Chapter 19 Flashcards
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:
Administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren.
A rhythmic contraction and relaxation of muscle groups that is commonly observed during a seizure indicates which type of activity?
Clonic
Which of the following is an example of receptive aphasia?
You ask a patient who the president is, and they say “January.”
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:
oxygen as tolerated, starting an IV line and administering ondansetron, and transporting without lights or siren.
An autoimmune disorder in which the body attacks the myelin of the brain and spinal cord is called:
multiple sclerosis.
Which of the following cranial nerves regulates movement of the head and shoulders?
Accessory
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?
Postural
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:
diphenhydramine, 25 mg.
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 toward the body when the patient’s eyes are closed.
In contrast to a patient in shock, you would expect a patient with increased intracranial pressure to present with:
a widened pulse pressure.
A stroke to the right cerebral hemisphere would likely cause:
left-sided weakness and right-sided visual field loss.
What portion of the brainstem regulates respiratory pattern and depth?
Pons
Which of the following cranial nerves is responsible for airway control?
Trigeminal
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:
open his airway and begin assisting his ventilations, establish an IV or IO line, and administer diazepam.
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?
Absence
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?
Although the patient is likely experiencing a TIA, you should treat her as though she is experiencing a stroke.
Tremors that increase as the patient’s hand gets closer to an object that they are trying to grab are what type of tremors?
Intention
Which of the following is an example of an acute cerebrovascular emergency?
Embolic blockage of a cerebral artery
A staggering gait is most suggestive of damage to the:
Cerebellum
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?
Parkinson disease
A patient with multiple sclerosis may present with:
Nystagmus
Which of the following assessment findings would indicate dysfunction of the trigeminal nerve?
Inability to feel the part of the face you are touching
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.
Components of the diencephalon include the:
thalamus and hypothalamus.
Which of the following causes of altered mental status is a gradual process?
Uremia
Patients with trismus often require:
sedation or chemical paralysis to facilitate airway control.
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
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:
rule out hypoglycemia by assessing his blood sugar, but suspect a right-sided ischemic stroke.
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:
Brainstem injury
Prehospital treatment for a patient with a suspected stroke who recently had a seizure may include which of the following?
Diazepam or lorazepam
An idiopathic seizure is one in which:
the cause is not known.
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?”
During a generalized tonic-clonic seizure, the patient is rigid and his back is arched. This represents which phase of the seizure?
Hypertonic
Chemicals that relay electrically conducted signals from one neuron to another are called:
Neurotransmitters
Which of the following is a term used to describe changes in a person’s ability to perform coordinated motions, such as walking?
Ataxia
Which of the following is a common cause of trismus in an unresponsive patient?
Cerebral hypoxia
Hyperventilating a patient who has increased intracranial pressure (ICP) will:
constrict the cerebral vasculature and decrease cerebral perfusion.
Emotions such as rage and anger are generated in the:
limbic system.
When assessing a patient’s respiratory pattern, you notice that inspiration and expiration are equal. This indicates which pattern of breathing?
Eupnea
Which of the following would have the most negative effect on the outcome of a patient with an intracranial hemorrhage?
Hypotension
Spasmodic torticollis is characterized by:
neck muscle contraction, which twists the head to one side.
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:
an intracranial neoplasm.
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?
Trochlear, oculomotor, abducens
According to the Los Angeles Prehospital Stroke Screen, the possibility of a stroke is increased if:
the blood glucose is between 60 and 400 mg/dL.
When assessing a patient’s response to pain, you notice that the patient is not responding to stimuli. What should you do first?
Carefully assess the airway.
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:
ensuring airway patency and adequate breathing.
Management for a patient with a neurologic emergency begins by:
taking deliberate actions to ensure personal safety.
When neurons are deprived of oxygen and glucose:
they convert to anaerobic metabolism.
Which of the following signs or symptoms are consistent with meningitis in an infant?
High-pitched cry and bulging fontanelles
Pupils that differ in size by less than 1 mm:
may be a normal variant in some patients.
