Having trouble remembering all the important questions to ask during your patient encounter? Then try this Hoarseness Mnemonic for USMLE Step 2 CS.
PHYSICAL EXAMINATION Hoarseness mnemonic
NOTE: Make sure to wash your hands or wear gloves before you start physical examination. Make sure to ask for permission before you start each physical exam. Make sure to use proper draping (don’t forget to tie back patient’s gown). Make sure to explain each physical examination in layman’s term to your patient. Do NOT repeat painful maneuvers.
- HEENT: Inspect mouth, throat, lymph nodes and thyroid gland
- Pulmonary exam: Auscultation
- Cardiovascular exam: Auscultation
- Abdominal exam: Auscultation, palpation
- Extremities: Inspection, DTRs
DIFFERENTIAL DIAGNOSIS Hoarseness mnemonic
- Laryngitis: This is a common condition of the larynx and can be acute or chronic. The acute form is most likely viral and is self-limited. Common causes of the chronic form are cigarette smoke, polluted air, and GERD.
- Laryngeal cancer: Common in patients with chronic history of smoking and drinking
- Vocal cord polyps/Nodules: Benign vocal fold lesions are sometimes related to overuse of the voice and can be easily identified by means of laryngoscopy
- Hyperthyroidism / Hypothyroidism: An enlarged goiter can cause compression of the recurrent laryngeal nerve. Other associated symptoms include fatigue, changes in weight and appetite.
- Mitral valve stenosis: Hoarseness in mitral valve stenosis is due compression of the recurrent laryngeal nerve due to enlargement of the left atrium.
DIAGNOSTIC WORKUP Hoarseness mnemonic
- Laryngoscopy: The gold standard for evaluating the larynx; allows direct visualization of the vocal cords. It also allows biopsy of suspicious lesions for pathologic evaluation.
- Complete Blood Count (CBC) : To look for anemia, which can be associated with hypothyroidism, and also elevated WBC count which indicates presence of an infections.
- ESR: Will be elevated in malignant and infectious causes.
- TSH and Free T4: To diagnose thyroid disease
- Esophageal pH monitoring: To diagnose GERD as a cause of laryngitis.
- Echocardiogram: Important in diagnosing cardiac valvular diseases.
- CT scan of chest and neck: Can identify the location and extent of most laryngeal lesions.
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