Presentation Pages — what to ask, what to examine

One block per presenting complaint: WHAT TO ASK · WHAT TO EXAMINE. The universal frame (7 attributes, meds/allergies, PMH, family, social) is assumed from Clinical Method Part 8 and not repeated — these are the presentation-specific questions and moves on top of it. Red = the must-not-miss. Compiled from the standard clerking canon (Macleod’s Clinical Examination, Bates’ 12e; Bailey & Love for the surgical presentations) — structure and content follow those traditions; verify page-level detail against the books in hand. Adam, Clinical Registrar · OncoDesk · v3.0

LOSS OF CONSCIOUSNESS / SYNCOPE

Ask

Before: posture (standing? on the toilet?) · warning — lightheaded, sweaty, vision greying (vasovagal) vs none at all (cardiac) · palpitations or chest pain first · during exertion? (exertional syncope = structural/arrhythmic until proven otherwise) · trigger — pain, fear, standing long, coughing, micturition, head-turning/tight collar.
During (WITNESS — phone them, this is the single highest-yield act): duration · colour · jerking and when it started · tongue-bitten — side of tongue = seizure · incontinence · eyes open or shut.
After: immediate full recovery (syncope) vs confusion/drowsiness >5–10 min = post-ictal · injury sustained · muscle ache.
Background: previous episodes + age at first · family history of sudden death <40 · cardiac disease · drugs — antihypertensives, diuretics, QT-prolongers, insulin/sulfonylurea (hypo) · alcohol · missed meals · pregnancy possible?

Examine

Lying AND standing BP (postural drop ≥20 systolic) · pulse rate + rhythm · murmur — especially aortic stenosis (ejection murmur to carotids) · carotid bruits.
Tongue for lateral bite · injuries (occiput, shoulder) · full neuro if any suggestion of seizure or deficit.
ECG in every single one — rhythm, QT, pre-excitation, Brugada pattern, LVH. Glucose. Never label "vasovagal" in an exertional or family-history patient without echo + cardiology.

COUGH

Ask

Duration first — <3 wk (acute, mostly infective) vs 3–8 wk vs >8 wk (chronic: asthma, reflux, post-nasal drip, ACE inhibitor, smoker’s/COPD, TB, cancer).
Dry or productive? Sputum — amount, colour, blood · daily purulent sputum for years = bronchiectasis · frothy pink = pulmonary oedema.
Haemoptysis? → go to that block; never file it under cough.
Timing — nocturnal (asthma, heart failure, reflux) · on eating/lying (reflux, aspiration) · seasonal + wheeze + atopy (asthma).
On an ACE inhibitor? (the drug cause everyone forgets) · smoking pack-years · occupational dust/asbestos · TB contact / travel / prior TB · HIV risk.
Constitutional — fever, night sweats, weight loss (TB, lymphoma, lung cancer).

Examine

Clubbing (cancer, bronchiectasis, fibrosis) · cervical + supraclavicular nodes · hoarseness (recurrent laryngeal — a hoarse smoker with cough is a red flag pair).
Full chest — wheeze (asthma/COPD), coarse crackles that shift with cough (bronchiectasis), fine end-inspiratory crackles (fibrosis), signs of consolidation or effusion.
Heart — displaced apex, gallop, oedema if the story could be cardiac. Peak flow if asthma suspected. CXR for any cough >3 wk in a smoker, any haemoptysis, any constitutional symptoms.

HAEMOPTYSIS

Ask

Is it truly from the chest? Coughed up (haemoptysis) vs vomited (haematemesis) vs from the nose/gums — the first branching question.
Volume — streaks vs teaspoons vs massive (>200 mL / frank blood: airway emergency) · how many days.
With it: fever + purulent sputum (infection) · pleuritic pain + breathless + VTE risk (PE) · weight loss + smoker + >40 = cancer until bronchoscopy says otherwise · night sweats + TB contact · recurrent with nosebleeds/haematuria (vasculitis).
Anticoagulants/antiplatelets · known lung disease · previous episodes.

Examine

Vitals + sats · conjunctivae (anaemia = it has been going on) · clubbing · cervical/supraclavicular nodes · full chest · calves + unilateral leg swelling (PE source) · skin/joints (vasculitis) · mouth/nose to exclude an upper source.
Everyone gets: CXR + FBC + coagulation. Smoker >40 or any mass/persistent change → CT + bronchoscopy referral.

