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Chapter 4. Head, Face, and Neck

MULTIPLE CHOICE

1. When obtaining a health history focusing on the patient’s head, face, and neck, which of the
following is particularly important with regard to risk of disease?
A. Past dental work
B. Use of alcohol and tobacco
C. History of tension headaches
D. Use of aspirin
ANS: B
Tobacco and/or alcohol use or abuse are the biggest risk factors for malignancies of the head and
neck.

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TEbe
2. Which of the cranial nerves should STtested
BANifKS ELpatient
the LER.complains
COM of numbness of the cheek?
A. Cranial nerve III
B. Cranial nerve V
C. Cranial nerve VII
D. Cranial nerve X
ANS: B
Cranial nerve V, the trigeminal nerve, controls the sensation of the face and function of the mas-
seter muscle. Cranial nerve VII, the facial nerve, controls facial expressions or motor function of
the facial muscles. Cranial nerve III, the oculomotor nerve, controls the pupil and movement of
eyes. Cranial nerve X is the vagus nerve, which is demonstrated by testing the gag reflex.

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3. Which of the cranial nerves should be tested when a patient presents with right-sided facial
droop and inability to close the right eye?
A. Cranial nerve III
B. Cranial nerve V
C. Cranial nerve VII
D. Cranial nerve X
ANS: C

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Cranial nerve VII, the facial nerve, controls facial expressions or motor function of the facial
muscles. The disorder that causes unilateral facial muscle dysfunction and inability to close the
eye is Bell’s palsy. Cranial nerve V, the trigeminal nerve, controls the sensation of the face and
function of the masseter muscle. Cranial nerve III, the oculomotor nerve, controls the pupil and
movement of eyes. Cranial nerve X is the vagus nerve, which is demonstrated by testing the gag
reflex.

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4. A patient complains of pain with chewing, earache, and grinding her teeth when asleep. These
are symptoms of:
A. Temporomandibular joint syndrome
B. Trigeminal neuralgia
C. Facial nerve palsy
D. Angina
ANS: A
The signs and symptoms of temporomandibular joint (TMJ) syndrome range from mild aching to
severe, sharp pain in and around the TMJs. Typically, there is pain with movement of the joint,
particularly with chewing. There is tenderness of the masticatory muscles. The pain is often re-
ferred to the ear, causing pain, tinnitus, and hearing difficulties. Stress can cause jaw clenching
or bruxism, resulting in fatigue orTspasm
ESTBof ANthe
KSmasticatory
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5. With the influx of immigrants to the United States and/or parent refusal of immunizations for
their children, paramyxovirus (mumps) can still be seen in the clinical setting. Mumps can cause
which of the following conditions?
A. Trigeminal neuralgia
B. Bruxism
C. Parotitis
D. Temporomandibular joint syndrome
ANS: C
Parotid gland inflammation can occur with paramyxovirus infection, also called mumps. There is
swelling of the preauricular regions of the face.

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6. Calcium phosphate stones can develop within the salivary gland ducts. This can occur in the
disorder called:

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A. Temporomandibular joint syndrome

B. Mumps
C. Trigeminal neuralgia
D. Sialadenitis
ANS: D
The submandibular glands can become inflamed and develop stones in a condition called sialoli-
thiasis. Often these patients have a history of recurrent sialadenitis, and the stones are composed
of calcium phosphate as a result of the pH of the saliva.

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7. Your patient presents to the emergency room due to a bee sting on the cheek. As you are
examining the patient, you note increasing facial swelling and redness, as well as swelling of the
lips and eyes. This condition is due to:
A. Angioedema
B. Parotitis
C. Sinusitis
D. Sialadenitis
ANS: A
Angioedema is basically anaphylaxis that is restricted to the skin and is generally benign and
TESTand
self-limiting. The causes are numerous BAN KSELinsect
include LER.stings;
COM atopic conditions; food allergies
(typically nuts, eggs, shellfish, fruit, and sulfites); drug allergies; allergy desensitization injec-
tions; a reaction to blood products; a response to exercise, cold, or pressure; heredity; and vascu-
litis.

