HEENT/Neck Questions Flashcards
- A 38-year-old accountant comes to your clinic for evaluation of a headache. The throbbing sensation is located in the right temporal region and is an 8 on a scale of 1 to 10. It started a few hours ago, and she has noted nausea with sensitivity to light; she has had headaches like this in the past, usually less than one per week, but not as severe. She does not know of any inciting factors. There has been no change in the frequency of her headaches. She usually takes an over-the-counter analgesic and this results in resolution of the headache. Based on this description, what is the most likely diagnosis of the type of headache?
A) Tension
B) Migraine
C) Cluster
D) Analgesic rebound
Ans: B
Chapter: 07
Page and Header: 196, The Health History
Feedback: This is a description of a common migraine (no aura). Distinctive features of a migraine include phonophobia and photophobia, nausea, resolution with sleep, and unilateral distribution. Only some of these features may be present.
- Which of the following is a symptom involving the eye?
A) Scotomas
B) Tinnitus
C) Dysphagia
D) Rhinorrhea
Ans: A
Chapter: 07
Page and Header: 196, The Health History
Feedback: Scotomas are specks in the vision or areas where the patient cannot see; therefore, this is a common/concerning symptom of the eye
- A 55-year-old bank teller comes to your office for persistent episodes of dizziness. The first episode started suddenly and lasted 3 to 4 hours. He experienced a lot of nausea with vomiting; the episode resolved spontaneously. He has had five episodes in the past 1½ weeks. He does note some tinnitus that comes and goes. Upon physical examination, you note that he has a normal gait. The Weber localizes to the right side and the air conduction is equal to the bone conduction in the right ear. Nystagmus is present. Based on this description, what is the most likely diagnosis?
A) Benign positional vertigo
B) Vestibular neuronitis
C) Ménière’s disease
D) Acoustic neuroma
Ans: C
Chapter: 07
Page and Header: 252, Table 7–3
Feedback: Ménière’s disease is characterized by sudden onset of vertiginous episodes that last several hours to a day or more, then spontaneously resolve; the episodes then recur. On physical examination, sensorineural hearing loss is present. The patient does complain of tinnitus.
- A 73-year-old nurse comes to your office for evaluation of new onset of tremors. She is not on any medications and does not take herbs or supplements. She has no chronic medical conditions. She does not smoke or drink alcohol. She walks into the examination room with slow movements and shuffling steps. She has decreased facial mobility and a blunt expression, without any changes in hair distribution on her face. Based on this description, what is the most likely reason for the patient’s symptoms?
A) Cushing’s syndrome
B) Nephrotic syndrome
C) Myxedema
D) Parkinson’s disease
Ans: D
Chapter: 07
Page and Header: 253, Table 7–4
Feedback: This is a typical description for a patient with Parkinson’s disease. Facial mobility is decreased, which results in a blunt expression—a “masked” appearance. The patient also has decreased blinking and a characteristic stare with an upward gaze. In combination with the findings of slow movements and a shuffling gait, the diagnosis of Parkinson’s is almost clinched.
- A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation, the right eyeball appears to be protruding forward. Based on this description, what is the most likely diagnosis?
A) Ptosis
B) Exophthalmos
C) Ectropion
D) Epicanthus
Ans: B
Chapter: 07
Page and Header: 255, Table 7–6
Feedback: Exophthalmos is the condition when the eyeball protrudes forward. If it is bilateral, it suggests the presence of Graves’ disease. If it is unilateral, it could still be caused by Graves’ disease. Alternatively, it could be caused by a tumor or inflammation in the orbit.
- A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left eye. It started this morning. He denies any trauma or injury. There is no visual disturbance. Upon physical examination, there is a red raised area at the margin of the eyelid that is tender to palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the most likely diagnosis?
A) Dacryocystitis
B) Chalazion
C) Hordeolum
D) Xanthelasma
Ans: C
Chapter: 07
Page and Header: 256, Table 7–7
Feedback: A hordeolum, or sty, is a painful, tender, erythematous infection in a gland at the margin of the eyelid.
- A 15-year-old high school sophomore presents to the emergency room with his mother for evaluation of an area of blood in the left eye. He denies trauma or injury but has been coughing forcefully with a recent cold. He denies visual disturbances, eye pain, or discharge from the eye. On physical examination, the pupils are equal, round, and reactive to light, with a visual acuity of 20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply demarcated area at the lateral aspect of the base of the left eye. The cornea is clear. Based on this description, what is the most likely diagnosis?
