NU 518
EXAM 2
STUDY GUIDE
University of South Alabama.
This document provides a focused
study guide
It summarizes key concepts, lecture highlights, and
exam-relevant material to support efficient last-
minute review. The guide is structured to help
students reinforce understanding, identify weak areas, and
prepare confidently for the assessment.
, Exam Two Study Guide 1
Chapter 11 / Head and Neck
Cervical Lymph Nodes – pg 343-345
o Submental—palpate in the midline a few centimeters behind the tip of the mandible.
o Submandibular—midway between the angle and the tip of the mandible. These nodes are usually smaller and
smoother than the lobulated submandibular gland against which they lie.
o Preauricular—palpate in front of the ear
o Posterior auricular—palpate behind the ear and superficial to the mastoid process.
o Tonsillar (jugulodigastric)—palpate at the angle of the mandible.
A small hard tender “tonsillar node” high and deep between the mandible and the SCM is probably an
elongated temporal styloid process.
o Occipital—palpate at the base of the skull posteriorly.
o Anterior superficial cervical—palpate for these nodes anterior and superficial to the SCM muscle.
o Posterior cervical—palpate along the anterior edge of the trapezius by flexing the patient’s neck slightly forward
toward the side being examined
o Deep cervical chain—deep in the SCM muscle and often inaccessible to examination. Hook your thumb and
fingers around either side of the SCM muscle to find them.
o Supraclavicular—palpate deep in the angle formed by the clavicle and the SCM muscle
Enlargement of a supraclavicular node, especially on the left (Virchow’s node), suggests possible metastasis
from a thoracic or an abdominal malignancy.
o Notes: tender nodes suggest inflammation, hard/fixed nodes suggest malignancy. Generalized lymphadenopathy
is seen in multiple infections/inflammatory/malignant conditions such as HIV/AIDS, mono, lymphoma, leukemia,
sarcoidosis.
Thyroid Gland – pg 346-347
o Inspect thyroid gland by having the patient tip their head back. Look for presence of goiter.
o Palpation is usually easier in long, slender necks. In shorter necks, hyperextension of the neck may be helpful.
o If the lower pole of the thyroid gland is not palpable, suspect a retrosternal location. If the thyroid gland is
retrosternal, below the suprasternal notch, it is often not palpable.
Retrosternal goiters can cause hoarseness, shortness of breath, stridor, or dysphagia from tracheal
compression; neck hyperextension and arm elevation may cause flushing from compression of the thoracic
inlet from the gland itself or from clavicular movement (Pemberton sign). More than 85% of goiters are
benign.
o Note the size, shape, and consistency (soft, firm, or hard)
Soft in Graves disease and may be nodular; firm in Hashimoto thyroiditis and malignancy. The thyroid is
tender in thyroiditis.
Chapter 12 / Eyes
Vision changes - pg 362-363
o Difficulty with close work suggests hyperopia (farsightedness) or presbyopia (aging vision), and, difficulty with
distance vision, suggest myopia (nearsightedness).
o If sudden visual loss is unilateral and painless, consider vitreous hemorrhage from diabetes or trauma, macular
degeneration, retinal detachment, retinal vein occlusion, or central retinal artery occlusion.
o If painful, causes are usually in the cornea and anterior chamber such as corneal ulcer, uveitis, traumatic
hyphema, and acute angle closure glaucoma. Optic neuritis from multiple sclerosis may also be painful.
Immediate referral is warranted. If associated with headache, a thorough neurologic examination is warranted.
, Exam Two Study Guide 2
o If vision loss is associated with headache, jaw pain or claudication, it may be associated with giant-cell arteritis. If
painless, it may be associated with a vascular occlusion, retinal detachment, or hemorrhage.
o If vision loss is bilateral and painless, consider vascular etiologies, stroke, or non-physiologic causes. If bilateral
and painful, consider intoxication, trauma, chemical or radiation exposures.
o Moving specks or strands suggest vitreous floaters; fixed defects, or scotomas, suggest lesions in the retina, visual
pathway, or brain.
o Moving specks or strands suggest vitreous floaters; fixed defects, or scotomas, suggest lesions in the retina, visual
pathway, or brain.
Visual acuity – pg 365-366
o Test the acuity of central vision by using a Snellen eye chart in a well-lit area, if possible. Position the patient 20 ft
from the chart. Patients who wear glasses other than for reading should put them on. Ask the patient to cover
one eye with a card and to read the smallest line of print possible.
o Visual acuity is expressed as two numbers (e.g., 20/30): the first indicates the distance of the patient from the
chart, and the second, the distance at which a normal eye can read the line of letters. The larger the second
number, the worse the vision.
o a person is usually considered legally blind when vision in the better eye, corrected by glasses, is 20/200 or less.
