Ch 19 Flashcards
Hyperventilating a patient who has increased intracranial pressure (ICP) will:
constrict the cerebral vasculature and decrease cerebral perfusion.
decrease ICP and maintain adequate cerebral perfusion.
increase the carbon dioxide levels in the brain through vasodilation.
dilate the cerebral vasculature and cause further increases in ICP.
constrict the cerebral vasculature and decrease cerebral perfusion.
Tremors that increase as the patient’s hand gets closer to an object that they are trying to grab are what type of tremors?
• Postural
• Clonic
• Rest
• Intention
Intention
Spasmodic torticollis is characterized by:
severe stabbing pain, usually to one side of the face.
involuntary unilateral myoclonic contractions of the face.
sustained and painful contraction of the eyelids.
neck muscle contraction, which twists the head to one side.
neck muscle contraction, which twists the head to one side.
Components of the diencephalon include the:
pons and medulla.
cerebellum and cerebral cortex.
brainstem and midbrain.
thalamus and hypothalamus.
thalamus and hypothalamus
Which of the following signs or symptoms are consistent with meningitis in an infant?
High-pitched cry and bulging fontanelles
Low-grade fever and depressed fontanelles
Kehr sign, vomiting, and poor skin turgor
High fever, drooling, and tachycardia
High-pitched cry and bulging fontanelles
A 51-year-old man complains of chronic headaches that have worsened progressively over the past 3 months. Today, he called 9-1-1 because his headache is severe and he is nauseated. His vital signs are stable and he is breathing adequately. The patient denies any medical problems and states that he has been taking acetaminophen for the headaches. You should be most suspicious of:
ruptured cerebral artery.
an intracranial neoplasm.
acute sinusitis.
acute hemorrhagic stroke.
an intercranial neoplasm
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:
placing her in a Fowler position, administering oxygen, and transporting her to the hospital for definitive care.
carefully assessing her pupils, administering oxygen, starting an IV and giving her morphine, and transporting.
administering high-flow oxygen, establishing vascular access, and administering nitroglycerin to lower her blood pressure.
oxygen as tolerated, starting an IV line and administering ondansetron, and transporting without lights or siren.
oxygen as tolerated, starting an IV line and administering ondansetron, and transporting without lights or siren.
In contrast to a patient in shock, you would expect a patient with increased intracranial pressure to present with:
a widened pulse pressure.
a narrow pulse pressure.
hypotension.
tachycardia
A widened pulse pressure
A 19-year-old man presents with a decreased level of consciousness. According to his girlfriend, he has no known medical problems and takes no medications. Initial treatment for this patient involves:
performing a rapid check of his blood glucose level.
evaluating his cardiac rhythm with the ECG monitor.
ensuring airway patency and adequate breathing.
administering oxygen via nonrebreathing mask.
ensuring airway patency and adequate breathing.
An autoimmune disorder in which the body attacks the myelin of the brain and spinal cord is called:
Guillain-Barre syndrome.
muscular dystrophy.
a dystonic reaction.
multiple sclerosis
multiple sclerosis
Common signs and symptoms of a cerebral abscess include:
an absence of fever, severe localized headache, and vomiting without nausea.
hemiplegia, low-grade fever, hyperactivity, and a diffuse stabbing headache.
paralysis below the waist, high fever, a diffuse headache, and slurred speech.
high-grade fever, persistent localized headache, confusion, and focal impairment.
high-grade fever, persistent localized headache, confusion, and focal impairment.
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, and pulse is slow and bounding. You should:
assist ventilations, apply the cardiac monitor, start an IV line with normal saline, assess his blood glucose level, and prepare for immediate transport.
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.
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.
hyperventilate with a bag-mask device at 30 breaths/min, begin transcutaneous pacing, establish vascular access, and administer 25 g of 50% dextrose.
assist ventilations, apply the cardiac monitor, start an IV line with normal saline, assess his blood glucose level, and prepare for immediate transport.
