Chapter 18 - Neurologic Emergencies

Question 1

A 30-year-old male experienced a generalized (tonic-clonic) seizure, which stopped before you arrived at the scene. The patient is conscious, is answering your questions appropriately, and refuses EMS transport. Which of the following would be the MOST compelling reason to disagree with his refusal of transport?

Select one:

A. His Glasgow Coma Scale (GCS) score is 15
B. He is currently not prescribed any medications
C. His wife states that this was his “usual” seizure
D. He has experienced seizures since he was 20

Answer 1

B. He is currently not prescribed any medications

Question 2

A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he or she:

Select one:

A. has had a prior heart attack.
B. has bleeding within the brain.
C. has a GCS score that is less than 8.
D. is older than 60 years of age.

Answer 2

B. has bleeding within the brain.

Question 3

A patient whose speech is slurred and difficult to understand is experiencing:

Select one:

A. dysphagia.
B. paraplegia.
C. dysarthria.
D. aphasia

Answer 3

C. dysarthria.

Question 4

A patient with an altered mental status is:

Select one:

A. usually able to be aroused with a painful stimulus.
B. not thinking clearly or is incapable of being aroused.
C. typically alert but is confused as to preceding events.
D. completely unresponsive to all forms of stimuli.

Answer 4

B. not thinking clearly or is incapable of being aroused.

Question 5

During the primary assessment of a semiconscious 70-year-old female, you should:

Select one:

A. ask family members if the patient has a history of stroke.
B. insert a nasopharyngeal airway and assist ventilations.
C. immediately determine the patient’s blood glucose level.
D. ensure a patent airway and support ventilation as needed.

Answer 5

D. ensure a patent airway and support ventilation as needed.

Question 6

Interruption of cerebral blood flow may result from all of the following, EXCEPT:

Select one:

A. a thrombus.
B. an embolism.
C. cerebral vasodilation.
D. an acute arterial rupture.

Answer 6

C. cerebral vasodilation.

Question 7

The left cerebral hemisphere controls:

Select one:

A. the right side of the face.
B. the right side of the body.
C. breathing and blood pressure.
D. heart rate and pupil reaction.

Answer 7

B. the right side of the body.

Question 8

The MOST significant risk factor contributing to hemorrhagic stroke is:

Select one:

A. severe stress.
B. hypertension.
C. diabetes mellitus.
D. heavy exertion.

Answer 8

B. hypertension.

Question 9

The three major parts of the brain are the:

Select one:

A. cerebellum, medulla, and occiput.
B. midbrain, cerebellum, and spinal cord.
C. brain stem, midbrain, and spinal cord.
D. cerebrum, cerebellum, and brain stem.

Answer 9

D. cerebrum, cerebellum, and brain stem.

Question 10

When assessing for arm drift of a patient with a suspected stroke, you should:

Select one:

A. ask the patient to hold his or her arms up with the palms down.
B. expect to see one arm slowly drift down to the patient’s side.
C. observe movement of the arms for approximately 2 minutes.
D. ask the patient to close his or her eyes during the assessment.

Answer 10

D. ask the patient to close his or her eyes during the assessment.

Question 11

When caring for a patient with documented hypoglycemia, you should be MOST alert for:

Select one:

A. a seizure.
B. respiratory distress.
C. a febrile convulsion.
D. an acute stroke

Answer 11

A. a seizure.

Question 12

When you are obtaining medical history from the family of a suspected stroke patient, it is MOST important to determine:

Select one:

A. when the patient last appeared normal.
B. the patient’s overall medication compliance.
C. if the patient has been hospitalized before.
D. if there is a family history of a stroke

Answer 12

A. when the patient last appeared normal.

Question 13

Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a stroke?

Select one:

A. Hypovolemia
B. Hypoglycemia
C. A postictal state
D. Intracranial bleeding

Answer 13

A. Hypovolemia

Question 14

Which of the following conditions would MOST likely affect the entire brain?

Select one:

A. Ruptured cerebral artery in the occipital lobe
B. Reduced blood supply to the left hemisphere
C. Respiratory failure or cardiopulmonary arrest
D. Blocked cerebral artery in the frontal lobe

Answer 14

C. Respiratory failure or cardiopulmonary arrest

Question 15

Which of the following MOST accurately describes a simple partial seizure?

Select one:

A. A seizure that causes the patient to stare blankly
B. A seizure that begins in one extremity
C. A generalized seizure without incontinence
D. A seizure that is not preceded by an aura

Answer 15

B. A seizure that begins in one extremity

Question 16

Which of the following MOST accurately describes what the patient will experience during the postictal state that follows a seizure?

