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Chapter 10: Head and Neck
Test Bank—Medical
MULTIPLE CHOICE
4. The trapezius and sternocleidomastoid muscles and the clavicle form a landmark called the
_____ triangle.
a. anterior
b. posterior
c. lateral
d. medial
e. ventral
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.
5. The medial border of the sternocleidomastoid muscles and the mandible form the _____
triangle.
a. dorsal
b. posterior
c. lateral
d. medial
e. anterior
ANS: E
The anterior triangle is adjacent to the posterior triangle, formed by the medial borders of the
sternocleidomastoid muscles and the mandible. The trapezius, sternocleidomastoid muscles,
and clavicle form the posterior triangle. The relationship of neck muscles to each other and to
adjacent bones creates the anatomic landmarks known as triangles.
6. The largest endocrine gland in the body lies in the _____ triangle.
a. anterior
b. posterior
c. lateral
d. medial
e. ventral
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.
7. The ________ cartilage is shaped like a shield, with its notch on the upper edge marking the
level of bifurcation of the common carotid artery.
a. cricoid
b. hyoid
c. thyroid
d. sternocleidomastoid
e. external jugular
ANS: C
The thyroid cartilage is shaped like a shield, with its notch on the upper edge marking the
level of bifurcation of the common carotid artery. The hyoid bone sits just below the
mandible, the thyroid gland is not a part of this region but rather lies across, and the
sternocleidomastoid muscles are on the lateral side of the neck. The external jugular vein
crosses the surface of the sternocleidomastoid muscle diagonally.
10. 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 sutures.
d. overlap of the cranial bones.
e. closure of the sagittal and coronal sutures.
ANS: B
At 2 months of age, the posterior fontanels should be closed or ossified with the anterior
fontanels, a larger fontanel, closing at 24 months. The only time the cranial bones should
overlap is during a vaginal birth as a result of pressure within the birth canal. Ossification of
the sutures begins after completion of brain growth, at about 6 years of age, and is finished by
adulthood.
11. Closure of the anterior skull fontanel should occur by _____ months.
a. 3
b. 6
c. 12
d. 18
e. 24
ANS: E
The anterior fontanels can remain palpable until 24 months, when they close.
13. The brown or tan pigmentation on the forehead, nose, and malar prominence of some
pregnant women is called
a. hormonal acne.
b. erythema.
c. alopecia.
d. chloasma.
e. craniotabes.
ANS: D
Chloasma, brown or tan facial pigmentation during pregnancy, fades after delivery. Hormonal
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 associated with
rickets and hydrocephalus.
16. Ms. G 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. G’s history?
a. Current medications
b. Elimination patterns
c. Immunization status
d. Previous pregnancies
e. Previous abdominal surgeries
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. Elimination patterns, immunization status, and
previous pregnancies or abdominal surgeries do not directly pertain initially to headaches.
17. Observation during history taking is the best way to examine for
a. head position.
b. scalp lice.
c. thyroid size.
d. tracheal alignment.
e. thickening of the temporal arteries.
ANS: A
Head positions and facial features are best observed when talking to the patient during the
history. Scalp lice, thyroid size, thickening of the temporal arteries, and tracheal alignment are
best assessed by palpation and closer physical observation.
18. 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.
e. the absence of fine motor skills.
ANS: A
Torticollis is a usual consequence caused by constraint of the newborn in utero and as a result
of 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.
19. During 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. obtain a complete blood analysis.
d. record the finding in the patient’s chart.
e. obtain a CT scan of the head.
ANS: D
It is not abnormal to have some slight asymmetry of the face, which 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.
20. 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 problems will be present.
e. Facial nerve paralysis may be present.
ANS: E
When the entire side of the face is asymmetrical, 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. Degenerative 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.
21. A bruit, or blowing sound, over the skull or temporal region of an adult indicates
a. degenerative change.
b. hyperthyroid storm.
c. a skull fracture.
d. a vascular anomaly.
e. Cushing syndrome.
