NURS 8020C HEENT Focused History
and Physical Exam with multiple
choice questions with correct
answers and rationale updated
2026 new!!
SECTION 1: HEAD ASSESSMENT (Questions 1-15)
Question 1
When assessing the head, which finding is MOST concerning and requires immediate referral?
Options:
A) Symmetric head with equal hair distribution
B) Palpable mass with asymmetry and skin changes
C) Slight occipital prominence in a 6-month-old infant
D) Frontal bossing in a child with normal development
Answer: B
Rationale: Palpable masses with asymmetry and skin changes suggest malignancy or serious
pathology requiring urgent evaluation. Normal findings include symmetric structure, even hair
distribution, and age-appropriate contours.
Question 2
During head palpation, you detect a boggy anterior fontanelle in a 9-month-old infant. What is the
MOST appropriate next step?
Options:
A) Document as normal variation and reassure parents
,B) Assess for signs of increased intracranial pressure and hydration status
C) Schedule routine follow-up in 2 weeks
D) Order CT scan immediately
Answer: B
Rationale: A boggy anterior fontanelle suggests possible increased ICP or dehydration. Assessment
should include fontanelle tenseness (should be flat when infant is calm and upright), developmental
milestones, feeding patterns, and hydration status before determining if imaging is needed.
Question 3
What is the normal timeline for closure of the anterior fontanelle?
Options:
A) 2-3 months of age
B) 6-8 months of age
C) 12-18 months of age
D) 24-36 months of age
Answer: C
Rationale: The anterior fontanelle typically closes between 12-18 months. Closure before 3 months
(premature) or after 18 months (delayed) may indicate pathology and requires further investigation.
Question 4
During assessment, you note the patient has severe temporal tenderness, jaw claudication, and
visual changes. Which diagnosis should be ruled out immediately?
Options:
A) Migraine headache
B) Temporal arteritis (Giant Cell Arteritis)
C) Tension headache
D) Sinusitis
,Answer: B
Rationale: This classic triad of temporal tenderness, jaw claudication, and visual symptoms is highly
suggestive of temporal arteritis, a medical emergency. Risk of vision loss (amaurosis fugax) exists.
ESR and temporal artery biopsy are indicated.
Question 5
A 45-year-old reports a new unilateral headache with facial drooping on the same side. Which
cranial nerve is likely affected?
Options:
A) CN III (Oculomotor)
B) CN V (Trigeminal)
C) CN VII (Facial)
D) CN XII (Hypoglossal)
Answer: C
Rationale: CN VII innervates the facial muscles. Unilateral facial drooping indicates facial nerve
involvement, commonly seen in Bell's palsy. The headache may be associated or coincidental.
Question 6
When assessing head size in children, macrocephaly is suggested when head circumference is:
Options:
A) Above the 75th percentile for age
B) Above the 90th percentile for age
C) Above the 95th percentile for age
D) Greater than 2 standard deviations above the mean
Answer: D
Rationale: Macrocephaly is defined as head circumference greater than 2 standard deviations above
the mean for age (approximately >98th percentile). Serial measurements are important to detect
abnormal growth trajectory.
, Question 7
A 3-year-old presents with a head tilt. Which assessment finding would suggest Klippel-Feil
syndrome?
Options:
A) Ability to rotate head fully without pain
B) Short neck with low hairline and limited cervical mobility
C) Symmetric shoulder height
D) Normal range of motion with mild discomfort
Answer: B
Rationale: Klippel-Feil syndrome is characterized by congenital cervical vertebral fusion, resulting in
a short neck, low posterior hairline, and significantly limited neck mobility. Associated cardiac and
renal anomalies may also be present.
Question 8
Which examination technique is CONTRAINDICATED in a patient with suspected epiglottitis?
Options:
A) Visual inspection from a distance
B) Palpation of the neck
C) Tongue depression with a spatula to visualize the throat
D) Auscultation of breath sounds
Answer: C
Rationale: Tongue depression in suspected epiglottitis may precipitate complete airway obstruction.
Visual inspection from distance, neck palpation, and auscultation are safer. Diagnosis is made via
lateral neck X-ray (thumbprint sign) or endoscopy in controlled setting.