According to the Los Angeles Prehospital Stroke Screen, the possibility of a stroke is increased if:
a bilateral facial droop is present during the exam.
the blood glucose is between 60 and 400 mg/dL.
at baseline, the patient is normally bedridden.
the patient is younger than 45 years of age.
the blood glucose is between 60 and 400 mg/dL.
Which of the following would have the most negative effect on the outcome of a patient with an intracranial hemorrhage?
Hypertension
Hypotension
Tachycardia
Hypothermia
Hypotension
Which of the following is an example of receptive aphasia?
A patient responds with “no” when asked if they have hypertension.
You ask a patient who the president is, and they say “January.”
You hand a patient a pencil and they try to cut paper with it.
A patient with slurred speech is able to tell you their name.
You ask a patient who the president is, and they say “January.”
A patient with multiple sclerosis may present with:
dysphagia.
anisocoria.
hyperopia.
nystagmus
nystagmus
Management for a patient with a neurologic emergency begins by:
protecting the patient from further injury or harm.
ensuring that the patient’s airway remains patent.
determining the degree of neurologic impairment.
taking deliberate actions to ensure personal safety.
taking deliberate actions to ensure personal safety.
Which of the following cranial nerves is responsible for airway control?
Oculomotor
Trochlear
Trigeminal
Abducens
Trigeminal
What portion of the brainstem regulates respiratory pattern and depth?
Basal nuclei
Pons
Medulla
Midbrain
Pons
A patient with a head injury is found lying supine. The patient’s feet are extended with the toes pointed, and the arms extended with the hands pronated. This indicates:
spinal cord injury.
decorticate posturing.
low intracranial pressure.
brainstem injury
brainstem injury
Emotions such as rage and anger are generated in the:
limbic system.
hypothalamus.
diencephalon.
thalamus.
limbic system
Which of the following assessment findings would indicate dysfunction of the trigeminal nerve?
Inability to move the eyes up, down, and laterally
Inability to shrug the shoulders against resistance
The tongue deviating to one direction or the other
Inability to feel the part of the face you are touching
Inability to feel the part of the face you are touching
When assessing a patient’s response to pain, you notice that the patient is not responding to stimuli. What should you do first?
Provide hyperventilation.
Give a sedative medication.
Perform tracheal intubation.
Carefully assess the airway.
Carefully assess the airway
A rhythmic contraction and relaxation of muscle groups that is commonly observed during a seizure indicates which type of activity?
Hypertonic
Tonic
Myoclonic
Clonic
Clonic
When assessing a patient’s respiratory pattern, you notice that inspiration and expiration are equal. This indicates which pattern of breathing?
Bradypnea
Eupnea
Tachypnea
Apnea
Eupnea
Patients with trismus often require:
immediate tracheal intubation before the airway swells shut.
premedication with lidocaine before being intubated.
sedation or chemical paralysis to facilitate airway control.
hyperventilation to reduce severe intracranial pressure.
sedation or chemical paralysis to facilitate airway control.
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:
establishing vascular access, administering diazepam or lorazepam to reduce her combativeness, and transporting to the closest hospital.
giving her high-flow oxygen, inserting an IO catheter in her proximal tibia, transporting, and observing for further seizure activity.
administering oxygen, restraining her to protect her from further injury, placing a bite block in her mouth in case she seizes again, and transporting.
administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren.
administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren.
Which of the following is a term used to describe changes in a person’s ability to perform coordinated motions, such as walking?
Myoclonus
Bradykinesia
Ataxia
Decussation
Ataxia
In contrast to a benign neoplasm, a malignant neoplasm:
is relatively easy to remove surgically.
can metastasize to other parts of the body.
remains within a capsule and grows minimally.
results in death in the vast majority of cases.
can metastasize to other parts of the body.
Prehospital treatment for a patient with a suspected stroke who recently had a seizure may include which of the following?
