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You are the nurse assessing a 16-year old girl who is the star of her high school's gymanstics team who is admitted to the hospital for fatigue and weakness. You examine her and notice that she appears hypovolemic, her hair appears thin and brittle, her parotid glands appear swollen, her knuckles have excoriations, and her teeth appear slightly yellow. You suspect that she most likely suffers from which of the following?
The correct answer is bulimia nervosa.
Bulimia nervosa is an eating disorder in which a patient classically consumes large amounts of food (binge eating) and then induces vomiting (purge behavior) to expel the food prior to absorption in the gastrointestinal tract. As such, the patient restricts their ability to gain weight. Patients with bulimia nervosa are frequently successful, high-achieving individuals under a great deal of stress, and often may be adolescent athletes, as patients in this population frequently have specific weight cutoffs that they must achieve for their respective sports/activities. Some signs of bulimia nervosa, as exhibited by this patient, are thin, brittle hair, a hypovolemic appearance (due to frequent vomiting), excoriations on the knuckles (from self-inducing vomiting with their hands), yellow discoloration of the teeth (from the acidity of vomitus), and swelling of the parotid glands (colloquially known as "chipmunk cheeks") as a response to the frequent vomiting. Patients with bulimia may also use other methods to purge themselves of food and drinks including diuretic use, and/or laxative use.
A key distinction between bulimia nervosa and anorexia nervosa is that in bulimia the patient exhibits a form of purge behavior following binge eating, whereas in anorexia, classically, the patient simply restricts eating rather than binging and purging.
Hypothyroidism is not a correct answer choice because while this patient is exhibiting lethargy, weakness, and brittle hair, given the constellation of her other symptoms and exam findings, it is less consistent with her presentation than bulimia nervosa. If these symptoms persisted following treatment for bulimia, then hypothyroidism could be considered as a concurrent finding.
Exogenous use of testosterone would not account for the symptoms seen in this patient.
Marfan's syndrome would also not account for the symptoms seen in this patient.
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What is the prognosis with Bell's palsy?
In the vast majority of cases Bell's palsy resolves within 1-6 months without medical intervention. Moistening of the affected eye (rather than nerve resection) is required during this period to prevent corneal damage. There is very little risk of permanent paralysis or loss of taste.
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All of the following are common etiologies of seizure disorders except __________.
The most common causes of seizures include brain injury or tumor, genetic predisposition, medications, and infections such as meningitis. While marijuana may be a trigger for sensitive individuals with seizure disorders, it has not been known to cause seizures in a non-epileptic individual and has shown to reduce seizure incidence in some individuals with this condition when used in a medical setting.
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All of the following medications are considered first-line treatments of absence seizures except __________.
The most commonly prescribed medication for absence seizures is Ethosuximide. Lamotrigine and valproic acid may also be used if seizures are unable to be controlled with ethosuximide. Carbamazepine, a common medication prescribed for simple and complex partial seizures, is specifically contraindicated in absence seizures.
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Which artery is most commonly involved in ischemic stroke?
The most common artery occluded in ischemic stroke is the middle cerebral artery, which supplies a large percentage of the frontal lobe and the lateral surface of the temporal and parietal lobes. Occlusion of this artery affects the motor and sensory areas of the face, throat, arm, hand and the areas for speech.
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A 50-year-old female client recently diagnosed with multiple sclerosis, presents to the clinic after having a history of several neurological symptoms and is asking the nurse about her condition. The nurse is glad to teach the client about multiple sclerosis.
Which of the following statements about multiple sclerosis is correct?
Multiple sclerosis is an autoimmune process with no exact known cause. The myelin sheath is attacked and plaque formation occurs in various regions of the CNS. Without myelin, nerve conduction slows down and may eventually be completely blocked leading to widespread loss of function.
Loss of the dopamine-producing neurons describes Parkinson's disease. Excess dopamine describes dementia. Deficiency of acetylcholine describes Huntington's disease, and the autoimmune disease of the neuromuscular junction is known as Myasthenia Gravis.
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Which of the following classes of medication is not used for treatment of migraine headaches?
Migraine headaches are commonly treated at first by over the counter (OTC) medications such as NSAIDS and acetaminophen. Other treatment options include triptans, antidepressants such as amitriptyline, and anti-hypertensives (beta blockers and calcium channel blockers).
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Which of the following herbs has been shown to be effective in prevention of migraine symptoms?
Petasites hybridus (butterbur) is a flowering plant of the family asteraceae. It has been shown in studies to reduce the frequency of migraine headaches by as much as 68%. None of the other herbs listed have any significant medicinal benefit in migraine headaches.
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Which of the following interventions has been shown to be effective in reducing the severity of pain in cluster headaches?
One non-pharmaceutical intervention that has shown to provide relief for a significant number of individuals with cluster headaches is 100% oxygen, delivered via mask at a minimum of 12 liters per minute. Relief can be felt in as little as 15 minutes. None of the other interventions mentioned would be likely to improve symptoms of a cluster headache.
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Bell's palsy is due to dysfunction of which of the following cranial nerves?
