18-1

Question 1

Which of the following would MOST likely cause a sustained increase in intracranial pressure?
Choose one answer.
	A. Projectile vomiting Incorrect 	
	B. Bearing down Incorrect 	
	C. Frequent coughing Incorrect 	
	D. Intracranial tumor Correct

Answer 1

D. Intracranial tumor Correct

Question 2

Marks: 1
You are dispatched to a residence for a 44-year-old woman with a severe headache. You arrive to find the patient lying on her sofa with a wet washcloth on her forehead. She tells you that she has a history of migraine headaches and that this is one of her “typical” headaches. She also complains of nausea and photophobia. Her blood pressure is 170/94 mm Hg, pulse rate is 120 beats/min and regular, and respirations are 22 breaths/min with adequate depth. The MOST appropriate treatment for this patient includes:
Choose one answer.
A. administering high-flow oxygen, establishing vascular access, and administering nitroglycerin to lower her blood pressure. Incorrect
B. oxygen as tolerated, starting an IV line and administering ondansetron, and transporting without lights or siren. Correct
C. placing her in a Fowler position, administering oxygen, and transporting her to the hospital for definitive care. Incorrect
D. carefully assessing her pupils, administering oxygen, starting an IV and giving her morphine, and transporting. Incorrect

Answer 2

B. oxygen as tolerated, starting an IV line and administering ondansetron, and transporting without lights or siren. Correct

Question 3

hich of the following conditions is a neural tube defect in which part of the nervous system remains outside the body?
Choose one answer.
	A. Multiple sclerosis Incorrect 	
	B. Spina bifida Correct 	
	C. Cerebral palsy Incorrect 	
	D. Poliomyelitis Incorrect

Answer 3

B. Spina bifida Correct

Question 4

The involuntary, rhythmic movement of the eyes is called:
Choose one answer.
	A. hyperopia. Incorrect 	
	B. nystagmus. Correct 	
	C. dysphagia. Incorrect 	
	D. anisocoria. Incorrect

Answer 4

B. nystagmus. Correct

Question 5

A synapse is:
Choose one answer.
A. a cluster of sensory nerve cells. Incorrect
B. the body’s main neurotransmitter. Incorrect
C. a slight gap between nerve cells. Correct
D. the point where a nerve cell terminates. Incorrect

Answer 5

C. a slight gap between nerve cells. Correct

Question 6

Marks: 1
A person’s level of consciousness is regulated by the:
Choose one answer.
A. cerebral cortex. Incorrect
B. occipital lobe of the brain. Incorrect
C. diencephalon. Incorrect
D. reticular activating system. Correct

Answer 6

D. reticular activating system. Correct

Question 7

The peripheral nervous system is responsible for:
Choose one answer.
A. memory, understanding, and thought processes. Incorrect
B. sending messages to and receiving messages from the brain. Correct
C. feeling and autonomic sensory and motor functions. Incorrect
D. thought, perception, and voluntary motor functions. Incorrect

Answer 7

B. sending messages to and receiving messages from the brain. Correct

Question 8

Marks: 1
A staggering gait is MOST suggestive of damage to the:
Choose one answer.
	A. brainstem. Incorrect 	
	B. medulla. Incorrect 	
	C. cerebrum. Incorrect 	
	D. cerebellum. Correct

Answer 8

D. cerebellum. Correct

Question 9

Apneustic breathing is characterized by:
Choose one answer.
A. extreme tachypnea and hyperpnea with a fruity or acetone breath odor. Incorrect
B. a gradual increase and decrease in breathing with periods of apnea. Incorrect
C. a prolonged inspiratory phase with a shortened expiratory phase and bradypnea. Correct
D. an irregular respiratory pattern with unpredictable periods of apnea. Incorrect

Answer 9

C. a prolonged inspiratory phase with a shortened expiratory phase and bradypnea. Correct

Question 10

Marks: 1
As intracranial pressure rises:
Choose one answer.
A. the heart rate acutely increases. Incorrect
B. mean arterial pressure decreases. Incorrect
C. the brain becomes hypocarbic. Incorrect
D. cerebral herniation may occur. Correct

Answer 10

D. cerebral herniation may occur. Correct

Question 11

Among other functions, the medulla oblongata:
Choose one answer.
A. communicates with the pituitary gland. Incorrect
B. directly regulates body temperature. Incorrect
C. controls blood pressure and heart rate. Correct
D. sends messages to move skeletal muscles. Incorrect

