NR 603 WEEK 1 Exam Questions AND Correct Answers
A 1-year-old boy presents with increasing lethargy. He is barely
responsive, and his parents deny any trauma or injury. What is the
most common cause of nontraumatic altered levels of consciousness?
Answer Choices
1 Seizure disorder
2 Diabetic ketoacidosis
3 Inborn errors of metabolism
4 Toxic ingestion
5 Infection
ANS:5 - ✔✔infection
Awareness of self and the surrounding environment or consciousness
may be altered into different abnormal states of consciousness.
Consciousness can shift from loss of clear thinking or confusion,
usually accompanied by disorientation, to delirium, a succession of
confused and unconnected ideas manifested in children as extreme
mental and motor excitement, to lethargy, a profound type of
slumber where movement or speech is limited, to stupor or deep
sleep where arousal is achieved only by repeated vigorous stimuli,
finally to coma, unresponsiveness to even painful stimuli. Non-
traumatic coma is most common in infants and toddlers with another
smaller peak of occurrence in adolescence. The most common cause
of non-traumatic altered level of consciousness in children is infection
of either the brain (encephalitis), meninges (meningitis), or both;
infections account for more than 1/3 of cases.
,Prolonged seizures, anticonvulsive therapy, and postictal states can
also lead to altered levels of consciousness.
The most common metabolic cause of alteration of consciousness is
diabetic ketoacidosis, which can occur at any age, but is most
common in adolescence. Caused by severe insulin deficiency,
hyperglycemia and ketogenesis lead initially to polyuria, polydipsia,
hyperpnea, vomiting, and abdominal pain. As the process progresses,
hyperosmolar dehydration and acid/base and electrolyte disturbances
occur. Advanced stages alter level of consciousness and can lead to
coma.
Alterations of consciousness due to inborn errors of metabolism that
present with electrolyte and glucose abnormalities typically present in
infancy. The availability of gluconeogenic precursors or the functions
of the enzymes required for production of hepatic glucose are
affected. Metabolic defects causing hypoglycemia include glycogen
storage d
A 10-year-old boy is referred to you for being fidgety at school,
though he makes good grades. Prior history is unremarkable, and
there has been no recent illness. The father had a similar history as a
child. While speaking with the patient, you notice that he clears his
throat several times per minute. Examination is otherwise normal,
except for rapid, nonrhythmic jerking movements of the face, neck,
and shoulders while at rest.
,Question
What is true of this patient's case?
Answer Choices
1 Does not have Tourette syndrome due to the absence of coprolalia
2 Has a factitious disorder
3 Has a condition that clusters in families
4 Must start a regimen of levodopa
5 Suffers from Sydenham chorea - ✔✔Has a condition that clusters in
families
The combination of vocal tics (here, throat clearing) and motor tics
should suggest Gilles de la Tourette (Tourette) syndrome, which is a
common tic disorder that clusters in families. Once thought to be a
single gene, autosomal dominant condition, it appears that multiple
genes and nongenetic factors may be at play.
Coprolalia is but one of many vocal tics seen in Tourette syndrome
(throat clearing, humming, whistling) and, although a notorious one,
is not a necessary feature.
, The positive family history makes it unlikely that the condition
described is factitious.
Pimozide, SSRIs, and other agents have been used in the treatment of
Tourette syndrome, but levodopa is not used.
The movement disorder of Sydenham chorea, as seen after a
streptococcal infection, is choreiform - that is, tends to be slower and
rhythmic, as opposed to the rapid, nonrhythmic jerks seen in Tourette
syndrome. Also, vocal tics are not typically seen with Sydenham
chorea.
A 12-month-old girl presents with her parents after a 3-day history of
intermittent episodes of strange behavior. A neurologist is consulted
because the parents are concerned she is having some form of seizure
activity. Her health history includes 2 episodes of otitis media, but she
is otherwise healthy. Her initial vital signs and physical exam by the
emergency room staff are all normal.
Question
What description of the infant's strange behavior would lead the
neurologist to suspect a diagnosis of simple partial seizures?
