NR,.603,.Week,.1,.APEA,.Predictor,.Exam,.Review,.Questions,.&,.
Answers
NR 603 WEEK 1 APEA PREDICTOR EXAM REVIEW
QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES 2025 LATEST UPDATE// ALREADRY
GRADED A+
A,.75-year-
old,.man,.is,.involved,.in,.a,.motor,.vehicle,.accident,.and,.strikes,.his,.forehead,.on,.the,.windshield.,.He,.complain
s,.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
Central,.Cord,.Syndrome
the,.central,.cord,.syndrome,.involves,.loss,.of,.motor,.function,.that,.is,.more,.severe,.in,.the,.upper,.extremi
ties,.than,.in,.the,.lower,.extremities,,.and,.is,.more,.severe,.in,.the,.hands.,.There,.is,.typically,.hyperesthesia,.
over,.the,.shoulders,.and,.arms.,.Anterior,.cord,.syndrome,.presents,.with,.paraplegia,.or,.quadriplegia,,.loss,
.of,.lateral,.spinothalamic,.function,.with,.preservation,.of,.posterior,.column,.function.,.Brown-
Séquard,.syndrome,.consists,.of,.weakness,.and,.loss,.of,.posterior,.column,.function,.on,.one,.side,.of,.the,.b
ody,.distal,.to,.the,.lesion,.with,.contralateral,.loss,.of,.lateral,.spinothalamic,.function,.one,.to,.two,.levels,.b
elow,.the,.lesion.,.Complete,.cord,.transection,.would,.affect,.motor,.and,.sensory,.function,.distal,.to,.the,.le
sion.,.Cauda,.equina,.syndrome,.typically,.presents,.as,.low,.back,.pain,.with,.radiculopathy.
A,.37-year-
old,.man,.fell,.from,.a,.ladder,.as,.he,.finished,.hanging,.the,.Christmas,.lights,.on,.his,.house.,.The,.right,.side,.
of,.his,.head,.hit,.the,.alley,.cement,,.and,.he,.lost,.consciousness,.for,.about,.1,.minute;,.he,.woke,.up,.with,.a,
.headache,,.but,.he,.had,.no,.other,.complaints.,.A,.few,.hours,.later,,.the,.patient,.is,.brought,.to,.the,.emerg
ency,.room,.by,.his,.neighbor,.because,.of,.an,.intense,.headache,,.confusion,,.and,.left,.hand,.hemiparesis.,.
On,.examination,,.the,.patient,.has,.a,.bruise,.located,.over,.the,.right,.temporal,.region,,.mydriasis,,.and,.rig
ht,.deviation,.of,.the,.right,.eye,,.papilledema,,.and,.left,.extensor,.plantar,.response.,.An,.emergency,.CT,.sca
n,.of,.the,.head,.without,.contrast,.reveals,.a,.lens-shaped,.hyper-
density,.under,.the,.right,.temporal,.bone,.with,.mass,.effect,.and,.edema.,.What,.is,.the,.most,.likely,.diagno
sis?
Answer,.Choices
1 Epidural,.hematoma
2 Subdural,.hematoma
3 Subarachnoid,. hemorrhage
, NR,.603,.Week,.1,.APEA,.Predictor,.Exam,.Review,.Questions,.&,.
Answers
4 Intracerebral,.parenchymal,.hemorrhage
5 Acute,.meningitis,.ANS:,.1
Epidural,.Hematoma
Epidural,.hematoma,.most,.often,.results,.from,.a,.traumatic,.tear,.of,.the,.middle,.meningeal,.artery.,.Althou
gh,.a,.lucid,.interval,.ranging,.from,.minutes,.to,.hours,.followed,.by,.altered,.mental,.status,.and,.focal,.defici
ts,.is,.typical,.for,.epidural,.hematoma,,.this,.clinical,.picture,.is,.only,.encountered,.in,.up,.to,.1/3,.of,.the,.pat
ients.,.The,.collection,.of,.blood,.between,.the,.skull,.and,.dura,.mater,.causes,.an,.evident,.mass,.effect,.wit
h,.ophthalmic,.nerve,.palsy,.and,.the,.contralateral,.hemiparesis.,.Surgical,.evacuation,.of,.the,.clot,.via,.burr
,.holes,.is,.the,.treatment,.of,.choice.