Vigorously airway suctioning
60-degree elevation of the head
Up to 325 mg of aspirin
Diazepam or lorazepam
Diazepam or lorazepam
When neurons are deprived of oxygen and glucose:
spontaneous intracerebral bleeding occurs.
they produce alkalotic waste products.
they convert to anaerobic metabolism.
the process of neuronal regeneration begins.
they convert to anaerobic metabolism
Which of the following cranial nerves are assessed when you ask a patient to follow your finger as you move it in an “H” shape?
Facial, accessory, glossopharyngeal
Accessory, olfactory, hypoglossal
Optic, trigeminal, glossopharyngeal
Trochlear, oculomotor, abducens
Trochlear, oculomotor, abducens
Which of the following is a common cause of trismus in an unresponsive patient?
Cerebral hypoxia
Opiate toxicity
Cushing reflex
Hypoglycemia
Cerebral hypoxia
A 29-year-old man, who was recently prescribed an antipsychotic medication, presents with an acute onset of bizarre contortions of the face. Treatment should include:
promethazine, 25 mg.
ondansetron, 4 mg.
diphenhydramine, 25 mg.
diazepam, 5 mg.
diphenhydramine, 25 mg.
During a generalized tonic-clonic seizure, the patient is rigid and his back is arched. This represents which phase of the seizure?
Tonic
Postictal
Hypertonic
Clonic
Hypertonic
A woman brings her 18-year-old son to your EMS station. The patient is actively seizing and, according to the mother, has been seizing for the past 10 minutes. She states that her son has a history of seizures and takes Depakote. The patient is cyanotic, is breathing erratically, and has generalized muscle twitching to all extremities. You should:
hyperventilate him with a bag-mask device to eliminate excess carbon dioxide, establish vascular access, and give lorazepam.
open his airway and begin assisting his ventilations, establish an IV or IO line, and administer diazepam.
protect him from further injury by restraining him, attempt orotracheal intubation, establish an IV, and give Valium.
place a bite block between his molars to prevent oral trauma, administer high-flow oxygen, and give lorazepam IM.
open his airway and begin assisting his ventilations, establish an IV or IO line, and administer diazepam.
Which of the following disease processes is characterized by an abnormal gait in which the patient places his or her feet very close together and shuffles while walking?
Alzheimer disease
Multiple sclerosis
Parkinson disease
Cerebral palsy
Parkinson disease
Chemicals that relay electrically conducted signals from one neuron to another are called:
catecholamines.
hormones.
neurotransmitters.
endorphins.
neurotransmitters.
A stroke to the right cerebral hemisphere would likely cause:
right-sided weakness and right-sided facial droop.
left-sided weakness and right-sided visual field loss.
left-sided weakness and an absence of facial droop.
right-sided weakness and left-sided visual field loss.
left-sided weakness and right-sided visual field loss.
You arrive at the scene shortly after a 7-year-old girl experienced a seizure. According to the child’s mother, she was sitting at the dinner table and then suddenly stopped speaking and started blinking her eyes very rapidly. The episode lasted less than 1 minute, after which the child’s condition rapidly improved. This clinical presentation is consistent with which type of seizure?
Simple partial
Absence
Tonic-clonic
Complex partial
Absence
A loss of balance and equilibrium suggests injury to the:
cerebrum.
midbrain.
cerebellum.
thalamus.
Cerebellum
Which of the following is an example of an acute cerebrovascular emergency?
Embolic blockage of a cerebral artery
Accumulation of atherosclerotic plaque
Frontal headache with sensitivity to light
Numbness and tingling in the extremities
Embolic blockage of a cerebral artery
An elderly man presents with slurred speech, confusion, and unilateral facial droop. When asked to squeeze your hands, the strength in his left hand is markedly less than the strength in his right hand. The patient’s wife tells you that her husband has type 2 diabetes and hypertension. On the basis of your clinical findings, you should:
suspect that he is experiencing a hemorrhagic stroke, begin immediate transport, and start an IV en route.
consider him a candidate for fibrinolytic therapy if his symptoms began less than 12 hours ago.
start an IV and administer crystalloid fluid boluses if his systolic blood pressure is less than 110 mm Hg.
rule out hypoglycemia by assessing his blood sugar, but suspect a right-sided ischemic stroke.
rule out hypoglycemia by assessing his blood sugar, but suspect a right-sided ischemic stroke.
