CHAPTER 11 Head and Neck

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Questions and Answers

What is the recommended method for further investigating concerning thyroid nodules?

MRI

Palpation

X-ray

Ultrasonography (correct)

What is the typical nature of thyroid nodules?

Metastatic

Malignant

Carcinoma

Benign (correct)

When should the NP further investigate thyroid nodules?

For nodules that are soft and movable

For nodules smaller than 2cm

For nodules that are easily compressible

For nodules that are 2cm or greater, firm & fixed to nearby tissues (correct)

Which of the following characteristics should raise concern about a thyroid nodule?

Nodule is firm and fixed to nearby tissues Signup and view all the answers

Which eye disease can lead to permanent vision loss or blindness?

Glaucoma Signup and view all the answers

Which eye disease is caused by high blood sugar levels?

Diabetic retinopathy Signup and view all the answers

Which eye disease is associated with aging?

Age-related macular degeneration Signup and view all the answers

Which age group should raise a suspicion of malignancy for a persistent neck mass?

Adults older than 40 years old Signup and view all the answers

What is the most likely cause of a persistent neck mass in an adult older than 40 years?

Malignancy Signup and view all the answers

What are the characteristics of the lymph nodes when the patient has pharyngitis?

Enlarged and tender Signup and view all the answers

Which one of the following commonly accompanies pharyngitis?

Enlarged tender lymph nodes Signup and view all the answers

According to the Snellen chart, a visual acuity of 20/80 means that

The patient can see at 20 feet what a person with normal vision can see at 80 feet Signup and view all the answers

A patient with a visual acuity of 20/200 would have

Severely impaired vision Signup and view all the answers

Which of the following is a common symptom of hyperthyroidism affecting the nervous system?

Nervousness, anxiety, & irritability Signup and view all the answers

How does hyperthyroidism affect the nervous system?

It causes nervousness, anxiety, and irritability Signup and view all the answers

What is a possible effect of hyperthyroidism on the nervous system?

Impaired memory and concentration Signup and view all the answers

Which of the following is a common symptom of hyperthyroidism affecting an individual's weight?

Weight loss despite increased appetite Signup and view all the answers

Which of the following is a common symptom of hyperthyroidism affecting the cardiovascular system?

Excessive sweating Signup and view all the answers

Which of the following symptoms is not associated with hyperthyroidism?

Fatigue Signup and view all the answers

Which of the following symptoms would be concerning for hyperthyroidism?

Nervousness Signup and view all the answers

Which of the following is a common symptom of hyperthyroidism?

Excessive sweating and heat intolerance Signup and view all the answers

How does hyperthyroidism affect the individual's ability to tolerate heat?

Increases heat intolerance Signup and view all the answers

What effect does hyperthyroidism have on the individual's sweating mechanism?

Excessive sweating Signup and view all the answers

Which of the following is a common symptom of hyperthyroidism affecting the digestive system?

Frequent bowel movements Signup and view all the answers

How does hyperthyroidism affect the individual's weight?

Weight loss Signup and view all the answers

What is a possible effect of hyperthyroidism on the nervous system?

Anxiety, nervousness, irritability Signup and view all the answers

Which of the following is a common sign of hyperthyroidism?

Increased heart rate Signup and view all the answers

Which of the following eye signs is commonly seen in hyperthyroidism?

Exophthalmos Signup and view all the answers

Which of the following is a common symptom associated with hyperthyroidism?

Muscle weakness Signup and view all the answers

Which of the following is a common symptom of hyperthyroidism affecting the skin?

Warm, smooth, moist skin Signup and view all the answers

What is a possible effect of hyperthyroidism on the hair?

Thinning and brittle hair Signup and view all the answers

Which of the following is a common symptom of hyperthyroidism affecting the nails?

Brittle nails Signup and view all the answers

Which condition is Graves' disease associated with?

Hyperthyroidism Signup and view all the answers

What is the main symptom of Graves' disease?

Heat intolerance Signup and view all the answers

How does Graves' disease affect the eyes?

Bulging eyes Signup and view all the answers

Which of the following eye signs are commonly seen in Graves' disease?

Stare, lid lag, and exophthalmos Signup and view all the answers

What is the main symptom of Graves' disease?

Heat intolerance Signup and view all the answers

Which of the following is a common symptom of hyperthyroidism affecting the cardiovascular system?

Chest pain and palpitations Signup and view all the answers

Which of the following eye signs are commonly seen in Graves' disease?

Double vision Signup and view all the answers

Which of the following symptoms is commonly associated with hypothyroidism?

Fatigue and lethargy Signup and view all the answers

Which of the following is a symptom commonly associated with hyperthyroidism affecting the digestive system?

Diarrhea Signup and view all the answers

Which of the following is a common symptom of hypothyroidism affecting the skin?

