NR 603 MIDTERM EXAM
NR 603 MIDTERM EXAM LATEST 2025/2026 ACTUAL EXAM COMPLETE
QUESTIONS AND CORRECT ANSWERS WITH DETAILED RATIONALES
GRADED A+ GUARANTEED PASS- ACE YOUR EXAM
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 - Correct Answer-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.
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, NR 603 MIDTERM EXAM
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
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, NR 603 MIDTERM EXAM
4 Subacute combined degeneration of the spinal cord
5 Antibodies to the acetylcholine receptor
ANS: 5 - Correct Answer-5 Antibodies to the acetylcholine receptor
Antibodies 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.
3|Page
, NR 603 MIDTERM EXAM
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 75-year-old man is involved in a motor vehicle accident and strikes his forehead
on the windshield. He complains of neck pain and severe burning in his shoulders
and arms. His physical examination reveals weakness of his upper extremities.
What type of spinal cord injury does this patient have?
A anterior cord syndrome
B central cord syndrome
C Brown-Séquard syndrome
D complete cord transection
E cauda equina syndrome
ANS: B - Correct Answer-Central Cord Syndrome
the central cord syndrome involves loss of motor function that is more severe in
the upper extremities than in the lower extremities, and is more severe in the
4|Page
NR 603 MIDTERM EXAM LATEST 2025/2026 ACTUAL EXAM COMPLETE
QUESTIONS AND CORRECT ANSWERS WITH DETAILED RATIONALES
GRADED A+ GUARANTEED PASS- ACE YOUR EXAM
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 - Correct Answer-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.
1|Page
, NR 603 MIDTERM EXAM
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
2|Page
, NR 603 MIDTERM EXAM
4 Subacute combined degeneration of the spinal cord
5 Antibodies to the acetylcholine receptor
ANS: 5 - Correct Answer-5 Antibodies to the acetylcholine receptor
Antibodies 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.
3|Page
, NR 603 MIDTERM EXAM
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 75-year-old man is involved in a motor vehicle accident and strikes his forehead
on the windshield. He complains of neck pain and severe burning in his shoulders
and arms. His physical examination reveals weakness of his upper extremities.
What type of spinal cord injury does this patient have?
A anterior cord syndrome
B central cord syndrome
C Brown-Séquard syndrome
D complete cord transection
E cauda equina syndrome
ANS: B - Correct Answer-Central Cord Syndrome
the central cord syndrome involves loss of motor function that is more severe in
the upper extremities than in the lower extremities, and is more severe in the
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