Hoarseness is a very common presentation. It be can anything from infecious, neurological or simple trauma from talking too much. Because I myself don’t, ironically, want to talk too much, how about we just crack on with the questions? Good luck!
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Approach to the Patient with Hoarseness
Stem 1 of 3
A 47 year old female operatic singer presents to GP with difficulty singing for 100 days. She states her voice is more hoarse. She is a 20-year pack history smoker with no other medical conditions.
According to NICE 2020 guidelines, how many red flags does this patient have?
Stem 2 of 3What is the next best step to investigate this patient?
CT head and neck
MR head and neck
Nerve conduction study
Stem 3 of 3The patient has a nodule, seen on the true vocal fold, preventing complete adduction across the rima glottidis. Select all the options you would advise as first-line management.
Do not whisper
Speech and language therapy exercises
Surgical ablation of nodule
Stem 1 of 4
A 71 year old type two diabetic, with stage one hypertension controlled by first-line medication, presents with a change of voice over the last few weeks.
Select all the medications below that may cause hoarseness
Antispasmodic for overactive bladder
Muscarinic receptor antagonists
Urticaria-treating H1-R blockade
Stem 2 of 4A flexible nasal endoscope (FNE) is undertaken as the patient also complained of dysphagia. During examination, the quadrangular membrane is notably dry and painful on irritation. What is the innervation of this region?
External branch of the inferior laryngeal nerve
External branch of the superior laryngeal nerve
Internal branch of the glossopharyngeal nerve
Internal branch of the inferior laryngeal nerve
Internal branch of the superior laryngeal nerve
Stem 3 of 4The patient’s anti-hypertensive is switched as per NICE 2020 guidelines to lessen the side effect. Which of the following is the best-matched medication to give?
Stem 4 of 4The patient is concerned about side effects of the new medication. Select from the following the least likely recognised things he should be concerned to develop from this new regimen.
Stem 1 of 3
A 3 year old, drooling patient presents with acute pyrexia, hoarseness, stridor and difficulty in breathing.
What is the most likely diagnosis?
Foreign body aspiration
Stem 2 of 3Given your working diagnosis, which vaccinations is this child more likely to have missed?
Haemophilus influenzae type B
Stem 3 of 3How would you initially manage this patient?
Flexible nose endoscopy
Mask ventilation and intubation
Spotted an error?
- BMJ. (2020). Epiglottis. Available: https://bestpractice.bmj.com/topics/en-gb/452/treatment-algorithm#patientGroup-0-0. Last accessed September 2020.
- House, S et al. (2017). Hoarseness in Adults. Available: https://www.aafp.org/afp/2017/1201/p720.html. Last accessed September 2020.
- Knott, L et al. (2014). Hoarseness. Available: https://patient.info/doctor/hoarseness-pro. Last accessed September 2020.
- Moore, A (2017). Moore’s Clinically Oriented Anatomy. London: Lippincott Williams and Wilkins. page X.
- Raftery, A et al (2014). Churchill’s Differential Diagnosis. 4th ed. London: Churchill Livingstone. pX.