Summary document for head + neck conditions relevant for medical student finals. Contains information about clinical features of each condition, as well as relevant diagnostic tests and investigations, risk factors, causes and management guidelines.
Everything has been cross referenced with passm...
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, DYSPHAGIA (ASSESSMENT)
HISTORY AETIOLOGY
- Level of dysphagia – pharynx, upper, mid, Extraluminal – external pressure on pharynx and
lower oesophagus
- Solids, liquids, saliva - Neck mass (retrosternal goitre)
- Associated symptoms: hoarseness, - Vascular abnormalities (e.g. thoracic aortic
odynophagia, otalgia, regurgitation, GI aneurysm, double aortic arch)
bleeding, weight loss - Any time of mediastinal mass
- Time course of symptoms - Lung cancer
- Risk factors for cancer of oesophagus and
pharynx – smoking, alcohol excess Intramural – pharyngeal, oesophageal
- Motility problems
- MND/MS
INVESTIGATIONS - CVA
- Achalasia
- FBC - ? IDA
- Oesophageal spasm
- CXR
- Pharyngeal pouch
- CT/MRI – suspicion of malignancy
- Benign/malignant stricture
- Barium swallow
- Candidiasis
- Panendoscopy – includes laryngoscopy and
upper oesophagoscopy Intraluminal – oesophageal
- Dynamic investigations – video fluoroscopy - Foreign body
- Oesophageal or pharyngeal cancer
- Candidiasis
- Oesophageal web/plummer-vinson syndrome
DYSPHONIA (ASSESSMENT)
INVESTIGATIONS AETIOLOGY
Flexible nasendoscopic examination of the larynx - Malignant e.g. SCC
Blood tests as appropriate - Benign
o Vocal cord nodules
Urgent referral to ENT for patients with dysphonia
o Papillomas
and red flag symptoms
o Cysts
- Neuromuscular – vocal cord palsy
- Trauma – surgery, intubation, excess use
RED FLAG SYMPTOMS - Endocrine – hypothyroidism
- Hx of smoking and alcohol use - Infective
- Concomitant neck mass o Laryngitis
- Unexplained weight loss o Corticosteroids (inhaled may predispose
- Accompanying neurological symptoms to this)
- Accompanying haemoptysis, dysphagia, - Iatrogenic
odynophagia, otalgia o Recurrent laryngeal nerve palsy
- Hoarseness that is persistent and worsening secondary to thyroid surgery
(rather than intermittent) - Functional - muscle tension dysphonia
- Hoarseness in immunocompromised patient
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