CH. 11 Seidel's Guide to Physical Examination

1. Which cranial nerves inner- vate the face? a. II and V b. III and VI c. V and VII d. VIII and IX e. I and VII 2. The trapezius and sternoclei- domastoid muscles and the clavicle form a landmark called the triangle. a. anterior b. posterior c. lateral d. medial e. ventral 3. The medial border of the sternocleidomastoid mus- cles and the mandible form the triangle. a. dorsal b. posterior c. lateral d. medial e. anterior 4. The largest endocrine gland in the body lies in the trian- gle. a. anterior b. posterior c. lateral ANS: C Facial nerves are controlled by cranial nerves V and VII, cranial nerve I involves smell, cra- nial nerves II, III, and VI control the eyes, cra- nial nerve VIII deals with hearing, and cranial nerve IX deals with swallowing. ANS: B Anatomically, these landmarks comprise what is referred to as the posterior triangle, which includes the posterior cervical lymph nodes. The anterior triangle is adjacent to the posterior triangle, formed by the medial borders of the sternocleidomastoid muscles and the mandible. The relationship of neck muscles to each other and to adjacent bones creates the anatomic landmarks known as triangles. ANS: E The anterior triangle is adjacent to the pos- terior triangle, formed by the medial borders of the sternocleidomastoid muscles and the mandible. The trapezius, sternocleidomastoid muscles, and clavicle form the posterior tri- angle. The relationship of neck muscles to each other and to adjacent bones creates the anatomic landmarks known as triangles. ANS: A The thyroid gland is the largest endocrine gland and lies in the anterior triangle. The posterior triangle does contain cervical lymph nodes, and the lateral and medial triangles are not anatomic landmarks d. medial e. ventral 5. Which structures dispropor- tionately enlarge in males during adolescence? a. Coronal sutures b. Hyoid and cricoid carti- lages c. Mandible and maxilla bones d. Nose and thyroid carti- lages e. Mastoid processes and ears 6. When examining the skull of a 4-month-old baby, you should normally find: a. closure of the anterior fontanel. b. closure of the posterior fontanel. c. ossification of the all su- tures. d. overlap of the cranial bones. e. closure of the sagittal and coronal sutures 7. The thyroid gland is partially obscured by the: a. cricoid cartilage. b. carotid artery. c. external jugular. 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. ANS: B At 2 months of age, the posterior fontanels should be closed or ossified with the anterior fontanels, a larger fontanel, closing at 12 to 15 months. The only time the cranial bones should overlap is during a vaginal birth as a result of pressure within the birth canal. Ossi- fication of the sutures begins after completion of brain growth, at about 6 years of age, and is finished by adulthood. ANS: D The thyroid sits just below the cricoid, an anatomic landmark for location of the thyroid; the lobes curve are somewhat hidden by the sternocleidomastoid muscle. d. sternocleidomastoid. e. hyoid bone. 8. The brown or tan pigmenta- tion on the forehead, nose, and malar prominence of some pregnant women is called: a. hormonal acne. b. erythema. c. alopecia. d. chloasma. e. craniotabes. 9. A bruit heard over the thyroid is suggestive of: a. hypothyroidism. b. hyperthyroidism. c. thyroid cancer. d. thyroid cyst. e. thyroid nodule. 10. What is the significance of a patient with asymmetry of the entire side of the face? a. A degenerative process may be developing. b. A peripheral trigeminal nerve problem exists. c. Asymmetry of body sides is a normal finding. d. Visual and hearing prob- lems will be present. e. Facial nerve paralysis may be present. ANS: D Chloasma, brown or tan facial pigmentation during pregnancy, fades after delivery. Hor- monal acne and erythema do not result in brown or tan pigmentation, and alopecia is loss of hair. Craniotabes is a softening of the outer table of the skull of an infant, often as- sociated with rickets and hydrocephalus. 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 hy- pothyroidism, cancer, or a cyst. A nodule is more indicative of cancer. ANS: E When the entire side of the face is asym- metrical, facial nerve paralysis may be the cause. When asymmetry is concentrated only to the lower portion of the face, weakness of the nerves in this area may be present; if the mouth is asymmetric, there may be an existing trigeminal nerve dysfunction. Degen- erative processes are more correlated with facial spasms. Visual and hearing problems may result in a patient turning his or her head to one side to favor the good eye or ear. 11. 