Chapter 17: Neurologic Emergencies

Which of the following mimics a stroke and also causes a seizure? (a) Meningitis (b) Postictal state (c) Hypoglycemia (d) Migraine headache

(c) Hypoglycemia

Components of the Cincinnati Prehospital Stroke Scale include: (a) speech, pupil reaction, and memory. (b) arm drift, memory, and grip strength. (c) arm drift, speech, and facial droop. (d) facial droop, speech, and pupil size.

(c) arm drift, speech, and facial droop.

Your patient answers your questions appropriately, although her eyes remain closed the entire time. She moves each extremity on command, although her left side is weaker than the right. You should assign a Glasgow Coma Scale (GCS) score of: (a) 12 (b) 13 (c) 14 (d) 15

(a) 12

What criteria must be met for a patient to have status epilepticus? (a) A seizure lasting more than 30 minutes (b) A seizure that was preceded by an aura (c) The presence of incontinence during the seizure (d) Multiple seizures with normal consciousness between each event

(a) A seizure lasting more than 30 minutes

Which of the following MOST accurately describes the cause of an ischemic stroke? (a) Blockage of a cerebral artery (b) Acute atherosclerotic disease (c) Rupture of a cerebral artery (d) Narrowing of a carotid artery

(a) Blockage of a cerebral artery

What happens when blood flow to a particular part of the brain is cut off by a blockage, resulting in tissue damage? (a) Ischemic stroke (b) Hemorrhagic stroke (c) Seizure (d) Status epilepticus

(a) Ischemic stroke

A 40-year-old patient without a history of seizures experiences a generalized (tonic-clonic) seizure. The LEAST likely cause of this seizure is: (a) epilepsy. (b) a brain tumor. (c) a serious infection. (d) intracranial bleeding.

(a) epilepsy.

Which of the following conditions is NOT a common cause of seizures? (a) Poisoning or overdose (b) Hypotension (c) Acute hypoglycemia (d) Acute alcohol withdrawal

(b) Hypotension

A generalized (tonic-clonic) seizure is characterized by: (a) severe twitching of all the body's muscles. (b) a blank stare and brief lapse of consciousness. (c) unconsciousness for greater than 30 minutes. (d) a core body temperature of greater than 103°F (40°C).

(a) severe twitching of all the body's muscles.

Which of the following patients would MOST likely demonstrate typical signs of infection, such as a fever? (a) A 3-month-old female who was born prematurely (b) A 17-year-old male with anxiety (c) A 35-year-old female in the later stages of AIDS (d) An 88-year-old male with chronic renal problems

(b) A 17-year-old male with anxiety

You are dispatched to a home where you find a 70-year-old man. He is exhibiting facial drooping and, when you ask him to tell you what day it is, he says "January." Which part of the brain is most likely to have been affected? (a) Right hemisphere (b) Left hemisphere (c) Brain stem (d) Cerebellum

(b) Left hemisphere

Which of the following medications would indicate that a patient has a history of seizures? (a) Enalapril (Vasotec) (b) Levetiracetam (Keppra) (c) Hydromorphone (Dilaudid) (d) Metformin (Glucophage)

(b) Levetiracetam (Keppra)

________ affect(s) the entire brain, often causing anxiety, restlessness, and confusion. (a) Poor blood supply to one side of the brain (b) Low oxygen levels in the bloodstream (c) Very low blood glucose levels (d) Aneurysms

(b) Low oxygen levels in the bloodstream

Which of the following findings should concern the EMT the MOST when assessing a patient who complains of a headache? (a) Sinus congestion (b) Neck stiffness or pain (c) History of migraines (d) Slow onset of symptoms

(b) Neck stiffness or pain

What is the name of the condition when the patient forgets about the injured side after a stroke? (a) Hemiparesis (b) Neglect (c) Aphasia (d) Ataxia

(b) Neglect

Muscle control and body coordination are controlled by the: (a) cerebrum. (b) cerebellum. (c) brain stem. (d) cerebral cortex.

(b) cerebellum.

The anterior aspect of the cerebrum controls: (a) touch. (b) emotion. (c) movement. (d) vision.

(b) emotion.

You arrive at a grocery store shortly after a 35-year-old male stopped seizing. Your assessment reveals that he is confused and incontinent of urine. The patient's girlfriend tells you that he has a history of seizures and takes topiramate (Topamax). When obtaining further medical history from the girlfriend, it is MOST important to: (a) determine if the patient is a known alcohol abuser. (b) obtain a description of how the seizure developed. (c) determine when he was last seen by his physician. (d) ask her how long the patient has been taking his medication.

