Chapter 7: The Head and Neck : Bates’ Guide to Physical Examination and History Taking, 12th Edition

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
over-the-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
 
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
 .
3. Which of the following is a symptom involving the eye?
A) Scotomas
B) Tinnitus
C) Dysphagia
D) Rhinorrhea
 
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
 
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
 
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
 
7. A 29-year-old physical therapist presents for evaluation of an eyelid problem. On
 
observation, the right eyeball appears to be protruding forward. Based on this description, what
is the most likely diagnosis?
A) Ptosis
B) Exophthalmos
C) Ectropion
D) Epicanthus
 
8. A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left
eye. It started this morning. He denies any trauma or injury. There is no visual disturbance. Upon
physical examination, there is a red raised area at the margin of the eyelid that is tender to
palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the
most likely diagnosis?
A) Dacryocystitis
B) Chalazion
C) Hordeolum
D) Xanthelasma
 
9. A 15-year-old high school sophomore presents to the emergency room with his mother for
evaluation of an area of blood in the left eye. He denies trauma or injury but has been coughing
forcefully with a recent cold. He denies visual disturbances, eye pain, or discharge from the eye.
On physical examination, the pupils are equal, round, and reactive to light, with a visual acuity of
20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply demarcated area at the
lateral aspect of the base of the left eye. The cornea is clear. Based on this description, what is
the most likely diagnosis?
A) Conjunctivitis
B) Acute iritis
C) Corneal abrasion