Neurological Emergencies Flashcards
Your patient states that he often experiences a painful cramping and “freezing up” of his hands and feet while handwriting or walking, respectively. This best describes:
Question 1 options:
A)
torticollis.
B)
dystonia.
C)
myoclonus.
D)
palsy.
dystonia
Which of the following is a risk factor for stroke?
Question 2 options:
A)
Atrial fibrillation
B)
Premature atrial contractions
C)
First-degree heart block
D)
Sinus arrhythmia
atrial fibrillation
Which of the following is a risk factor for stroke?
Question 2 options:
A)
Atrial fibrillation
B)
Premature atrial contractions
C)
First-degree heart block
D)
Sinus arrhythmia
Bells palsy
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?
Question 4 options:
A)
Suctioning the airway, inserting a nasopharyngeal airway, assisting respirations by bag-valve-mask device with 100 percent oxygen
B)
An IV of normal saline at a keep open rate, check blood glucose level, administer 3 mg of lorazepam, IV
C)
Immediate nasal intubation and hyperventilation with 100 percent oxygen
D)
An IV of normal saline at a keep open rate, check blood glucose level, administer 5 mg of diazepam, IV
suctioning the airway, inserting a nasopharyngeal airway, assisting respirations by bag-valve-mask device with 100 percent oxygen
Your patient is a 45-year-old female type I diabetic with a history of a nonhealing foot ulcer. On examination, you find that her pedal pulse is present, but she lacks sensation in her foot. This is most likely due to:
Question 5 options:
A)
Brown-Séquard syndrome.
B)
Raynaud’s disease.
C)
claudication.
D)
peripheral neuropathy.
peripheral neuropathy
Your patient is a 48-year-old female who is alert and oriented after a possible seizure. Her friends state they witnessed her slump to the floor and “shake” for about 15 seconds. She awoke in less than 1 minute and was “a bit groggy” for a few minutes. She does not believe she had a seizure but thinks she may have fainted. Which of the following questions is least important when differentiating seizure and syncope?
Question 6 options:
A)
“Are you allergic to any medications?”
B)
“Do you have a history of seizures?”
C)
“What happened just before the event?”
D)
“What kind of medications do you take?”
are you allergic to any medications
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?
Question 7 options:
A)
“I took two Tylenol tablets 2 hours ago, and the pain is still there.”
B)
“I have never had a headache this bad.”
C)
“I have never been nauseated like this with a headache before.”
D)
“The pain gets worse when the lights are on.”
I have never had a headache this bad
Your patient is a 76-year-old female who was initially lethargic but responded to verbal stimuli. According to family members, the patient experienced a sudden decrease in responsiveness. She had a left-sided facial droop, aphasia, a dilated and nonreactive right pupil, and a flaccid left arm. Lung sounds are decreased bilaterally. HR = 58, BP = 172/102, RR = 6 and shallow, SaO2 = 88%. As you start to treat her, the patient has a generalized seizure lasting about 30 seconds. She is now unresponsive. Which of the following is most appropriate?
Question 8 options:
A)
Hyperventilate by bag-valve mask, IV of normal saline at a keep open rate, check blood glucose level, administer 25 gm of dextrose if needed, administer naloxone and thiamine, intubate if no improvement, transport without delay
B)
Hyperventilate by bag-valve mask, IV of normal saline at a keep open rate, diazepam 5 mg IV, intubate if no improvement, transport without delay
C)
Intubation, IV of normal saline at a keep open rate, cardiac monitor, blood glucose determination, sublingual nitroglycerin spray, transport without delay
D)
Intubation, IV of normal saline at a keep open rate, cardiac monitor, blood glucose determination, transport without delay
intubation, IV of normal saline at a keep open rate, cardiac monitor blood glucose determination, transport without delay
Your patient is a 32-year-old female who is alert but in significant distress, complaining of a migraine. She has a history of migraines, describes a gradual onset of headache this morning, and is now experiencing nausea and intense throbbing pain behind her temples. She is lying on a couch in a dim room and keeps her eyes closed while talking to you in a low voice. HR = 100, BP = 148/100, RR = 12, SaO2 = 99%. Which of the following is most appropriate in the prehospital management of this patient?