Answer 11

C. controls blood pressure and heart rate. Correct

Question 12

Question 12
Marks: 1
You respond to the residence of a known heroin abuser. The patient, a 30-year-old man, is unconscious and unresponsive. He is hypoventilating, bradycardic, and hypotensive. Administration of 10 mg of naloxone has had no effect, and your transport time to the hospital is approximately 30 minutes. You should:
Choose one answer.
A. check his blood glucose level as your partner prepares to intubate. Correct
B. hyperventilate him with high-flow oxygen to minimize tissue hypoxia. Incorrect
C. administer 25 g of 50% dextrose and reassess his level of consciousness. Incorrect
D. transport at once and administer additional naloxone while en route. Incorrect

Answer 12

A. check his blood glucose level as your partner prepares to intubate. Correct

Question 13

Components of the diencephalon include the:
Choose one answer.
A. cerebellum and cerebral cortex. Incorrect
B. pons and medulla. Incorrect
C. thalamus and hypothalamus. Correct
D. brainstem and midbrain. Incorrect

Answer 13

C. thalamus and hypothalamus. Correct

Question 14

Marks: 1
What portion of the brainstem regulates respiratory rate and depth?
Choose one answer.
	A. Basal nuclei Incorrect 	
	B. Midbrain Incorrect 	
	C. Pons Correct 	
	D. Medulla Incorrect

Answer 14

C. Pons Correct

Question 15

A patient experiences severe, shock-like or stabbing pain to one side of the face. This is consistent with:
Choose one answer.
A. glossopharyngeal neuralgia. Incorrect
B. trigeminal neuralgia. Correct
C. an acoustic neuroma. Incorrect
D. hemifacial spasm. Incorrect

Answer 15

B. trigeminal neuralgia. Correct

Question 16

Marks: 1
You are dispatched to a local pharmacy, where a 24-year-old woman experienced an apparent seizure. During your assessment, you note that the patient is conscious but combative. The patient’s supervisor states that she has a history of seizures and takes Tegretol. The patient’s blood pressure is 146/90 mm Hg, pulse rate is 110 beats/min and regular, and respirations are 24 breaths/min with adequate depth. The MOST appropriate treatment for this patient includes:
Choose one answer.
A. giving her high-flow oxygen, inserting an IO catheter in her proximal tibia, transporting, and observing for further seizure activity. Incorrect
B. administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren. Correct
C. administering oxygen, restraining her to protect her from further injury, placing a bite block in her mouth in case she seizes again, and transporting. Incorrect
D. establishing vascular access, administering diazepam or lorazepam to reduce her combativeness, and transporting to the closest hospital. Incorrect

Answer 16

B. administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren. Correct

Question 17

An idiopathic seizure is one in which:
Choose one answer.
A. a postictal phase is not present. Incorrect
B. the entire brain is affected. Incorrect
C. the cause is not known. Correct
D. a part of the brain is affected. Incorrect

Answer 17

C. the cause is not known. Correct

Question 18

Marks: 1
A high level of oxygen to the brain of a patient with a hemorrhagic stroke and increased intracranial pressure:
Choose one answer.
A. dilates the blood vessels and can cause brain herniation. Incorrect
B. causes vasoconstriction and can impair brain perfusion. Correct
C. increases intracranial pressure, but oxygenates the brain. Incorrect
D. lowers intracranial pressure and oxygenates the brain. Incorrect

Answer 18

B. causes vasoconstriction and can impair brain perfusion. Correct

Question 19

Marks: 1
A 59-year-old woman presents with acute onset of confusion, left-sided hemiparesis, and a right-sided facial droop. Her airway is patent and she is breathing adequately. Her blood pressure is 150/100 mm Hg and her pulse is 70 beats/min. The cardiac monitor displays atrial fibrillation with a variable rate of 60 to 90 beats/min. When obtaining the patient’s medical history from her husband, the MOST important question to ask him is:
Choose one answer.
A. “When did your wife last see her physician?” Incorrect
B. “Is your wife allergic to aspirin or contrast dye?” Incorrect
C. “When did you first notice your wife’s symptoms?” Correct
D. “Does your wife have a history of diabetes?” Incorrect

Answer 19

C. “When did you first notice your wife’s symptoms?” Correct

Question 20

Marks: 1
Increased intracranial pressure hydrocephalus occurs when:
Choose one answer.
A. total CSF volume decreases, which leads to excessive cerebral edema. Incorrect
B. the movement of CSF decreases, but the production of CSF does not. Correct
C. CSF production increases, which causes increased pressure in the skull. Incorrect
D. the movement of CSF in the brain exceeds the production of CSF. Incorrect

