Chapter 11: Head and Neck

Question 1

Which cranial nerves innervate the face?
a. II and V
b. III and VI
c. V and VII
d. VIII and IX

Answer 1

ANS: C
Facial nerves are controlled by cranial nerves V and VII; cranial nerves II, III, and VI control the eyes, cranial nerve VIII deals with hearing, and cranial nerve IX deals with swallowing.

Question 2

Mrs. Britton brings her 16-year-old son in with a complaint that he is not developing correctly
into adolescence. Which structures disproportionately enlarge in the male during adolescence?
a. Coronal sutures
b. Hyoid and cricoid cartilages
c. Mandible and maxilla bones
d. Nose and thyroid cartilages

Answer 2

ANS: D
In adolescent males, the nose enlarges and the thyroid cartilage becomes the largest
component of the anterior larynx, known as the Adam’s apple.

Question 3

Which of the following is an expected change in the assessment of the thyroid during
pregnancy?
a. Palpation of the gland becomes difficult.
b. A bruit is auscultated.
c. Inspection reveals a goiter.
d. The gland is tender on palpation.

Answer 3

ANS: B
During pregnancy, the thyroid gland hypertrophies (not to the point of a goiter), palpation is
easier and, because the gland also has increased vascularity, bruits are common. It is an
abnormal finding for the thyroid to feel fibrotic, tender, or smaller.

Question 4

Mr. Mathews is a 47-year-old patient who presents for a routine physical examination. On
examination, you noted a bruit heard over the thyroid. This is suggestive of
a. hypothyroidism.
b. hyperthyroidism.
c. thyroid cancer.
d. thyroid cyst.

Answer 4

ANS: B
Because of hypermetabolic states such as hyperthyroidism, a bruit may be heard as a result of
the increased blood flow to the area. Auscultating a bruit is not symptomatic of
hypothyroidism, cancer, or a cyst. A nodule is more indicative of cancer.

Question 5

Observation during history taking is the best way to examine for
a. head position.
b. scalp lice.
c. thyroid size.
d. tracheal alignment.

Answer 5

ANS: A
Head position as well as facial features is best observed when talking to the patient during the
history. Scalp lice, thyroid size, and tracheal alignment are best assessed by palpation and
closer physical observation.

Question 6

Ms. Galvan is a 22-year-old secretary who comes to the clinic with headaches of 6 weeks’
duration. She tells the office assistant about her heavy schedule, including part-time work and
evening classes. Her vital signs are normal. Which information is most appropriate to Ms.
Galvan’s history?
a. Current medications
b. Elimination patterns
c. Immunization status
d. Previous pregnancies

Answer 6

ANS: A
Some current medications, such as birth control pills, nitroglycerin, antihypertensives,
antiseizure drugs, and some diabetic drugs, can be headache triggers. Withdrawal of headache medication can also trigger headaches.

Question 7

During a head and neck assessment of a neonate, it is important to screen for
a. the presence of torticollis.
b. signs and symptoms of cerebral palsy.
c. uneven movement of the eyes.
d. unilateral movement of the tongue.

Answer 7

ANS: A
Torticollis is usually caused by constraint of the newborn in utero or injury during vaginal
delivery. The other symptoms may be difficult to discern because of the infant’s lack of fine
motor skills and control of voluntary muscle groups. During a head and neck assessment of a
neonate, it is not important to screen for signs and symptoms of cerebral palsy, uneven
movement of the eyes, or unilateral movement of the tongue.

Question 8

During a physical examination of a 30-year-old Chinese man, you notice a slight asymmetry
of his face. The cranial nerve examination is normal. Your best action is to
a. ask the patient if this characteristic runs in his family.
b. perform monofilament testing on the face.
c. consult with the clinician regarding the laboratory tests needed.
d. record the finding in the patient’s chart.

Answer 8

ANS: D
It is not abnormal to have some slight asymmetry of the face that does not require further
questioning, tests, or unnecessary laboratory work, but it does require a notation in the chart
that could be referenced for future concerns.

Question 9

Which is the best way to position a patient’s neck for palpation of the thyroid?
a. Flexed away from the side being examined
b. Flexed directly forward
c. Flexed toward the side being examined
d. Hyperextended directly backward

Answer 9

ANS: C
The patient should be positioned so that the sternocleidomastoid muscle is relaxed and the
thyroid is easier to palpate. This is done by having the patient flex the neck slightly forward
and laterally toward the side being examined.

