Which symptoms are associated with focal impaired awareness seizures?
Generalized muscle stiffening.
Loss of consciousness.
Dreamlike state.
Emotional changes.
Automatisms.
Correct Answer : C,D,E
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
The setting-sun sign is a clinical finding where the infant's eyes appear to be driven downward, with the sclera visible above the iris, resembling the sun setting below the horizon. This is highly indicative of hydrocephalus as the increased intracranial pressure (ICP) presses on the midbrain tectum, causing paralysis of upward gaze.
Choice B rationale
A high-pitched, shrill cry is a non-specific sign of neurological distress and is often associated with increased intracranial pressure (ICP). While it can occur with hydrocephalus, it is a less specific and less consistent finding than the setting-sun sign, which directly reflects the mechanical pressure effects on the oculomotor and associated midbrain structures.
Choice C rationale
A sunken or depressed fontanel is a classic sign of dehydration or hypovolemia due to decreased intracranial volume. Conversely, an infant with hydrocephalus, characterized by excessive cerebrospinal fluid accumulation, will typically present with a bulging, tense, and non-pulsatile anterior fontanel due to the severely elevated intracranial pressure.
Choice D rationale
Normal head circumference would be an unexpected finding in an infant with significant, uncompensated hydrocephalus. The defining clinical feature in infants is the rapid and often exaggerated increase in head circumference (macrocephaly), as the cranial sutures are not yet fused, allowing the head to expand markedly to accommodate the accumulating cerebrospinal fluid and rising pressure.
Correct Answer is ["A","C","E"]
Explanation
Choice A rationale
Drooling is a hallmark sign of epiglottitis because the severe inflammation and swelling of the epiglottis make swallowing extremely painful. The child is reluctant to swallow their saliva, which pools in the mouth and causes characteristic drooling, indicating a critical impending airway obstruction.
Choice B rationale
A barking cough, often described as a "seal-like" cough, is the classic presentation of croup (laryngotracheobronchitis), which involves subglottic inflammation. Epiglottitis, in contrast, primarily involves supraglottic inflammation, leading to a blocked, or muffled, vocalization rather than the resonant, inspiratory stridor and cough of croup.
Choice C rationale
A muffled or "hot potato" voice is highly suggestive of epiglottitis. The swollen epiglottis and surrounding supraglottic structures impede the air column and vocal cord vibration, altering the quality of speech but allowing air to pass, unlike the near-complete aphonia seen in other laryngeal obstructions.
Choice D rationale
Wheezing is a high-pitched whistling sound typically heard on expiration, caused by the narrowing of the lower airways (bronchi/bronchioles), common in conditions like asthma or bronchiolitis. Epiglottitis is a supraglottic obstruction, manifesting predominantly as inspiratory stridor, not wheezing.
Choice E rationale
The tripod position (sitting upright, leaning forward with the neck hyperextended and chin thrust out) is adopted by children with epiglottitis to maximize the patency of the swollen airway and facilitate breathing. This is a sign of significant respiratory distress and impending airway failure.
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