Subdural,.hematoma,.results,.from,.a,.traumatic,.rupture,.of,.the,.bridging,.veins,.that,.connect,.the,.cerebru
m,.to,.the,.venous,.sinuses,.within,.the,.dura.,.This,.venous,.hemorrhage,.will,.result,.in,.a,.gradual,.increase,.
of,.the,.hematoma,,.with,.a,.progressive,.clinical,.picture,.over,.days,.or,.weeks.,.The,.CT,.scan,.will,.show,.a,.c
oncave,,.crescent-shaped,.hyper-density,.compared,.to,.the,.convex,,.lens-shaped,.hyper-
density,.in,.epidural,.hematoma.
Subarachnoid,.hemorrhage,.is,.the,.result,.of,.an,.aneurysm,.rupture;,.the,.most,.common,.is,.the,.congenital
,.berry,.aneurysm.,.The,.clinical,.picture,.is,.of,.a,.sudden,,.severe,.headache,.with,.meningeal,.irritation.,.A,.CT
,.scan,.will,.show,.blood,.in,.the,.subarachnoid,.space,,.and,.a,.lumbar,.puncture,.will,.reveal,.xanthochromia,.
CSF.
Intracerebral,.parenchymal,.hemorrhage,.is,.most,.likely,.caused,.by,.hypertension,.complicated,.with,.Char
cotBouchard,.aneurysms.,.The,.blood,.accumulates,.into,.the,.brain,.substance,.and,.most,.commonly,.involv
es,.the,.basal,.ganglia.
Acute,.meningitis,.is,.not,.associated,.with,.trauma.,.Fever,.and,.signs,.of,.meningeal,.irritation,.dominate,.the
,.clinical,.picture.,.Lumbar,.puncture,,.indicated,.if,.there,.are,.no,.focal,.neurological,.signs,.on,.clinical,.exam
ination,,.will,.be,.the,.diagnostic,.procedure.,.The,.CT,.scan,.of,.the,.patient,.presented,.in,.this,.case,.is,.chara
cteristic,.for,.epidural,.hematoma,,.and,.there,.is,.no,.indication,.for,.a,.lumbar,.puncture.
A,.31-year-
old,.woman,.presents,.with,.a,.purpural,.rash,.covering,.her,.arms,,.legs,,.and,.abdomen.,.She,.also,.has,.fever
,,.chills,,.nausea,,.abdominal,.tenderness,,.tachycardia,,.and,.generalized,.myalgias.,.Prior,.to,.the,.developm
ent,.of,.the,.rash,,.the,.patient,.noted,.that,.she,.had,.a,.headache,,.cough,,.and,.sore,.throat.,.Laboratory,.stud
ies,.were,.positive,.for,.Gram-
negative,.diplococci,.in,.the,.blood,,.along,.with,.thrombocytopenia,.and,.an,.elevation,.in,.PMNs.,.Urinalysis,.
showed,.blood,,.protein,,.and,.casts.,.Vital,.signs,.are,.as,.follows:,.PB,.92/66,,.P,.96,,.RR,.14,,.T,.39.,.The,.patien
t,.denies,.any,.foreign,.travel,.and,.does,.not,.have,.any,.sick,.contacts.,.However,,.she,.does,.work,.part,.time,
.as,.a,.nurse,.in,.a,.local,.hospital.
Question
The,.patient,.is,.diagnosed,.with,.Meningococcemia;,.she,.is,.admitted,.to,.the,.hospital,.and,.placed,.in,.respi
ratory,.isolation.,.What,.major,.course,.of,.therapy,.should,.this,.patient,.receive?
Answer,.Choices
, NR,.603,.Week,.1,.APEA,.Predictor,.Exam,.Review,.Questions,.&,.
Answers
1 Steroids
2 Supportive,.care
3 Antibiotics
4 Transfusion
5 Bactericidal/permeability-increasing, . protein
ANS:3
Antibiotics
Antibiotics,.are,.the,.treatment,.of,.choice,.for,.meningococcemia.,.The,.preferred,.drug,.for,.active,.infection,
.is,.penicillin,.G.,.For,.those,.allergic,.to,.penicillin,,.chloramphenicol,.and,.cephalosporins,.(ie,,.cefotaxime,,.c
efuroxime),.may,.be,.used,.as,.alternatives.
