NR 603 WEEK 1 COMPLETE ALL POSSIBLE QUESTIONS AND VERIFIED ANSWERS WITH RATIONALES 2024 VERSION

NR 603 WEEK 1
COMPLETE ALL
POSSIBLE
QUESTIONS AND
VERIFIED
ANSWERS WITH
RATIONALES
2024 VERSION
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 - ANSWER-infection
RationaleAwareness 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 44-year-old man starts to notice that his eyelids are drooping.
Some time afterwards, his jaw becomes weak. He has difficulty
swallowing and also experiences weakness in his limbs. He is
quite embarrassed when he eats because he must use his hand
to help support his jaw. His weakness gets progressively worse.
Finally, he seeks medical attention. His physical examination
demonstrates the weakness in his limbs; however, no sensory
defects are present. A Tensilon test is done and is positive. His
doctor is concerned about an associated malignancy. What is
the underlying pathology of this disease?
Answer Choices
1 Inhibition of acetylcholine release
2 Blockage of the sodium channels
3 Demyelination
4 Subacute combined degeneration of the spinal cord
5 Antibodies to the acetylcholine receptor
ANS: 5 - ANSWER-5 Antibodies to the acetylcholine receptor
RationaleAntibodies directed towards the acetylcholine receptor at the
neuromuscular junction are seen with myasthenia gravis.
This man has myasthenia gravis. Ocular muscle weakness,
ptosis, dysphagia, and limb weakness can all be seen with
myasthenia gravis. When the initial symptom is ocular
weakness, Eaton Lambert Syndrome is extremely unlikely.
Eaton Lambert Syndrome tends to not involve the extra-ocular
muscles or the muscles involving chewing, swallowing, or
speech.
The Tensilon test is used in the diagnosis of myasthenia gravis.
The Tensilon test consists of the administration of
edrophonium. Edrophonium is a quick acting
anticholinesterase.
Thymic tumors are associated with myasthenia gravis. Thymic
tumors are also referred to as thymomas. Approximately 10 -
15% of patients with myasthenia gravis have an associated
thymoma. The majority of patients with myasthenia gravis have
hyperplasia of their thymus.
Botulinum toxin inhibits acetylcholine release. The site of action
is at the neuromuscular junction. Botulinum toxin is an
enterotoxin produced by Clostridium botulinum. Botulism can
result from incorrectly canned foods.
Tetrodotoxin is a toxin produced by puffer fish. The sodium
channels are blocked by tetrodotoxin. The blockage of the
sodium channels interferes with the inflow of sodium. As a
result, the propagation of nerve and muscle action potentials is
affected.
Demyelination refers to the loss of myelin around the axon.
Several disorders result in demyelination. An example of a
demyelinating disease is multiple sclerosis.
Subacute combined degeneration of the spinal cord is also
called combined systems disease. Subacute combined
degeneration of the spinal cord is a neuropathy secondary to
B12 deficiency. It is seen in patients with pernicious anemia,
especially p
A 74-year-old man presents after his wife witnessed him grab
his head in pain and fall to the floor.