NURS612
On your patient schedule see a diagnosis of plagiocephaly on your patient schedule. You vaguely recall
learning something about this in Nurs 612 so you check UpToDate and are able to explain the etiology of
this head growth disturbance is to the parents of this 4-month-old :
A. Your child's head appears small. His head size is 2 SD below the mean, this can result abnormal brain
development from a genetic or teratogenic exposure
B. Your child's head appears flat. This form of craniostenosis can result from premature fusion of
lambdoidal or coronal skull sutures and often results in brain injury.
C. Your child's head appears large. His head size is 2 SD above the mean, this can result from
hydrocephalus while skull sutures are open.
D. Your child's head appears flat. This form of craniostenosis can result from premature fusion of
lambdoidal or coronal skull sutures and is often only cosmetic and can be treated with a s ANS: D. Your
child's head appears flat. This form of craniostenosis can result from premature fusion of lambdoidal or
coronal skull sutures and is often only cosmetic and can be treated with a special helmet.
During a 1-week-old male well child check the head circumference is 3 S.D. (standard deviations) below
the predicted mean. What risk factors increases the risk of this finding?
A. Positioning infant on their back
B. Prenatal Zika virus exposure
C. Hydrocephaly
D. Subdural hematoma or tumor ANS: B. Prenatal Zika virus exposure
You are seeing a 6-month-old today for follow-up after a febrile seizure yesterday. On exam you expect
to find:
A. the anterior fontanel closed.
B. the posterior fontanel closed
C. sleepiness from a post-ictal state
D. nuchal rigidity ANS: B. the posterior fontanel closed
,You are examining a 22-month-old today for follow-up after a with a new sudden onset of jerking
movements while febrile earlier today. Which of the following is not typical of this type seizure?
A. Positive family history
B. Age onset between 3 months and 5 years
C. Seizure lasting more than 15 minutes
D. Most likely to occur with a rapid rise in body temperature ANS: C. Seizure lasting more than 15
minutes
A 15-year-old with a diagnosis of epilepsy had a seizure in your office lasting 12 minutes requiring rectal
diazepam (Valium). He is stable in a postictal state. His parents express concern as his last seizure was 2
years ago and he wanted to be weaned off his phenytoin (Dilantin).Which of the following may have
contributed to this seizure?
A. Experimentation with alcohol consumption which lowers seizure threshold.
B. Recent growth spurt resulting in decreased kg/mg dosage
C. Adolescent may be challenging diagnosis and non-compliant with phenytoin regimen
D. All choices are correct ANS: D. All choices are correct
What question in an adolescent's history is the MOST important to ask concerning new onset of
headaches?
A. Alcohol use
B. Caffeine use
C. History of headache most severe when arising from sleep
D. Positive family history for headaches ANS: C. History of headache most severe when arising from
sleep
A 17-year-old arrives for evaluation of a headache. He states it is worse in the morning and does not
respond to ibuprofen. His caffeine intake has not changed, he has no known head trauma. On exam you
note he is slow to respond to questions and your fundoscopic exam the optic disc borders are blurred
(papilledema). You explain your next action
, A. He exhibits a focal neurological sign, order a CT
B. He exhibits a focal neurological sign, discharge the patient home prescribing bedrest, acetaminophen
and recommend sunglasses
C. He exhibits no focal neurological signs, discharge the patient home on bedrest, teaching family
members signs warning signs of increased ICP
D. He exhibits no focal neurological signs. discharge the patient home recommending return to school,
but no contact sports until headache resolved ANS: A. He exhibits a focal neurological sign, order a CT
A 17-year-old gymnast presents following her competition with a resolving headache rated 3/10, after
her spotter missed her and she fell 4 feet and struck her head. Although she did not lose consciousness
and seems fine now, her parents are concerned because she does not remember how she got off the
gym floor. Which of the following would NOT be indicated.
A. Prescribe bedrest, acetaminophen and recommend sunglasses if light sensitive
B. Teach warning signs of head injuryand send home on bedrest
C. Order a CT of the Head
D. Recommend return to school, but no contact sports until headache resolved. ANS: C. Order a CT of
the Head
An 11-year-old male presents with a history head trauma resulting from a "hard hit" while playing
football 2 days ago. His GCS score is 14. Despite 20/15 vision recorded 3 months ago during his sports
physical he states he has blurred vision and is unable to read fine print, otherwise his neuro exam is
normal. What is your best plan of care?
A. You assess this is not a mild concussion and order a CT because he exhibits a focal neurological sign
B. You assess this is a moderate concussion and discharge the patient home prescribing bedrest,
acetaminophen and recommend sunglasses if light sensitive
C. You assess this is a mild concussion discharge the patient home and teaching family members signs
warning signs of head injury, send home on bedrest
D. You assess this is a mild concussion discharge the patient home and recommend return to school, but
no contact sports until headache resolved ANS: A. You assess this is not a mild concussion and order a
CT because he exhibits a focal neurological sign
On your patient schedule see a diagnosis of plagiocephaly on your patient schedule. You vaguely recall
learning something about this in Nurs 612 so you check UpToDate and are able to explain the etiology of
this head growth disturbance is to the parents of this 4-month-old :
A. Your child's head appears small. His head size is 2 SD below the mean, this can result abnormal brain
development from a genetic or teratogenic exposure
B. Your child's head appears flat. This form of craniostenosis can result from premature fusion of
lambdoidal or coronal skull sutures and often results in brain injury.
