Chapter 17

Question 1

… is the fifth leading cause of death and the leading cause of adult disability in the US
common in geriatric patients

Answer 1

stroke

Question 2

… and … are other common neurological emergencies

Answer 2

seizures; altered mental status

Question 3

the brain controls …, …, and all other body functions

three major parts: …, …, and ..–> … is the largest part

Answer 3

breathing; speech; brain stem; cerebellum; cerebrum; cerebrum

Question 4

the … controls the most basic functions

the cerebellum controls … and … coordination

Answer 4

brain stem; muscle; body

Question 5

messages sent to and from the brain travel through nerves:
… nerves run directly from the brain to parts of the head
the rest of the nerves join in the … and exit the brain through the foramen magnum
at each vertebra in the neck and back, two nerves branch out from the …and carry signals to and from the body

Answer 5

twelve cranial nerves; spinal cord; spinal cord

Question 6

many different disorders can cause brain dysfunction: can affect the patient’s …, …, and …
the brain is sensitive to changes in oxygen, glucose, and …–> significant change in any one of these levels will result in a neurologic change

Answer 6

level of consciousness; speech; voluntary muscle control; temperature

Question 7

headache is one of the most common complaints and can be a symptom of another condition or a … on its own
only a small percentage of headaches are caused by a serious med condition

Answer 7

neurologic condition

Question 8

tension headaches: caused by … in the head and neck
attributed to …
pain is usually described as squeezing, dull, or as an ache
usually do not require med attention

Answer 8

muscle contractions; stress

Question 9

migraine headaches:
thought to be caused by changes in the … size in the base of the brain
pain is usually described as pounding, throbbing, and pulsating
often associated with … and … and may be preceded by … changes
can last for several hours or days

Answer 9

blood vessel; nausea; vomiting; visual

Question 10

sinus headaches: caused by pressure that results from … in the sinuses

Answer 10

accumulated fluid

Question 11

serious conditions that include headache as a symptom are …, .., and …

Answer 11

hemorrhagic stroke; brain tumors; meningitis

Question 12

stroke: also called a …
interruption of .. to an area within the brain
results in the loss of …

Answer 12

cerebrovascular accident (CVA); blood flow; brain function

Question 13

ischemic stroke:
most common, accounting for more than 80% of strokes
results from … or an …
symptoms may range form nothing to complete ..
… in the blood vessels is often the cause

Answer 13

thrombosis; embolus; paralysis; atherosclerosis

Question 14

hemorrhagic stroke accounts for 13% of strokes
cerebral hemorrhages are often ..
… are a common cause of hemorrhagic strokes in healthy, young people–> presents as the “worst headache of their life” and causes a … hemorrhage

Answer 14

fatal; berry aneurysms; subarachnoid

Question 15

transient ischemic attack (TIA): when stroke-like symptoms go away on their own in less than … hrs, the event is called a TIA
may be a warning sign of a … to come and is considered an emergency–> about one third of patients who have a TIA will experience a stroke soon after
all patients with a TIA should be evaluated by a physician

Answer 15

24; larger stroke

Question 16

signs and symptoms of stroke:
…
sudden … or … in the face, arm, leg, or one side of body
decreased/absent … and … on one side of the body
lack of … (ataxia) or loss of …
sudden … in one eye, blurred or double vision

Answer 16

facial drooping;
weakness; numbness; 
movement; sensation
muscle coordination; balance
vision loss

Question 17

signs and symptoms of stroke: 
difficulty … 
decreased level of … 
… disorders
difficulty expressing … or inability to use the right … 
… speech (dysarthria)
… and … headache

Answer 17

swallowing; responsiveness; speech; thoughts; words; slurred; sudden; severe

Question 18

signs and symptoms of stroke cont: 
..
…
…
…
…
..
...

Answer 18

confusion
dizziness
weakness
combativeness
restlessness
tongue deviation
coma

Question 19

stroke in the left cerebral hemisphere may cause …–> inability to produce/understand speech
strokes that affect the left side of the brain can also cause paralysis of the … side of the body

Answer 19

aphasia; right

Question 20

strokes that affect the right side of the brain cause paralysis of the … side of the body. patients can … language and speak, but their words may be …
patients may be oblivious to their problem; this symptom is called …
patients with a problem affecting the back part of the cerebrum may neglect certain parts of their …
neglect and lack of pain cause many patients to delay seeking help

Answer 20

left; understand; slurred; neglect; vision

Question 21

bleeding in the brain:
patients may have …–> may be the cause of the bleeding or may be caused by the bleeding as a compensatory response
a trend of an … is an important sign
significant drops may occur as the patient’s condition worsens

Answer 21

high blood pressure; increasing blood pressure

Question 22

conditions that may mimic stroke:
…
…
… or … bleeding

Answer 22

hypoglycemia
postictal state
subdural; epidural

Question 23

a seizure is a neurologic episode caused by a sure of … activity in the brain
in the US it is estimated that 2 to 3 million people have epilepsy

Answer 23

electrical

Question 24

generalized (tonic-clonic) seizure: this type of seizure results from abnormal … from large areas of the brain, usually involving both hemispheres
characterized by … and a generalized severe … of all muscles that lasts several mins or longer

Answer 24

electrical discharges; unconsciousness; twitching

Question 25

absence seizure:
does not involve any changes in .. activity
characterized by a brief … in which the patient seems to … and not respond

