Head and neck symptoms and signs

Question 1

List three differentials for hoarseness

Answer 1

infective- acute laryngitis
benign e.g. nodules
irratative e.g. laryngeal reflux
malignant
post-surgical

Question 2

List two benign causes of hoarseness

Answer 2

nodules
polyps
cysts
papillomas

Question 3

List one irratative cause of hoarseness

Answer 3

laryngeal reflux
reinke’s oedema

Question 4

List one post surgical causes of hoarseness

Answer 4

vocal cord surgery
recurrent laryngeal nerve palsy

Question 5

Which is the strongest risk factor for reinke’s oedema

Answer 5

smoking- occurs exclusively in this population

Question 6

If patient has problems swallowing solids but not liquids, what is the nature of the cause?

Answer 6

obstructive

Question 7

If patient has problems swallowing liquids more than solids, what is the nature of the problem?

Answer 7

neurological

Question 8

List three differentials for dysphagia

Answer 8

foreign body
neurological
tumour
stricture
iatrogenic

Question 9

List a benign obstructive cause of dysphagia

Answer 9

pharyngeal pouch

Question 10

List a malignant cause of dysphagia

Answer 10

oesophageal cancer

Question 11

List two differentials for strictures causing dysphagia

Answer 11

GORD
congenital web
systemic sclerosis

Question 12

List three differentials for throat pain

Answer 12

1. Infective (lasting < 2 weeks with systemic upset)
2. Malignant (lasting > 2 weeks, lateralising, radiating to ear, progressive)
   G3. lobus pharyngeus (sensation in throat not pain as such – swallow not affected)
3. Laryngopharyngeal reflux – symptoms of heartburn / waterbrash
4. Neuralgic – (rare) pharyngeal plexus (CN IX, X) – Eagle’s syndrome (overlong styloid process)

Question 13

List three differentials for midline/para median neck lump

Answer 13

thyroid
thryoglossal cyst
dermoid cyst
lymph nodes
cutaneous lesions- sebaceous cysts, lipoma

Question 14

List three airway noises

Answer 14

inspiratory stridor
stertor= snoring
biphasic stridor
wheeze= expiratory stridor

Question 15

Where does wheeze suggest obstruction is?

Answer 15

tracheobronchial

Question 16

Where does inspiratory stridor suggest problem is?

Answer 16

glottis/supraglottis

Question 17

What is the site of problem with snoring?

Answer 17

oropharynx

Question 18

List two congenital conditions that cause airway noise

Answer 18

laryngomalacia
subglottic stenosis
webs
subglottic cysts
haemangioma

Question 19

List three causes of airway noise

Answer 19

tonsillitis
foreign body
haematoma
goitre
obstuctive sleep apnoea
angioedema

Question 20

List two infective causes of airway noise

Answer 20

Tonsillitis, parapharyngeal abscess, epiglottitis, croup, respiratory papillomatosis

Question 21

List two traumatic causes of airway noise

Answer 21

Foreign body, Intubation trauma, Vocal cord palsy, Laryngeal #, Haematoma

Question 22

List two neoplastic causes of airway noise

Answer 22

Benign (goitre, cystic hygroma, haemangioma) – Malignant (SCC, Lymphoma)

Question 23

What is stertor?

Answer 23

noisy breathing above larynx

Question 24

What is stridor?

Answer 24

pathology within larynx itself

Question 25

Differential diagnosis for airway problems

Answer 25

infective- tonsillitis, epiglottis
hypersensitivity- angioedema, allergy
trauma
neurological
malignancy
foreign body
big thyroid

Question 26

Score for tonsillitis and deciding whether abx?

Answer 26

Centor-score
cough
body temp
cervical lymph nodes
tonsillar swelling or exudate

Question 27

What centor score recommends antibiotics

Answer 27

4

Question 28

Complications of tonsillitis?

Answer 28

peritonsillar abscess
rheumatic fever
post-strep glomerulonephritis
lemierre disease? = thrombosis of internal jugular vein, septic emboli- sepsis

Question 29

Complications of tonsillectomy surgery?

Answer 29

oropharyngeal bleed
pain

Question 30

Difference between tracheostomy and laryngectomy?

Answer 30

? important
layngectomy= only hole patient has to breathe so don’t occlude!!!
no tube for laryngectomy
tube mandatory for tracheostomy

Question 31

Laryngectomy patient comes into A&E blue, where do you put the oxygen mask?

Answer 31

over the stoma/layngectomy
NOT over the mouth- oxygen goes to stomach
tracheo- still have communication between mouth and lungs, can put mask over trache as well