exam 3 Neurology Flashcards
A 63-year-old female with a history of type II diabetes presents with a four-day history of increased urination and thirst. She called EMS this morning when she experienced a brief period of dizziness while getting out of bed. Your assessment reveals a BP of 108/60, RR of 14 and regular, and a HR of 122 and regular. You also note that the patient is slightly confused and has warm, dry skin and mucous membranes. Based on this patient presentation, what other finding could you expect? Answers: Atrial flutter Fruity breathodor A blood glucose of 68 mg/dL Glucosuria
Glucosuria
You have administered glucagon to a diabetic patient. Which of the following should occur?Answers: Stimulation of the pancreatic alpha cells, resulting in lipolysis
Stimulation of the pancreatic beta cells, resulting in a decreased blood glucose level
Glycogenesis, resulting in a decreased blood glucose level
Glycogenolysis, resulting in an increased blood glucose level
Stimulation of the pancreatic beta cells, resulting in a decreased blood glucose level
Your diabetic patient asks you why he “passes out” when his blood sugar gets too low. Which of the following responses is most accurate?
Answers:
“When the blood sugar is low, the brain does not get enough oxygen.”
“Brain cells need a constant supply of glucose, or sugar, to function. Without sugar the brain cells cannot work to maintain consciousness.”
“When the blood sugar is low, the blood vessels relax and the blood pressure drops, causing you to faint.”
“The cells of the heart can only use glucose, or sugar, for energy. Without sugar the heart cannot effectively pump blood to the brain.”
Selected Answer: “Brain cells need a constant supply of glucose, or sugar, to function. Without sugar the brain cells cannot work to maintain consciousness.”
Acute exacerbation of Addison’s disease can lead to ECG changes and cardiovascular collapse as a result of electrolyte imbalance secondary to:
Answers: Increased mineralocorticoid secretion from the adrenal glands
Potassium retention and sodium excretion
Fluid retention, potassium excretion, and sodium retention
Decreased mineralocorticoid secretion with increased sodium and potassium excretion
Potassium retention and sodium excretion
Which of the following is the most direct cause of polyuria in untreated diabetes?
Hyperglycemia
Your patient is a 72-year-old male patient who is conscious but slow to respond to questions and commands. He has become increasingly lethargic, unemotional, and easily fatigued over the past two months. He has had a decreased appetite and has gained weight over the same period. The patient further states, “I’m constipated and always cold.” Which of the following additional signs or symptoms would be consistent with this patient presentation?
A puffy face, an enlarged tongue, and pale, doughy skin
Which of the following findings would be atypical in a patient with a history of Cushing’s syndrome?
Temperature of 101°F
A chemical substance that is released into the blood by a gland and that controls or affects processes in other glands or body systems is a(n):
Hormone
Hyperglycemia is most likely a result of damage to the pancreatic ________ cells.
Beta
Your patient is a 39-year-old male with a history of alcoholism. He is unresponsive, with cool, clammy skin and a weak, rapid pulse of 108. BP = 128/92, RR = 12 and regular. Your partner manages the airway and assists ventilations, but you are unable to start an IV after three attempts. Which of the following is most appropriate at this point?
Glucagon, 1.0 mg, and thiamine, 100 mg, both IM
A finding of exophthalmos and goiter should increase your suspicion for a problem with the:
Thyroid gland
Which of the following should occur with the administration of insulin?
Hepatic glycogen synthesis
A patient has a fever of 105°F, irritability, delirium, tachycardia, vomiting, and hypotension. These signs and symptoms are most consistent with:
thyrotoxic crisis
Which of the following statements about the epidemiology of Graves’ disease is TRUE?
Graves’ disease is about six times more common in women than in men
A type I diabetic presents with deep, rapid respirations and a fruity odor on her breath. Which of the following would best help correct the underlying physiologic disturbance?
:
Insulin
A 34-year-old female, conscious, alert, and oriented, is complaining of a three-week history of increased appetite, weight loss, weakness, insomnia, and inability to tolerate heat. She has recently been frequently agitated and prone to mood swings. Based on these signs and symptoms, which of the following best describes the additional findings you could expect?
Exophthalmos and goiter
Your patient is a 56-year-old male who is conscious and exhibits slurred speech, irritability, and cool, clammy skin. Blood glucose is 54 mg/dL. Proper treatment for this patient could include all of the following EXCEPT:
5 to 10 mg of glucagon IM
Cushing’s syndrome is a disorder of the:
Adrenal glands
Secretion of glucagon from the pancreas results in ________, which causes a(n) ________ in blood glucose levels.