A) Conjunctivitis
B) Acute iritis
C) Corneal abrasion
D) Subconjunctival hemorrhage
Ans: D
Chapter: 07
Page and Header: 257, Table 7–8
Feedback: A subconjunctival hemorrhage is a leakage of blood outside of the vessels, which produces a homogenous, sharply demarcated bright red area; it fades over several days, turning yellow, then disappears. There is no associated eye pain, ocular discharge, or changes in visual acuity; the cornea is clear. Many times it is associated with severe cough, choking, or vomiting, which increase venous pressure. It is rarely caused by a serious condition, so reassurance is usually the only treatment necessary.
- A 67-year-old lawyer comes to your clinic for an annual examination. He denies any history of eye trauma. He denies any visual changes. You inspect his eyes and find a triangular thickening of the bulbar conjunctiva across the outer surface of the cornea. He has a normal pupillary reaction to light and accommodation. Based on this description, what is the most likely diagnosis?
A) Corneal arcus
B) Cataracts
C) Corneal scar
D) Pterygium
Ans: D
Chapter: 07
Page and Header: 258, Table 7-9
Feedback: A pterygium is a triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea, usually from the nasal side. Reddening may occur, and it may interfere with vision as it encroaches on the pupil. Otherwise, treatment is unnecessary.
- Which of the following is a “red flag” regarding patients presenting with headache?
A) Unilateral headache
B) Pain over the sinuses
C) Age over 50
D) Phonophobia and photophobia
Ans: C
Chapter: 07
Page and Header: 196, The Health History
Feedback: A unilateral headache is often seen with migraines and may commonly be accompanied by phonophobia and photophobia. Pain over the sinuses from sinus congestion may also be unilateral and produce pain. Migraine and sinus headaches are common and generally benign. A new severe headache in someone over 50 can be associated with more serious etiologies for headache. Other red flags include: acute onset, “the worst headache of my life”; very high blood pressure; rash or signs of infection; known presence of cancer, HIV, or pregnancy; vomiting; recent head trauma; and persistent neurologic problems.
- A sudden, painless unilateral vision loss may be caused by which of the following?
A) Retinal detachment
B) Corneal ulcer
C) Acute glaucoma
D) Uveitis
Ans: A
Chapter: 07
Page and Header: 196, The Health History
Feedback: Corneal ulcer, acute glaucoma, and uveitis are almost always accompanied by pain. Retinal detachment is generally painless, as is chronic glaucoma.
- Sudden, painful unilateral loss of vision may be caused by which of the following conditions?
A) Vitreous hemorrhage
B) Central retinal artery occlusion
C) Macular degeneration
D) Optic neuritis
Ans: D
Chapter: 07
Page and Header: 196, The Health History
Feedback: In multiple sclerosis, sudden painful loss of vision may accompany optic neuritis. The other conditions are usually painless.
- Diplopia, which is present with one eye covered, can be caused by which of the following problems?
A) Weakness of CN III
B) Weakness of CN IV
C) A lesion of the brainstem
D) An irregularity in the cornea or lens
Ans: D
Chapter: 07
Page and Header: 196, The Health History
Feedback: Double vision in one eye alone points to a problem in “processing” the light rays of an incoming image. The other causes of diplopia result in a misalignment of the two eyes.
- A patient complains of epistaxis. Which other cause should be considered?
A) Intracranial hemorrhage
B) Hematemesis
C) Intestinal hemorrhage
D) Hematoma of the nasal septum
Ans: B
Chapter: 07
Page and Header: 196, The Health History
Feedback: Although the source of epistaxis may seem obvious, other bleeding locations should be on the differential. Hematemesis can mimic this and cause delay in life-saving therapies if not considered. Intracranial hemorrhage and septal hematoma are instances of contained bleeding. Intestinal hemorrhage may cause hematemesis if there is obstruction distal to the bleeding, but this is unlikely.
- Glaucoma is the leading cause of blindness in African-Americans and the second leading cause of blindness overall. What features would be noted on funduscopic examination?
A) Increased cup-to-disc ratio
B) AV nicking
C) Cotton wool spots
D) Microaneurysms
Ans: A
Chapter: 07
Page and Header: 201, Health Promotion and Counseling
Feedback: It is important to screen for glaucoma on funduscopic examination. The cup and disc are among the easiest features to find. AV nicking and cotton wool spots are seen in hypertension. Microaneurysms are seen in diabetes.
- Very sensitive methods for detecting hearing loss include which of the following?
A) The whisper test
B) The finger rub test
C) The tuning fork test
D) Audiometric testing
Ans: D
Chapter: 07
Page and Header: 201, Health Promotion and Counseling
Feedback: While it is important to screen for hearing complaints with methods available to you, it should be realized that some physical examination techniques are limited. Nonetheless, you should be comfortable performing these tests, as audiometric testing is not always available.
