H&N- History taking, clinical examination and investigations

common presenting symptoms in head and neck cases

sore throat

dysphonia - hoarseness

dysphagia

odynophagia

visible mouth obstruction/throat ulcer

neck lump

common methods of investigation for head and neck pathology

fine needle aspiration

CT/MRI/PET scan

US scan

Plain Xray

Contrast swallow

Endoscopy

when would you NOT do a fine needle aspiration?

Lump is PULSATILE

neck node levels

I: submental and submandibular

II: upper jugular nodes, upper third of sternocleidomastoid muscle

III: middle jugular nosed, middle third of sternocleidomastoid muscle

IV: lower jugular node, lower third of sternocleidomastoid muscle

V: posterior triangle lymph nodes, bounded by the clavicle, sternocleidomastoid muscle and trapezius muscle

VI: anterior compartment nodes, located in central part of neck

what examines oral cavity, pharynx, larynx?

indirect laryngoscopy, rigid laryngoscopy, fibreoptic nasolaryngescopy

what does auscultation pick up in neck?

thyroid bruit

carotid bruit

treatment modalities for H&N cancer

radiation therapy

surgery - secure airway - intubate

• front of neck abscess - tracheostomy, cricothyroidotomy

chemotherapy

after laryngeal carcinoma what are you left with?

laryngeal stoma where you breathe and cough through

reccurent laryngeal nerve cancer

lung cancer spreads to mediastinum into lymph node → nodal metastases swell up and eat away at recurrent laryngeal nerve (presents with hoarseness with those with lung cancer)

H&N cancers are mainly which histological description?

squamous carcinoma

describe common salivary gland conditions

salivary gland swelling

• tumour e.g. benign pleomorphic adenoma

• inflammation e.g. parotitis

salivary gland stones

• submandibular glands

• duct calculus

how to diagnose and manage viral tonsilitis

majorly viral

reactive lymph node

sore throat

swollen tonsils

dysphagia

fever

headache

coughing

swollen neck

earache

white or yellow coating on tonsils

manage - rest and drink plenty fluids

how to diagnose and manage bacterial tonsilitis

pus covering

neck nodes

fever

no cough

manage - antibiotics e.g. phenoxymethyl penicillin

6-7 attacks in 1 year (5 per year over two years, 3 per year over three years) 

•Disrupting daily activities 

•More than 1 quinsy (painful abscess in tissue around tonsils) → Offer Tonsillectomy

how to assess hoarse patient

how long

any recent URTI

persistent (more worrying) or intermittent

pain

cough/choking/swallowing

asthma/rhinosinusitis/reflex - conditions that irritate the throat

voice use

smoker

medication

what are benign causes of hoarseness?

nodules

cysts

vocal abuse

laryngitis

infection

smoking

reflux

how to assess a patient with dysphagia

what is difficult to swallow? - solids or liquids

persistent or intermittent

pain

where

• localised in neck

• localised lower down

lumen - foreign body gets stuck liquids pass fine

wall - tumour, stricture, neuromuscular - liquids unable to get down as need control, pouch food goes down by gravity

extra luminal - thyroid, heart, mediastinal mass

how to assess patient with neck lump

examination:

site

size

shape

sore

skin

stuck

soft

history:

how long

site

fluctuates?

sore?

H&N symptoms

B symptoms (lymphoma symptoms: weight loss, drenching night sweats, poor appetite, lethargy)

travel

description of reactive lymph node in neck

oval

soft

smooth

mobile

tender

benign reactive lymph nodes examples

tonsilitis

nasal inflammation

swollen adenoids

branchial cyst

lipoma

thyroglossal cyst

stridor and management

caused by infection, tumour, foreign body

can be on inspiration (main) - higher obstruction

expiration

biphasic - stridor on both inspiration and expiration

management: Treat ABC - humidified O₂ ,steroids, adrenaline nebuliser

secure airway e.g. intubate, front of neck abscess (FONA) - cricothyroidotomy, tracheostomy

common sites of head and neck pathologies

oral cavity, larynx, nasopharynx

what is a thyroid bruit a sign of?

Grave’s thryoiditis

what is a carotid bruit a sign of?

carotid stenosis

what colour should the vocal cords be normally

pearly white