Patients,.will,.also,.receive,.supportive,.care,,.but,.antibiotic,.therapy,.must,.be,.initiated,.quickly,.if,.the,.patie
nt,.is,.to,.survive.,.Intensive,.care,.placement,.may,.be,.necessary,.if,.organ,.failure,.is,.imminent.,.Ventilatory,
.support,,.inotropic,.support,,.and,.IV,.fluids,.are,.necessary,.in,.some.,.If,.adrenal,.insufficiency,.occurs,,.corti
costeroid,.replacement,.may,.be,.considered.,.A,.central,.venous,.line,.helps,.to,.provide,.large,.amounts,.of,.
volume,.expanders,.and,.inotropic,.medications,.for,.adequate,.tissue,.perfusion.
Steroids,.have,.not,.been,.shown,.to,.play,.a,.major,.role,.in,.the,.treatment,.of,.meningococcemia.,.However,,
.they,.have,.been,.used,.in,.addition,.to,.antibiotic,.therapy.,.In,.the,.case,.of,.adrenal,.insufficiency,,.for,.exa
mple,,.steroid,.replacement,.has,.been,.shown,.to,.be,.beneficial.
Transfusion,.does,.not,.generally,.play,.a,.major,.role,.in,.treatment.,.If,.the,.patient,.suffers,.from,.a,.devastating,.c
oagulopathy,,.blood,.or,.blood,.products,.may,.be,.replaced,.as,.necessary.
Bactericidal/permeability-
increasing,.protein,.is,.a,.protein,.stored,.in,.the,.granules,.of,.neutrophils.,.It,.binds,.to,.endotoxin,.in,.vitro,.an
d,.neutralizes,.it.,.This,.technique,.is,.experimental,,.and,.it,.is,.not,.used,.in,.everyday,.treatment,.of,.mening
ococcemia.
In,.myasthenia,.gravis,,.weakness,.is,.a,.result,.of,.insufficient,.acetylcholine,.transmission,.at,.the,.neuromu
scular,.junction;,.however,,.weakness,.can,.also,.occur,.with,.overdosing,.of,.the,.cholinergic,.medications,.u
sed,.to,.treat,.myasthenia.,.What,.symptom,.helps,.differentiate,.a,.myasthenic,.crisis,.from,.a,.cholinergic,.cr
isis?
Answer,.Choices
1 Respiratory,.failure
2 Bilateral,.ptosis
3 Muscle,.fasciculations
4 Diplopia
5 Normal,.muscle,.stretch,.reflexes
, NR,.603,.Week,.1,.APEA,.Predictor,.Exam,.Review,.Questions,.&,.
Answers
ANS:,.3
Muscle,.Fasiculations
Signs,.of,.cholinergic,.overdosage,.include,.muscle,.fasciculation,,.rhinorrhea,,.lacrimation,,.salivation,,.incr
eased,.bronchial,.secretions,,.nausea,,.or,.diarrhea.,.The,.presence,.of,.any,.of,.these,.suggests,.that,.the,.pa
tient's,.weakness,.may,.be,.due,.to,.cholinergic,.crisis.,.The,.other,.signs,.are,.due,.to,.weakness,.and,.can,.occ
ur,.in,.either,.condition.
A,.54-year-
old,.man,.presents,.after,.having,.a,.generalized,.seizure.,.The,.patient,.is,.HIV,.positive,,.but,.he,.has,.been,.u
nable,.to,.afford,.antiretroviral,.therapy,.since,.losing,.his,.job,.2,.years,.ago.,.Other,.than,.cachexia,,.the,.phys
ical,.exam,.is,.unremarkable.,.Upon,.further,.inquiry,,.the,.patient,.also,.notes,.that,.he,.has,.become,.shortte
mpered,.and,.hypercritical;,.at,.times,,.he,.seems,.confused.,.An,.MRI,.of,.the,.brain,.is,.performed,,.and,.it,.rev
eals,.several,.cortical,.ring-enhancing,.lesions.
Question
What,.is,.the,.most,.likely,.diagnosis?,.An
swer,.Choices
1 AIDS,.dementia,.complex
2 Cryptococcal,.meningitis
3 Cytomegalovirus,.encephalitis
4 Progressive,.multifocal,.leukoencephalopathy
5 Toxoplasma,.encephalitis,.ANS:5
Toxoplasma,.encephalitis
The,.patient's,.symptoms,.and,.MRI,.findings,.are,.most,.consistent,.with,.the,.diagnosis,.of,.toxoplasma,.enc
ephalitis.,.Toxoplasmosis,.is,.the,.most,.common,.cerebral,.mass,.lesion,.among,.HIV-
positive,.patients.,.Infection,.with,.the,.Toxoplasma,.gondii,.parasite,.is,.relatively,.common,.and,.usually,.as
ymptomatic.
