NUR 505 Module 7 Study Guide 2026 | HEENT Assessment, Thyroid Disorders,
Eye & ENT Examination Exam Prep PDF | University of Alabama
Chapter 11 Head and Neck
1. Review your anatomy and physiology in your textbook. Review anatomic landmarks, underlying structures of the neck. What
are some differences between infants, children, adolescents, pregnant, and elderly patients regarding anatomy and physiology?
• The sternocleidomastoid muscle (SCM): easily
recognizable, palpable muscle that plays a vital role in the
posture of the neck and the body.
• The anatomic areas of the neck, designated as “triangles,” are
useful in assessing superficial structures (The SCM –
attached to the sternum, clavicle, and mastoid process of the
temporal bone) provides a visible landmark that separates the
anterior and posterior triangles of the neck.
• The posterior triangle of the neck includes the external
jugular vein, posterior cervical lymph nodes, and the accessory cranial nerve. The anterior triangle of
the neck includes the bifurcation of the common carotid artery; anterior cervical lymph nodes; and
the facial, glossopharyngeal, vagus, accessory, and hypoglossal cranial nerves.
• Underlying structures located within the anterior triangle form the midline of the neck; these
structures include the hyoid bone, thyroid cartilage, cricoid cartilage, trachea, and thyroid and
parathyroid glands (10-20 g in adults, decreases with iodine)
• In infants, the 7 cranial bones are soft and separated by the sagittal, coronal, and lambdoid sutures.
Spaces between the cranial bones permit the expansion of the skull to accommodate brain growth.
Ossification of the sutures begins after completion of brain growth, at about 6 yrs, and is finished by
adulthood. The fontanels ossify earlier, with the posterior fontanel usually closing by 2 months of
age and the anterior fontanel closing by 12 to 15 months of age. The process of birth through the
vaginal canal often causes molding of the newborn skull, during which the cranial bones may shift
and overlap. Within days, the newborn skull usually resumes its appropriate shape and size.
• Children and Adolescents; Subtle changes in facial appearance occur throughout childhood. In
adolescents assigned male at birth, the nose and thyroid cartilage enlarge, and facial hair develops,
emerging first on the upper lip, then the cheeks, lower lip, and chin.
• Pregnant Patients; The fetal thyroid gland becomes functional in the second trimester. Before this
time, the pregnant patient is the source of thyroid hormone for the fetus and thus requires increased
iodine intake. As long as adequate iodine intake is maintained, the size of the thyroid will not
detectably change on physical examination; however, a slight enlargement may be detectable on
ultrasound (Fig. 11.7).
• Older Adults: The rate of T4 production and degradation gradually decreases with aging, and the
thyroid gland becomes more fibrotic.
2. How do you examine the thyroid gland? Describe and demonstrate the technique. What are normal findings? What are
abnormal findings? What do each of these indicate? If the thyroid gland is enlarged, what should you auscultate for?
• The estimation of thyroid size by lateral inspection is the most sensitive test for determining the
presence of a goiter; a thyroid that is not visible on lateral inspection rules out a goiter
• position the patient to relax the sternocleidomastoid, with the neck flexed slightly forward and
laterally toward the side being examined. Ask the patient to hold a sip of water in the mouth until
you have your hands positioned, and then instruct the patient to swallow. To palpate the thyroid
using the frontal approach, have the patient sit on the examining table. First place your thumb over
the trachea approximately 3 cm beneath the prominence of the thyroid cartilage, and during a
swallow, attempt to identify the isthmus. To examine the right lobe of the thyroid, use your left
1
, thumb to press the trachea toward the patient’s right. Such pressure helps move the right lobe out of
the tracheoesophageal groove for easier palpation. Then place the first three fingers of your right
hand in the right thyroid bed with your fingertips medial to the margin of the sternocleidomastoid
muscle. Leave your fingers still while the patient again swallows, thus allowing the gland to move
beneath your fingers (Fig. 11.27). To examine the left lobe, move your hands to the reverse
corresponding positions. By palpating above the cricoid cartilage, you may be able to feel the
pyramidal lobe of the thyroid, if present.
• For examining the thyroid from behind, have the patient sit with the neck at a comfortable level.