Question 9 options:
A)
Lorazepam, 2 mg
B)
Morphine sulfate, IV in 2 mg increments, up to 10 mg
C)
A calm, quiet environment and dim lights
D)
NTG SL, 0.4 mg, up to 3 tablets or a diastolic blood pressure of 80 mmHg
a calm quiet environment and dim lights
Your patient is a 62-year-old female who is alert and oriented and sitting at her kitchen table. Her husband describes an episode of slurred speech and facial drooping that lasted about 10 minutes and resolved just before your arrival. Physical examination is unremarkable. She has no significant medical history and takes no medications. HR = 78, BP = 134/78, RR = 12, SaO2 = 99%. Which of the following is most likely?
Question 10 options:
A)
Stroke
B)
Absence seizure
C)
Ménière’s disease
D)
Transient ischemic attack
transient ischemic attack
A series of two or more generalized motor seizures without an intervening period of consciousness is known as:
Question 11 options:
A)
a petit mal seizure.
B)
status epilepticus.
C)
a complex partial seizure.
D)
hypertonic seizures.
status epilepticus
Which of the following infectious childhood diseases would most likely result in paralysis?
Question 12 options:
A)
German measles
B)
Spina bifida
C)
Poliomyelitis
D)
Rubella
poliomyelitis
The most common cause of dementia is:
Question 13 options:
A)
stroke.
B)
Alzheimer’s disease.
C)
Bell’s palsy.
D)
Korsakoff’s psychosis.
Alzheimer’s disease
A seizure that begins as an electrical discharge in a small area of the brain but spreads to include the entire cerebral cortex is a ________ seizure.
Question 14 options:
A)
complex partial
B)
simple partial
C)
myoclonic
D)
generalized
generalized
You should most highly suspect that a patient with tremors, periodic muscular rigidity, slowed movement, and impaired balance and coordination suffers from:
Question 15 options:
A)
peripheral neuralgia.
B)
amyotrophic lateral sclerosis.
C)
Parkinson’s disease.
D)
autonomic dysreflexia.
Parkinson’s disease
Which of the following should be suspected as a potential cause of syncope?
Question 16 options:
A)
Hypovolemia
B)
All of these
C)
Unknown cause
D)
Cardiac arrhythmia
all of these
A patient tells you that she experienced an episode of involuntary “shaking” in her arm. She describes a 1- to 2-minute-long episode of muscular jerking and contracting of her entire left arm. She retained consciousness, lacked an aura, and had no pain associated with the episode. This most indicates a(n) ________ seizure.
Question 17 options:
A)
psychosomatic
B)
petit mal
C)
simple partial
D)
absence
simple partial
Your patient is a 24-year-old male who is alert and oriented, complaining of severe “dizziness” and an earache for two days. He states that any movement of his head causes him to become very dizzy and nauseated. The patient’s skin is warm and dry, his pupils are equal and reactive, and there is no gross neurological deficit. HR = 82, BP = 120/82, RR = 12, SaO2 = 99%. Which of the following is most likely?
Question 18 options:
A)
Transient cerebral attack
B)
Subdural hematoma
C)
Labyrinthitis
D)
Hypersensitivity of the carotid sinus
labyrinthitis
You suspect your patient is experiencing a hemorrhagic stroke. He is confused, has a respiratory rate of 20, and a blood pressure of 178/88. Which of the following additional findings would most increase your suspicion of increased intracranial pressure?
Question 19 options:
A)
Slurred speech
B)
Heart rate of 50
C)
Anterograde amnesia
D)
Hallucinations
heart rate of 50
Which three cranial nerves are involved in the cardinal positions of gaze?
Question 20 options:
A)
III, IV, and VI
B)
I, III, and IV
C)
VI, VII, and X
D)
I, III, and VI
III, IV and VI
You are transporting a male patient to the hospital for an evaluation after a possible seizure when you notice the patient’s loss of consciousness. His muscles start to contract so that he is arching his back. This best describes the ________ phase of a generalized seizure.
