 22

Nodules
Cysts
Vocal abuse
Laryngitis
Smoking
Reflux
Infection

Question 23

What is a more worrying cause of hoarseness?

Answer 23

Laryngeal carcinoma

Question 24

What is the treatment for a laryngeal carcinoma?

Answer 24

Removal of voice box (larynx)
Could get a laryngectomy stoma where larynx is removed and trachea is stitched to the skin at the front of the neck.

Question 25

Which other cancer may present with hoarseness and why?

Answer 25

Lung cancer May metastase to hilum of lung and compress recurrent laryngeal nerve

Question 26

List some questions to ask a patient presenting with dysphagia.

Answer 26

How long? What is difficult to swallow? Persistent or intermittent? Pain? Where do they feel food sticking?

Question 27

What could be an issue with the lumen of the oesophagus causing dysphagia?

Answer 27

Foreign body

Question 28

What could be an issue with the wall of the oesophagus causing dysphagia?

Answer 28

Stricture Tumour Pouch Neuromuscular

Question 29

What could be an extra-luminal issue of the oesophagus causing dysphagia?

Answer 29

Thyroid Heart Mediastinal mass

Question 30

Which investigation may be carried out in someone with difficulty swallowing?

Answer 30

Barium swallow (contrast)

Question 31

What is Globus phartyngeus?

Answer 31

Feeling like there is something stuck in the throat when there isn't anything there

Question 32

What is the cause of Globus phartyngeus?

Answer 32

Spasm of the Cricopharyngeus muscle

Question 33

What can trigger spasm of the Cricopharyngeus muscle and therefore cause Globus Phartyngeus?

Answer 33

Reflex Recent infection Postnasal drip Anxiety/stress

Question 34

What is the most common type of malignancy in head and neck?

Answer 34

Squamous cell carcinoma

Question 35

List some common sites for cancer of the head and neck.

Answer 35

Oral cavity Larynx Oropharynx Nasopharynx Hypopharynx

Question 36

If someone has a nasopharynx cancer, what other related symptoms may they get?

Answer 36

Fluid in ear

Question 37

Describe what would be felt in a malignant node of the neck.

Answer 37

Firm Round Irregular Fixed Non-tender

Question 38

What is the symptom for airway obstruction?

Answer 38

Difficulty breathing

Question 39

What is a clinical sign of airway obstruction?

Answer 39

Stridor

Question 40

What are some of the causes of airway obstruction?

Answer 40

Tumours, foreign bodies, infection

Question 41

How would an airway obstruction be treated?

Answer 41

ABC humidified oxygen, steroids, adrenaline nebuliser Secure airway, may involve surgery

Question 42

Which surgery may be involved in the treatment of airway obstruction in cases of tumours?

Answer 42

Cricothyroidotomy or tracheostomy.

Question 43

What is a complication of tonsillitis?

Answer 43

Quinsy (abscess)

Question 44

When may a patient be offered tonsillectomy?

Answer 44

Bacterial tonsillitis 6-7 attacks in one year Disrupting daily activities More than one quinsy