Answer 25

motor; lapse of consciousness; stare

Question 26

partial (focal) seizure:
simple partial seizure: no change in the patient’s level of …
may have .., .., …, … changes, or unusual … and …
may cause some .. or brief …

Answer 26

consciousness; numbness; weakness; dizziness; visual; smells; tastes; twitching; paralysis

Question 27

partial (focal) seizure
complex partial seizure:
altered …
results from abnormal discharges from the … of the brain
characterized by …, …, …
patients also may experience unpleasant .. or visual …, exhibit … or perform … physical behavior

Answer 27

mental status; temporal lobe; lip smacking; eye blinking; isolated jerking; smells; hallucinations; uncontrolled fear; repetitive

Question 28

patients may experience an .. prior to a seizure

Answer 28

aura

Question 29

generalized seizure:
characterized by sudden …, chaotic muscle … and … and …
most seizures last 3 to 5 mins
followed by a … state

Answer 29

loss of consciousness; movement; tone; apnea; postictal

Question 30

absence seizure:
formerly called petit mal
lasts for …
patient fully recovers with a brief … of the event

Answer 30

seconds; lapse of memory

Question 31

status epilepticus: seizures that continue every .. without the person regaining … or last longer than .. mins

Answer 31

few minutes; consciousness; 30

Question 32

causes of seizures: 
… 
… 
… 
… 
epileptic seizure can usually be controlled with meds

Answer 32

congenital
structural
metabolic
febrile

Question 33

recognize when a seizure is occurring and whether this episode differs from ..
identify other problems associated with the seizure

Answer 33

previous ones

Question 34

postictal state:
following the seizure, a patient’s muscles … and the breathing becomes ..
patients may be present with …, …, or …
if the patient’s condition does not improve, consider other problems such as infection/hypoglycemia

Answer 34

relax; labored; hemiparesis; lethargy; confusion

Question 35

seizures are often mistaken for …

Answer 35

syncope

Question 36

aside from stroke and seizures, the most common type of neurologic emergency that you will encounter is a patient with an altered mental status. causes include: 
… 
… 
… 
.. 
… 
unrecognized … injury
.. infection
… abnormality
.. 
…

Answer 36

hypoglycemia
hypoxemia
intoxication
delirium 
drug overdose
head
brain
body temp
brain tumor 
poisoning

Question 37

causes of AMS (altered mental status):
…: patients can have signs and symptoms that mimic stroke and seizures
…: a symptom, not a disease; presents as a new complaint; temporary state often with a physical or mental cause; can be reversed with proper treatment

Answer 37

hypoglycemia; delirium

Question 38

other causes of AMS: 
unrecognized … injury
severe … 
… disorders
… complications
.., particularly those involving the brain/bloodstream

Answer 38

head; intoxication; psychological; medication; infections

Question 39

all patients with an altered mental status should receive …
hyperventilation may have several negative consequences–> overinflates the lungs, which can impair … to the right atrium and cause a decrease in …

Answer 39

high-flow oxygen; blood return; cardiac output

Question 40

hyperventilation also increases the risk of … and … and may cause severe injury in patients with … and increased … causing cerebral vasoconstriction, which shunts blood (and oxygen) away from the brain causing further injury to the brain

Answer 40

regurgitation; aspiration; intracerebral bleeding; intracranial pressure

Question 41

secondary assessment: patients with intracranial bleeding may have increased … compressing the brain
can slow the … and cause … respirations
blood pressure is usually … to compensate for poor perfusion in the brain
changes in … size and reactivity indicate significant bleeding nd pressure on the brain. check … levels

Answer 41

pressure; pulse; erratic; high; pupil; blood glucose

Question 42

secondary assessment cont: 
stroke assessment: Cincinnati prehospital stroke scale 
los angeles prehospital stroke screen
… 
… mnemonic
… score

Answer 42

3-item stroke severity scale (LAG)
FAST
Glasgow Coma Scale (GCS)

Question 43

for suspected stroke patients, physicians in the ED need to determine whether there is … in the brain–> if there isn’t, the patient may be a candidate for … medication
notify the hospital regarding the last time the patient was known to be without their current signs and symptoms of stroke q

Answer 43

bleeding; blood clot-dissolving

Question 44

patients who have had a seizure require definitive eval and treatment in the hospital
for patients having a seizure:
protect them from harm
maintain a clear airway by ..
provide … as quickly as possible
if head or neck trauma is suspected, provide spinal immobilization

Answer 44

suctioning; oxygen

Question 45

headache–> you should be concerned if the patient complains of:
a …, severe headache
a sudden headache with .., …, …, or following …

Answer 45

sudden onset; fever; seizures; AMS; trauma

Question 46

stroke:
support the … and provide rapid transport to a stroke center
maintain a SPO2 level of at least 94%
oxygen therapy is not recommended unless the patient is experiencing … or is showing signs of …

Answer 46

ABCs; resp distress; hypoxia

Question 47

.. therapy and methods to mechanically remove the blood clot may reverse stroke symptoms and even stop the stroke if given within 3-6 hrs
transport to a designated stroke center

Answer 47

thrombolytic

Question 48

Seizure and AMS–> the patient may be in a … state on your arrival; care for patients actively seizing

Answer 48

postictal