Question 21 options:
A)
postictal
B)
tonic
C)
hypertonic
D)
clonic
hypertonic
A patient with speech impairment following a stroke would have involvement in the ________ lobe of the brain.
Question 22 options:
A)
occipital
B)
parietal
C)
temporal
D)
frontal
temporal
Your patient has a history of epilepsy and is experiencing loss of consciousness, tonic-clonic muscle activity, and erratic ocular movement. Based on this, you might also expect to find all of the following EXCEPT:
Question 23 options:
A)
pinpoint pupils.
B)
increased oral secretions.
C)
urinary incontinence.
D)
impaired respiration.
pinpoint pupils
Your female patient is experiencing sharp, stabbing, right-sided face pain of her upper and lower lips, cheek, and around her orbit. This best describes:
Question 24 options:
A)
Bell’s palsy.
B)
trigeminal neuralgia.
C)
temporomandibular joint syndrome.
D)
a cluster headache.
trigeminal neuralgia
Which of the following is a collection of genetic diseases characterized by progressive muscle weakness and skeletal muscle degeneration?
Question 25 options:
A)
Myasthenia gravis
B)
Multiple sclerosis
C)
Amyotrophic lateral sclerosis
D)
Muscular dystrophy
muscular dystrophy
The dorsal roots of the spinal cord contain afferent fibers that transmit impulses from ________ to ________.
Question 26 options:
A)
sensory nerves, central nervous system
B)
the central nervous system, sensory nerves
C)
the central nervous system, motor nerves
D)
motor nerves, the central nervous system
sensory nerves, central nervous system
The most common cause of lower back pain is:
Question 27 options:
A)
idiopathic.
B)
sciatica.
C)
arthritis.
D)
osteomyelitis.
idiopathic
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.
Question 28 options:
A)
simple partial
B)
pseudo
C)
complex partial
D)
absence
pseudo
A 35-year-old male complains of a “pressure”-type headache to the back of his head and neck. He states that he woke up with the discomfort this morning, and the pain has steadily gotten worse through the day. He denies any radiation of the pain and denies photophobia but states that he is slightly nauseated. Based on this clinical presentation, the paramedic should be suspicious of what type of headache?
Question 29 options:
A)
Tension
B)
Cluster
C)
Vascular
D)
Migraine
tension
All of the following may cause a transient ischemic attack EXCEPT:
Question 30 options:
A)
a small embolus.
B)
hypotension.
C)
intracranial hemorrhage.
D)
cerebrovascular spasm.
intracranial hemorrhage
Which of the following complaints is most typical for a patient suffering an exacerbation of multiple sclerosis?
Question 31 options:
A)
“I cannot remember my address or phone number.”
B)
“Each night I seem to get a fever and break out in a sweat.”
C)
“My legs feel heavy, and I am having trouble walking.”
D)
“I have no feeling in either my arms or my legs.”
my legs feel heavy and I am having trouble walking
Which of the following diseases involves inflammation followed by demyelination of the brain and spinal cord nerve fibers?
Question 32 options:
A)
Myasthenia gravis
B)
Muscular dystrophy
C)
Alzheimer’s disease
D)
Multiple sclerosis
multiple sclerosis
The postsynaptic neurotransmitter of the sympathetic nerves is:
Question 33 options:
A)
norepinephrine.
B)
epinephrine.
C)
dopamine.
D)
acetylcholine.
norepinephrine
A type of generalized seizure characterized by a rapid loss of consciousness and motor coordination, muscle spasms, and jerking motions is known as a(n):
Question 34 options:
A)
complex partial seizure.
B)
absence.
C)
tonic-clonic seizure.
D)
simple partial seizure.
tonic-clonic seizure
Which of the following is NOT characteristic of a migraine?
Question 35 options:
A)
Throbbing headache
B)
Vomiting
C)
Photosensitivity
D)
Low back pain
low back pain
Which of the following should NOT be part of the general management of a patient with altered mental status?