Position two fingers of each hand on the sides of the trachea just beneath the cricoid cartilage. Ask
the patient to swallow, feeling for movement of the isthmus.
• * The thyroid gland moves with swallowing; subcutaneous fat that mimics a goiter does not
• Abnormal findings: An enlarged thyroid gland (goiter), nodules, or tenderness
during palpation. - A goiter could indicate a condition such as Graves' disease,
Hashimoto's thyroiditis, or iodine deficiency. - Nodules could suggest thyroid
cancer, though they can also be benign. - Tenderness might suggest thyroiditis.
If the thyroid gland is enlarged, you should auscultate for a bruit, which is a
whooshing sound made by blood rushing through an area. This can indicate
hyperthyroidism, as the increased hormone production leads to increased blood
flow.
.
3. Review changes that can occur in the head and neck of pregnant patients in your textbook. How would you assess for and
diagnose abnormalities of the thyroid gland in the pregnant population?
• Pregnancy causes hormonal and physiologic changes in thyroid function; the thyroid can increase in
size during pregnancy due to increased demand, especially in iodine-deficient environments. During
the first 10 to 12 weeks of pregnancy, the fetus is dependent on maternal thyroid hormone for brain
development, which necessitates close monitoring of maternal thyroid function to avoid adverse
outcomes. Pregnant and postpartum women are at increased risk for thyroid dysfunction, including
hypothyroidism
4. hypothyroidism vs hyperthyroidism. Describe the pathophysiology of each disease. What subjective findings would your patient
present with? What objective findings would you see on your exam? Review Myxedema, Graves disease, and Hashimoto disease
in your textbook. Know how each of these diseases affect the body and what causes them.
• Hypothyroidism: insufficient secretion of thyroid hormone due to inadequate secretion of either
thyroid-stimulating hormone (TSH) from the pituitary gland or thyrotropin-releasing hormone
(TRH) from the hypothalamus, More common than hyperthyroidism
• Hyperthyroidism: Excess thyroid hormone causes an increase in metabolic rate, associated with
increased total body heat production and increased heart contractility, heart rate, and vasodilation.
Multinodular goiter (Plummer disease)
2
Eye & ENT Examination Exam Prep PDF | University of Alabama
Chapter 11 Head and Neck
1. Review your anatomy and physiology in your textbook. Review anatomic landmarks, underlying structures of the neck. What
are some differences between infants, children, adolescents, pregnant, and elderly patients regarding anatomy and physiology?
• The sternocleidomastoid muscle (SCM): easily
recognizable, palpable muscle that plays a vital role in the
posture of the neck and the body.
• The anatomic areas of the neck, designated as “triangles,” are
useful in assessing superficial structures (The SCM –
attached to the sternum, clavicle, and mastoid process of the
temporal bone) provides a visible landmark that separates the
anterior and posterior triangles of the neck.
• The posterior triangle of the neck includes the external
jugular vein, posterior cervical lymph nodes, and the accessory cranial nerve. The anterior triangle of
the neck includes the bifurcation of the common carotid artery; anterior cervical lymph nodes; and
the facial, glossopharyngeal, vagus, accessory, and hypoglossal cranial nerves.
• Underlying structures located within the anterior triangle form the midline of the neck; these
structures include the hyoid bone, thyroid cartilage, cricoid cartilage, trachea, and thyroid and
parathyroid glands (10-20 g in adults, decreases with iodine)
• In infants, the 7 cranial bones are soft and separated by the sagittal, coronal, and lambdoid sutures.
Spaces between the cranial bones permit the expansion of the skull to accommodate brain growth.
Ossification of the sutures begins after completion of brain growth, at about 6 yrs, and is finished by
adulthood. The fontanels ossify earlier, with the posterior fontanel usually closing by 2 months of
age and the anterior fontanel closing by 12 to 15 months of age. The process of birth through the
vaginal canal often causes molding of the newborn skull, during which the cranial bones may shift
and overlap. Within days, the newborn skull usually resumes its appropriate shape and size.
• Children and Adolescents; Subtle changes in facial appearance occur throughout childhood. In
adolescents assigned male at birth, the nose and thyroid cartilage enlarge, and facial hair develops,
emerging first on the upper lip, then the cheeks, lower lip, and chin.
