QuestionSBA
QuestionChoice
Whilst hypothyroidism can cause a hoarse voice, it is more important to exclude head and neck cancer in the initial sense. The patient also did not mention any other symptoms of hypothyroidism.
10035046
e
Arrange thyroid function tests
QuestionChoice
Whilst an upper respiratory tract infection can cause a hoarse voice, the persistent nature of the hoarseness and smoking history is concerning and suggests the patient should be referred under a 2-week wait pathway.
10035043
b
Arrange a respiratory viral swab
QuestionChoice
A persistent hoarse voice in patients aged 45 or over warrants a referral for suspected laryngeal cancer. It is also worth noting in a smoker that lung cancer is an important differential.
10035042
a
2 week-wait referral under the suspected laryngeal cancer pathway
QuestionChoice
Whilst this is likely the investigation that will be carried out by ENT, the referral needs to be urgent to exclude laryngeal cancer.
10035045
d
Non-urgent referral to ENT for nasendoscopy
QuestionChoice
This is an inappropriate management strategy as the persistent hoarseness in a patient aged 45 years or older merits an urgent referral for suspected laryngeal cancer.
10035044
c
Advise simple analgesia and throat lozenges
Concept
Chapter
2693
5950
Hoarseness
Topic
186
Ear, Nose and Throat
19412
Persistent hoarseness lasting over three weeks in individuals over 45, especially smokers, requires urgent referral for suspected laryngeal cancer.
A 57-year-old male has a hoarse voice.

He initially had symptoms of a cough, nasal discharge and sore throat but the hoarseness has persisted for more than a month after these symptoms resolved.

He has no other past medical history but smokes 30 cigarettes a day.

What is the most appropriate management option?
a