Question 36 options:
A)
Thiamine
B)
Hyperventilation with 100 percent oxygen
C)
50 percent dextrose
D)
IV with saline lock
Hyperventilation with 100 percent oxygen
Which of the following is characterized by involuntary muscle twitching?
Question 37 options:
A)
Myoclonus
B)
Ataxia
C)
Trismus
D)
Dystonia
Myoclonus
The most common cause of dementia in the elderly is:
Question 38 options:
A)
multi-infarct dementia.
B)
cerebrovascular disease.
C)
Parkinson’s disease.
D)
Alzheimer’s disease.
Alzheimer’s disease
An eight-year-old male child is alert and oriented after a brief episode of eyelid fluttering and slight loss of muscle tone, which caused him to slump in his chair. His teacher reports that the child was inattentive for 15 to 20 seconds during the episode but was fine after. This most indicates a(n) ________ seizure.
Question 39 options:
A)
absence
B)
generalized
C)
simple partial
D)
pseudo
absence
A seizure that remains confined to a limited portion of the brain, causing localized dysfunction, is a(n) ________ seizure.
Question 40 options:
A)
petit mal
B)
absence
C)
tonic
D)
partial
partial
Your patient is a 57-year-old male who is alert and oriented and complaining of a slight headache. His coworker states the patient “fainted.” The patient describes feeling weak and lightheaded before the incident and “came to” lying on the floor. Medical history includes cardiovascular disease with a history of angina and hypertension. Medications include clopidogrel (Plavix), nitroglycerin, and metoprolol. Which of the following is least helpful when formulating a field impression for this patient?
Question 41 options:
A)
Cardiac monitoring
B)
Neurological exam
C)
Pulse oximetry
D)
Orthostatic vital signs
pulse oximetry
Which of the following diseases is characterized by a progressive degeneration of the nerve cells that control voluntary movement, weakness, loss of motor control, difficulty speaking, and cramping?
Question 42 options:
A)
Multiple sclerosis
B)
Bell’s palsy
C)
Amyotrophic lateral sclerosis
D)
Muscular dystrophy
Amyotrophic lateral sclerosis
Which of the following is least likely to be detrimental when treating a stroke patient?
Question 43 options:
A)
IV of 5 percent dextrose in water
B)
Hyperventilation with 100 percent oxygen
C)
Administration of 50 percent dextrose, IV push
D)
IV of lactated Ringer’s solution
Iv of lactated Ringers solution
Which of the following is least pertinent in the prehospital setting when obtaining the history of a patient with a suspected transient ischemic attack or stroke?
Question 44 options:
A)
History of diabetes
B)
Allergies
C)
History of cardiovascular disease
D)
Medications
Allergies
Your patient is a 19-year-old female who is exhibiting generalized seizure activity. Her roommate states that she had a seizure that lasted about 3 minutes. She remained unresponsive, then started having another seizure about 5 minutes after the first. The patient has peripheral cyanosis and copious oral secretions. Which of the following is of HIGHEST priority for this patient?
Question 45 options:
A)
Suctioning the airway, assisting ventilations with a bag-valve-mask device
B)
Starting an IV, administering succinylcholine, and intubation
C)
Suctioning the airway, applying 15 liters per minute of oxygen by nonrebreathing mask
D)
Starting an IV and administering 5 mg of diazepam
suctioning the airway, assisting ventilations with a bag valve mask device
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):
Question 46 options:
A)
osteogenesis imperfecta.
B)
myelomeningocele.
C)
hydrocele.
D)
meningioma.
myelomeningocele
Your patient is a 52-year-old female who is alert but slightly confused after a syncopal episode lasting about 1 minute. She has no complaints, and your physical exam reveals no abnormalities aside from slight confusion. She has had a stroke and has a history of type II diabetes and hypertension. HR = 100, BP = 132/84, RR = 12, SaO2 = 99%. Which of the following is the least likely cause of the patient’s episode?
Question 47 options:
A)
Orthostatic hypotension
B)
Transient cardiac arrhythmia
C)
Transient ischemic attack
D)
Hypoglycemia
orthostatic hypotension
You are transporting a male patient with the complaint of expressive aphasia and right upper extremity paralysis to the hospital. When calling the hospital, which of the following pieces of information is it most critical to convey?