Bell's palsy is due to dysfunction of cranial nerve VII, the facial nerve. The facial nerve provides motor control to the musculature of the face and sensory innervation of taste, facial sensation, and parasympathetic innervation of the submandibular and sublingual glands.
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Bell's palsy is associated with infection by which of the following pathogens?
While Bell's palsy is most frequently associated with prior infection with herpes simplex 1, is may also be associated with cytomegalovirus, Epstein Barr virus, and herpes zoster.
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A patient is hospitalized for alcohol withdrawal and is started on medication to prevent complications from withdrawal. Which type of medication is used to attenuate the possibility of seizures during this hospitalization?
Benzodiazepines are the mainstay of treatment for alcohol withdrawal. Anti-epileptic drug (AEDs) are not to be used during alcohol withdrawal, and are reserved for patients who have a true seizure disorder. The Clinical Institute Withdrawal Assessment for Alcohol (CIWA) protocol is used as symptom based therapy with benzodiazepines to prevent seizures and other complications from withdrawal.
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Which of the following is the first-line treatment for cauda equina syndrome?
Cauda equina syndrome is a serious condition in which the cauda equina is disturbed within the spinal cord, generally due to impingement, trauma, local lesion, or compression. The first-line treatment is surgical decompression. Neither physiotherapy nor muscle relaxants would address the cause of this condition, and chiropractic manipulation may actually exacerbate the symptoms.
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What is the most common cranial mononeuropathy in diabetic patients?
Third nerve palsy (cranial nerve III, the oculomotor nerve) is the most common cranial mononeuropathy seen in diabetic patients. They will present with ptosis, dilated and fixed pupils, and an outward and slightly downward deviation of the eye. Bell's palsy involves unilateral facial paralysis as a result of damage to the facial nerve (cranial nerve VII). Cranial mononeuropathy VI is caused by damage to the abducens nerve (cranial nerve VI). Signs of damage include inability to laterally rotate the eye and/or double vision. Auditory neuropathy may be a result of damage to the vestibulocochlear nerve (cranial nerve VIII); the most pronounced symptom is loss of audition.
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A 62-year-old male client is admitted to the hospital with acute pancreatitis. The client has a well-established history of alcohol abuse. The nurse caring for this client is aware he may exhibit withdrawal symptoms during the inpatient course.
The nurse's plan of care for this client should include assessment for all the following symptoms of alcohol withdrawal except?
The symptoms of alcohol withdrawal may include confusion, disorientation, and anxiety. Hypersomnolence or excessive sleep is not associated with this condition. Additional symptoms may include agitation, hypervigilance, tremor, rapid and irregular heart beat, hypertension, seizure, and hallucinations (mostly visual).
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What condition is described by the following: A defect of copper excretion, leading to copper overload and feedback inhibition of ceruloplasmin synthesis?
Wilson's disease is characterized by a defect of copper excretion, leading to copper overload and feedback inhibition of ceruloplasmin synthesis. This results in copper accumulation, primarily in the liver and the brain. Signs and symptoms include liver failure, cognitive deterioration, clumsiness, and changes in behavior. Symptoms often start in adolescence, but can start any time between 6-20 years old. Aceruloplasminemia is a rare condition of iron accumulation in the basal ganglia, retina, and liver. Hereditary hemochromatosis is also a disorder of iron accumulation, often caused by mutations in the HFE gene. Huntington disease is a genetic neurodegenerative disease unrelated to any mineral storage disorders.
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What is the most common cause of meningitis?
All of the answers given are possible causes of meningitis, but the most common (and least severe) etiology is viral. There is no vaccine for viral meningitis, but there are vaccines for three different organisms that cause bacterial meningitis:
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Approximately 80% of strokes are of what type?
Approximately 80% of strokes are ischemic, either caused by thrombus or emboli. Hemorrhagic strokes only account for approximately 15% of all strokes, but are significantly more lethal and account for 30% of all stroke deaths. They involve the rupturing of a weakened blood vessel in the brain and subsequent bleeding in the surrounding areas. Transient ischemic attacks are not considered true strokes, and are often referred to as "mini strokes."
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Which of the following is the most common etiology of intracerebral hemorrhagic stroke?
Hypertension is a leading etiology in intracerebral hemorrhagic stroke. Chronic hypertension can cause damage and stress to the blood vessel wall, leading to aneurism or increased risk of spontaneous rupture.
AVM, trauma, and medications such as blood thinners are all also responsible for a significant (though lesser) number of hemorrhagic strokes, or may be co-morbidities that increase the risk of a rupture in the presence of prolonged hypertension.
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A client has a history of spinal injury and the nurse is evaluating the client with the onset of new symptoms. The symptoms include hypertension, a throbbing headache, a slow heart rate of 40 beats per minute, and piloerection.
The nurse recognizes these symptoms are consistent with what disorder?
These symptoms are evidence of autonomic dysreflexia, which is a sequela of spinal shock. It is a medical emergency and requires immediate intervention as it may lead to stroke, cardiac arrest, coma or death if untreated.
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