ANS: D
Temporal bruits can indicate a vascular anomaly such as arterial obstruction, an aneurysms, or
a vascular neoplasm. Audible bruits are not associated with degenerative changes or skull
fracture. Hyperthyroid storm would cause tachycardia and palpations but not usually a bruit.
Patients with Cushing syndrome may have a rounded or moon-shaped face but no vascular
bruit.
22. Spasmodic muscular contractions of the head, face, or neck are called
a. torticollis.
b. tics.
c. dimpling.
d. webbing.
e. chloasma.
ANS: B
Tics, by definition, are spasmodic, repetitive contractions of the muscles of the face, head, or
neck. The other conditions do not relate to muscle spasms.
23. Coarse, dry, and brittle hair is associated with which metabolic disorder?
a. Hypothyroidism
b. Diabetes mellitus
c. Addison disease
d. Cushing syndrome
e. Fetal alcohol syndrome
ANS: A
Hypothyroidism affects hair texture, resulting in coarse, dry, and brittle changes.
25. 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
e. Rotated away from the side being examined
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.
REF: p. 194 TOP: Discipline: Gross Anatomy MSC: Organ System: General
REF: p. 194 TOP: Discipline: Gross Anatomy MSC: Organ System: Endocrine
29. 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 indicate
a. a congenital anomaly.
b. a normal thyroid gland.
c. a multinodular goiter.
d. thyroiditis.
e. a hypothyroid goiter.
ANS: B
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.
REF: p. 194 TOP: Discipline: Gross Anatomy MSC: Organ System: Endocrine
35. When noting a bulging fontanel with marked pulsations in a 6-month-old infant, you suspect
a. normal development.
b. Down syndrome.
c. increased intracranial pressure.
d. fever response to a viral infection.
e. cephalhematoma.
ANS: C
A bulging fontanel with pulsations suggests increased intracranial pressure. A normal fontanel
feels slightly depressed with mild pulsations.
36. Which type of headache occurs 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
ANS: E
Cluster headaches are usually unilateral and occur at night; they are associated with alcohol
consumption and have a higher prevalence in men. Classic migraine, temporal arteritis,
muscular tension, and hypertensive headaches do not meet these criteria.
37. A 29-year-old woman presents to the urgent care center with a history of a severe headache of
2 hours’ duration. She describes it as bandlike and constricting. In interviewing the woman
about her complaint, you would ask
a. whether she has experienced increased tearfulness.
b. the date of her last menstrual period.
c. whether these headaches started in childhood.
d. whether she is particularly stressed or overworked.
e. whether she is missing meals.
ANS: D
This woman is describing tension headaches, which feel bandlike and similar to a clamping
vice. These headaches are associated with stress, so you should inquire about her stress level.
Increased tearfulness is common with cluster headaches, and migraines are associated with
menstrual periods and missing meals.
REF: p. 199 TOP: Discipline: Gross Anatomy MSC: Organ System: General
39. Moist skin with fine hair, prominent eyes, eyelid retraction, and a staring expression are
characteristics associated with
a. Cushing syndrome.
b. Graves disease.
c. myxedema.
d. systemic lupus erythematosus.
e. Hippocratic facies.
ANS: B
Skin problems along with changes in hair, protruding eyes, and a glazed look are symptoms
associated with Graves disease or hyperthyroidism. Myxedema is a condition of
hypothyroidism. Cushing syndrome is characterized 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.
40. You are examining Ms. L, age 78 years. You find a sunken appearance of her eyes, cheeks,
and temporal areas. Her skin is dry, and her nose appears sharp. Ms. L’s facies description is
associated with
a. cutis laxa syndrome.
b. Hurler syndrome.
c. old age.
d. terminal illness.
e. myxedema.
ANS: D
In the late stages of terminal illness, the face may appear sunken, the facial bones are more
visible, and the skin is dry. This is referred to as Hippocratic facies. Hurler syndrome is
marked by an enlarged skull and short neck. This is not a common finding in older adults.