CHEST PAIN

Ask

Site + radiation (arm/jaw · interscapular/back — dissection · shoulder-tip) · character (pressure vs sharp vs tearing vs burning).
Onset — abrupt and maximal immediately (dissection, PE, pneumothorax) vs building over minutes (ischaemic) · duration of each episode · >20 min at rest?
Relation to: exertion/relief by rest (angina) · breathing/cough (pleuritic) · position — worse flat, better leaning forward (pericarditis) · meals/lying (reflux) · movement/pressing (wall).
With it: sweating, nausea, breathlessness (MI) · syncope, neuro symptoms, hoarseness (dissection) · haemoptysis + calf pain (PE) · fever + sputum (pneumonia).
Coronary risk factors · VTE risk incl. cancer · hypertension · recent viral illness / radiotherapy (pericarditis) · cocaine in the young.

Examine

Vitals with BP both arms + four pulses · JVP · apex · all areas + sit forward on held expiration: rub, aortic regurgitation · lungs (consolidation, effusion, absent sounds + hyperresonance) · chest-wall palpation for reproducibility · calves · epigastrium.
ECG + troponin every cardiac-possible story · erect CXR · the story picks CT aortogram vs CTPA — do not let a troponin delay a dissection scan.

BREATHLESSNESS

Ask

Speed of onset — seconds (PE, pneumothorax) · hours–days (pneumonia, pulmonary oedema) · months (COPD, fibrosis, anaemia) · episodic + normal in between (asthma).
Cough first or breathlessness first · sputum · wheeze · orthopnoea — "how many pillows?" · PND — "wake up gasping, have to sit or stand?" · ankle swelling.
Night attacks + triggers + atopy (asthma) · pleuritic pain / haemoptysis / calf / immobility / surgery / cancer (PE cluster) · fever + sputum (pneumonia).
Smoking pack-years · occupation (dust, asbestos, birds) · drugs — bleomycin/methotrexate/amiodarone, immunotherapy · perioral tingling (hyperventilation — last, never first).
Exercise tolerance NOW vs 6 months ago, in metres/stairs — the severity measure that means something.

Examine

RR, sats, work of breathing first · trachea · expansion · percussion (hyperresonant = pneumothorax, stony dull = effusion) · breath + added sounds · peak flow if asthma.
JVP · apex · S3 gallop · oedema and its level · calves · conjunctivae (anaemia) · stridor is not wheeze — it is an airway emergency · face/arm swelling + distended neck veins (SVC obstruction).
Sats/ABG + CXR + ECG universally; BNP/echo if cardiac; spirometry if chronic; Wells → CTPA if the cluster says PE; Hb always in a cancer patient.

PALPITATIONS

Ask

"Tap it out on the table." Fast + regular (SVT/VT) vs irregularly irregular (AF) vs occasional thumps/skips (ectopics).
Onset/offset — abrupt like a switch (SVT) vs gradual (sinus tachy/anxiety) · can he stop it (vagal manoeuvres)? · duration, frequency.
With it: syncope or presyncope during palpitations = malignant until proven otherwise · chest pain · breathlessness.
Triggers — caffeine, alcohol ("holiday heart"), decongestants, salbutamol, cocaine, stress · thyroid symptoms — heat intolerance, weight loss, tremor · family history of sudden death · known heart disease.

Examine

Pulse rate + rhythm · BP · thyroid signs (goitre, tremor, lid lag) · murmurs (mitral disease → AF) · heart failure signs.
ECG in all — rhythm, pre-excitation (WPW), QT interval. TFTs, Hb, electrolytes (K, Mg). Holter/event monitor if episodic. Echo + cardiology if syncope, exertional, or structural suspicion.

FEVER

Ask

Duration + pattern · rigors (bacteraemia, cholangitis, pyelonephritis, malaria) · night sweats drenching + weight loss (TB, lymphoma).
Localising sweep, system by system: cough/sputum · dysuria/frequency/flank · headache + neck stiffness + rash · sore throat/ear · abdominal pain/diarrhoea · joint pain/swelling · skin breaks, bites, cellulitis · new murmur symptoms.
Travel (malaria, typhoid, dengue — and WHERE + prophylaxis) · animal/tick exposure · unwell contacts · TB contact.
Devices + doors in: lines, ports, catheters, prosthetic valves/joints · IV drug use (endocarditis) · recent surgery/dental work.
Immunosuppressed? On chemotherapy? → neutropenic fever pathway — cultures + antibiotics within the hour, no waiting. Drugs (drug fever, neuroleptics).