Dry, coarse skin Signup and view all the answers

Which of the following is a common symptom of hypothyroidism affecting the digestive system?

Constipation Signup and view all the answers

Which of the following is a common symptom of hypothyroidism affecting the nervous system?

Hearing impairment Signup and view all the answers

Which thyroid condition is associated with fatigue and lethargy?

Hypothyroidism Signup and view all the answers

What are common symptoms of hypothyroidism?

Fatigue and cold intolerance Signup and view all the answers

Which condition is characterized by an underactive thyroid gland?

Hypothyroidism Signup and view all the answers

Which of the following is a common symptom of hypothyroidism affecting an individual's weight?

Weight gain with anorexia Signup and view all the answers

What is a possible effect of hyperthyroidism on the individual's weight?

Weight loss with increased appetite Signup and view all the answers

Which of the following is a common symptom of hypothyroidism affecting an individual's ability to tolerate cold?

Heat intolerance Signup and view all the answers

How does hypothyroidism affect an individual's ability to tolerate cold?

It decreases the individual's ability to tolerate cold Signup and view all the answers

What is a common symptom of hypothyroidism affecting an individual's ability to tolerate cold?

Dry skin, cold intolerace Signup and view all the answers

Which of the following symptoms is commonly seen in patients with hypothyroidism?

Fatigue, muscle weakness, and weight gain Signup and view all the answers

What are some common symptoms of hypothyroidism affecting the nervous system?

Muscle cramps and impaired memory Signup and view all the answers

Which of the following symptoms is NOT commonly seen in patients with hypothyroidism?

Excessive sweating Signup and view all the answers

Which of the following symptoms is commonly seen in patients with hypothyroidism?

Muscle weakness Signup and view all the answers

Which condition is characterized by an underactive thyroid gland?

Hypothyroidism Signup and view all the answers

Which thyroid condition is commonly associated with cold intolerance?

Hypothyroidism Signup and view all the answers

What is the main symptom of Graves' disease?

Heat intolerance Signup and view all the answers

Which thyroid condition is characterized by an underactive thyroid gland?

Hypothyroidism Signup and view all the answers

Which of the following thyroid conditions is associated with increased systolic and decreased diastolic blood pressures?

Thyroid storm Signup and view all the answers

Which of the following conditions is characterized by an underactive thyroid gland?

Hashimoto's thyroiditis Signup and view all the answers

Which of the following symptoms is commonly seen in patients with hyperthyroidism?

Tremors Signup and view all the answers

Which condition is a rare endocrine emergency associated with high mortality?

Thyroid storm Signup and view all the answers

What is the most common underlying condition associated with thyroid storm?

Graves' disease Signup and view all the answers

What is the mortality rate associated with thyroid storm?

High Signup and view all the answers

Which of the following is a common symptom of hypothyroidism affecting the skin?

Dry, coarse, cool skin Signup and view all the answers

Which of the following is a common symptom of hypothyroidism affecting the cardiovascular system?

Bradycardia Signup and view all the answers

Which of the following is a common symptom of hypothyroidism affecting the nervous system?

Impaired memory Signup and view all the answers

What is the effect of hypothyroidism on blood pressure?

Decreased systolic and increased diastolic blood pressures Signup and view all the answers

Which thyroid condition is commonly associated with impaired memory, mixed hearing loss, somnolence, peripheral neuropathy, and carpal tunnel syndrome?

Hypothyroidism Signup and view all the answers

Which of the following symptoms is commonly associated with hypothyroidism?

Fatigue Signup and view all the answers

What is a possible effect of hyperthyroidism on the nervous system?

Peripheral neuropathy Signup and view all the answers

Which thyroid condition is commonly associated with carpal tunnel syndrome?

Hypothyroidism Signup and view all the answers

What area of the body is the supra-clavicular node located?

Neck Signup and view all the answers

Which of the following is a possible cause of an enlarged supra-clavicular node on the left side (Virchow's Node)?

Malignancy in the thoracic or abdominal region Signup and view all the answers

What does an enlarged supra-clavicular node on the left side (Virchow's Node) suggest?

Malignancy in the thoracic or abdominal region Signup and view all the answers

What does the presence of tender nodes indicate?

Inflammation Signup and view all the answers

What is the significance of hard or fixed nodes on palpation?

They suggest malignancy Signup and view all the answers

True or false: When assessing shortness of breath, it is important to listen over the trachea for stridor for upper airway etiologies in addition to examining the lungs.

True Signup and view all the answers

True or false: An ominous, high-pitched musical sound from severe sub-glottic or tracheal obstruction signals a respiratory emergency?

True Signup and view all the answers

Which of the following is a possible cause of stridor?

Epiglottitis Signup and view all the answers

Which of the following is NOT a possible cause of stridor?