Question 10

The thyroid gland should
a. be slightly left of midline.
b. have a clear vascular sound.
c. move when the patient swallows.
d. tug with each heartbeat.

Answer 10

ANS: C
It is a normal finding for the thyroid gland to move with swallowing; however, being off
center may indicate a nodular growth or enlargement. The thyroid gland should not be slightly
left of midline. Vascular sounds indicate hypermetabolic states such as hyperthyroidism, and a
tug with each heartbeat is a sign of an aortic aneurysm.

Question 11

You are palpating a patient’s thyroid and find that its broadest dimension measures 4 cm. The
right lobe is 25% larger than the left. These data would indicate
a. a congenital anomaly.
b. a multinodular goiter.
c. a normal thyroid gland.
d. thyroiditis.

Answer 11

ANS: C
The situation described is most likely a normal finding; the right lobe of the thyroid gland is
typically 25% larger than the left and measures 4 cm. The other choices produce enlargements
beyond these normal findings.

Question 12

The correct way to transilluminate an infant’s skull is to
a. hold the light 18 inches from the skull.
b. move the light toward and then away from the head.
c. place the light firmly against the skull.
d. shine the light inside the infant’s mouth.

Answer 12

ANS: C
The correct technique for transillumination of the infant’s skull is to place the light source
tightly against the skull so that no light escapes.

Question 13

Which of the following is true regarding a cephalohematoma?
a. It is bound by suture lines.
b. The affected part feels soft.
c. It is obvious at birth.
d. The margins are poorly defined.

Answer 13

ANS: A
The condition is subperiosteal, under the bone, and contained by the margins of the suture
lines; it does not cross the suture line. It is often unnoticed at birth and typically feels firm,
with its edges well defined.

Question 14

Nuchal rigidity is most commonly associated with
a. thyroiditis.
b. meningeal irritation.
c. Down syndrome.
d. cranial nerve V damage.

Answer 14

ANS: B
Stiffness and inability to flex the neck, or nuchal rigidity, constitute a classic symptom of
meningeal irritation.

Question 15

When noting a bulging fontanel with marked pulsations in a 6-month-old, you suspect
a. normal development.
b. congenital anomaly.
c. increased intracranial pressure.
d. fever response to a viral infection.

Answer 15

ANS: C
A bulging fontanel with pulsations suggests increased intracranial pressure. A normal fontanel
feels slightly depressed, with mild pulsations.

Question 16

Which type of headache usually occurs at night, is precipitated by alcohol consumption, and
occurs more often in men than in women?
a. Classic migraine
b. Temporal arteritis
c. Cluster
d. Hypertensive

Answer 16

ANS: C
Cluster headaches usually occur at night; they are associated with alcohol consumption and
occur more often in men.

Question 17

Mr. Johnson presents with a freely movable cystic mass in the midline of the high neck
region, at the base of the tongue. This is most likely a
a. parotid gland tumor.
b. branchial cleft cyst.
c. Stensen duct stone.
d. thyroglossal duct cyst.

Answer 17

ANS: D
A thyroglossal duct cyst presents as a freely movable mass at the base of the tongue. A parotid
gland tumor occurs in the ear and cheek bone area. A branchial cleft cyst occurs in the lateral
neck area. A Stensen duct stone occurs in the parotid duct.

Question 18

The premature union of cranial sutures that involves the shape of the head without mental
retardation is
a. craniosynostosis.
b. encephalocele.
c. microcephaly.
d. myxedema.

Answer 18

ANS: A
In patients with craniosynostosis, the cranial sutures fuse prematurely, causing a misshapen head, but mental retardation is not involved. Encephalocele and microcephaly involve mental
retardation. Myxedema is a condition of hyperthyroidism.

Question 19

Mr. Donaldson is a 64-year-old patient with complaints of headaches. As the examiner, you
are palpating his head during your physical examination. Which of the following would be
your first step?
a. Palpate the patient’s hair, noting texture, color, and distribution.
b. Palpate the temporomandibular joint.
c. Palpate the skull from front to back.
d. Palpate the temporal artery.

Answer 19

ANS: C
Palpate the skull in a gentle rotary movement first, progressing systematically from front to
back.