(b) obtain a description of how the seizure developed.

You are performing a Glasgow Coma Scale on a patient who opens her eyes in response to pain, is confused in her responses to questions, and has abnormal flexion. What is this patient's GCS score and corresponding state of dysfunction? (a) 3 - severe dysfunction (b) 6 - severe dysfunction (c) 9 - moderate dysfunction (d) 12 - mild dysfunction

(c) 9 - moderate dysfunction

What is the difference between a stroke and a transient ischemic attack? (a) A TIA has longer-lasting effects than a stoke. (b) A TIA involves surges of electrical activity in the brain. (c) A TIA resolves completely within 24 hours of onset. (d) A TIA affects a limited portion of the brain.

(c) A TIA resolves completely within 24 hours of onset.

You are treating a patient who is exhibiting slurred speech, facial droop, and an inability to move his left arm. Which neurologic examination emphasizes these possible stroke signs? (a) Chicago Prehospital Stroke Scale (b) 3-Item Stroke Severity Scale (c) Cincinnati Prehospital Stroke Scale (d) Glasgow Coma Scale

(c) Cincinnati Prehospital Stroke Scale

You are examining a patient whose signs include lip smacking, jerking of the left arm, and agitation. Based on these signs, what type of seizure is this patient experiencing? (a) Generalized (b) Simple partial (c) Complex partial (d) Status epilepticus

(c) Complex partial

Which of the following is a metabolic cause for a seizure? (a) Brain tumor (b) Head trauma (c) Hypoglycemia (d) High fever

(c) Hypoglycemia

Law enforcement has summoned you to a nightclub, where a 22-year-old female was found unconscious in an adjacent alley. Your primary assessment reveals that her respirations are rapid and shallow and her pulse is rapid and weak. She is wearing a medical alert bracelet that identifies her as an epileptic. There is an empty bottle of vodka next to the patient. You should: (a) place a bite block in her mouth in case she has a seizure and transport at once. (b) apply oxygen via a nonrebreathing mask, place her on her left side, and transport. (c) assist ventilations, perform a rapid exam, and prepare for immediate transport. (d) apply oxygen via nonrebreathing mask and transport her for a blood-alcohol test.

(c) assist ventilations, perform a rapid exam, and prepare for immediate transport.

A patient who is experiencing aphasia is: (a) not able to swallow without choking. (b) experiencing a right hemispheric stroke. (c) unable to produce or understand speech. (d) usually conscious but has slurred speech.

(c) unable to produce or understand speech.

Which of the following clinical signs is MOST suggestive of a ruptured aneurysm? (a) Unilateral hemiparesis (b) Confusion and weakness (c) Nasal discharge of blood (d) Sudden, severe headache

(d) Sudden, severe headache

A 58-year-old male presents with confusion, right-sided weakness, and slurred speech. His wife is present and is very upset. As your partner is applying oxygen, it is MOST important for you to: (a) list all of the patient's current medications. (b) obtain a complete set of baseline vital signs. (c) administer glucose to rule out hypoglycemia. (d) ask his wife when she noticed the symptoms.

(d) ask his wife when she noticed the symptoms.

A 29-year-old male complains of a severe headache and nausea that has gradually worsened over the past 12 hours. He is conscious, alert, and oriented and tells you that his physician diagnosed him with migraine headaches. He further tells you that he has taken numerous different medications, but none of them seem to help. His blood pressure is 132/74 mm Hg, his pulse is 110 beats/min and strong, and his respirations are 20 breaths/min. Treatment should include: (a) assisting him with his migraine medication and transporting without lights and siren. (b) placing him in a supine position and transporting with lights and siren to a stroke center. (c) applying warm compresses to the back of his neck and transporting with lights and siren. (d) dimming the lights in the back of the ambulance and transporting without lights and siren.

(d) dimming the lights in the back of the ambulance and transporting without lights and siren.

Status epilepticus is characterized by: (a) generalized seizures that last fewer 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.

(d) prolonged seizures without a return of consciousness.

Successful treatment of a stroke depends on whether: (a) surgical intervention is performed to remove obstructive clots. (b) medications are given to restore the function of infarcted cells. (c) the stroke occurs within the left or right hemisphere of the brain. (d) thrombolytic therapy is given within 3 hours of symptoms beginning.

(d) thrombolytic therapy is given within 3 hours of symptoms beginning.

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

(d) usually have an altered mental status or decreased level of consciousness.