Chapter 18 Neurological Emergencies

Which of the following would MOST likely cause a sustained increase in intracranial pressure? A. Intracranial tumor B. Projectile vomiting C. Frequent coughing D. Bearing down

A. Intracranial tumor

Which of the following causes of altered mental status is NOT an acute process? A. Uremia B. Psychosis C. Acidosis D. Epilepsy

A. Uremia

During a generalized tonic/clonic seizure, the patient is rigid and his back is arched. This represents the _________ phase of the seizure

hypertonic

An adult who opens her eyes in response to verbal stimuli, is disoriented, and pushes your hand away when you palpate a painful area has a Glasgow Coma Scale score of:

12

As blood glucose levels fall below ____ mg/dL, level of consciousness begins to decrease.

60

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: A. "When did you first notice your wife's symptoms?" B. "Does your wife have a history of diabetes?" C. "When did your wife last see her physician?" D. "Is your wife allergic to aspirin or contrast dye?"

A. "When did you first notice your wife's symptoms?"

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? A. 75 mm Hg B. 90 mm Hg C. 95 mm Hg D. 60 mm Hg

A. 75 mm Hg

During a generalized tonic/clonic seizure, the patient is rigid and his back is arched. This represents the _________ phase of the seizure. A. hypertonic B. tonic C. clonic D. postictal

A. Hypertonic

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 a(n) _____________ seizure. A. absence B. complex partial C. tonic-clonic D. simple partial

A. absence

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 for: A. an intracranial neoplasm. B. acute sinusitis. C. a ruptured cerebral artery. D. acute hemorrhagic stroke.

A. an intracranial neoplasm.

In contrast to syncope, a seizure: A. can occur when the patient is in any position. B. most often occurs when the patient is standing. C. is less commonly observed in older patients. D. is characterized by a quick return of orientation.

A. can occur when the patient is in any position.

A high level of oxygen to the brain of a patient with a hemorrhagic stroke and increased intracranial pressure: A. causes vasoconstriction and can impair brain perfusion. B. lowers intracranial pressure and oxygenates the brain. C. increases intracranial pressure, but oxygenates the brain. D. dilates the blood vessels and can cause brain herniation.

A. causes vasoconstriction and can impair brain perfusion.

An idiopathic seizure is one in which: A. the cause is not known. B. the entire brain is affected. C. a part of the brain is affected. D. a postictal phase is not present.

A. the cause is not known.

Prehospital treatment for a patient with a suspected stroke may include all of the following, EXCEPT: A. up to 325 mg of aspirin. B. diazepam or lorazepam. C. 30° elevation of the head. D. crystalloid fluid boluses.

A. up to 325 mg of aspirin.

Which of the following cranial nerves regulates movement of the head and shoulders?

Accessory

__________ is a term used to describe changes in a person's ability to perform coordinated motions, such as walking

Ataxia

As intracranial pressure rises: A. mean arterial pressure decreases. B. cerebral herniation may occur. C. the heart rate acutely increases. D. the brain becomes hypocarbic.

B. cerebral herniation may occur.

A 33-year-old woman had an apparent syncopal episode. According to her husband, she complained of dizziness shortly before the episode. He further states that he caught her before she fell to the ground. Upon your arrival, the patient is conscious but confused and is sitting in a chair. Her blood pressure is 90/60 mm Hg, pulse rate is 110 beats/min and weak, and respirations are 22 breaths/min and regular. Her blood glucose level is 74 mg/dL. The MOST likely cause of her syncopal episode is: A. a vasovagal response. B. dehydration. C. a seizure. D. acute hypoglycemia.

B. dehydration.

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: A. protect him from further injury by restraining him, attempt orotracheal intubation, establish an IV, and give Valium. B. open his airway and begin assisting his ventilations, establish an IV or IO line, and administer 5 to 10 mg of diazepam. C. hyperventilate him with a bag-mask to eliminate excess carbon dioxide, establish vascular access, and give lorazepam. D. place a bite block between his molars to prevent oral trauma, administer high-flow oxygen, and give lorazepam IM.

B. open his airway and begin assisting his ventilations, establish an IV or IO line, and administer 5 to 10 mg of diazepam.

When neurons are deprived of oxygen and glucose: A. the process of neuronal regeneration begins. B. they convert to anaerobic metabolism. C. they produce alkalotic waste products. D. spontaneous intracerebral bleeding occurs.

B. they convert to anaerobic metabolism.

Which of the following would MOST likely casue a sustained increase in ICP?

Blood, Swelling, Pus or a tumor within the crainal vault

A patient with suspected meningitis involuntarily flexes her knees when her head is flexed toward her chest. This is called:

Brudzinski sign.

In contrast to a benign neoplasm, a malignant neoplasm: A. results in death in the vast majority of cases. B. remains within a capsule and grows minimally. C. can metastasize to other parts of the body. D. is relatively easy to remove surgically.

C .can metastasize to other parts of the body.