Examine

Full vitals · the septic screen with hands and eyes: throat, ears, sinuses · neck stiffness · chest · heart — new murmur + fever = endocarditis; splinters, Janeway/Osler · abdomen incl. Murphy’s + renal angles · every joint · the whole skin including back, perineum, between toes; every line site and port · calves.
Cultures before antibiotics (blood ×2 + urine ± others); FBC, CRP, LFTs, urine dip, CXR; malaria films if travel. Neutropenic = emergency.

HEADACHE

Ask

"Your usual headache, or new/different?" · speed to worst — thunderclap (<1 min) = SAH · first ever after 50?
Pattern: unilateral throbbing + nausea/photophobia ± aura (migraine) · band, builds through the day (tension) · orbital, 15–180 min, clustered, tearing/red eye (cluster).
Raised-ICP screen: worse mornings, wakes him, worse coughing/straining/lying, vomiting. · Meningitis screen: fever, neck stiffness, rash, photophobia.
>50: jaw claudication, scalp tenderness, visual dimming (GCA) · eye pain + halos + red eye (glaucoma).
Analgesic-overuse (daily painkillers) · anticoagulants / falls (subdural) · OCP + young obese woman (venous thrombosis, IIH) · known cancer = mets until imaged · pregnancy (pre-eclampsia).

Examine

BP · GCS · neck stiffness + Kernig · FUNDI — non-negotiable · pupils, cranial nerves, limbs for focal deficit · temporal artery palpation · sinuses/TMJ · the eye (red, fixed mid-dilated pupil).
CT now for thunderclap/deficit/papilloedema/cancer + new headache · LP after normal CT if SAH or meningitis still the question · immediate ESR/CRP + steroids on clinical GCA suspicion · document the negative red-flag screen for a clinical migraine/tension diagnosis.

DIZZINESS / VERTIGO

Ask

"What do you mean by dizzy?" — the room SPINNING (vertigo) vs about to FAINT (presyncope → syncope block) vs unsteady on the feet (disequilibrium) vs vague lightheadedness. Everything follows this split.
Vertigo: seconds, on turning in bed / looking up = BPPV · hours + hearing loss + tinnitus + fullness = Ménière’s · days, constant, after a viral illness = vestibular neuritis · with headache, diplopia, dysarthria, weakness, or unable to stand = central/posterior circulation.
Hearing change · ear discharge · new medication — aminoglycosides, furosemide, cisplatin (ototoxic), antihypertensives (presyncope) · anaemia/bleeding source · anxiety.

Examine

Lying/standing BP · pulse · ears + hearing (whisper, Weber/Rinne) · nystagmus — direction, fatigability · Dix–Hallpike (BPPV) → Epley if positive · HINTS if continuous vertigo: head impulse, nystagmus direction-change, skew — a normal head impulse points CENTRAL · cerebellar signs + gait · full cranial nerves.
In a cisplatin patient do not anchor on BPPV — check Mg, Hb, hydration, hearing.

FOCAL WEAKNESS / ?STROKE

Ask

Exact time of onset (or last seen well) — this is the thrombolysis clock, get it to the minute.
What is weak — face/arm/leg, one side? · speech, swallow, vision (field loss, diplopia) · sensory loss · onset sudden (vascular) vs over days (mass, subdural) vs fluctuating.
Resolved fully? (TIA — still an emergency: high early stroke risk) · headache + vomiting (bleed) · seizure at onset (Todd’s) · trauma/falls + anticoagulants (subdural) · AF, prosthetic valves, prior stroke, diabetes (hypoglycaemia mimics!) · known cancer — mets/cord compression.
If legs + back pain + sphincters: the cord-compression questions — saddle numbness, retention, incontinence. Hours matter.

Examine

Glucose first — the five-second stroke mimic. GCS · BP · pulse (AF) · FAST then full neuro: tone, power grade, reflexes + plantars, sensation, visual fields, speech · cerebellar · carotid bruit · heart (murmur, AF).
Suspected cord: sensory level, anal tone, bladder scan. Immediate CT (bleed vs infarct) · whole-spine MRI + dexamethasone for suspected cord compression — hours, not days.