• Pregnant Patients; The fetal thyroid gland becomes functional in the second trimester. Before this
time, the pregnant patient is the source of thyroid hormone for the fetus and thus requires increased
iodine intake. As long as adequate iodine intake is maintained, the size of the thyroid will not
detectably change on physical examination; however, a slight enlargement may be detectable on
ultrasound (Fig. 11.7).
• Older Adults: The rate of T4 production and degradation gradually decreases with aging, and the
thyroid gland becomes more fibrotic.
2. How do you examine the thyroid gland? Describe and demonstrate the technique. What are normal findings? What are
abnormal findings? What do each of these indicate? If the thyroid gland is enlarged, what should you auscultate for?
• The estimation of thyroid size by lateral inspection is the most sensitive test for determining the
presence of a goiter; a thyroid that is not visible on lateral inspection rules out a goiter
• position the patient to relax the sternocleidomastoid, with the neck flexed slightly forward and
laterally toward the side being examined. Ask the patient to hold a sip of water in the mouth until
you have your hands positioned, and then instruct the patient to swallow. To palpate the thyroid
using the frontal approach, have the patient sit on the examining table. First place your thumb over
the trachea approximately 3 cm beneath the prominence of the thyroid cartilage, and during a
swallow, attempt to identify the isthmus. To examine the right lobe of the thyroid, use your left
1
, thumb to press the trachea toward the patient’s right. Such pressure helps move the right lobe out of
the tracheoesophageal groove for easier palpation. Then place the first three fingers of your right
hand in the right thyroid bed with your fingertips medial to the margin of the sternocleidomastoid
muscle. Leave your fingers still while the patient again swallows, thus allowing the gland to move
beneath your fingers (Fig. 11.27). To examine the left lobe, move your hands to the reverse
corresponding positions. By palpating above the cricoid cartilage, you may be able to feel the
pyramidal lobe of the thyroid, if present.
• For examining the thyroid from behind, have the patient sit with the neck at a comfortable level.
Position two fingers of each hand on the sides of the trachea just beneath the cricoid cartilage. Ask
the patient to swallow, feeling for movement of the isthmus.
• * The thyroid gland moves with swallowing; subcutaneous fat that mimics a goiter does not
• Abnormal findings: An enlarged thyroid gland (goiter), nodules, or tenderness
during palpation. - A goiter could indicate a condition such as Graves' disease,
Hashimoto's thyroiditis, or iodine deficiency. - Nodules could suggest thyroid
cancer, though they can also be benign. - Tenderness might suggest thyroiditis.
If the thyroid gland is enlarged, you should auscultate for a bruit, which is a
whooshing sound made by blood rushing through an area. This can indicate
hyperthyroidism, as the increased hormone production leads to increased blood
flow.
.
3. Review changes that can occur in the head and neck of pregnant patients in your textbook. How would you assess for and
diagnose abnormalities of the thyroid gland in the pregnant population?
• Pregnancy causes hormonal and physiologic changes in thyroid function; the thyroid can increase in
size during pregnancy due to increased demand, especially in iodine-deficient environments. During
the first 10 to 12 weeks of pregnancy, the fetus is dependent on maternal thyroid hormone for brain
development, which necessitates close monitoring of maternal thyroid function to avoid adverse
outcomes. Pregnant and postpartum women are at increased risk for thyroid dysfunction, including
hypothyroidism
4. hypothyroidism vs hyperthyroidism. Describe the pathophysiology of each disease. What subjective findings would your patient
present with? What objective findings would you see on your exam? Review Myxedema, Graves disease, and Hashimoto disease
in your textbook. Know how each of these diseases affect the body and what causes them.
• Hypothyroidism: insufficient secretion of thyroid hormone due to inadequate secretion of either
thyroid-stimulating hormone (TSH) from the pituitary gland or thyrotropin-releasing hormone
(TRH) from the hypothalamus, More common than hyperthyroidism
• Hyperthyroidism: Excess thyroid hormone causes an increase in metabolic rate, associated with
increased total body heat production and increased heart contractility, heart rate, and vasodilation.
Multinodular goiter (Plummer disease)
2