Cornea and lens – pg 369, table 12-5
o Corneal Arcus: A thin grayish-white arc or circle not quite at the edge of the cornea. Accompanies normal aging
but also seen in younger adults, especially African Americans. In young adults, suggests possible
hyperlipoproteinemia. Usually benign.
o Corneal Scar: A superficial grayish-white opacity in the cornea, secondary to an old injury or to inflammation. Size
and shape are variable. Do not confuse with the opaque lens of a cataract, visible on a deeper plane and only
through the pupil.
o Cataracts: Opacity of the lenses visible through the pupil. Risk factors are older age, smoking, diabetes,
corticosteroid use.
Nuclear Cataract: gray when seen by a flashlight. If the pupil is widely dilated, the gray opacity is surrounded
by a black rim.
o Kayser–Fleischer Ring: A golden to red brown ring, sometimes shading to green or blue, from copper deposition in
the periphery of the cornea found in Wilson disease. Due to a rare autosomal recessive mutation of the ATO7B
gene on chromosome 13 causing abnormal copper transport, reduced biliary copper excretion, and abnormal
accumulation of copper in the liver and tissues throughout the body. Patients present with liver disease, renal
failure, and neurologic symptoms of tremor, dystonia, and a variety of psychiatric disorders.
o Pterygium: A triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the
cornea, usually from the nasal side. Reddening and irritation may occur. May interfere with vision as it encroaches
on the pupil.
o Peripheral Cataract: Produces spoke-like shadows that point—gray against black, as seen with a flashlight, or black
against red with an ophthalmoscope. A dilated pupil, as shown here, facilitates this observation.
Near reaction – pg 359, 371
o When a person shifts gaze from a far object to a near object, the pupils constrict This response is mediated by the
oculomotor nerve (CN III).
o Coincident with this pupillary constriction, but not part of it, are (1) convergence of the eyes, a bilateral medial
rectus movement; and (2) accommodation, an increased convexity of the lenses caused by contraction of the
ciliary muscles.
EXAM 2
STUDY GUIDE
University of South Alabama.
This document provides a focused
study guide
It summarizes key concepts, lecture highlights, and
exam-relevant material to support efficient last-
minute review. The guide is structured to help
students reinforce understanding, identify weak areas, and
prepare confidently for the assessment.
, Exam Two Study Guide 1
Chapter 11 / Head and Neck
Cervical Lymph Nodes – pg 343-345
o Submental—palpate in the midline a few centimeters behind the tip of the mandible.
o Submandibular—midway between the angle and the tip of the mandible. These nodes are usually smaller and
smoother than the lobulated submandibular gland against which they lie.
o Preauricular—palpate in front of the ear
o Posterior auricular—palpate behind the ear and superficial to the mastoid process.
o Tonsillar (jugulodigastric)—palpate at the angle of the mandible.
A small hard tender “tonsillar node” high and deep between the mandible and the SCM is probably an
elongated temporal styloid process.
o Occipital—palpate at the base of the skull posteriorly.
o Anterior superficial cervical—palpate for these nodes anterior and superficial to the SCM muscle.
o Posterior cervical—palpate along the anterior edge of the trapezius by flexing the patient’s neck slightly forward
toward the side being examined
o Deep cervical chain—deep in the SCM muscle and often inaccessible to examination. Hook your thumb and
fingers around either side of the SCM muscle to find them.
o Supraclavicular—palpate deep in the angle formed by the clavicle and the SCM muscle
Enlargement of a supraclavicular node, especially on the left (Virchow’s node), suggests possible metastasis
from a thoracic or an abdominal malignancy.
o Notes: tender nodes suggest inflammation, hard/fixed nodes suggest malignancy. Generalized lymphadenopathy
is seen in multiple infections/inflammatory/malignant conditions such as HIV/AIDS, mono, lymphoma, leukemia,
sarcoidosis.
Thyroid Gland – pg 346-347
o Inspect thyroid gland by having the patient tip their head back. Look for presence of goiter.
o Palpation is usually easier in long, slender necks. In shorter necks, hyperextension of the neck may be helpful.
o If the lower pole of the thyroid gland is not palpable, suspect a retrosternal location. If the thyroid gland is
retrosternal, below the suprasternal notch, it is often not palpable.
