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History Related to the Neck

Stiff neck

Masses

Diseases to be kept in mind:

40yrs of age: Neoplastic

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Basing on Position

Mid-line swellings Congenital or dermoid cysts or thyroglossal

cysts or thyroid swellings

Usually benign or congenital

Lateral swellings:

Think of infections, metastatic problems

Suspect malignant nature for them

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Examination of the Neck

Observe the neck & check range ofmotion

Palpate

Nodes

Trachea

Thyroid

Carotids

Auscultate the neck

Thyroid

Carotids

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Things to note in swelling Size, Shape, & Situation

Borders: Regular or irregular

Margins: Well-defined or ill-defined

Consistency: Firm or cystic or hard

Mobility: Horizontally or/and vertically mobile Relation to superficial & deep structures:

Can the overlying skin be elevated from the swelling?

Can the swelling be lifted from underlying structures?

Tenderness & Temperature

Associated changes: Ulceration/openings/discharge

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Larynx

Trachea

Sternocleidomastoid muscle

Thyroid gland

Isthmus

Lateral lobes

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Posterior TriangleAnterior Triangle

Clavicular head

Sternal headSternocleidomastoid muscle

Triangles of the Neck

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Anterior auricularPosterior auricular

Occipital

Posterior cervical

Supraclavicular

Superficial cervical

Deep cervical

Tonsillar

Submaxillary

Submental

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Mastoid

Trapezius

muscle

Clavicle

Sternocleidomastoid muscle

Hyoid bone

Thyroid cartilage

Sternum

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Hyoid bone

Thyroid notch

Thyroid cartilage

Cricothyroid membrane

Cricoid cartilage

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Anterior approach

Posterior approach

Thyroid Palpation

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Pembertons sign

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Multinodular goiter

Graves Disease

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Thyroglossal cyst

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History Related to the Ear

Earache Discharge

Vertigo

Hearing loss Conductive

Sensorineural

Mixed Tinnitus

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Hearing loss Otosclerosis: Hearing improves in noisy areas

Drugs:

Salicylates & some diuretics = transient hearing loss

Aminoglycosides (Streptomycin/gentamycin) =

permanent hearing lossAnticancer drugs like cisplatin

Observe Pts voice: Abnormally loud or soft

Depending on age think of 2-5 yrs: Foreign bodies

5-15 yrs: Middle ear infections

15-50 yrs: Otosclerosis

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Vertigo Onset & duration of symptom

Frequency of attacks & any predisposing factor Onset & duration of each attack

Aggravating & relieving factors: Esp with position

Associated problems: Double vision/weakness/hearing loss/gaitproblems/nausea/vomiting/tinnitus

Current medications

Etiology: Ear/ nerves/ brain/ psychological/ drugs

Remember: Menieres disease & acoustic

neuroma

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Tinnitus

Onset & duration

Predisposing factors

Aggravating & relieving factors

Associated problems

Pulsatile tinnitus: Vascular tumor of head or

neck

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Otorrhea

Nature of discharge

Associated problems:

Dizziness/ ear pain/ hearing problems

H/O similar episodes

H/O Trauma/ Swimming

Recent ear or throat infection

Current medications: Ear drops

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Ear Pain

External ear: Infections/ trauma

Middle ear:

Infections

Referred pain:

Teeth, pharynx, & cervical spine

Inner ear: Inflammation/ tumor

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Examination of the Ear

Examine the ear

External ear

Auditory acuity

Middle ear

Sinuses

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Helix

Antihelix

Tragus

Lobule

External auditory meatus

Antitragus

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Rinne Test

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Weber Test

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Short process of malleusPars flaccida

Posterior fold

Pars tensa

Handle of malleusUmbo

Light reflex

Anterior fold

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Incus

Short process

Umbo

Light reflex

Normal Right TM

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Hematoma of External Ear Canal

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Air bubble

Incus

Umbo

Light reflexSerous

Otitis Media

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Acute otitis externa

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Acute otitis media

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History Related to the Nose

Rhinitis

Sinusitis

Nasal obstruction

Perforation

Epistaxis

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Nasal Obstruction

Unilateral or bilateral Duration & Predisposing factors

H/O Allergies/trauma/nasal polyps

Seasonal variationAssociated symptoms

Aggravating & relieving factors: Like stress

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DISCHARGE:

Unilateral or bilateral

Nature of discharge

BLEEDING:

H/O bleeding disorders

H/O trauma

Nose picking

Cocaine abuse

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Examination of the Nose

InspectionExternal examination

Internal examination:

Use of Nasal illuminatorUse of Nasal speculum

Palpation of sinuses

Transillumination of sinuses

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History Related to the Mouth

Salivary gland problems Decreased secretion: Dry Mouth

Increased secretion

Tongue problems Coated tongue, burning tongue, abnormal

motility

Gum problems

Bleeding, swelling, recession

Others

Ulcers, Hoarseness, sore throat,dysphagia, swelling, numbness

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Things to note in history

Sore throatAssociation with fever, cough, sputum, postnasal

drip, pharyngeal exudates

Hoarseness Ck overuse, allergy, smoking or other inhaled

irritants

Acute or chronic

Duration < or > 2 weeks Dental history

Last visit to dentist, any procedures done, anyprosthesis used, any change in fit of dentures, etc

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Examination of the Mouth and Throat

Inspect the mucosa, teeth and gingivae Inspect the tongue and pharynx

Palpate the tongue

Examine the floor of the mouth

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Lets now look at some pathologic

conditions.

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Osler-Weber-Rendu

syndrome

Peutz-Jegher

syndrome

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Mucocele

Sublingual varices

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Torus palatinus

Torus mandibularis

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Aphthous ulcer

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Palatal Petechiae

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Leukoplakia

K i

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Kaposis

Sarcoma

C didi i

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Candidiasis

Gingival Hypertrophy

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Gingival Hypertrophy

Dilantin induced

AML

Herpetic Lesions

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Herpetic Lesions

Gingivostomatitis

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Oral Cancers

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