Glycogenolysis, increase
A 16-year-old female with a history of diabetes is found unconscious in a high school bathroom following volleyball practice. She is tachycardic; has cool, clammy skin; is lethargic; is slightly combative; and is very confused. She is most likely experiencing:
Hypoglycemia
A patient presents with a history of frequent urination, signs and symptoms of dehydration, and a blood glucose of 958 mg/dL. There is no acetone odor on his breath. To which of the following can the absence of an acetone odor most likely be attributed?
The ability to use enough glucose to meet metabolic needs
Which of the following is LEAST likely to be detrimental when treating a stroke patient?
IV of lactated Ringer’s solution
A seizure that begins as an aberrant electrical discharge in a small area of the brain but spreads to include the entire cerebral cortex is a ________ seizure
Generalized
Which of the following is caused by unilateral paralysis of cranial nerve VII?
Bell’s palsy
Which of the following diseases involves inflammation followed by demyelination of the brain and spinal cord nerve fibers?
Multiple sclerosis
Which of the following is a risk factor for stroke?
Atrial fibrillation
The dorsal roots of the spinal cord contain afferent fibers that transmit impulses from ________ to ________.
Sensory nerves, central nervous system
What is the best method to control a Pseudoseizure?
A command to stop
The postsynaptic neurotransmitter of the sympathetic nerves is:
Acetylcholine
Your patient is a 32-year-old male who is alert and oriented and complaining of severe pain. He states he has a history of disk herniation. Today, he experienced an acute onset of lower back pain while lifting a heavy box. Physical examination reveals a palpable muscle spasm and pain with palpation at the level of L4 and L5. He is lying on his right side and states that the pain is too severe for him to move. HR = 132, BP = 152/104, RR = 20, SaO2 = 99%. Which of the following would NOT be appropriate?
Cervical collar, supine immobilization on a long backboard
A form of spina bifida in which some of the spinal cord and meninges are protruding from a defect in the spine is a(n):
Myelomeningocele
While you are caring for a patient on the floor of her kitchen, she begins to have a generalized seizure. Which of the following is the most appropriate first action?
Move objects away from her and wait to see if the seizure stops.
Atrial fibrillation is most associated with ________ strokes.
Embolic
Your patient is a 55-year-old male with a history of seizures who is on the floor and experiencing tonic-clonic motor activity. His jaw is clenched, he has peripheral cyanosis, and there are frothy secretions in his airway. HR = 130, RR = 4 and shallow, SaO2 = 88%. Which of the following is MOST appropriate?
Suctioning the airway, inserting a nasopharyngeal airway, assisting respirations by bag-valve mask device with 100 percent oxygen
During a domestic disturbance your patient experienced a sudden onset of violent, bizarre movements of the extremities followed by unresponsiveness to verbal stimuli. On your arrival the bizarre movements begin again but stop suddenly when you firmly say, “Stop!” This most indicates ________ seizure.
Pseudo
What is the innermost layer of meninges that directly overlies the central nervous system?
Pia mater
A seizure that remains confined to a limited portion of the brain, causing localized dysfunction, is a(n) ________ seizure.
Partial
All of the following are assessed during the Cincinnati Prehospital Stroke Screen EXCEPT
Memory
Which three cranial nerves are involved in the cardinal positions of gaze?
III, IV, and VI
Which of the following is the most common cause of dementia?
Alzheimer’s disease
Your patient is a 72-year-old male with a history of coronary artery disease and atrial fibrillation. He complains of a sudden onset of blindness in his right eye. He is noncompliant with both his digitalis and coumadin. He is alert and oriented. HR = 112, irregular; BP = 154/94; RR = 16. Which of the following is LEAST likely?
Hemorrhagic stroke
Which of the following patients is the most likely candidate for fibrinolytic therapy to treat a stroke?
67-year-old female who called EMS as soon as she noticed difficulty speaking but shows no improvement with prehospital treatment
Which type of seizure does this statement define? A series of two or more generalized motor seizures without an intervening period of consciousness.
Status epilepticus
Valium would be LEAST likely to impact the cause of ________ seizures.
Pseudo
You have been called for a 46-year-old female complaining of a headache. Which of the following statements made by the patient should you find most concerning?
“I have never had a headache this bad.”
