Vol 3 Ch 3
A patient is stimulated by a vigorous sternal rub and, in response to such stimuli, he flexes his arms and extends his legs. What is this called?
Decorticate posturing
Which of the following nonstroke disorders could result in a "probability of ischemic stroke" according to the Cincinnati Prehospital Stroke Scale?
Bell's palsy
You are dispatched to the local mall for a 25-year-old female who is seizing. When you arrive you note that she is having a tonic-clonic seizure. A bystander, trained in first aid, tells you that this is the third time she has seized and that she hasn't regained consciousness between events. After controlling her movements you assist her ventilations, administer oxygen, check her vital signs, which are within normal limits, and initiate an IV of D5W TKO. Your patient then starts to seize again. You decide to administer 5 mg diazepam; shortly afterward your patient stops active seizing and you take advantage of the break to reassess her, only to find her respiratory rate has dropped to 6 breaths per minute and she is now hypotensive. While continuing to assist her ventilations, which drug would you consider next?
0.2 mg flumazenil
How many pairs of spinal nerves exit the spinal cord?
31
Your patient is postictal from a seizure. He opens his eyes to painful stimulation, makes incomprehensible sounds, and reaches away from the midline when a sternal rub is applied. What is his Glasgow Coma Scale value?
8
Which of the following treatments would most likely benefit a patient complaining of general weakness and dizziness?
A fluid bolus of normal saline
You are called to the scene of a 68-year-old female patient. The family told your dispatcher that she was "breathing but wouldn't wake up." On your arrival you find the patient lying in bed with sonorous respirations and decorticate posturing. What is your initial concern?
Airway maintenance
Your patient is a 60-year-old male who has a severe headache, hypoxia, a new pattern of seizures, cognitive changes, vomiting, and a change of sensation in his right arm. You diagnose him with a probable spinal or cerebral neoplasm. Which of the following are appropriate interventions? A. Administer diazepam if seizure activity is present. B. Transport the patient to an emergency department. C. Administer supplemental oxygen to correct hypoxia. D. All of the above.
All of the above
Why is collection of a thorough history important when building a differential diagnosis on the victim of a severe headache?
A severe, acute onset headache or a change in headache pattern indicates the need for immediate attention
An increase in intracranial pressure that results in increased blood pressure, decreased pulse, and irregular ventilations is known as what?
Cushing's triad
What type of exam(s) would best assist you in differentiating potential causes for patients complaining of generalized weakness and vertigo?
Detailed history and focused assessment
Identify the correct statement regarding a stroke.
It occurs when the normal blood flow to an area of the brain is compromised due to partial or total blockage of a cerebral artery.
The portion of the brainstem that is located between the diencephalon (interbrain) and the pons that is responsible for motor coordination and control of eye movement is which of the following?
Mesencephalon (midbrain)
Which of the following assessment tools can provide an accurate differential diagnosis for a patient with altered mental status?
Portable glucometer
Why do reflex movements lack the fine motor control of conscious movement?
Reflex impulses come from the spinal cord.
You are called to a residence for a 7yearold male subject not acting appropriately. On scene the patient appears to be unaware of your arrival and responsive to verbal stimuli from his mother. ABC's appear to be intact and no life threats are immediately present. The mother reports that the child was watching television and noticed the child's fingers began to twitch. As she continues to describe the course of events leading up to calling for EMS, the patient becomes unresponsive and exhibits hyperextension of the back. Which of the following describes the evolution of the patient's current condition?
Simple partial to tonic-clonic
Which of the following is the third most common cause of death and, in middle-aged and older patients, is a frequent cause of disability each year in the U.S.?
Stroke
Neurologic disorders that display symptoms of unilateral hemispheric involvement are generally the result of which of the following mechanisms?
Structural lesions
What is the neurologic condition characterized by a sudden, temporary loss of consciousness that can be caused by hypovolemia, hypoglycemia, a heart arrhythmia, and/or TIA?
Syncope
As you question a patient who has recovered from a complex partial seizure, which of the following is he likely to mention?
The patient has a very bad metallic taste in his mouth.
When considering the etiology of most brain tumors, which of the following is correct?
They are often metastasized from elsewhere in the body.
Why are benign neoplasms of the central nervous system potentially harmful?
They can easily result in elevated intracranial pressures.
You are dispatched to the scene of a "belligerent man" who is ranting at passersby. As you approach, you note that police have already arrived at the convenience store, and your victim, who appears to be in his 50s, is standing between them talking loudly, and appears to be confused. The store owner is telling the officers that your patient frequently panhandles in front of the store and then purchases wine, but today he just started "carrying on" in a loud voice. The police would like him transported to the ED, and one of the officers has volunteered to accompany you. His vital signs are all within normal limits and your exam is unremarkable except for yellowing of the conjunctiva. You initiate an IV and contact the ED while en route. Of the following medications, which one might your protocol indicate administering given this specific presentation?
Thiamine
What is one of the major causes behind Wernicke's syndrome or Korsakoff's psychosis?
Thiamine deficiency
Which of the following is not a typical cause of altered mental status?
Tinnitus
When dealing with the victim of a stroke, why is it imperative to establish the exact time of onset while rapidly delivering the patient to the ED?
To determine the patient's fibrinolytic candidacy
What is an idiopathic syncopal episode usually caused by?
Undetermined cause
If a patient were to suffer a hemorrhagic stroke in the occipital cortex of the cerebrum, what would the patient complain about most?
Vision disturbances
When responding to a patient with a known a degenerative nervous disorder, it is necessary for the paramedic to:
conduct a primary assessment and patient history to determine the chief complaint.
The spinal cord leaves the brain at the medulla and proceeds through an opening called the:
foramen magnum.
If you believe that your unresponsive patient suffered a syncopal episode, but he didn't regain consciousness within a few moments, then:
it is likely something more serious than a syncopal episode.
The two functional divisions of the autonomic nervous system are the:
sympathetic and the parasympathetic.
Which of the following is a disease process caused by a genetic defect specific to chromosome 4?
Huntington's disease
What approximate portion of patients who experience a TIA is likely to soon after experience a stroke?
One-third
Approximately 50,000 people are newly diagnosed in the United States each year with what nervous system disorder?
Parkinson's disease