Which of the following is an early sign of respiratory distress in an infant?

Choice A rationale

Generalized muscle stiffening, or tonic posturing, is characteristic of tonic-clonic seizures, which involve both cerebral hemispheres and typically include a tonic phase of muscle rigidity followed by a clonic phase of rhythmic jerking. This is not a hallmark of focal impaired awareness seizures.

Choice B rationale

Complete loss of consciousness, meaning unresponsiveness to external stimuli, is characteristic of generalized seizures affecting both hemispheres from the onset. Focal impaired awareness seizures involve a change or impairment of consciousness, not necessarily a complete loss, hence the term "impaired awareness.”.

Choice C rationale

A dreamlike state, often described as déjà vu, fear, or a sense of unreality, is a common experiential alteration that can occur during the onset (aura) or ictal phase of a focal impaired awareness seizure, originating typically from the temporal lobe.

Choice D rationale

Sudden, unprovoked emotional outbursts such as fear, anxiety, or laughing (gelastic seizures) are frequently observed manifestations of focal seizures, especially those originating in the limbic system structures like the amygdala within the temporal lobe, reflecting the seizure's impact on emotional processing centers.

Choice E rationale

Automatisms are involuntary, repetitive, non-purposeful behaviors such as lip smacking, chewing, fidgeting, or walking that occur when a person's awareness is impaired during a seizure. They reflect the focal discharge interfering with cortical control over subcortical motor programs.

Coarctation of the aorta is a congenital heart defect characterized by a narrowing of the aortic lumen, typically distal to the left subclavian artery. This narrowing creates an obstruction to blood flow, resulting in increased proximal pressure (upper extremities, head) and decreased distal pressure (lower extremities). Consequently, pulses and blood pressure are stronger in the arms than in the legs due to the mechanical obstruction limiting adequate systemic perfusion beyond the narrowed segment. Choice False rationale:

The assertion is inaccurate because coarctation, a stricture of the aorta, significantly impedes systemic blood flow to the distal body. The pressure gradient created across the narrowing causes the blood pressure and pulse amplitude to be significantly higher and stronger in the vessels proximal to the coarctation (upper body) and notably diminished in the vessels distal to the coarctation (lower body).