Answer 20

B. the movement of CSF decreases, but the production of CSF does not. Correct

Question 21

Which of the following would have the MOST negative effect on the outcome of a patient with an intracranial hemorrhage?
Choose one answer.
A. Slow rise in intracranial pressure Incorrect
B. Hypotension Correct
C. Hypertension Incorrect
D. Tachycardia Incorrect

Answer 21

B. Hypotension Correct

Question 22

\_\_\_\_\_\_\_\_\_\_ is a term used to describe changes in a person's ability to perform coordinated motions, such as walking.
Choose one answer.
	A. Bradykinesia Incorrect 	
	B. Ataxia Correct 	
	C. Decussation Incorrect 	
	D. Myoclonus Incorrect

Answer 22

B. Ataxia Correct

Question 23

The MOST immediate and significant complication associated with a hemorrhagic stroke is:
Choose one answer.
A. acute hypovolemic shock. Incorrect
B. hypertension and bradycardia. Incorrect
C. mean arterial pressure increase. Incorrect
D. increased intracranial pressure. Correct

Answer 23

D. increased intracranial pressure. Correct

Question 24

You are assessing an unresponsive 66-year-old man with a history of two prior strokes. According to the patient’s wife, he complained of a severe headache and then passed out. His respiratory effort is poor, blood pressure is elevated markedly, and pulse is slow and bounding. The glucometer reads “error.” You should:
Choose one answer.
A. assist ventilations, apply the cardiac monitor, start an IV line with normal saline, administer 12.5 g of 50% dextrose, and reassess his level of consciousness. Correct
B. intubate after 30 seconds of preoxygenation, ventilate at a rate of 8 breaths/min, start an IV with normal saline, administer 50 g of 50% dextrose, and reassess. Incorrect
C. hyperventilate with a bag-mask at 30 breaths/min, begin transcutaneous pacing, establish vascular access, and administer 25 g of 50% dextrose. Incorrect
D. give high-flow oxygen, apply the cardiac monitor, start an IV line with normal saline, and administer 0.5 mg of atropine to treat his bradycardia. Incorrect

Answer 24

A. assist ventilations, apply the cardiac monitor, start an IV line with normal saline, administer 12.5 g of 50% dextrose, and reassess his level of consciousness. Correct

Question 25

Which of the following cranial nerves regulates movement of the head and shoulders?
Choose one answer.
	A. Accessory Correct 	
	B. Hypoglossal Incorrect 	
	C. Abducens Incorrect 	
	D. Trigeminal Incorrect

Answer 25

A. Accessory Correct

Question 26

All of the following are examples of acute cerebrovascular emergencies, EXCEPT:
Choose one answer.
A. rupture of a cerebral arterial aneurysm. Incorrect
B. embolic blockage of a cerebral artery. Incorrect
C. accumulation of atherosclerotic plaque. Correct
D. stroke secondary to thrombus rupture. Incorrect

Answer 26

C. accumulation of atherosclerotic plaque. Correct

Question 27

During a generalized tonic/clonic seizure, the patient is rigid and his back is arched. This represents the \_\_\_\_\_\_\_\_\_ phase of the seizure.
Choose one answer.
	A. tonic Incorrect 	
	B. hypertonic Correct 	
	C. postictal Incorrect 	
	D. clonic Incorrect

Answer 27

B. hypertonic Correct

Question 28

When a patient with Parkinson disease is asked to turn, he or she takes small steps until the turn is complete. This is called:
Choose one answer.
	A. bradykinesia. Correct 	
	B. dystonia. Incorrect 	
	C. ataxia. Incorrect 	
	D. decussation. Incorrect

Answer 28

A. bradykinesia. Correct

Question 29

Management for a patient with a neurologic emergency begins by:
Choose one answer.
A. determining the degree of neurologic impairment. Incorrect
B. ensuring that the patient’s airway remains patent. Incorrect
C. taking deliberate actions to ensure personal safety. Correct
D. protecting the patient from further injury or harm. Incorrect

Answer 29

C. taking deliberate actions to ensure personal safety. Correct

Question 30

What is the cerebral perfusion pressure of a patient with a mean arterial pressure of 80 mm Hg and an intracranial pressure of 5 mm Hg?
Choose one answer.
	A. 95 mm Hg Incorrect 	
	B. 60 mm Hg Incorrect 	
	C. 90 mm Hg Incorrect 	
	D. 75 mm Hg Correct

Answer 30

D. 75 mm Hg Correct