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8. Your patient accidentally cut his cheek while shaving 3 days ago. Today, the region is warm,
erythematous, swollen, and has the appearance of an orange peel. There is a serous exudate
coming from the wound. This is most likely due to:
A. Folliculitis
B. Cellulitis
C. Suppurative parotitis
D. Sialadenitis
ANS: B
Streptococcus and Staphylococcus are the most common organisms responsible for superficial
cellulitis. It can occur from a wound or bite, or as a complication of infections of the eyes, ears,
mouth, or nose. The symptoms include redness, warmth, edema, leukocyte infiltration, tender-
ness, and regional lymphadenopathy. The skin may have a thick, orange peel appearance, and the
borders are usually indistinct.

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9. A patient with systemic lupus erythematosus has been taking a prolonged course of steroids. She
complains that her face appears swollen and she has experienced a 10-pound weight gain. This is
often referred to as:
A. Angioedema
B. Parotitis
C. Cushingoid effect
D. Myxedema
ANS: C
A cushingoid look can occur in patients who take long-term steroids for chronic diseases, in-
cluding respiratory, hematologic, and autoimmune. The typical symptoms are those of Cushing’s
disease, with a rounded moon face appearance and truncal obesity.

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10. A patient with a positive Lyme titer presents with left-sided unilateral facial droop and inability
to close the left eye. This is most likely due to:
A. Temporal arteritis TESTBANKSELLER.COM
B. Temporomandibular joint syndrome
C. Multiple sclerosis
D. Bell’s palsy
ANS: D
Bell’s palsy is a unilateral paralysis of the face. The etiology is uncertain, but the paralysis is
thought to be due to an inflammation of cranial nerve VII. Lyme disease is a common cause. The
onset of Bell’s palsy is sudden, and the symptoms are unilateral. The affected side of the face
droops with asymmetrical facial movement; there is pain in or around the ear, excessive lacrima-
tion and salivation, and inability to close the eye.

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11. A solitary cold nodule on radioactive iodine (RAI) uptake on a thyroid scan is suspicious for:
A. Hyperthyroidism
B. Myxedema
C. Trigeminal neuralgia
D. Thyroid cancer
ANS: D
Hyperthyroidism does not necessarily coincide with a thyroid nodule. Myxedema is a tissue
swelling of the face and body due to hypothyroidism. Trigeminal neuralgia causes paroxysms of

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pain on one side of the face. Thyroid cancer presents as a solitary cold nodule on a thyroid ultra-
sound. Predisposing factors include female gender, positive family history, and history of radia-
tion exposure to the head, face, or neck.

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12. A 6-year-old patient complains of a constantly itchy scalp that developed after returning home
from school today. The most common cause for this condition in a child is:
A. Seborrheic dermatitis
B. Pediculosis
C. Psoriasis
D. Basal cell carcinoma
ANS: B
It would be unusual for pruritus in the head and neck to indicate anything except a skin condi-
tion/disease or infestation. If the patient is a school-age child, pediculosis (head lice) is an obvi-
ous choice, and the child’s friends and school administrators should be questioned about recent
outbreaks. Nits are lice eggs that are fixed to the hair shaft and are grayish-white in appearance.
Unlike the flakiness of seborrhea or psoriasis, nits cannot be easily dislodged. Basal cell carci-
noma is a slow-growing, invasive type of skin cancer that occurs on sun-exposed regions of the
head, such as the nose.
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13. One of the most common signs of Epstein-Barr viral infection (infectious mononucleosis) is:
A. Swelling of the face
B. Parotitis
C. Cervical lymphadenopathy
D. Thyroid enlargement
ANS: C
Sore throat, fever, and prominent cervical lymphadenopathy are key signs of Epstein-Barr virus,
also called infectious mononucleosis. Parotitis is swelling of the parotid glands that occur in
mumps. Swelling of the deep tissues of the face often occurs with myxedema, which occurs due
to thyroid disease.