Reactivation,.occurs,.in,.HIV,.positive,.patients,.due,.to,.failing,.cellular,.immunity,,.and,.it,.causes,.a,.multifo
cal,.necrotizing,.encephalitis.,.Seizures,.may,.be,.the,.initial,.manifestation,.of,.central,.nervous,.system,.(CN
S),.infection;,.other,.common,.clinical,.manifestations,.include,.focal,.neurologic,.deficits,,.such,.as,.impaired
,.speech,.and,.hemiparesis.,.Personality,.change,,.lethargy,,.headache,,.and,.confusion,.are,.also,.observed.,.T
he,.MRI,.in,.patients,.with,.toxoplasma,.encephalitis,.characteristically,.reveals,.multiple,,.ring-
enhancing,.lesions,.with,.surrounding,.edema;,.these,.lesions,.usually,.occur,.bilaterally,.in,.the,.frontal,.and,.
parietal,.cortices.
AIDS,.dementia,.complex,.describes,.a,.constellation,.of,.cognitive,.symptoms,.seen,.among,.HIV,.positive,.p
atients.,.The,.condition,.occurs,.when,.HIV,.virus,.disseminates,.to,.the,.CNS.,.Within,.the,.CNS,,.the,.virus,.ten
ds,.to,.concentrate,.in,.the,.basal,.ganglia,.and,.subcortical,.regions.,.Symptoms,.include,.a,.constellation,.of,.
cognitive,,.behavioral,,.and,.motor,.disturbances,.that,.cause,.varying,.degrees,.of,.functional,.impairment.
Characteristic,.MRI,.findings,.include,.non-
enhancing,.white,.matter,,.cerebral,.atrophy,,.and,.ventricular,.enlargement.,.The,.diagnosis,.requires,.that,.othe
r,.central,.nervous,.system,.infections,,.carcinoma,,.as,.well,.as,.general,.medical,.conditions,.and,.substance,.abu
se,.have,.been,.excluded.
Answers
NR 603 WEEK 1 APEA PREDICTOR EXAM REVIEW
QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES 2025 LATEST UPDATE// ALREADRY
GRADED A+
A,.75-year-
old,.man,.is,.involved,.in,.a,.motor,.vehicle,.accident,.and,.strikes,.his,.forehead,.on,.the,.windshield.,.He,.complain
s,.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
Central,.Cord,.Syndrome
the,.central,.cord,.syndrome,.involves,.loss,.of,.motor,.function,.that,.is,.more,.severe,.in,.the,.upper,.extremi
ties,.than,.in,.the,.lower,.extremities,,.and,.is,.more,.severe,.in,.the,.hands.,.There,.is,.typically,.hyperesthesia,.
over,.the,.shoulders,.and,.arms.,.Anterior,.cord,.syndrome,.presents,.with,.paraplegia,.or,.quadriplegia,,.loss,
.of,.lateral,.spinothalamic,.function,.with,.preservation,.of,.posterior,.column,.function.,.Brown-
Séquard,.syndrome,.consists,.of,.weakness,.and,.loss,.of,.posterior,.column,.function,.on,.one,.side,.of,.the,.b
ody,.distal,.to,.the,.lesion,.with,.contralateral,.loss,.of,.lateral,.spinothalamic,.function,.one,.to,.two,.levels,.b
elow,.the,.lesion.,.Complete,.cord,.transection,.would,.affect,.motor,.and,.sensory,.function,.distal,.to,.the,.le
sion.,.Cauda,.equina,.syndrome,.typically,.presents,.as,.low,.back,.pain,.with,.radiculopathy.
A,.37-year-
old,.man,.fell,.from,.a,.ladder,.as,.he,.finished,.hanging,.the,.Christmas,.lights,.on,.his,.house.,.The,.right,.side,.
of,.his,.head,.hit,.the,.alley,.cement,,.and,.he,.lost,.consciousness,.for,.about,.1,.minute;,.he,.woke,.up,.with,.a,
.headache,,.but,.he,.had,.no,.other,.complaints.,.A,.few,.hours,.later,,.the,.patient,.is,.brought,.to,.the,.emerg
ency,.room,.by,.his,.neighbor,.because,.of,.an,.intense,.headache,,.confusion,,.and,.left,.hand,.hemiparesis.,.