11. Coarse, dry, and brittle hair is associated with which meta- bolic disorder? a. Hypothyroidism b. Diabetes mellitus c. Addison disease d. Cushing syndrome e. Fetal alcohol syndrome 12. Which is the best way to po- sition a patient's neck for pal- pation of the thyroid? a. Flexed away from the side being examined b. Flexed directly forward c. Flexed toward the side be- ing examined d. Hyperextended directly backward e. Rotated away from the side being examined 13. A stethoscope is used in a head and neck examination to assess: a. intracranial fluid. b. pulsating fontanels. c. skull bone development. d. thyroid vascular sounds. e. parotid glands. 14. Tracheal tug suggests the presence of a(n): a. enlarged thyroid. b. swallowing disorder. ANS: A Hypothyroidism affects hair texture, resulting in coarse, dry, and brittle changes. 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. ANS: D Although the skull is not routinely auscultat- ed, the neck is auscultated using the bell of the stethoscope at the thyroid gland to screen for states of hypermetabolism that have increased with blood supply and pro- duce bruits. ANS: C When palpating the trachea, an ominous sign of an aortic aneurysm is a tugging sensa- tion in sync with the pulse of the patient. An enlarged thyroid, swallowing disorder, hyper- c. aortic aneurysm. d. thoracic carcinoma. e. hyperparathyroidism. 15. The thyroid gland should: a. be slightly left of midline. b. have a clear vascular sound. c. feel nodular. d. tug with each heartbeat. e. move when the patient swallows. 16. You are palpating a pa- tient's thyroid and find that its broadest dimension mea- sures 4 cm. The right lobe is 25% larger than the left. These data indicate: a. a congenital anomaly. b. a normal thyroid gland. c. a multinodular goiter. d. thyroiditis. e. a hypothyroid goiter. 17. The most common form of birth trauma of the scalp is: a. caput succedaneum. b. cephalhematoma. c. cranial bossing. d. torticollis. e. dilated scalp veins parathyroidism, or thoracic carcinoma would not produce a tracheal tug. ANS: E It is a normal finding for the thyroid gland to move with swallowing; however, being off center may indicate a nodular growth or en- largement. Vascular sounds indicate hypermetabolic states such as hyperthy- roidism, and a tug with each heartbeat is a sign of an aortic aneurysm. The consistency of the thy- roid should be firm but pliable, not nodular. ANS: B The situation described is 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. ANS: A Caput succedaneum as a result of birth trauma causes swelling of the scalp. The swelling can cross the suture lines. Cephalo- hematoma is a hematoma under the skull, and cranial bossing is compensatory growth of the skull related to craniosynostosis. Tor- ticollis involves the neck. Dilated scalp veins and a head circumference increasing faster than expected may indicate increased in- tracranial pressure. 18. Which of the following is true regarding caput suc- cedaneum? a. It is a subperiosteal collec- tion of blood. b. It is firm and its edges are well defined. c. It develops several days af- ter delivery. d. It is seen over the present- ing part of the head. e. It is a head circumfer- ence increasing faster than expected. 19. Which of the following is true regarding cephalhe- matoma? ANS: D Caput succedaneum is subcutaneous edema seen over the presenting part of the head during delivery as the skull passes through the pelvis; the scalp usually feels edematous to touch, which fades after a few days. ANS: A The condition is subperiosteal, under the bone, and is contained by the margins of the suture lines; it does not cross the suture line. a. It is bound by suture lines. It is often unnoticed at birth and typically feels b. The affected part feels soft. c. It is obvious at birth. d. The margins are poorly de- fined. e. It never feels fluctuant on palpation 20. When noting a bulging fontanel with marked pulsa- firm with its edges well defined. As it ages, it may liquefy and become fluctuant on palpa- tion. ANS: C A bulging fontanel with pulsations suggests tions in a 6-month-old infant, increased intracranial pressure. A normal you suspect: a. normal development. b. Down syndrome. c. increased intracranial pressure. d. fever response to a viral fontanel feels slightly depressed with mild pul- sations infection. e. cephalhematoma. 21. Which type of headache oc- curs at night, is precipitated by alcohol consumption, and occurs more often in men than in women? a. Classic migraine b. Temporal arteritis c. Muscular tension d. Hypertensive e. Cluster 22. RJ 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. torticollis. b. branchial cleft cyst. c. Stensen duct stone. d. thyroglossal duct cyst. e. parotid gland tumor. 