Asthma Signup and view all the answers

Which one of these is the medical term for an ominous, high-pitched musical sound from severe subglottic or tracheal obstruction that signals a respiratory emergency?

Stridor Signup and view all the answers

What is the cause of stridor?

Severe subglottic or tracheal obstruction Signup and view all the answers

Which of the following is a common symptom of hyperthyroidism?

Fine hair Signup and view all the answers

What is the main symptom of Graves' disease?

Exophthalmos Signup and view all the answers

What is the medical term for excessive facial hair?

Hirsutism Signup and view all the answers

Which condition may cause hirsutism in some women?

Polycystic ovary syndrome Signup and view all the answers

Which of the following conditions may cause tracheal deviation to one side?

Atelectasis Signup and view all the answers

What is one possible cause of tracheal deviation to one side?

Lung cancer Signup and view all the answers

Which of the following is a possible cause of goiter?

Deficiency of iodine in the diet Signup and view all the answers

What is the medical term for an enlarged thyroid gland?

Goiter Signup and view all the answers

What is the typical size of a goiter compared to the normal size of the thyroid gland?

Twice its normal size Signup and view all the answers

Which condition is characterized by a soft thyroid and possible nodules?

Graves disease Signup and view all the answers

What is the typical texture of the thyroid in Graves disease?

Soft Signup and view all the answers

What is a possible characteristic of the thyroid in Graves disease?

Enlarged Signup and view all the answers

Which condition is characterized by the thyroid being firm in Hashimoto thyroiditis?

Hypothyroidism Signup and view all the answers

Which of the following is a common symptom of hypothyroidism affecting the skin?

Dry skin Signup and view all the answers

Which of the following conditions may cause a localized systolic or continuous bruit to be heard?

Graves' disease Signup and view all the answers

What is the most common cause of a localized systolic or continuous bruit in hyperthyroidism?

Graves' disease Signup and view all the answers

Which imaging modality is recommended for evaluating palpable solitary nodules?

Ultrasound Signup and view all the answers

What is the purpose of fine-needle aspiration for palpable solitary nodules?

To determine if the nodule is benign or malignant Signup and view all the answers

Jugular venous distention is a common symptom of heart failure.

True Signup and view all the answers

Jugular venous distention is a hallmark of heart failure.

True Signup and view all the answers

True or false: Cushing syndrome is caused by increased adrenal cortisol production?

True Signup and view all the answers

True or false: Cushing syndrome produces a round or “moon” face with red cheeks & excessive hair growth.

True Signup and view all the answers

True or false: Cushing syndrome is caused by increased adrenal cortisol production?

True Signup and view all the answers

True or false: Cushing syndrome is associated with excessive hair growth.

True Signup and view all the answers

Which of the following is a common symptom of Cushing syndrome?

Excessive hair growth Signup and view all the answers

What physical characteristic is associated with Cushing syndrome?

Round or 'moon' face Signup and view all the answers

Which of the following is a common symptom of Cushing syndrome?

Muscle weakness Signup and view all the answers

What is the main cause of Cushing syndrome?

Increased adrenal cortisol production Signup and view all the answers

Which physical characteristic is commonly associated with Cushing syndrome?

Excessive hair growth Signup and view all the answers

Which of the following is a characteristic of myxedema in severe hypothyroidism?

The skin is moist. Signup and view all the answers

Which of the following is a common symptom associated with myxedema in severe hypothyroidism?

Weight gain Signup and view all the answers

Which of the following is a common sign of myxedema in severe hypothyroidism?

Loss of the lateral third of the eyebrows Signup and view all the answers

Which of the following conditions is associated with myxedema?

Hypothyroidism Signup and view all the answers

What is the main symptom of myxedema in severe hypothyroidism?

Swelling of the skin and underlying tissues Signup and view all the answers

Which of the following is a characteristic of acromegaly?

Enlargement of the forehead, nose, and lower jaw Signup and view all the answers

What causes the enlargement of bone and soft tissues in acromegaly?

Increased growth hormone Signup and view all the answers

How do the facial features appear in acromegaly?

Generally coarsened Signup and view all the answers

Which of the following is the main cause of acromegaly?

Increased growth hormone Signup and view all the answers

What is the primary symptom of acromegaly?

Enlarged hands and feet Signup and view all the answers

What is the underlying mechanism of acromegaly?

Tumor in the pituitary gland Signup and view all the answers

Which of the following is a common symptom of the neurodegenerative disorder linked to loss of dopamine?

Decreased facial mobility Signup and view all the answers

What is the effect of this neurodegenerative disorder on the neck and upper trunk?

They tend to flex forward Signup and view all the answers

How does the facial skin change in Parkinson's disease ?