On,.examination,,.the,.patient,.has,.a,.bruise,.located,.over,.the,.right,.temporal,.region,,.mydriasis,,.and,.rig
ht,.deviation,.of,.the,.right,.eye,,.papilledema,,.and,.left,.extensor,.plantar,.response.,.An,.emergency,.CT,.sca
n,.of,.the,.head,.without,.contrast,.reveals,.a,.lens-shaped,.hyper-
density,.under,.the,.right,.temporal,.bone,.with,.mass,.effect,.and,.edema.,.What,.is,.the,.most,.likely,.diagno
sis?
Answer,.Choices
1 Epidural,.hematoma
2 Subdural,.hematoma
3 Subarachnoid,. hemorrhage
, NR,.603,.Week,.1,.APEA,.Predictor,.Exam,.Review,.Questions,.&,.
Answers
4 Intracerebral,.parenchymal,.hemorrhage
5 Acute,.meningitis,.ANS:,.1
Epidural,.Hematoma
Epidural,.hematoma,.most,.often,.results,.from,.a,.traumatic,.tear,.of,.the,.middle,.meningeal,.artery.,.Althou
gh,.a,.lucid,.interval,.ranging,.from,.minutes,.to,.hours,.followed,.by,.altered,.mental,.status,.and,.focal,.defici
ts,.is,.typical,.for,.epidural,.hematoma,,.this,.clinical,.picture,.is,.only,.encountered,.in,.up,.to,.1/3,.of,.the,.pat
ients.,.The,.collection,.of,.blood,.between,.the,.skull,.and,.dura,.mater,.causes,.an,.evident,.mass,.effect,.wit
h,.ophthalmic,.nerve,.palsy,.and,.the,.contralateral,.hemiparesis.,.Surgical,.evacuation,.of,.the,.clot,.via,.burr
,.holes,.is,.the,.treatment,.of,.choice.
Subdural,.hematoma,.results,.from,.a,.traumatic,.rupture,.of,.the,.bridging,.veins,.that,.connect,.the,.cerebru
m,.to,.the,.venous,.sinuses,.within,.the,.dura.,.This,.venous,.hemorrhage,.will,.result,.in,.a,.gradual,.increase,.
of,.the,.hematoma,,.with,.a,.progressive,.clinical,.picture,.over,.days,.or,.weeks.,.The,.CT,.scan,.will,.show,.a,.c
oncave,,.crescent-shaped,.hyper-density,.compared,.to,.the,.convex,,.lens-shaped,.hyper-
density,.in,.epidural,.hematoma.
Subarachnoid,.hemorrhage,.is,.the,.result,.of,.an,.aneurysm,.rupture;,.the,.most,.common,.is,.the,.congenital
,.berry,.aneurysm.,.The,.clinical,.picture,.is,.of,.a,.sudden,,.severe,.headache,.with,.meningeal,.irritation.,.A,.CT
,.scan,.will,.show,.blood,.in,.the,.subarachnoid,.space,,.and,.a,.lumbar,.puncture,.will,.reveal,.xanthochromia,.
CSF.
Intracerebral,.parenchymal,.hemorrhage,.is,.most,.likely,.caused,.by,.hypertension,.complicated,.with,.Char
cotBouchard,.aneurysms.,.The,.blood,.accumulates,.into,.the,.brain,.substance,.and,.most,.commonly,.involv
es,.the,.basal,.ganglia.
Acute,.meningitis,.is,.not,.associated,.with,.trauma.,.Fever,.and,.signs,.of,.meningeal,.irritation,.dominate,.the
,.clinical,.picture.,.Lumbar,.puncture,,.indicated,.if,.there,.are,.no,.focal,.neurological,.signs,.on,.clinical,.exam
ination,,.will,.be,.the,.diagnostic,.procedure.,.The,.CT,.scan,.of,.the,.patient,.presented,.in,.this,.case,.is,.chara
cteristic,.for,.epidural,.hematoma,,.and,.there,.is,.no,.indication,.for,.a,.lumbar,.puncture.
