Head And Neck - History Taking

Question 1

What symptoms should be asked in a head and neck history?

Answer 1

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

Question 2

What id a lifestyle factor to consider in history?

Answer 2

Smoking
Alcohol

Question 3

What is another important aspect to history in head and neck?

Answer 3

Family history (thyroid problem)

Question 4

Where should you examine for head and neck?

Answer 4

Neck
Oral cavity
Pharynx
Larynx
Nose/ears/salivary glands

Question 5

What nodes are in level 1 of the neck nodes?

Answer 5

Submental
Submandibular

Question 6

What nodes are in level 2, 3 and 4 of the neck nodes?

Answer 6

Nodes in the anterior edge of SCM

Question 7

What nodes are in level 5 of the neck nodes?

Answer 7

Posterior triangle
Feel for posterior nodes
Include supraclavicular fossa

Question 8

What nodes are in level 6 of the neck nodes?

Answer 8

Pretracheal

Question 9

How should salivary glands be palpated?

Answer 9

Bimanual palpation
Feel gland and associated duct

Question 10

What should you ausculatate for in head and neck?

Answer 10

Thyroid bruit (grave’s thyroiditis)
Carotid bruit (carotid stenosis)

Question 11

What can be used for throat examination?

Answer 11

Indirect laryngoscopy
Fibre optic nasolaryngoscopy
Rigid larygoscopy

Question 12

What investigations should be done for head and neck?

Answer 12

Fine needle aspiration cytology
CT/MRI/PET scan
Us scan
Plain X-ray
Contrast swallow
Endoscopy

Question 13

What should be considered when a patient present with a neck lump?

Answer 13

How long?
Site?
Fluctuates?
Sore?
H&N symptoms?
B symptoms
Travel?

Question 14

What should be examined for in neck lumps?

Answer 14

Site
Size
Shape
Sore
Skin
Stuck
Soft

Question 15

What would a reactive lymph node feel like?

Answer 15

Oval
Soft
Smooth
Mobile
Tender

Question 16

What can be causes of salivary gland swelling?

Answer 16

Tumour eg benign pleomorphic adenoma
Inflammation- parotitis

Question 17

What should be asked in history of hoarseness?

Answer 17

How long?
Recent URTI?
Persistent or intermittent?
Pain?
Cough/ choking/ swallowing?
Asthma/ rhinosinusitis/ reflux?
Voice use?
Smoker?
Medication?

Question 18

What are benign causes of hoarseness?

Answer 18

Nodules
Cysts
Vocal abuse
Laryngitis
Infection
Smoking
Reflux

Question 19

What can be a non benign cause of hoarseness?

Answer 19

Laryngeal carcinoma

Question 20

What should be asked with dysphagia?

Answer 20

What is difficult?
Persistent/ intermittent?
Pain?
Where?

Question 21

What is a cause of dysphagia in the lumen?

Answer 21

Foreign body

Question 22

What is a cause of dysphagia in the wall?

Answer 22

Tumour
Stricture
Neuromuscular
Pouch

Question 23

What is a cause of dysphagia that is extra luminal?

Answer 23

Thyroid
Heart
Mediastinal mass

Question 24

What can be used to investigate the cause of dysphagia?

Answer 24

Barium swallow

Question 25

What is FOSIT?

Answer 25

Feeling of something in throat Globus pharyngeus

Question 26

Does FOSIT present with dysphagia?

Answer 26

No

Question 27

Is FOSIT a red flag symptom?

Answer 27

No

Question 28

What can FOSIT be caused by?

Answer 28

Acid reflux “silent” (laryngopharngeal reflux) Stress/ anxiety

Question 29

Where are common sites of head and neck cancer?

Answer 29

Oral cavity Larynx Oropharynx Nasopharynx Hypopharynx

Question 30

What does a malignant neck node feel like?

Answer 30

Round Firm Irregular Fixed Non-tender

Question 31

What is the symptom of airway obstruction?

Answer 31

Difficulty breathing

Question 32

What are the signs of airway obstruction?

Answer 32

Stridor -inspiratory = obst above vocal cord level) - expiratory = wheeze - biphasic = below vocal cords and above trachea

Question 33

What are causes of airway obstruction?

Answer 33

Infection Tumour Foreign body

Question 34

How should airway obstruction be treated?

Answer 34

ABC Humidifies O2 Steroids Adrenaline nebuliser Secure the airway (intubate; FONA - cricothyroidotomy, tacheostomy)

Question 35

How does bacterial tonsilitis present?

Answer 35

Pus covering Neck nodes Fever No cough

Question 36

When should tonsilectomy be offered?

Answer 36

6-7 attacks in 1 year Disrupts daily activities More than 1 quinsy