Question 48 options:
A)
Blood pressure 168/82 mmHg
B)
History of hypertension
C)
SaO2 94% despite oxygen
D)
Time of symptom onset
time of symptom onset
Atrial fibrillation is most associated with ________ strokes.
Question 49 options:
A)
embolic
B)
hemorrhagic
C)
hypoxic
D)
thrombotic
embolic
All of the following are assessed during the Cincinnati Prehospital Stroke Screen EXCEPT:
Question 50 options:
A)
speech.
B)
facial droop.
C)
arm drift.
D)
memory.
memory
The family members of a 72-year-old female state that the patient complained of a sudden, severe headache; had slurred speech; then became unresponsive. She responds to painful stimuli with decorticate posturing and has snoring respirations at a rate of 10 per minute. Her radial pulse is palpable but grossly irregular. According to her son, she also suffers from congestive heart failure, hypertension, and diabetes. Which of the following should you do first?
Question 51 options:
A)
Insert an endotracheal tube.
B)
Check her blood sugar.
C)
Attach the cardiac monitor.
D)
Manage the airway with a modified jaw-thrust maneuver.
manage the airway with a modified jaw- thrust maneuver
The father of a 15-year-old male who has had a generalized seizure asks you why his son turned blue during the seizure. Which of the following is the best answer?
Question 52 options:
A)
“It is a normal part of the seizure process and nothing to worry about.”
B)
“The brain stem stops working during a seizure, which causes breathing to stop, decreasing the amount of oxygen in the blood.”
C)
“The muscles used in breathing cannot work effectively during the seizure, decreasing the amount of oxygen in the blood.”
D)
“The heart slows down and the blood pressure drops during a seizure, causing a lack of circulation to the skin.”
the muscles used in breathing cannot work effectively during the seizure, decreasing the amount of oxygen in the blood
Pseudoseizures are best controlled by:
Question 53 options:
A)
a command to stop.
B)
phenytoin.
C)
lorazepam.
D)
using physical restraints.
a command to stop
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?
Question 54 options:
A)
Move objects away from her and wait to see if the seizure stops.
B)
Insert an oropharyngeal airway.
C)
Restrain her so she does not injure herself.
D)
Start an IV, and administer 5 mg diazepam.
move objects away from her and wait to see if the seizure stops
Which of the following is evaluated in the Los Angeles Prehospital Stroke Screen but is not part of the Cincinnati Prehospital Stroke Scale?
Question 55 options:
A)
Arm drift
B)
Facial droop
C)
Temperature
D)
Blood glucose level
blood glucose level
Your patient is a 49-year-old male complaining of a headache and weakness of his left arm, accompanied by nausea and vomiting. The information that would be most helpful in differentiating a brain abscess from a brain tumor is whether or not the patient:
Question 56 options:
A)
exhibits nuchal rigidity.
B)
has a recent history of brain surgery.
C)
has had a change in the level of responsiveness.
D)
has had a seizure.
exhibits nuchal rigidity
You are examining a newborn and note that the meninges and spinal cord are protruding through an opening over the lower back. This is known as:
Question 57 options:
A)
a myelomeningocele.
B)
spina bifida occulta.
C)
poliomyelitis.
D)
a meningocele.
a myelomengingocele
What neurological problem results in a neural defect in which the fetal vertebrae do not close properly, often resulting in spinal cord dysfunction?
Question 58 options:
A)
Spina bifida
B)
Guillain-Barré syndrome
C)
Multiple sclerosis
D)
Creutzfeldt-Jakob disease
spina bifida
What is the innermost layer of meninges that directly overlies the central nervous system?
Question 59 options:
A)
Pia mater
B)
Dura mater
C)
Cerebrospinal membrane
D)
Arachnoid membrane
pia mater
Which of the following diseases is most likely to cause dementia in the patient?
Question 60 options:
A)
Spina bifida
B)
Multiple sclerosis
C)
Pick’s disease
D)
Amyotrophic lateral sclerosis
Pick’s disease
Epilepsy affects roughly:
Question 61 options:
A)
10 percent of the population.