ABDOMINAL PAIN

Ask

Point with one finger — where did it start, where is it now, where does it go? (periumbilical→RLQ appendicitis · epigastric→back ulcer/pancreas · RUQ→shoulder biliary · loin→groin ureteric · sudden diffuse + board-rigid = perforation).
Colicky in waves (blocked tube — writhing) or constant (inflammation — lying still)?
Food: fatty-meal pain (biliary) · hunger-like/food-related (ulcer) · pain after every meal + weight loss + vascular patient ("food fear" — mesenteric ischaemia, or gastric cancer).
Bowels: last opened, passing wind? (obstruction) · vomiting — before or after pain, faeculent? · blood up or down, black stool.
Fever/rigors + jaundice (cholangitis) · urinary symptoms · LMP + could she be pregnant (ectopic) · NSAIDs/steroids/alcohol · AF/vascular disease · previous operations (adhesions) · known cancer · hernias noticed.

Examine

Look (distension, scars, visible peristalsis) · listen (tinkling vs silent) · percuss (tympany, shifting dullness, percussion tenderness = peritonism) · palpate light→deep starting away from the pain — guarding, rebound, masses · Murphy’s · hernial orifices in EVERY abdomen · aorta · renal angles · PR in bleeding/anaemia/constipation · genitalia (torsion in any young male with abdominal pain).
Urine dip + β-hCG in any woman who could be pregnant · lipase · LFTs · lactate · erect CXR (free air) · US biliary/AAA · CT for the surgical questions · ECG (inferior MI presents epigastric).

GI BLEEDING — haematemesis · melaena · PR blood

Ask

Which is it — vomited blood (fresh vs coffee-ground), black tarry sticky stool (melaena = upper source), or fresh PR blood (on paper · coating stool · mixed in · clots)?
Volume + times · preceded by retching (Mallory–Weiss) · dizziness/collapse (volume loss).
Liver risk — alcohol, hepatitis, known cirrhosis (varices change everything) · NSAIDs/aspirin/anticoagulants/steroids · previous ulcer/bleeds.
PR blood: pain on defecation + bright on paper (fissure/haemorrhoids) · mixed with stool + change in habit + weight loss + >45 = cancer until scoped · diarrhoea + mucus (colitis) · family history of colorectal cancer.

Examine

Haemodynamics first — pulse, BP, postural drop; resuscitate before you finish the history if unstable. Pallor · stigmata of chronic liver disease (spiders, palmar erythema, gynaecomastia) · jaundice · splenomegaly + ascites (portal hypertension) · abdomen for tenderness/masses · PR — melaena on the glove settles the upper-source question.
FBC, U&E (urea rises in upper GI bleed), coagulation, crossmatch. Glasgow-Blatchford; endoscopy. Fresh PR + >45 or any alarm = colonoscopy referral, not a haemorrhoid label.

DYSPHAGIA

Ask

Solids, liquids, or both — and which came first? Solids first, progressing to liquids = structural, and progressive painless dysphagia in a smoker/reflux patient = oesophageal cancer until scoped · solids AND liquids from the start, intermittent = motility (achalasia, spasm).
Where does it stick? (throat vs retrosternal — patient pointing is surprisingly accurate) · trouble STARTING the swallow + coughing/choking/nasal regurgitation = oropharyngeal/neuro (stroke, bulbar).
Odynophagia (painful — candida, ulcer, spasm) · regurgitation of old food (achalasia, pharyngeal pouch) · weight loss, anaemia symptoms · reflux history · caustic ingestion · neuro symptoms elsewhere.

Examine

Nutritional state + weight · mouth + tongue · supraclavicular nodes (Virchow’s) · neck masses (pouch, goitre) · epigastric mass, hepatomegaly · cranial nerves IX–XII + watch a sip of water swallowed (if safe).
Alarm dysphagia (progressive, weight loss, anaemia, >55, new onset) = urgent endoscopy — a barium swallow first only if pouch/achalasia suspected.

JAUNDICE

Ask

The three-colour question: urine dark? stool pale? itching? — all three = obstructive/cholestatic; normal urine/stool = pre-hepatic (haemolysis).
Painless progressive jaundice + weight loss in an older patient = pancreatic head cancer until proven otherwise (Courvoisier) · RUQ pain + fever + rigors = cholangitis · colicky RUQ pain + fatty-food history = stone.
Alcohol honestly quantified · every drug incl. herbal + paracetamol · hepatitis risks — travel, transfusion, tattoos, needles, sexual · unwell contacts · family (Gilbert’s, haemochromatosis, Wilson’s) · known cancer (liver mets) · pregnancy.
Prodrome of malaise/anorexia/nausea (viral hepatitis) · confusion/drowsiness (decompensation — encephalopathy).

