A 4-Day-Old Infant Is Brought to the Emergency Department with Abnormal

question 55

Multiple Choice

A 4-day-old infant is brought to the emergency department with abnormal movements.  The patient has had intermittent episodes of tonic posturing over the past 3 hours as well as poor feeding, vomiting, and irritability for the past 2 days.  The mother also reports that his diapers smell like "caramelizing sugar."  There are no known medical problems in the family, but the child's maternal aunt died "sometime in the first year" of life from unknown causes.  Examination shows a lethargic infant with intermittent posturing episodes and increased generalized muscle tone.  Laboratory studies of plasma and urine confirm the diagnosis.  In addition to appropriate dietary restriction, supplementation with which of the following may improve this infant's condition?

• A)Arginine
• B)Cobalamin
• C)Pyridoxine
• D)Tetrahydrobiopterin
• E)Thiamine

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Definitions:

Delusion of Grandeur

A Delusion of Grandeur is a false belief in one's own superiority, greatness, or power, often a symptom of psychiatric disorders like bipolar disorder or schizophrenia.

DSM-IV-TR

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; a manual for the assessment and diagnosis of mental disorders.

Axis I

A classification in earlier versions of the Diagnostic and Statistical Manual of Mental Disorders that describes clinical disorders, including mood disorders, anxiety disorders, and schizophrenia.

Axis II

A classification previously used in the DSM (Diagnostic and Statistical Manual of Mental Disorders) for diagnosing personality disorders and intellectual disabilities.