Which of the following causes of altered mental status is a gradual process?
Acidosis
Epilepsy
Psychosis
Uremia
Uremia
Which of the following cranial nerves regulates movement of the head and shoulders?
Accessory
Hypoglossal
Abducens
Trigeminal
Accessory
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?
75 mm Hg
85 mm Hg
95 mm Hg
65 mm Hg
75 mm Hg
What type of tremor occurs when a body part is placed in a particular position and required to maintain that position for a long period of time?
Intention
Postural
Jacksonian
Rest
Postural
An idiopathic seizure is one in which:
a postictal phase is not present.
the entire brain is affected.
a part of the brain is affected.
the cause is not known
The cause is not known
An elderly man who is a resident of a skilled nursing facility is found unresponsive by a staff nurse. When you and your partner arrive, you assess the patient and note that his respirations are slow and shallow; his heart rate is slow, weak, and irregular; and his skin is cool and clammy. You should:
assist his ventilations and assess his oxygen saturation.
assess his blood glucose level and give high-flow oxygen.
apply oxygen via nonrebreathing mask and apply the ECG.
obtain a 12-lead ECG tracing and assess his pupils.
assist his ventilations and assess his oxygen saturation.
Pupils that differ in size by less than 1 mm:
indicate increased intracranial pressure.
are a sign of methamphetamine abuse.
are a sign of optic nerve compression.
may be a normal variant in some patients.
may be a normal variant in some patients.
A 33-year-old woman had an apparent syncopal episode. According to her husband, she complained of dizziness shortly before the episode. He further states that he caught her before she fell to the ground. Upon your arrival, the patient is conscious but confused and is sitting in a chair. Her blood pressure is 90/60 mm Hg, pulse rate is 110 beats/min and weak, and respirations are 22 breaths/min and regular. Her blood glucose level is 74 mg/dL. The most likely cause of her syncopal episode is:
• dehydration.
• a vasovagal response.
• a seizure.
• acute hypoglycemia.
Dehydration
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:
• “When did you first notice your wife’s symptoms?”
• “Does your wife have a history of diabetes?”
• “Is your wife allergic to aspirin or contrast dye?”
• “When did your wife last see her physician?”
“When did you first notice your wife’s symptoms?”
A staggering gait is most suggestive of damage to the:
• cerebrum
• cerebellum
• brainstem
• medulla
Cerebellum
You are dispatched to a residence for a middle-aged woman with generalized weakness of approximately 18 hours duration. Your primary assessment reveals right-sided hemiparesis, a left-sided facial droop, and bilaterally equal and reactive pupils. Further assessment reveals that her blood glucose level is 70 mg/dL. En route to the hospital, you note increased movement of her right arm. You are monitoring her vital signs and IV access has been established. Which of the following statements regarding this scenario is correct?
• You should administer nitroglycerin or labetalol if her systolic blood pressure is greater than 150 mm Hg.
• The patient’s signs and symptoms are likely the result of her blood sugar and will resolve with dextrose.
• The patient will likely receive fibrinolytic therapy in the emergency department if no contraindications exist.
• Although the patient is likely experiencing a TIA, you should treat her as though she is experiencing a stroke.
Although the patient is likely experiencing a TIA, you should treat her as though she is experiencing a stroke.
When performing the arm drift test on a patient with a suspected stroke, a positive finding is characterized by:
• one arm drifting downward and turning away from the body when the patient’s eyes are open.
• one arm drifting downward and turning away from the body when the patient’s eyes are closed.
• both arms moving downward more than 3 inches in 30 seconds when the patient’s eyes are open.
• one arm drifting downward and turning toward the body when the patient’s eyes are closed.
one arm drifting downward and turning toward the body when the patient’s eyes are closed.