Examine

Depth of jaundice (sclera) · chronic liver stigmata — spiders, palmar erythema, Dupuytren’s, gynaecomastia · liver — size, edge, tender? · splenomegaly · ascites (shifting dullness) · palpable non-tender gallbladder + jaundice = not stones (Courvoisier) · excoriations · lymph nodes · flap + orientation (encephalopathy).
Split the bilirubin + LFT pattern (hepatitic ALT/AST vs cholestatic ALP/GGT) + INR (true function) + FBC/reticulocytes; US of the biliary tree is the decisive first image: dilated ducts = obstructive → CT/MRCP.

DIARRHOEA

Ask

Duration — <2 wk = infective until otherwise; >4 wk = chronic (IBD, coeliac, IBS, cancer, overflow, thyroid, drugs).
Stool: watery vs fatty/greasy floating foul (steatorrhoea — malabsorption/pancreatic) vs bloody + mucus (colitis, dysentery, cancer) · nocturnal diarrhoea = organic, not IBS · frequency + urgency + incontinence.
Food + water history, takeaway/eggs/chicken, travel, unwell contacts · antibiotics within 3 months (C. diff) · PPIs, metformin, laxatives, magnesium, chemo, immunotherapy (colitis — grade it, it is an emergency at grade 3).
Weight loss, appetite · mouth ulcers, eye/joint/skin symptoms (IBD) · family history — IBD, coeliac, colorectal cancer · alternating with constipation + never truly empty + >45 = scope.

Examine

Hydration first — postural BP, mucous membranes, urine output · fever · abdomen — tenderness, distension (toxic megacolon), masses · mouth ulcers · eyes/joints/skin (IBD) · PR — impaction with overflow in the elderly, mass, blood on glove.
Stool culture + C. diff toxin when indicated; FBC/CRP, U&E, TFTs, coeliac serology, faecal calprotectin; scope for blood, chronicity, or age >45.

CONSTIPATION

Ask

What he means — frequency, hard stool, straining, incomplete emptying · his baseline and WHEN it changed — a recent CHANGE in an adult >45 is the alarm, lifelong constipation is not.
Alarm set: blood in stool, weight loss, anaemia symptoms, family colorectal cancer, mass felt. · Absolute constipation (no stool OR wind) + distension + vomiting = obstruction.
Drugs — opioids above all (in a cancer patient: prophylactic laxatives should already be running), anticholinergics, iron, calcium, verapamil, ondansetron · dehydration, immobility.
Metabolic screen by symptoms: thirst + polyuria + confusion (hypercalcaemia — in cancer think of it early), cold intolerance + fatigue (hypothyroid) · neuro — back pain + saddle numbness + urinary trouble (cauda equina / cord compression) · pain on defecation (fissure — the cause AND the perpetuator).

Examine

Abdomen — distension, faecal loading LIF, masses · bowel sounds · PR — hard stool vs empty ballooned rectum (obstruction above), mass, fissure, tone; do it — constipation is a PR presentation · perianal sensation if any neuro hint.
Ca, TFTs, glucose, FBC; AXR only if obstruction suspected; scope/imaging for the alarm set. Opioid-induced: stimulant (senna) ± osmotic — never a softener alone; PAMORA if refractory.

WEIGHT LOSS — unintentional

Ask

Quantify: how many kg over how long, and was it TRYING or not? Clothes/belt looser · appetite — eating less (anorexia: cancer, depression, uraemia) vs eating MORE and still losing (hyperthyroid, diabetes, malabsorption).
System sweep for the primary: cough/haemoptysis · dysphagia/early satiety/abdominal pain · change in bowels/blood · urinary/prostate · post-menopausal bleeding · breast lump · night sweats + fevers + nodes (lymphoma, TB).
Mood, sleep, anhedonia (depression is a top-three cause) · alcohol/drugs · diabetes symptoms (thirst, polyuria) · heat intolerance/tremor (thyroid) · dentition/swallow/who cooks (the elderly) · medications (metformin, chemo, stimulants).

Examine

Weight NOW documented (the baseline for everything) · muscle bulk/temporal wasting · every node basin — cervical, supraclavicular, axillary, inguinal · thyroid · chest · breasts · abdomen — masses, hepatomegaly · PR · skin (jaundice, pigmentation).
First round: FBC, ESR/CRP, U&E, LFTs, Ca, glucose/HbA1c, TFTs, urine dip + CXR — then let symptoms + findings direct the scan; a fishing CT before the history is finished is how things get missed.