Select one:

A. Confusion and fatigue
B. Hyperventilation and hypersalivation
C. A rapidly improving level of consciousness
D. A gradually decreasing level of consciousness

Answer 16

A. Confusion and fatigue

Question 17

Which of the following symptoms would lead the EMT to believe that a patient’s headache is caused by sinus congestion?

Select one:

A. The headache began suddenly
B. The pain is worse when bending over
C. There is numbness in the extremities
D. There is associated neck stiffness

Answer 17

B. The pain is worse when bending over

Question 18

You are caring for a 68-year-old man with sudden onset of left-sided paralysis and slurred speech. His airway is patent, his respirations are 14 breaths/min with adequate depth, and his oxygen saturation is 98%. Treatment for this patient should include:

Select one:

A. oral glucose gel and transport.
B. high-flow oxygen and transport.
C. ventilatory assistance and transport.
D. recovery position and transport.

Answer 18

D. recovery position and transport.

Question 19

You respond to a residence for a child who is having a seizure. Upon arrival at the scene, you enter the residence and find the mother holding her child, a 2-year-old male. The child is conscious and crying. According to the mother, the child had been running a high fever and then experienced a seizure that lasted approximately 3 minutes. You should:

Select one:

A. call medical control and request permission to give the child aspirin.
B. cover the child with wet towels and give oxygen via nasal cannula.
C. transport the child to the hospital and reassure the mother en route.
D. advise the mother to take her child to the doctor the following day.

Answer 19

C. transport the child to the hospital and reassure the mother en route.

Question 20

Your patient opens his eyes, moans, and pulls away from you when you pinch his trapezius muscle. You should assign a Glasgow Coma Scale (GCS) score of:

Select one:

A. 9.
B. 8.
C. 6.
D. 7.

Answer 20

B. 8.

Question 21

Febrile seizures:

Select one:

A. often result in permanent brain damage.
B. are also referred to as petit mal seizures.
C. are usually benign but should be evaluated.
D. occur when a child’s fever progressively rises.

Answer 21

C. are usually benign but should be evaluated.

Question 22

Status epilepticus is characterized by:

Select one:

A. generalized seizures that last less than 5 minutes.
B. an absence seizure that is not preceded by an aura.
C. profound tachycardia and total muscle flaccidity.
D. prolonged seizures without a return of consciousness.

Answer 22

D. prolonged seizures without a return of consciousness.

Question 23

What Glasgow Coma Scale (GCS) score would you assign to a patient who responds to painful stimuli, uses inappropriate words, and maintains his or her arms in a flexed position?

Select one:

A. 6
B. 8
C. 9
D. 10

Answer 23

B. 8

Question 24

A 41-year-old man presents with slow, irregular breathing; hypotension; and dilated pupils. These signs MOST likely indicate dysfunction of the:
A. brainstem.
B. hypothalamus.
C. cerebrum.
D. cerebellum.

Answer 24

A. brainstem.

The brainstem is responsible for functions such as breathing, blood pressure, and pupil constriction

Question 25

An acute ischemic stroke is caused by:
A. a ruptured cerebral artery.
B. increased intracranial pressure.
C. an acute rise in a person’s blood pressure.
D. a blocked cerebral artery.

Answer 25

D. a blocked cerebral artery.

There are two types of stroke—hemorrhagic and ischemic. A hemorrhagic stroke is caused by a ruptured cerebral artery (aneurysm), which causes bleeding within the brain and increased intracranial pressure. An ischemic stroke is caused by a blocked cerebral artery—either from a clot that grows locally (thrombus) or that travels to the brain from another part of the body (embolus).

Question 26

A 56-year-old man experienced a sudden, severe headache and then became unresponsive. He has a history of high blood pressure. The MOST likely cause of his condition is a(n):
A. hemorrhagic stroke.
B. acute ischemic stroke.
C. severe migraine headache.
D. transient ischemic attack.

Answer 26

A. hemorrhagic stroke.

Question 27

Unlike an ischemic stroke, a transient ischemic attack is characterized by all of the following, EXCEPT:
A. symptoms that resolve within 24 hours.
B. symptoms that persist for longer than 24 hours.
C. weakness or paralysis to one side of the body.
D. an acute onset of confusion and slurred speech.

Answer 27

B. symptoms that persist for longer than 24 hours.

Signs and symptoms of a transient ischemic attack (TIA) are usually identical to those of an acute ischemic stroke (eg, hemiparesis, slurred speech, confusion, facial droop). Unlike the ischemic stroke, however, the symptoms of a TIA usually resolve within 24 hours.