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14. A goiter is most commonly associated with:

A. Hypothyroidism
B. Hyperthyroidism

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C. Euthyroid function
D. All of the above
ANS: D
A goiter, an enlargement of the thyroid gland, may be associated with hypothyroidism or hyper-
thyroidism, but patients with goiters may also be euthyroid, a condition termed nontoxic goiter.

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15. On physical examination, your 55-year-old female patient has an enlarged thyroid gland. She
complains of feeling hot all the time, nervousness, palpitations, tremor, and recent weight loss of
10 pounds over the past 3 weeks. These signs and symptoms are commonly due to:
A. Hypothyroidism
B. Hyperthyroidism
C. Thyroid cancer
D. All of the above
ANS: B
Clinical manifestations of Grave’s disease (hyperthyroidism) include diffuse goiter, nervousness,
irritability, tremor, heat intolerance, weakness, tachycardia, palpitations, widened pulse pressure,
increased sweating, weight loss, insomnia, frequent bowel movements, menstrual irregularities,
exophthalmos, and infiltrative dermopathy. Patients older than 50 years often present with cardi-
ac symptoms, such as hypertension, TES TBAfibrillation,
atrial NKSELLE orRheart
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16. A patient complains of burning, epigastric pain, and regurgitation of food when lying flat. It is
important to recognize that these symptoms are common in:
A. Gastroesophageal reflux disease
B. Neuromuscular disorders
C. Esophageal cancer
D. Achalasia
ANS: A
The patient with gastroesophageal reflux disease describes burning and pain in the esophagus
with or without dysphagia. The symptoms may occur more with eating or drinking, and at night
when the patient is recumbent. Persons with neuromuscular disorders, achalasia, or esophageal
cancer describe difficulty swallowing or feeling of a lump in the throat.

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17. A 40-year-old female patient presents with extremely tight, shiny skin over the hands and face.

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There is also a lack of nasolabial folds and blank facial expression. This is a common sign of:
A. Bell’s palsy
B. Trigeminal neuralgia
C. Scleroderma
D. Hypothyroid myxedema
ANS: C
Scleroderma is an autoimmune disease that causes infiltration of the skin with autoantibodies and
immune complexes. Signs include extremely shiny and taut skin over the face, hands, and feet.
Onset is between 30 and 55 years, and occurs mostly in women.

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18. Chronic abuse of alcohol and tobacco are associated with __________________, which can
present with lymphadenopathy of the head and neck.
A. Lymphoma
B. Squamous cell carcinoma
C. Leukemia
D. Thyroid cancer
ANS: B
The most common malignancies of the head and neck are squamous cell carcinomas of the lar-
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ynx, palatine tonsil, and hypopharynx. BANthan
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LLEof
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tory of tobacco and/or alcohol use or abuse.

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19. Weight loss, fever, fatigue, and cervical and mediastinal lymphadenopathy are often the
presenting signs of:
A. Hypothyroidism
B. Scleroderma
C. Esophageal cancer
D. Lymphoma
ANS: D
Cervical and mediastinal lymphadenopathy are often the presenting complaints of lymphoma and
generally precede systemic symptoms, which include fever, night sweats, weight loss, and fa-
tigue.

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20. Which of the following is a sexually transmitted infection that can cause pharyngitis and cervical

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lymphadenopathy with oral sex?

A. Hemolytic streptococcus
B. Chlamydia trachomatis
C. Epstein-Barr virus
D. Cytomegalovirus
ANS: B
Gonococcus or Chlamydia trachomatis are sexually transmitted infections that can cause phar-
yngitis and lymphadenopathy. Epstein-Barr virus causes infectious mononucleosis, which is not
regarded as a sexually transmitted infection. Strep throat is pharyngitis caused by group A beta
Hemolytic streptococcus. Streptococcal pharyngitis is not a sexually transmitted infection.

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