C. Your child's head appears large. His head size is 2 SD above the mean, this can result from
hydrocephalus while skull sutures are open.
D. Your child's head appears flat. This form of craniostenosis can result from premature fusion of
lambdoidal or coronal skull sutures and is often only cosmetic and can be treated with a s ANS: D. Your
child's head appears flat. This form of craniostenosis can result from premature fusion of lambdoidal or
coronal skull sutures and is often only cosmetic and can be treated with a special helmet.
During a 1-week-old male well child check the head circumference is 3 S.D. (standard deviations) below
the predicted mean. What risk factors increases the risk of this finding?
A. Positioning infant on their back
B. Prenatal Zika virus exposure
C. Hydrocephaly
D. Subdural hematoma or tumor ANS: B. Prenatal Zika virus exposure
You are seeing a 6-month-old today for follow-up after a febrile seizure yesterday. On exam you expect
to find:
A. the anterior fontanel closed.
B. the posterior fontanel closed
C. sleepiness from a post-ictal state
D. nuchal rigidity ANS: B. the posterior fontanel closed
,You are examining a 22-month-old today for follow-up after a with a new sudden onset of jerking
movements while febrile earlier today. Which of the following is not typical of this type seizure?
A. Positive family history
B. Age onset between 3 months and 5 years
C. Seizure lasting more than 15 minutes
D. Most likely to occur with a rapid rise in body temperature ANS: C. Seizure lasting more than 15
minutes
A 15-year-old with a diagnosis of epilepsy had a seizure in your office lasting 12 minutes requiring rectal
diazepam (Valium). He is stable in a postictal state. His parents express concern as his last seizure was 2
years ago and he wanted to be weaned off his phenytoin (Dilantin).Which of the following may have
contributed to this seizure?
A. Experimentation with alcohol consumption which lowers seizure threshold.
B. Recent growth spurt resulting in decreased kg/mg dosage
C. Adolescent may be challenging diagnosis and non-compliant with phenytoin regimen
D. All choices are correct ANS: D. All choices are correct
What question in an adolescent's history is the MOST important to ask concerning new onset of
headaches?
A. Alcohol use
B. Caffeine use
C. History of headache most severe when arising from sleep
D. Positive family history for headaches ANS: C. History of headache most severe when arising from
sleep
A 17-year-old arrives for evaluation of a headache. He states it is worse in the morning and does not
respond to ibuprofen. His caffeine intake has not changed, he has no known head trauma. On exam you
note he is slow to respond to questions and your fundoscopic exam the optic disc borders are blurred
(papilledema). You explain your next action
, A. He exhibits a focal neurological sign, order a CT
B. He exhibits a focal neurological sign, discharge the patient home prescribing bedrest, acetaminophen
and recommend sunglasses
C. He exhibits no focal neurological signs, discharge the patient home on bedrest, teaching family
members signs warning signs of increased ICP
D. He exhibits no focal neurological signs. discharge the patient home recommending return to school,
but no contact sports until headache resolved ANS: A. He exhibits a focal neurological sign, order a CT
A 17-year-old gymnast presents following her competition with a resolving headache rated 3/10, after
her spotter missed her and she fell 4 feet and struck her head. Although she did not lose consciousness
and seems fine now, her parents are concerned because she does not remember how she got off the
gym floor. Which of the following would NOT be indicated.
A. Prescribe bedrest, acetaminophen and recommend sunglasses if light sensitive
B. Teach warning signs of head injuryand send home on bedrest
C. Order a CT of the Head
D. Recommend return to school, but no contact sports until headache resolved. ANS: C. Order a CT of
the Head
An 11-year-old male presents with a history head trauma resulting from a "hard hit" while playing
football 2 days ago. His GCS score is 14. Despite 20/15 vision recorded 3 months ago during his sports
physical he states he has blurred vision and is unable to read fine print, otherwise his neuro exam is
normal. What is your best plan of care?
A. You assess this is not a mild concussion and order a CT because he exhibits a focal neurological sign
B. You assess this is a moderate concussion and discharge the patient home prescribing bedrest,
acetaminophen and recommend sunglasses if light sensitive
C. You assess this is a mild concussion discharge the patient home and teaching family members signs
warning signs of head injury, send home on bedrest
D. You assess this is a mild concussion discharge the patient home and recommend return to school, but
no contact sports until headache resolved ANS: A. You assess this is not a mild concussion and order a
CT because he exhibits a focal neurological sign