A,.31-year-
old,.woman,.presents,.with,.a,.purpural,.rash,.covering,.her,.arms,,.legs,,.and,.abdomen.,.She,.also,.has,.fever
,,.chills,,.nausea,,.abdominal,.tenderness,,.tachycardia,,.and,.generalized,.myalgias.,.Prior,.to,.the,.developm
ent,.of,.the,.rash,,.the,.patient,.noted,.that,.she,.had,.a,.headache,,.cough,,.and,.sore,.throat.,.Laboratory,.stud
ies,.were,.positive,.for,.Gram-
negative,.diplococci,.in,.the,.blood,,.along,.with,.thrombocytopenia,.and,.an,.elevation,.in,.PMNs.,.Urinalysis,.
showed,.blood,,.protein,,.and,.casts.,.Vital,.signs,.are,.as,.follows:,.PB,.92/66,,.P,.96,,.RR,.14,,.T,.39.,.The,.patien
t,.denies,.any,.foreign,.travel,.and,.does,.not,.have,.any,.sick,.contacts.,.However,,.she,.does,.work,.part,.time,
.as,.a,.nurse,.in,.a,.local,.hospital.
Question
The,.patient,.is,.diagnosed,.with,.Meningococcemia;,.she,.is,.admitted,.to,.the,.hospital,.and,.placed,.in,.respi
ratory,.isolation.,.What,.major,.course,.of,.therapy,.should,.this,.patient,.receive?
Answer,.Choices
, NR,.603,.Week,.1,.APEA,.Predictor,.Exam,.Review,.Questions,.&,.
Answers
1 Steroids
2 Supportive,.care
3 Antibiotics
4 Transfusion
5 Bactericidal/permeability-increasing, . protein
ANS:3
Antibiotics
Antibiotics,.are,.the,.treatment,.of,.choice,.for,.meningococcemia.,.The,.preferred,.drug,.for,.active,.infection,
.is,.penicillin,.G.,.For,.those,.allergic,.to,.penicillin,,.chloramphenicol,.and,.cephalosporins,.(ie,,.cefotaxime,,.c
efuroxime),.may,.be,.used,.as,.alternatives.
Patients,.will,.also,.receive,.supportive,.care,,.but,.antibiotic,.therapy,.must,.be,.initiated,.quickly,.if,.the,.patie
nt,.is,.to,.survive.,.Intensive,.care,.placement,.may,.be,.necessary,.if,.organ,.failure,.is,.imminent.,.Ventilatory,
.support,,.inotropic,.support,,.and,.IV,.fluids,.are,.necessary,.in,.some.,.If,.adrenal,.insufficiency,.occurs,,.corti
costeroid,.replacement,.may,.be,.considered.,.A,.central,.venous,.line,.helps,.to,.provide,.large,.amounts,.of,.
volume,.expanders,.and,.inotropic,.medications,.for,.adequate,.tissue,.perfusion.
Steroids,.have,.not,.been,.shown,.to,.play,.a,.major,.role,.in,.the,.treatment,.of,.meningococcemia.,.However,,
.they,.have,.been,.used,.in,.addition,.to,.antibiotic,.therapy.,.In,.the,.case,.of,.adrenal,.insufficiency,,.for,.exa
mple,,.steroid,.replacement,.has,.been,.shown,.to,.be,.beneficial.
Transfusion,.does,.not,.generally,.play,.a,.major,.role,.in,.treatment.,.If,.the,.patient,.suffers,.from,.a,.devastating,.c
oagulopathy,,.blood,.or,.blood,.products,.may,.be,.replaced,.as,.necessary.
Bactericidal/permeability-
increasing,.protein,.is,.a,.protein,.stored,.in,.the,.granules,.of,.neutrophils.,.It,.binds,.to,.endotoxin,.in,.vitro,.an
d,.neutralizes,.it.,.This,.technique,.is,.experimental,,.and,.it,.is,.not,.used,.in,.everyday,.treatment,.of,.mening
ococcemia.
In,.myasthenia,.gravis,,.weakness,.is,.a,.result,.of,.insufficient,.acetylcholine,.transmission,.at,.the,.neuromu
scular,.junction;,.however,,.weakness,.can,.also,.occur,.with,.overdosing,.of,.the,.cholinergic,.medications,.u
sed,.to,.treat,.myasthenia.,.What,.symptom,.helps,.differentiate,.a,.myasthenic,.crisis,.from,.a,.cholinergic,.cr
isis?
