Following a car accident of a male teenager who did not have his ...

[renzo156]

Following a car accident of a male teenager who did not have his seatbelt on, he arrived in the emergency department with a traumatic brain injury.
 
  He has severe cerebral edema following emergent craniotomy. Throughout the night, the nurse has been monitoring and reporting changes in his assessment. Which of the following assessments correspond to a supratentorial herniation that has progressed to include midbrain involvement? Select all that apply.
  A)
  Clouding of consciousness
  B)
  Decorticate posturing with painful stimulation
  C)
  Pupils fixed at approximately 5 mm in diameter
  D)
  Respiration rate of 40 breaths/minute
  E)
  Decerebrate posturing following painful stimulation of the sternum

Question 2

The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism.
 
  Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis?
  A)
  Have you ever given your child any honey or honey-containing products?
  B)
  Is there any family history of neuromuscular diseases?
  C)
  Has your baby ever been directly exposed to any chemical cleaning products?
  D)
  Is there any mold in your home that you know of?

[aburgess]

Answer to Question 1

Ans:
C, D, E

Feedback:

With midbrain involvement, pupils are fixed and midsized (5 mm in diameter), and reflex adduction of the eyes is impaired; pain elicits decerebrate posturing; and respirations change from Cheyne-Stokes respiration to neurogenic hyperventilation. Cloudiness of consciousness occurs in early diencephalic stages. Decorticate posturing with pain occurs in the diencephalic stage.

Answer to Question 2

Ans:
A

Feedback:

Botulism in infants is frequently attributable to honey. Family history is not a relevant consideration given the bacterial etiology, and mold and chemical cleaning products are not known to predispose to botulism toxicity.

[renzo156]

TYSM

[ktidd]

Excellent