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NRSG5115 Health Assessment Northeastern University

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Northeastern University

NRSG5115 Health Assessment Northeastern University

Bates’ Guide to Physical Examination and History Taking, 12th Edition
Chapter 7: The Head and Neck
Multiple Choice
1. A 38-year-old accountant comes to your clinic for evaluation of a headache. The throbbing
sensation is located in the right temporal region and is an 8 on a scale of 1 to 10. It started a few
hours ago, and she has noted nausea with sensitivity to light; she has had headaches like this in
the past, usually less than one per week, but not as severe. She does not know of any inciting
factors. There has been no change in the frequency of her headaches. She usually takes an overthe-
counter analgesic and this results in resolution of the headache. Based on this description,
what is the most likely diagnosis of the type of headache?
A) Tension
B) Migraine
C) Cluster
D) Analgesic rebound
Ans: B
Chapter: 07
Page and Header: 196, The Health History
Feedback: This is a description of a common migraine (no aura). Distinctive features of a
migraine include phonophobia and photophobia, nausea, resolution with sleep, and unilateral
distribution. Only some of these features may be present.
2. A 29-year-old computer programmer comes to your office for evaluation of a headache. The
tightening sensation is located all over the head and is of moderate intensity. It used to last
minutes, but this time it has lasted for 5 days. He denies photophobia and nausea. He spends
several hours each day at a computer monitor/keyboard. He has tried over-the-counter
medication; it has dulled the pain but not taken it away. Based on this description, what is your
most likely diagnosis?
A) Tension
B) Migraine
C) Cluster
D) Analgesic rebound
Ans: A
Chapter: 07
Page and Header: 196, The Health History
Feedback: This is a description of a typical tension headache.
3. Which of the following is a symptom involving the eye?
A) Scotomas
B) Tinnitus
C) Dysphagia
D) Rhinorrhea
Ans: A
Chapter: 07
Page and Header: 196, The Health History
Feedback: Scotomas are specks in the vision or areas where the patient cannot see; therefore,
this is a common/concerning symptom of the eye.
4. A 49-year-old administrative assistant comes to your office for evaluation of dizziness. You
elicit the information that the dizziness is a spinning sensation of sudden onset, worse with head
position changes. The episodes last a few seconds and then go away, and they are accompanied
by intense nausea. She has vomited one time. She denies tinnitus. You perform a physical
examination of the head and neck and note that the patient’s hearing is intact to Weber and Rinne
and that there is nystagmus. Her gait is normal. Based on this description, what is the most likely
diagnosis?
A) Benign positional vertigo
B) Vestibular neuronitis
C) Ménière’s disease
D) Acoustic neuroma
Ans: A
Chapter: 07
Page and Header: 252, Table 7–3
Feedback: This is a classic description of benign positional vertigo. The vertigo is episodic,
lasting a few seconds to minutes, instead of continuous as in vestibular neuronitis. Also, there is
no tinnitus or sensorineural hearing loss as occurs in Ménière’s disease and acoustic neuroma.
You may choose to learn about Hallpike maneuvers, which are also helpful in the evaluation of
vertigo.
5. A 55-year-old bank teller comes to your office for persistent episodes of dizziness. The first
episode started suddenly and lasted 3 to 4 hours. He experienced a lot of nausea with vomiting;
the episode resolved spontaneously. He has had five episodes in the past 1½ weeks. He does note
some tinnitus that comes and goes. Upon physical examination, you note that he has a normal
gait. The Weber localizes to the right side and the air conduction is equal to the bone conduction
in the right ear. Nystagmus is present. Based on this description, what is the most likely
diagnosis?
A) Benign positional vertigo
B) Vestibular neuronitis
C) Ménière’s disease
D) Acoustic neuroma
Ans: C
Chapter: 07
Page and Header: 252, Table 7–3
Feedback: Ménière’s disease is characterized by sudden onset of vertiginous episodes that last
several hours to a day or more, then spontaneously resolve; the episodes then recur. On physical
examination, sensorineural hearing loss is present. The patient does complain of tinnitus.
6. A 73-year-old nurse comes to your office for evaluation of new onset of tremors. She is not on
any medications and does not take herbs or supplements. She has no chronic medical conditions.
She does not smoke or drink alcohol. She walks into the examination room with slow
movements and shuffling steps. She has decreased facial mobility and a blunt expression,
without any changes in hair distribution on her face. Based on this description, what is the most
likely reason for the patient’s symptoms?
A) Cushing’s syndrome
B) Nephrotic syndrome
C) Myxedema
D) Parkinson’s disease
Ans: D
Chapter: 07
Page and Header: 253, Table 7–4
Feedback: This is a typical description for a patient with Parkinson’s disease. Facial mobility is
decreased, which results in a blunt expression—a “masked” appearance. The patient also has
decreased blinking and a characteristic stare with an upward gaze. In combination with the

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NRSG5115 Health Assessment Northeastern University

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