Answer Choices
1 Facial and right arm twitching lasting about a minute, then loss of
consciousness
2 Blank stare and impaired awareness for 10-20 seconds
3 Eye deviation with facial twitching that lasts 1-2 minutes
A 1-year-old boy presents with increasing lethargy. He is barely
responsive, and his parents deny any trauma or injury. What is the
most common cause of nontraumatic altered levels of consciousness?
Answer Choices
1 Seizure disorder
2 Diabetic ketoacidosis
3 Inborn errors of metabolism
4 Toxic ingestion
5 Infection
ANS:5 - ✔✔infection
Awareness of self and the surrounding environment or consciousness
may be altered into different abnormal states of consciousness.
Consciousness can shift from loss of clear thinking or confusion,
usually accompanied by disorientation, to delirium, a succession of
confused and unconnected ideas manifested in children as extreme
mental and motor excitement, to lethargy, a profound type of
slumber where movement or speech is limited, to stupor or deep
sleep where arousal is achieved only by repeated vigorous stimuli,
finally to coma, unresponsiveness to even painful stimuli. Non-
traumatic coma is most common in infants and toddlers with another
smaller peak of occurrence in adolescence. The most common cause
of non-traumatic altered level of consciousness in children is infection
of either the brain (encephalitis), meninges (meningitis), or both;
infections account for more than 1/3 of cases.
,Prolonged seizures, anticonvulsive therapy, and postictal states can
also lead to altered levels of consciousness.
The most common metabolic cause of alteration of consciousness is
diabetic ketoacidosis, which can occur at any age, but is most
common in adolescence. Caused by severe insulin deficiency,
hyperglycemia and ketogenesis lead initially to polyuria, polydipsia,
hyperpnea, vomiting, and abdominal pain. As the process progresses,
hyperosmolar dehydration and acid/base and electrolyte disturbances
occur. Advanced stages alter level of consciousness and can lead to
coma.
Alterations of consciousness due to inborn errors of metabolism that
present with electrolyte and glucose abnormalities typically present in
infancy. The availability of gluconeogenic precursors or the functions
of the enzymes required for production of hepatic glucose are
affected. Metabolic defects causing hypoglycemia include glycogen
storage d
A 10-year-old boy is referred to you for being fidgety at school,
though he makes good grades. Prior history is unremarkable, and
there has been no recent illness. The father had a similar history as a
child. While speaking with the patient, you notice that he clears his
throat several times per minute. Examination is otherwise normal,
except for rapid, nonrhythmic jerking movements of the face, neck,
and shoulders while at rest.
,Question
What is true of this patient's case?
Answer Choices
1 Does not have Tourette syndrome due to the absence of coprolalia
2 Has a factitious disorder
3 Has a condition that clusters in families
4 Must start a regimen of levodopa
5 Suffers from Sydenham chorea - ✔✔Has a condition that clusters in
families
The combination of vocal tics (here, throat clearing) and motor tics
should suggest Gilles de la Tourette (Tourette) syndrome, which is a
common tic disorder that clusters in families. Once thought to be a
single gene, autosomal dominant condition, it appears that multiple
genes and nongenetic factors may be at play.
Coprolalia is but one of many vocal tics seen in Tourette syndrome
(throat clearing, humming, whistling) and, although a notorious one,
is not a necessary feature.
, The positive family history makes it unlikely that the condition
described is factitious.
Pimozide, SSRIs, and other agents have been used in the treatment of
Tourette syndrome, but levodopa is not used.
The movement disorder of Sydenham chorea, as seen after a
streptococcal infection, is choreiform - that is, tends to be slower and
rhythmic, as opposed to the rapid, nonrhythmic jerks seen in Tourette
syndrome. Also, vocal tics are not typically seen with Sydenham
chorea.
A 12-month-old girl presents with her parents after a 3-day history of
intermittent episodes of strange behavior. A neurologist is consulted
because the parents are concerned she is having some form of seizure
activity. Her health history includes 2 episodes of otitis media, but she
is otherwise healthy. Her initial vital signs and physical exam by the
emergency room staff are all normal.
Question
What description of the infant's strange behavior would lead the
neurologist to suspect a diagnosis of simple partial seizures?
Answer Choices
1 Facial and right arm twitching lasting about a minute, then loss of
consciousness
2 Blank stare and impaired awareness for 10-20 seconds
3 Eye deviation with facial twitching that lasts 1-2 minutes