23. Moist skin with fine hair, prominent eyes, eyelid re- traction, and a staring ex- pressionare characteristics associated with: a. Cushing syndrome. b. Graves disease. c. myxedema. d. systemic lupus erythe- matosus. e. Hippocratic facies. ANS: E Cluster headaches are usually unilateral and occur at night; they are associated with al- cohol consumption and have a higher preva- lence in men. Classic migraine, temporal ar- teritis, muscular tension, and hypertensive headaches do not meet these criteria. ANS: D A thyroglossal duct cyst presents as a freely movable mass at the base of the tongue. Torticollis is associated with the sternoclei- domastoid muscle. A parotid gland tumor oc- curs around the ear and cheek bone area, a branchial cleft cyst occurs around the lateral neck area, and a Stensen duct stone occurs in the parotid duct. ANS: B Skin problems along with changes in hair, protruding eyes, and a glazed look are symp- toms associated with Graves disease or hy- perthyroidism. Myxedema is a condition of hypothyroidism. Cushing syndrome is charac- terized by plump skin around the face, and lupus usually presents with a rash around the face. Hippocratic facies is usually seen in the terminal stages of illness; the skin is dry and rough 24. Which of the following findings would be consis- tent with fetal alcohol syn- drome? a. Corneal clouding b. Eye slanting c. Mild ptosis d. Symmetric bulging fontanels e. Maxillary hypoplasia 25. The premature union of cra- nial sutures that involves the shape of the head without mental retardation is: a. craniosynostosis. b. encephalocele. c. microcephaly. d. myxedema. e. fetal alcohol syndrome. 26. All of the following are rec- ommendations of the Ameri- ANS: C With fetal alcohol syndrome (FAS), clas- sic findings include a poorly formed or flat philtrum, widespread eyes with inner epican- thal folds and mild ptosis, a hirsute forehead, a short nose, a relatively thin upper lip, and small eye openings. Corneal clouding is seen with Hurler syndrome, eye slanting is seen in Down syndrome, and bulging fontanels are seen in hydrocephalus. Maxillary hypoplasia is seen with several congenital syndromes, but not FAS. ANS: A With craniosynostosis, the cranial sutures fuse prematurely, causing a misshapen head, but this does not involve mental retardation. Encephalocele, microcephaly, and fetal alco- hol syndrome all involve mental retardation, and myxedema is a condition of hyperthy- roidism. ANS: D The recommendations include supine posi- can Academy of Pediatrics to tioning ("Back to Sleep"), use of a firm sleep reduce the risk of sleep-re- lated infant deaths including SIDS except: a. firm sleep surface. b. breast-feeding. c. routine immunizations. d. prone sleeping position. e. avoidance of tobacco smoke. surface, breast-feeding, room-sharing with- out bed-sharing, routine immunizations, con- sideration of pacifier use, as well as avoid- ance of soft bedding, overheating, and ex- posure to tobacco smoke, alcohol, and illicit drugs 27. ANS: D. Microcephaly Which condition is charac- terized by a smaller than nor- mal head circumference? a. Torticollis b. Encephalocele c. Hydrocephalus d. Microcephaly 28. Where does the parotid duct open? a. Under the tongue b. Near the angle of the jaw c. Buccal mucosa near the second molar tooth d. Near the lingual vein on the undersurface of the tongue 29. While assessing the neck, the nurse displaces the thy- roid cartilage to the left side and is able to feel a pulsation. This sign could be associat- ed with which condition? a. Acromegaly b.Hyperthyroidism c. Cardiac tamponade d. Aortic arch aneurysm 30. Which is the expected as- sessment finding when pal- pating the thyroid in an adult? a. Several small nodules are often felt. b. The thyroid is slightly pal- ANS: C. Buccal mucosa near the second mo- lar tooth ANS: D. Aortic arch aneurysm ANS: B. The thyroid is slightly palpable. pable. c. There is slight tenderness. d. Four parathyroid glands are palpable. 31. Which assessment finding is affected by an older adult's nutritional status? a. Crepitus b. Tissue fibrosis c. Exophthalmus d. Facies 32. At what age should the ante- rior fontanel be closed? a. 2 to 3 months. b. 4 to 5 months. c. 12 to 15 months. d. It remains slightly open un- til puberty. 33. The nurse reviews the histo- ry of a child who was diag- nosed with positional plagio- cephaly as an infant. What is the cause of this condition? a. Obstruction of drainage of cerebrospinal fluid b. Mother drank excessive al- cohol while pregnant c. Positioning the child to sleep in a prone position d. Positioning the child to sleep in a supine position 34. While assessing a patient, the nurse palpates the thy- ANS: D. Facies ANS: C. 12 to 15 months. ANS: D. Positioning the child to sleep in a supine position ANS: B. Listen to the area with a stethoscope. roid gland and finds that it is enlarged. What should the nurse do next? a. Apply cricoid pressure. b. Listen to the area with a stethoscope. c. Observe the neck area with tangential lighting. d. Auscultate the heart for a systolic murmur.