Cutis laxa is a rare condition in which the skin loses its elasticity and sags all over. Myxedema
facies consists of dull, puffy, yellowed skin and periorbital edema as well as other
characteristic findings.
REF: p. 189 TOP: Discipline: Pathophysiology
MSC: Organ System: Skin/Connective
41. Which of the following findings would be consistent with fetal alcohol syndrome?
a. Corneal clouding
b. Eye slanting
c. Mild ptosis
d. Symmetric bulging fontanels
e. Maxillary hypoplasia
ANS: C
With fetal alcohol syndrome (FAS), classic findings include a poorly formed or flat philtrum,
widespread eyes with inner epicanthal 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.
42. What abnormal palpable cystic mass in the neck rises from the foramen cecum at the junction
of the anterior two thirds and posterior third of the tongue?
a. Branchial cleft cyst
b. Thyroglossal duct cyst
c. Lacrimal duct
d. Submandibular lymph node
e. Stensen duct
ANS: A
Thyroglossal duct cyst is a remnant of fetal development which rises from the foramen cecum.
Branchial cleft cyst is a remnant of fetal development which rises from incomplete involution
of the branchial cleft.
REF: p. 199 TOP: Discipline: Gross Anatomy MSC: Organ System: General
44. 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.
e. fetal alcohol syndrome.
ANS: A
With craniosynostosis, the cranial sutures fuse prematurely, causing a misshapen head, but
this does not involve mental retardation. Encephalocele, microcephaly, and fetal alcohol
syndrome all involve mental retardation, and myxedema is a condition of hyperthyroidism.
NORTHERN CONSTELLATIONS.
No. of Principal
Constellations. Author.
Stars. Stars.
Ursa Minor, the Lesser Bear Aratus. 24 Polaris, 2.
Ursa Major, the Great Bear Aratus. 87 Dubhe, 1;
Alioth, 2.
Perseus, and Head of Medusa Aratus. 59 Algenib, 2;
Algol, 2.
Auriga, the Waggoner Aratus. 66 Capella, 1.
Bootes, the Herdsman Aratus. 54 Arcturus, 1.
Draco, the Dragon Aratus. 80 Rastaben, 3.
Cepheus Aratus. 35 Alderamin,
3.
Canes Venatici, the Greyhounds Hevelius. 25
Chara and Asteria
Cor Caroli, Heart of Charles II Halley. 3
Triangulum, the Triangle Aratus. 16
Triangulum Minus, the Lesser Hevelius. 10
Triangle
Musca, the Fly Bode. 6
Lynx Hevelius. 44
Leo Minor, the Lesser Lion Hevelius. 53
Coma Berenices, Berenice’s Hair Tycho 43
Brahe.
Cameleopardalis, the Giraffe Hevelius. 58
Mons Menelaus, Mount Menelaus Hevelius. 11
Corona Borealis, the Northern Aratus. 21
Crown
Serpens, the Serpent Aratus. 64
Scutum Sobieski, Sobieski’s Hevelius. 8
Shield
Hercules, with Cerberus Aratus. 113 Ras
Algratha,
3.
Serpentarius, or Ophiuchus, the Aratus. 74 Ras Aliagus,
Serpent-Bearer 2.
Taurus Poniatowski, or the Bull of Poezobat. 7
Poniatowski
Lyra, the Harp Aratus. 22 Vega, 1.
Vulpeculus et Anser, the Fox and Hevelius. 37
the Goose
Sagitta, the Arrow Aratus. 18
Aquila, the Eagle, with Antinous Aratus. 71 Altair, 1.
Delphinus, the Dolphin Aratus. 18
Cygnus, the Swan Aratus. 81 Deneb, 1.
Cassiopeia, the Lady in her Chair Aratus. 55
Equulus, the Horse’s Head Ptolemy. 10
Lacerta, the Lizard Hevelius. 16
Pegasus, the Flying Horse Aratus. 89 Markab, 2.
Andromeda Aratus. 66 Almaac, 2.
Turandus, the Reindeer Lemonnier. 12