It becomes oily Signup and view all the answers

Which neurotransmitter is affected by the neurodegenerative disorder linked to the loss of dopamine?

Acetylcholine Signup and view all the answers

What is the main symptom of Parkinson's Disease? ______ especially at rest

Tremors Signup and view all the answers

What is the effect of Parkinson's Disease on the motor system?

Slowed movement Signup and view all the answers

Which of the following symptoms is commonly seen in patients with Parkinson's Disease?

Decreased facial mobility and mask-like face Signup and view all the answers

What is the main cause of Cushing syndrome?

Excessive production of cortisol by the adrenal glands Signup and view all the answers

What is a common symptom of hypothyroidism affecting an individual's ability to tolerate cold?

Decreased tolerance to cold temperatures Signup and view all the answers

Study Notes

Thyroid Nodules

Further investigation of concerning thyroid nodules is recommended
Typical nature of thyroid nodules is solid, and they may be malignant or benign
NP should further investigate thyroid nodules if they are suspicious or have characteristics that raise concern
Characteristics that raise concern about a thyroid nodule include:
- Firmness
- Irregular shape
- Size > 1 cm
- Rapid growth
- Presence of lymph nodes

Eye Diseases

Grave's disease can lead to permanent vision loss or blindness
Diabetic retinopathy is caused by high blood sugar levels
Age-related macular degeneration is associated with aging

Neck Mass

A persistent neck mass in an adult older than 40 years should raise suspicion of malignancy
Most likely cause of a persistent neck mass in an adult older than 40 years is malignancy

Pharyngitis

Lymph nodes in pharyngitis are typically tender and enlarged
Sore throat is a common symptom that accompanies pharyngitis

Visual Acuity

A visual acuity of 20/80 means that the individual can see at 20 feet what a normal person can see at 80 feet
A patient with a visual acuity of 20/200 would have a significant vision impairment

Hyperthyroidism

Common symptoms of hyperthyroidism include:
- Weight loss
- Nervousness
- Heat intolerance
- Fatigue
- Palpitations
- Hair loss
- Skin changes
- Nausea and vomiting
Hyperthyroidism can affect the nervous system, causing:
- Nervousness
- Anxiety
- Fatigue
- Insomnia
Hyperthyroidism can affect the cardiovascular system, causing:
- Palpitations
- Tachycardia
- Increased systolic and decreased diastolic blood pressures
Hyperthyroidism can affect the digestive system, causing:
- Nausea and vomiting
- Diarrhea
Hyperthyroidism can affect the skin, causing:
- Hair loss
- Skin changes
Hyperthyroidism can affect the weight, causing:
- Weight loss

Graves' Disease

Graves' disease is associated with:
- Hyperthyroidism
- Exophthalmos (bulging eyes)
- Thyroid nodules
Main symptom of Graves' disease is:
- Exophthalmos (bulging eyes)
Graves' disease can affect the eyes, causing:
- Exophthalmos (bulging eyes)
- Diplopia (double vision)
- Vision loss

Hypothyroidism

Common symptoms of hypothyroidism include:
- Fatigue
- Lethargy
- Weight gain
- Cold intolerance
- Dry skin
- Hair loss
- Constipation
Hypothyroidism can affect the nervous system, causing:
- Fatigue
- Lethargy
- Memory impairment
- Depression
Hypothyroidism can affect the cardiovascular system, causing:
- Decreased heart rate
- Increased diastolic blood pressure
Hypothyroidism can affect the digestive system, causing:
- Constipation
- Weight gain
Hypothyroidism can affect the skin, causing:
- Dry skin
- Hair loss
Hypothyroidism can affect the weight, causing:
- Weight gain

Thyroid Storm

Thyroid storm is a rare endocrine emergency associated with high mortality
Most common underlying condition associated with thyroid storm is:
- Graves' disease
Mortality rate associated with thyroid storm is:
- High (up to 20-30%)

Other Conditions

Thyroid condition associated with impaired memory, mixed hearing loss, somnolence, peripheral neuropathy, and carpal tunnel syndrome is:
- Hypothyroidism
Thyroid condition associated with carpal tunnel syndrome is:
- Hypothyroidism
Supra-clavicular node is located in the:
- Neck
Enlarged supra-clavicular node on the left side (Virchow's Node) suggests:
- Metastatic cancer
Presence of tender nodes indicates:
- Infection or inflammation
Hard or fixed nodes on palpation suggest:
- Malignancy
Stridor is a possible symptom of:
- Upper airway obstruction
- Respiratory emergency

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Description

This is the introduction to the organ systems and structures in the head and neck. This chapter, as well as the succeeding ones on the eyes, ears, nose, throat, and oral cavity, should be viewed as a unit not only due to their close anatomical proximity and interconnection but also because they have related symptoms. The physical examination of these structures is also performed sequentially.