History Related to the Neck

Stiff neck
Masses

Diseases to be kept in mind:
<20 yrs of age: Congenital
20-50 yrs of age: Thyroid swellings
>40yrs of age: Neoplastic

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
Examination of the Neck
Observe the neck & check range of
motion
Palpate
Nodes
Trachea
Thyroid
Carotids
Auscultate the neck
Thyroid
Carotids
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
Larynx
Trachea
Sternocleidomastoid muscle
Thyroid gland
Isthmus
Lateral lobes
Posterior Triangle
Anterior Triangle
Clavicular head
Sternal head
Sternocleidomastoid muscle
Triangles of the Neck
Anterior auricular
Posterior auricular
Occipital
Posterior cervical
Supraclavicular
Superficial cervical
Deep cervical
Tonsillar
Submaxillary
Submental
Mastoid
Trapezius
muscle
Clavicle
Sternocleidomastoid muscle
Hyoid bone
Thyroid cartilage
Sternum
Hyoid bone
Thyroid notch
Thyroid cartilage
Cricothyroid membrane
Cricoid cartilage
Anterior approach
Posterior approach
Thyroid Palpation
Pembertons sign
Multinodular goiter
Graves Disease
Thyroglossal cyst
History Related to the Ear
Earache
Discharge
Vertigo
Hearing loss
Conductive
Sensorineural
Mixed
Tinnitus
Hearing Loss
Unilateral Or bilateral
Congenital or acquired
Onset: Sudden or gradual
Duration
Relation of hearing loss with noise Improves or
not
Associated changes
H/O recent trauma
H/O playing with small objects (in children)
Current medications
Occupational history & Personal history

Hearing loss
Otosclerosis: Hearing improves in noisy areas
Drugs:
Salicylates & some diuretics = transient hearing loss
Aminoglycosides (Streptomycin/gentamycin) =
permanent hearing loss
Anticancer 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
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/gait
problems/nausea/vomiting/tinnitus
Current medications

Etiology: Ear/ nerves/ brain/ psychological/ drugs
Remember: Menieres disease & acoustic
neuroma
Tinnitus
Onset & duration
Predisposing factors
Aggravating & relieving factors
Associated problems
Pulsatile tinnitus: Vascular tumor of head or
neck
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
Ear Pain
External ear:
Infections/ trauma
Middle ear:
Infections
Referred pain:
Teeth, pharynx, & cervical spine
Inner ear:
Inflammation/ tumor

Examination of the Ear
Examine the ear
External ear
Auditory acuity
Middle ear
Sinuses
Helix
Antihelix
Tragus
Lobule
External auditory meatus
Antitragus
Rinne Test
Weber Test
Short process of malleus
Pars flaccida
Posterior fold
Pars tensa
Handle of malleus
Umbo
Light reflex
Anterior fold
Incus
Short process
Umbo
Light reflex
Normal Right TM
Hematoma of External Ear Canal
Air bubble
Incus
Umbo
Light reflex
Serous
Otitis Media
Acute otitis externa
Acute otitis media
History Related to the Nose
Rhinitis
Sinusitis
Nasal obstruction
Perforation
Epistaxis
Nasal Obstruction
Unilateral or bilateral
Duration & Predisposing factors
H/O Allergies/trauma/nasal polyps
Seasonal variation
Associated symptoms
Aggravating & relieving factors: Like stress


DISCHARGE:
Unilateral or bilateral
Nature of discharge

BLEEDING:
H/O bleeding disorders
H/O trauma
Nose picking
Cocaine abuse
Examination of the Nose
Inspection
External examination
Internal examination:
Use of Nasal illuminator
Use of Nasal speculum
Palpation of sinuses
Transillumination of sinuses

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
Things to note in history
Sore throat
Association 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, any
prosthesis used, any change in fit of dentures, etc
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
Lets now look at some pathologic
conditions.
Osler-Weber-Rendu
syndrome
Peutz-Jegher
syndrome
Mucocele
Sublingual varices
Torus palatinus
Torus mandibularis
Aphthous ulcer
Palatal Petechiae
Leukoplakia
Kaposis
Sarcoma
Candidiasis
Gingival Hypertrophy
Dilantin induced
AML
Herpetic Lesions
Gingivostomatitis
Oral Cancers