History, Examination and Investigation Flashcards
(23 cards)
Common presenting symptoms in head and neck
Sore throat Dysphonia Dysphagia Odonophagia Mouth/throat ulcer Neck lump
Common way to examine the oral cavity
Use pen torch and tongue depressor - ask patient to open mouth and say “ah”
Ways to examine the throat
Indirect laryngoscopy
Fibreoptic nasolaryngoscopy
Things that might be identified on auscultation of the neck
Thyroid bruit
Carotid bruit
Pseudo-aneurysm
Methods of investigation of head and neck
Fibre-optic nasolaryngoscopy Laryngoscopy Fine needle aspiration cytology CT/MRI/PET Ultrasound Plain x-ray Contrast swallow Endoscopy
Histological type of 90% of head and neck malignancies
Squamous cell carcinoma
Treatment options for head and neck cancer
Surgery
Radiotherapy
Chemotherapy
Palliative Care
Surgical options for head and neck cancer
Neck dissection and flap reconstruction
Tracheostomy
Cricothyroidotomy
Laryngectomy
When might neck dissection and flap reconstruction be used
Malignant neck node with following qualities; round firm irregular fixed non-tender
Major salivary glands
Parotid
Submandibular
Sublingual
How are the salivary glands examined?
Bimanual palpation
Salivary gland conditions
Tumour e.g. pleomorphic adenoma (benign)
Parotitis
Duct calculus
Features of bacterial tonsillitis
Exudates on tonsils
Enlarged neck nodes
Fever
No cough
Treatment of viral tonsillitis
Analgesia
Treatment of bacterial tonsillitis
Analgesia and antibiotics - penicillin V
Criteria for patient to be considered for tonsillectomy
6-7 episodes of bacterial tonsillitis in one year
5 episodes per year over two years
3 episodes per year over 3 years
Questions to ask when assessing a hoarse patient
How long hoarseness has lasted Whether hoarseness is persistent or intermittent Any pain Cough, choking or dysphagia Is voice use normal PMH of asthma, rhinosinusitis or reflux If they smoke Drug history
Conditions to consider in a patient with hoarseness (differential diagnoses)
Nodules Cysts Vocal abuse Laryngitis Infection Caused by smoking/reflux Laryngeal cancer Recurrent laryngeal nerve problem
Questions to ask a patient with dysphagia
What is difficult to swallow - liquids or solids Persistent or intermittent Any pain Where they feel food/liquid stick Assess lumen for foreign body
What does dysphagia with solids but not liquids suggest
Mechanical disruption
What does dysphagia with liquids but not solids suggest
Neuromuscular problem
Questions to ask when taking history of a patient with a neck lump
How long they have had the lump Site Whether size fluctuates Pain Head and neck symptoms Recent travel
Aspects of a neck lump important to determine on examination
Site Size Shape Sore to touch Surrounding skin - bruised, rash, bleeding etc. Soft or hard Fixed or mobile