Question 28

A patient with a suspected stroke presents with slurred speech that is difficult for you to understand. This is referred to as:
A. aphasia.
B. dysphasia.
C. dysphagia.
D. dysarthria.

Answer 28

D. dysarthria.

Question 29

A type of seizure that is characterized by severe twitching of all the body’s muscles and lasts for several minutes or longer is called a(n):
A. partial seizure.
B. absence seizure.
C. tonic-clonic seizure.
D. generalized seizure.

Answer 29

D. generalized seizure.

Question 30

The MOST important reason for promptly transporting a stroke patient to the hospital is:
A. a transient ischemic attack can be ruled out.
B. medications may be given to reverse the stroke.
C. the clot in the coronary artery may be dissolved.
D. he or she needs close blood pressure monitoring.

Answer 30

B. medications may be given to reverse the stroke.

Fibrinolytic medications (clot busters) have been shown to reverse the symptoms of a stroke by dissolving the clot that is blocking the cerebral artery. However, for the patient to be eligible for this therapy, it must be initiated within 3 hours after the onset of symptoms. For this reason, prompt transport of the stroke patient is critical.

Question 31

Which of the following are components of the Cincinnati Prehospital Stroke Scale?
A. Arm drift, blood pressure, speech
B. Speech, pupil response, arm drift
C. Facial symmetry, speech, arm drift
D. Pupil response, facial droop, speech

Answer 31

C. Facial symmetry, speech, arm drift

Both sides of the patient’s face should move symmetrically (equally) when he or she smiles. The patient’s speech should be easily understandable and without slurring. The patient should be able to hold both arms out in front of his or her body—with eyes closed and palms up—without one arm drifting down to his or her side.

Question 32

Your patient opens his eyes when you say his name, is making incomprehensible sounds, and withdraws when you pinch his earlobe. What is his GCS score?
A. 9
B. 8
C. 11
D. 12

Answer 32

A. 9

Question 33

If a patient complains of a severe migraine, how should she be transported?
A. In a brightly lit ambulance so she can see while her vision is impaired
B. With loud sirens so she can get to the hospital as soon as possible
C. Without lights and siren
D. This patient should not be transported.

Answer 33

C. Without lights and siren

Question 34

Which of the following conditions is NOT a common cause of seizures?
Select one:
A. Hypotension
B. Acute hypoglycemia
C. Acute alcohol withdrawal
D. Poisoning or overdose

Answer 34

A. Hypotension

Question 35

Which of the following medications would indicate that a patient has a history of seizures?
Select one:
A.
Metformin (Glucophage)
B.
Levetiracetam (Keppra)
C.
Hydromorphone (Dilaudid)
D.
Enalapril (Vasotec)

Answer 35

B.
Levetiracetam (Keppra)

Question 36

When caring for a patient with documented hypoglycemia, you should be MOST alert for:
Select one:
A.
respiratory distress.
B.
a febrile convulsion.
C.
an acute stroke.
D.
a seizure.

Answer 36

D.
a seizure.

Question 37

You arrive at a local grocery store approximately 5 minutes after a 21-year-old female stopped seizing. She is confused and disoriented; she keeps asking you what happened and tells you that she is thirsty. Her brother, who witnessed the seizure, tells you that she takes valproate (Depakote) for her seizures, but has not taken it in a few days. He also tells you that she has diabetes. In addition to administering oxygen, you should:
Select one:
A.
administer one tube of oral glucose and prepare for immediate transport.
B.
give her small cups of water to drink and observe for further seizure activity.
C.
monitor her airway and breathing status and assess her blood glucose level.
D.
place her in the recovery position and transport her with lights and siren.

Answer 37

C.
monitor her airway and breathing status and assess her blood glucose level.

Question 38

Which of the following is a metabolic cause of a seizure?
Select one:
A.
Brain tumor
B.
Poisoning
C.
Head trauma
D.
Massive stroke

Answer 38

B.
Poisoning

Question 39

The principal clinical difference between a stroke and hypoglycemia is that patients with hypoglycemia:
Select one:
A.
are typically alert and attempt to communicate with health care providers.
B.
always take oral medications to maintain normal blood glucose levels.
C.
do not present with slurred speech or weakness to one side of the body.
D.
usually have an altered mental status or decreased level of consciousness.

Answer 39

D.
usually have an altered mental status or decreased level of consciousness.

Question 40

Which of the following patients would MOST likely demonstrate typical signs of infection, such as a fever?
Select one:
A.
An 88-year-old male with chronic renal problems
B.
A 3-month-old female who was born prematurely
C.
A 17-year-old male with anxiety
D.
A 35-year-old female in the later stages of AIDS

Answer 40

C.
A 17-year-old male with anxiety