Retrosternal goiters can cause hoarseness, shortness of breath, stridor, or dysphagia from tracheal
compression; neck hyperextension and arm elevation may cause flushing from compression of the thoracic
inlet from the gland itself or from clavicular movement (Pemberton sign). More than 85% of goiters are
benign.
o Note the size, shape, and consistency (soft, firm, or hard)
Soft in Graves disease and may be nodular; firm in Hashimoto thyroiditis and malignancy. The thyroid is
tender in thyroiditis.
Chapter 12 / Eyes
Vision changes - pg 362-363
o Difficulty with close work suggests hyperopia (farsightedness) or presbyopia (aging vision), and, difficulty with
distance vision, suggest myopia (nearsightedness).
o If sudden visual loss is unilateral and painless, consider vitreous hemorrhage from diabetes or trauma, macular
degeneration, retinal detachment, retinal vein occlusion, or central retinal artery occlusion.
o If painful, causes are usually in the cornea and anterior chamber such as corneal ulcer, uveitis, traumatic
hyphema, and acute angle closure glaucoma. Optic neuritis from multiple sclerosis may also be painful.
Immediate referral is warranted. If associated with headache, a thorough neurologic examination is warranted.
, Exam Two Study Guide 2
o If vision loss is associated with headache, jaw pain or claudication, it may be associated with giant-cell arteritis. If
painless, it may be associated with a vascular occlusion, retinal detachment, or hemorrhage.
o If vision loss is bilateral and painless, consider vascular etiologies, stroke, or non-physiologic causes. If bilateral
and painful, consider intoxication, trauma, chemical or radiation exposures.
o Moving specks or strands suggest vitreous floaters; fixed defects, or scotomas, suggest lesions in the retina, visual
pathway, or brain.
o Moving specks or strands suggest vitreous floaters; fixed defects, or scotomas, suggest lesions in the retina, visual
pathway, or brain.
Visual acuity – pg 365-366
o Test the acuity of central vision by using a Snellen eye chart in a well-lit area, if possible. Position the patient 20 ft
from the chart. Patients who wear glasses other than for reading should put them on. Ask the patient to cover
one eye with a card and to read the smallest line of print possible.
o Visual acuity is expressed as two numbers (e.g., 20/30): the first indicates the distance of the patient from the
chart, and the second, the distance at which a normal eye can read the line of letters. The larger the second
number, the worse the vision.
o a person is usually considered legally blind when vision in the better eye, corrected by glasses, is 20/200 or less.
Cornea and lens – pg 369, table 12-5
o Corneal Arcus: A thin grayish-white arc or circle not quite at the edge of the cornea. Accompanies normal aging
but also seen in younger adults, especially African Americans. In young adults, suggests possible
hyperlipoproteinemia. Usually benign.
o Corneal Scar: A superficial grayish-white opacity in the cornea, secondary to an old injury or to inflammation. Size
and shape are variable. Do not confuse with the opaque lens of a cataract, visible on a deeper plane and only
through the pupil.
o Cataracts: Opacity of the lenses visible through the pupil. Risk factors are older age, smoking, diabetes,
corticosteroid use.
Nuclear Cataract: gray when seen by a flashlight. If the pupil is widely dilated, the gray opacity is surrounded
by a black rim.
o Kayser–Fleischer Ring: A golden to red brown ring, sometimes shading to green or blue, from copper deposition in
the periphery of the cornea found in Wilson disease. Due to a rare autosomal recessive mutation of the ATO7B
gene on chromosome 13 causing abnormal copper transport, reduced biliary copper excretion, and abnormal
accumulation of copper in the liver and tissues throughout the body. Patients present with liver disease, renal
failure, and neurologic symptoms of tremor, dystonia, and a variety of psychiatric disorders.
o Pterygium: A triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the
cornea, usually from the nasal side. Reddening and irritation may occur. May interfere with vision as it encroaches
on the pupil.
o Peripheral Cataract: Produces spoke-like shadows that point—gray against black, as seen with a flashlight, or black
against red with an ophthalmoscope. A dilated pupil, as shown here, facilitates this observation.
Near reaction – pg 359, 371
o When a person shifts gaze from a far object to a near object, the pupils constrict This response is mediated by the
oculomotor nerve (CN III).
o Coincident with this pupillary constriction, but not part of it, are (1) convergence of the eyes, a bilateral medial
rectus movement; and (2) accommodation, an increased convexity of the lenses caused by contraction of the
ciliary muscles.
