Neck History

• History & examination- follows the standard pattern

• Most common presenting symptom: Swelling / lump Goiters Lymphadenopathy

• Goiters & Lymphadenopathy - local & systemic complains

History of swellings

• How noticed? - Self / others
• Duration-  Acute or chronic
• Pain-  acute lymphadenitis, thyroiditis, bleeding in goitre, Submandibular salivary gland stone
• Painless- chronic lymphadenopathy, goitre, branchial cyst, neoplasms
• Change in size: Rapid increase- infection, bleeding, Slow increase- neoplasms
• Single or multiple?   multiple- lymph nodes

Associated local symptoms with neck swellings

• Voice change (malignant invasion)
• Dysphagia (pressure on esophagus)
• Dyspnea (pressure on trachea)
• Eye symptoms
• Throat pain / Oral ulcer
• Nasal symptoms
• Scalp lesion/Loss of hair

Systemic symptoms - Goitre

• Nervousness
• Weight loss/gain
• Palpitation
• Preference for cold / warm weather
• Muscle fatigue
• Sweating

Systemic symptoms-  Lymphadenopathy

• Fever
• Night Sweating
• Contact with infectious disease
• Weight loss
• Change in appetite
• Respiratory / gastrointestinal symptoms

General Systemic inquiry

• GI – appetite, wt. change, bowel habit (thyroid, LN)
• RS- dyspnea on exertion, (retrosternal extension)
• CVS- palpitation, ankle swelling
• GU- amenorrhea
• CNS- nervousness, irritability, insomnia (thyrotoxicosis)
• Endocrines- preference to warm or cold weather

Other parts of history

• PH- medical / surgical
• Medications
• Allergies
• Social history
• Family history - MTC,  MEN 2 (MTC, pheochromocytoma, HPT)

Personal History as usual

• Complaint:
  • Swelling in lower part of front of neck
• Present history
  • Swelling:
    • Onset (sudden or gradual)
    • Course (increasing or decreasing)
    • Duration
  • Pain:
    • Description (e.g., sharp, dull, throbbing)
    • Location (e.g., radiating to jaw, ear)
    • Severity (e.g., 1-10 scale)
  • Disturbance of function:
    • Difficulty swallowing
    • Difficulty breathing
    • Hoarseness
• General:
  • Fever
  • Metastasis
  • General manifestations:
    • Toxicity
    • Hyperthyroidism
  • Local:
    • Pressure on recurrent laryngeal nerve causing hoarseness
    • Local manifestations:
      • Dysphagia (not common in retrosternal goiter or malignancy)
      • Dyspnea

Example for History Taking

• · ----------------, 25 years, mechanic, not married, living in ----, takes 20 cigarettes per day for 10 years.
• · He is coming complain of swelling in lower part of neck since 6 years.
• · The condition started 6 years ago with swelling in lower part of front of neck, gradual onset, and progressive course.
• · He had toxic manifestations in the form of palpitation, Nervousness. Irritability, insomnia, loss of weight inspite of good appetite, exophthalos , polyuria.
• · The patient did hormonal assay & was told that he is toxic.
• · He had surgery since five & half years.
• · After one 7 half month, the swelling appeared again, exophthalmos & he developed hoarsness of voice.
• · He is now on course of Indral.
• · There is no history of pain.
• · There ino history of hypothyroidism as gain of weight, slurred speech, intolerance to cold weather, puffy eyelids & lost 1/3 of outer eyebrow, constipation
• · No history of Dyspnea or Dysphagia.
• · No history of Discharge.
• · No history of Psychological trauma.
• · No past history of operations, drug intake, D.M. or hypertension
• · No family history of similar conditions or D.M. or hypertension. s no history of metastasis in the form of ……
• · There is