Question 9
A patient reports neck stiffness with headache and fever. What is the significance of a positive
Kernig sign?
and Physical Exam with multiple
choice questions with correct
answers and rationale updated
2026 new!!
SECTION 1: HEAD ASSESSMENT (Questions 1-15)
Question 1
When assessing the head, which finding is MOST concerning and requires immediate referral?
Options:
A) Symmetric head with equal hair distribution
B) Palpable mass with asymmetry and skin changes
C) Slight occipital prominence in a 6-month-old infant
D) Frontal bossing in a child with normal development
Answer: B
Rationale: Palpable masses with asymmetry and skin changes suggest malignancy or serious
pathology requiring urgent evaluation. Normal findings include symmetric structure, even hair
distribution, and age-appropriate contours.
Question 2
During head palpation, you detect a boggy anterior fontanelle in a 9-month-old infant. What is the
MOST appropriate next step?
Options:
A) Document as normal variation and reassure parents
,B) Assess for signs of increased intracranial pressure and hydration status
C) Schedule routine follow-up in 2 weeks
D) Order CT scan immediately
Answer: B
Rationale: A boggy anterior fontanelle suggests possible increased ICP or dehydration. Assessment
should include fontanelle tenseness (should be flat when infant is calm and upright), developmental
milestones, feeding patterns, and hydration status before determining if imaging is needed.
Question 3
What is the normal timeline for closure of the anterior fontanelle?
Options:
A) 2-3 months of age
B) 6-8 months of age
C) 12-18 months of age
D) 24-36 months of age
Answer: C
Rationale: The anterior fontanelle typically closes between 12-18 months. Closure before 3 months
(premature) or after 18 months (delayed) may indicate pathology and requires further investigation.
Question 4
During assessment, you note the patient has severe temporal tenderness, jaw claudication, and
visual changes. Which diagnosis should be ruled out immediately?
Options:
A) Migraine headache
B) Temporal arteritis (Giant Cell Arteritis)
C) Tension headache
D) Sinusitis
,Answer: B
Rationale: This classic triad of temporal tenderness, jaw claudication, and visual symptoms is highly
suggestive of temporal arteritis, a medical emergency. Risk of vision loss (amaurosis fugax) exists.
ESR and temporal artery biopsy are indicated.
Question 5
A 45-year-old reports a new unilateral headache with facial drooping on the same side. Which
cranial nerve is likely affected?
Options:
A) CN III (Oculomotor)
B) CN V (Trigeminal)
C) CN VII (Facial)
D) CN XII (Hypoglossal)
Answer: C
Rationale: CN VII innervates the facial muscles. Unilateral facial drooping indicates facial nerve
involvement, commonly seen in Bell's palsy. The headache may be associated or coincidental.
Question 6
When assessing head size in children, macrocephaly is suggested when head circumference is:
Options:
A) Above the 75th percentile for age
B) Above the 90th percentile for age
C) Above the 95th percentile for age
D) Greater than 2 standard deviations above the mean
Answer: D
Rationale: Macrocephaly is defined as head circumference greater than 2 standard deviations above
the mean for age (approximately >98th percentile). Serial measurements are important to detect
abnormal growth trajectory.
, Question 7
A 3-year-old presents with a head tilt. Which assessment finding would suggest Klippel-Feil
syndrome?
Options:
A) Ability to rotate head fully without pain
B) Short neck with low hairline and limited cervical mobility
C) Symmetric shoulder height
D) Normal range of motion with mild discomfort
Answer: B
Rationale: Klippel-Feil syndrome is characterized by congenital cervical vertebral fusion, resulting in
a short neck, low posterior hairline, and significantly limited neck mobility. Associated cardiac and
renal anomalies may also be present.
Question 8
Which examination technique is CONTRAINDICATED in a patient with suspected epiglottitis?
Options:
A) Visual inspection from a distance
B) Palpation of the neck
C) Tongue depression with a spatula to visualize the throat
D) Auscultation of breath sounds
Answer: C
Rationale: Tongue depression in suspected epiglottitis may precipitate complete airway obstruction.
Visual inspection from distance, neck palpation, and auscultation are safer. Diagnosis is made via
lateral neck X-ray (thumbprint sign) or endoscopy in controlled setting.
Question 9
A patient reports neck stiffness with headache and fever. What is the significance of a positive
Kernig sign?