Answer,.Choices
1 Respiratory,.failure
2 Bilateral,.ptosis
3 Muscle,.fasciculations
4 Diplopia
5 Normal,.muscle,.stretch,.reflexes
, NR,.603,.Week,.1,.APEA,.Predictor,.Exam,.Review,.Questions,.&,.
Answers
ANS:,.3
Muscle,.Fasiculations
Signs,.of,.cholinergic,.overdosage,.include,.muscle,.fasciculation,,.rhinorrhea,,.lacrimation,,.salivation,,.incr
eased,.bronchial,.secretions,,.nausea,,.or,.diarrhea.,.The,.presence,.of,.any,.of,.these,.suggests,.that,.the,.pa
tient's,.weakness,.may,.be,.due,.to,.cholinergic,.crisis.,.The,.other,.signs,.are,.due,.to,.weakness,.and,.can,.occ
ur,.in,.either,.condition.
A,.54-year-
old,.man,.presents,.after,.having,.a,.generalized,.seizure.,.The,.patient,.is,.HIV,.positive,,.but,.he,.has,.been,.u
nable,.to,.afford,.antiretroviral,.therapy,.since,.losing,.his,.job,.2,.years,.ago.,.Other,.than,.cachexia,,.the,.phys
ical,.exam,.is,.unremarkable.,.Upon,.further,.inquiry,,.the,.patient,.also,.notes,.that,.he,.has,.become,.shortte
mpered,.and,.hypercritical;,.at,.times,,.he,.seems,.confused.,.An,.MRI,.of,.the,.brain,.is,.performed,,.and,.it,.rev
eals,.several,.cortical,.ring-enhancing,.lesions.
Question
What,.is,.the,.most,.likely,.diagnosis?,.An
swer,.Choices
1 AIDS,.dementia,.complex
2 Cryptococcal,.meningitis
3 Cytomegalovirus,.encephalitis
4 Progressive,.multifocal,.leukoencephalopathy
5 Toxoplasma,.encephalitis,.ANS:5
Toxoplasma,.encephalitis
The,.patient's,.symptoms,.and,.MRI,.findings,.are,.most,.consistent,.with,.the,.diagnosis,.of,.toxoplasma,.enc
ephalitis.,.Toxoplasmosis,.is,.the,.most,.common,.cerebral,.mass,.lesion,.among,.HIV-
positive,.patients.,.Infection,.with,.the,.Toxoplasma,.gondii,.parasite,.is,.relatively,.common,.and,.usually,.as
ymptomatic.
Reactivation,.occurs,.in,.HIV,.positive,.patients,.due,.to,.failing,.cellular,.immunity,,.and,.it,.causes,.a,.multifo
cal,.necrotizing,.encephalitis.,.Seizures,.may,.be,.the,.initial,.manifestation,.of,.central,.nervous,.system,.(CN
S),.infection;,.other,.common,.clinical,.manifestations,.include,.focal,.neurologic,.deficits,,.such,.as,.impaired
,.speech,.and,.hemiparesis.,.Personality,.change,,.lethargy,,.headache,,.and,.confusion,.are,.also,.observed.,.T
he,.MRI,.in,.patients,.with,.toxoplasma,.encephalitis,.characteristically,.reveals,.multiple,,.ring-
enhancing,.lesions,.with,.surrounding,.edema;,.these,.lesions,.usually,.occur,.bilaterally,.in,.the,.frontal,.and,.
parietal,.cortices.
AIDS,.dementia,.complex,.describes,.a,.constellation,.of,.cognitive,.symptoms,.seen,.among,.HIV,.positive,.p
atients.,.The,.condition,.occurs,.when,.HIV,.virus,.disseminates,.to,.the,.CNS.,.Within,.the,.CNS,,.the,.virus,.ten
ds,.to,.concentrate,.in,.the,.basal,.ganglia,.and,.subcortical,.regions.,.Symptoms,.include,.a,.constellation,.of,.
cognitive,,.behavioral,,.and,.motor,.disturbances,.that,.cause,.varying,.degrees,.of,.functional,.impairment.
Characteristic,.MRI,.findings,.include,.non-
enhancing,.white,.matter,,.cerebral,.atrophy,,.and,.ventricular,.enlargement.,.The,.diagnosis,.requires,.that,.othe
r,.central,.nervous,.system,.infections,,.carcinoma,,.as,.well,.as,.general,.medical,.conditions,.and,.substance,.abu
se,.have,.been,.excluded.