HAEMATURIA

Ask

Visible or dipstick-only · timing in the stream — initial (urethral), terminal (bladder neck), total (bladder/upper tract) · clots?
Painless visible haematuria = bladder/renal cancer until proven otherwise, especially the smoker >45. · Pain: loin→groin colic (stone) · dysuria + frequency + fever (infection — but confirm it CLEARS after treatment).
Smoking + occupational dyes/rubber (urothelial) · anticoagulants (never blame them without a workup) · recent sore throat (post-strep GN) + BP + frothy urine (nephritic) · family (polycystic, stones) · menstruation/beetroot/rifampicin (false alarms) · trauma, exercise.

Examine

BP (nephritic) · oedema · abdomen — palpable kidneys (polycystic), bladder, masses · renal angles · prostate on PR · genitalia.
Urine dip + microscopy (casts = glomerular) + culture · U&E · visible or persistent non-visible >45 → CT urogram + cystoscopy — the referral is the point; do not sit on painless haematuria.

LEG SWELLING

Ask

One leg or both? — the whole differential. Unilateral: DVT (pain, tightness, risk factors — surgery, immobility, cancer, OCP, flights, previous clot) · cellulitis (hot, red, fever, skin break) · ruptured Baker’s cyst · trauma.
Bilateral: heart failure (breathless, orthopnoea) · renal (frothy urine, facial puffiness — nephrotic) · liver (alcohol, distension) · drugs — amlodipine, NSAIDs, steroids, pregabalin · low albumin (nutrition, gut loss) · venous insufficiency (chronic, better mornings) · lymphoedema (non-pitting, painless — in cancer: nodal disease or post-treatment) · pregnancy — and pre-eclampsia.
Speed of onset · pain vs painless · how far up · skin changes/ulcers.

Examine

Both legs measured — calf circumference difference >3 cm matters · pitting vs non-pitting · level it reaches · tenderness, warmth, redness · skin — haemosiderin, ulcers, lipodermatosclerosis · inguinal nodes + pelvic masses (the obstructing cause).
JVP + heart + lungs · ascites + liver · urine dip for protein · Wells → d-dimer/US Doppler for the unilateral leg; albumin, U&E, LFTs, BNP for the bilateral.

BACK PAIN

Ask

Onset — lifting/twisting (mechanical) vs no trauma in an older/osteoporotic patient (crush fracture) · site + radiation — below the knee in a dermatome = radicular.
The red-flag screen, every back: age <20 or >50 new-onset · known or past CANCER (mets until proven otherwise) · night pain / pain at rest · fever, IV drug use, immunosuppression (discitis/abscess) · weight loss · trauma · steroids/osteoporosis.
Cauda equina, ask explicitly: saddle numbness · urinary retention or incontinence · faecal incontinence · bilateral leg symptoms.
Inflammatory pattern — young, morning stiffness >30 min, better with movement, night-time second-half pain (axial spondyloarthritis) · aortic risk — tearing pain + vascular patient (AAA/dissection mimicking renal colic).

Examine

Inspect + palpate spine — focal bony tenderness (fracture, mets, infection) vs paraspinal · movement range · straight-leg raise · full lower-limb neuro: power, reflexes, sensation — and in any red flag: perianal sensation, anal tone, post-void bladder scan · abdomen — pulsatile mass · peripheral pulses.
Mechanical + no red flags = no imaging, analgesia + movement. Any red flag = image; suspected cord compression/cauda equina = MRI + dexamethasone same day.

NECK LUMP / LYMPHADENOPATHY

Ask

How long + growing? · <2 wk with a sore throat = reactive; >6 wk persistent = biopsy conversation · painful (infective) vs painless + hard + fixed (malignant) · alcohol-induced pain in a node (Hodgkin’s, classic).
B symptoms: drenching night sweats, fevers, >10% weight loss. · ENT sweep: hoarseness, dysphagia, otalgia, mouth ulcer, nasal blockage/epistaxis (a neck node’s primary is usually above the clavicles) · smoking + alcohol · TB contact, HIV risk, cat scratch, travel.
Moves on swallowing (thyroid) or tongue protrusion (thyroglossal) · other lumps elsewhere — axilla, groin.

Examine

The lump properly — site (which triangle/level), size, consistency, fixity, tenderness, pulsatility · moves with swallow/tongue · then EVERY other node basin + liver + spleen (generalised = lymphoma/leukaemia/HIV until otherwise).
Full ENT look (mouth, tongue base, tonsils) — and the definitive path: persistent node = ultrasound + CORE biopsy, and an ENT nasoendoscopy hunt for the primary BEFORE anyone excises a neck node whole. Left supraclavicular node (Virchow’s) = abdomen first.