B)
15 percent of the population.
C)
1 percent of the population.
D)
5 percent of the population.
1 percent of the population
The nervous system is divided into which two main parts?
Question 62 options:
A)
Central and peripheral
B)
Autonomic and cranial
C)
Peripheral and autonomic
D)
Central and autonomic
central and peripheral
The entire central nervous system is covered by the:
Question 63 options:
A)
meninges.
B)
peritoneum.
C)
pia mater.
D)
dura mater.
meninges
The area that connects the brain to the spinal cord is known as the:
Question 64 options:
A)
cerebellum.
B)
foramen magnum.
C)
medulla oblongata.
D)
pons.
pons
The primary neurotransmitter of the sympathetic nervous system is:
Question 65 options:
A)
epinephrine.
B)
acetylcholine.
C)
dopamine.
D)
reteplase.
epinephrine
The primary neurotransmitter of the parasympathetic nervous system is:
Question 66 options:
A)
epinephrine.
B)
reteplase.
C)
dopamine.
D)
acetylcholine.
acetylcholine
The two mechanisms capable of producing alterations in mental state are:
Question 67 options:
A)
cranial nervous and the central nervous system.
B)
physiologic and RAS.
C)
structural and RAAS.
D)
structural and toxic-metabolic.
structural and toxic- metabolic
The acronym AVPU is used to quickly assess a patient’s:
Question 68 options:
A)
judgment.
B)
mental status.
C)
mood.
D)
thought.
mental status
Increasing PaCO2 will cause:
Question 69 options:
A)
cerebral vasodilation.
B)
hyperventilation syndrome.
C)
cerebral vasoconstriction.
D)
ataxic respirations.
cerebral vasodilation
Decreasing PaCO2 will cause:
Question 70 options:
A)
ataxic respirations.
B)
cerebral vasoconstriction.
C)
cerebral vasodilation.
D)
hyperventilation syndrome.
cerebral vasoconstriction
Posturing with the arms flexed and the legs extended is known as:
Question 71 options:
A)
decorticate position.
B)
decerebrate position.
C)
neurogenic shock position.
D)
postictal position.
decorticate position
You respond to a patient who has an AV shunt in place. You notice that the patient is unresponsive with the following vital signs: blood pressure, 180/100 mmHg; pulse: 48; respirations: 12 and irregular. You suspect:
Question 72 options:
A)
seizure.
B)
increased intracranial pressure.
C)
normal status for an AV shunt patient.
D)
decreased intracranial pressure.
increased intracranial pressure
One cause of altered mental status that you are able to quickly rule out is:
Question 73 options:
A)
hypoglycemia.
B)
TIA.
C)
CVA.
D)
hyperglycemia.
hypoglycemia
When evaluating a patient with a possible neurologic emergency, which acronym can help you remember the causes?
Question 74 options:
A)
AEIOU-TIPS
B)
ISAL
C)
TICKLES
D)
AVPU
AEIOU-TIPS
A condition seen in chronic alcoholics that causes ataxia, eye muscle weakness, and mental derangement is known as:
Question 75 options:
A)
Brugada syndrome.
B)
Wolff-Parkinson-White syndrome.
C)
Wernicke’s syndrome.
D)
Korsakoff’s psychosis.
Wernicke’s syndrome
You respond to a patient who is complaining of a sudden onset of a severe headache. The patient has a history of hypertension. You should suspect:
Question 76 options:
A)
occlusive stroke.
B)
hypertensive urgency.
C)
migraine.
D)
hemorrhagic stroke.
hemorrhagic stroke
A TIA typically:
Question 77 options:
A)
never resolves.
B)
is caused by intracranial hemorrhage.
C)
resolves within 24 hours.
D)
can be reversible with tPA.
resolves within 24 hours
A tonic-clonic seizure is characterized by:
Question 78 options:
A)
flaccidity.
B)
movement of one area of the body.
C)
increased muscle tone and rhythmic jerking.
D)
a period of apnea.
increased muscle tone and rhythmic jerking