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. She is receiving oxygen via nasal cannula and has a patent IV line in place. Which of the following statements regarding this scenario is correct? A. The patient's signs and symptoms are likely the result of her blood sugar and will resolve with dextrose. B. The patient will likely receive fibrinolytic therapy in the emergency department if no contraindications exist. C. Although the patient is likely experiencing a TIA, you should treat her as though she is experiencing a stroke. D. You should administer nitroglycerin or labetalol if her systolic blood pressure is greater than 150 mm Hg.

C. Although the patient is likely experiencing a TIA, you should treat her as though she is experiencing a stroke.

Which of the following would have the MOST negative effect on the outcome of a patient with an intracranial hemorrhage? A. Tachycardia B. Slow rise in intracranial pressure C. Hypotension D. Hypertension

C. Hypotension

All of the following are examples of acute cerebrovascular emergencies, EXCEPT: A. stroke secondary to thrombus rupture. B. embolic blockage of a cerebral artery. C. accumulation of atherosclerotic plaque. D. rupture of a cerebral arterial aneurysm.

C. accumulation of atherosclerotic plaque.

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: A. evaluating his cardiac rhythm with the ECG monitor. B. performing a rapid check of his blood glucose level. C. ensuring airway patency and adequate breathing. D. administering oxygen via nonrebreathing mask.

C. ensuring airway patency and adequate breathing.

An elderly man presents with slurred speech, confusion, and unilateral facial asymmetry. 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: A. consider him a candidate for fibrinolytic therapy if his symptoms began less than 12 hours ago. B. suspect that he is experiencing a hemorrhagic stroke, begin immediate transport, and start an IV en route. C. rule out hypoglycemia by assessing his blood sugar, but suspect a right-sided ischemic stroke. D. start an IV and administer crystalloid fluid boluses if his systolic blood pressure is less than 110 mm Hg.

C. rule out hypoglycemia by assessing his blood sugar, but suspect a right-sided ischemic stroke.

According to the Los Angeles Prehospital Stroke Screen, the possibility of a stroke is increased if: A. a bilateral facial droop is present during the exam. B. at baseline, the patient is normally bedridden. C. the blood glucose is between 60 and 400 mg/dL. D. the patient is younger than 45 years of age.

C. the blood glucose is between 60 and 400 mg/dL.

A patient with a unilateral eyelid droop when smiling:

Can indicate Bell's palsy or a stroke

What portion of the brainstem regulates respiratory rate and depth?

Pons

A neoplasm is MOST accurately defined as a: A. normal cell. B. damaged cell. C. cancerous tumor. D. new growth.

D. New Growth

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: A. establishing vascular access, administering diazepam or lorazepam to reduce her combativeness, and transporting to the closest hospital. B. giving her high-flow oxygen, inserting an IO catheter in her proximal tibia, transporting, and observing for further seizure activity. C. administering oxygen, restraining her to protect her from further injury, placing a bite block in her mouth in case she seizes again, and transporting. D. administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren.

D. administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren.

For any patient with an increase in intracranial pressure, the paramedic must: A. give glucose to prevent hypoglycemia. B. avoid administering IV fluid boluses. C. take measures to lower blood pressure. D. maintain an adequate blood pressure.

D. maintain an adequate blood pressure.

The involuntary, rhythmic movement of the eyes is called: A. anisocoria. B. hyperopia. C. dysphagia. D. nystagmus.

D. nystagmus

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: A. placing her in a Fowler position, administering oxygen, and transporting her to the hospital for definitive care. B. administering high-flow oxygen, establishing vascular access, and administering nitroglycerin to lower her blood pressure. C. carefully assessing her pupils, administering oxygen, starting an IV and giving her morphine, and transporting. D. oxygen as tolerated, starting an IV line and administering ondansetron, and transporting without lights or siren.

D. oxygen as tolerated, starting an IV line and administering ondansetron, and transporting without lights or siren.

An acutely frustrated, angry or aggressive patient should be assumed to be?

Low glucose and O2 or taking narcotics

Which of the following signs is MOST commonly observed in patients with a severe headache or increased intracranial pressure?

Nausea and vomiting

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's disease

A persons LOC is regulated by?

RAS- Reticular Activating System

An elderly man presents with slurred speech, confusion, and unilateral facial asymmetry. 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

Which of the following conditions is a neural tube defect in which part of the nervous system remains outside the body?

Spina bifida

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

Which of the following is an example of receptive aphasia?

You ask a patient who the president is and he or she says, "January."

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.

You are assessing an unresponsive 66-year-old man with a history of two prior strokes. According to the patient's wife, he complained of a severe headache and then passed out. His respiratory effort is poor, blood pressure is elevated markedly, and pulse is slow and bounding. The glucometer reads "error." You should:

assist ventilations, apply the cardiac monitor, start an IV line with normal saline, administer 12.5 g of 50% dextrose, and reassess his level of consciousness.

The MOST common sign of an infectious disease is the presence of:

a fever.

Degenerative conditions of the nervous system result when:

a normal structure is altered over time.

A synapse is:

a slight gap between nerve cells.

In contrast to patients in shock, patients with increased intracranial pressure MOST often experience:

a widened pulse pressure

All of the following cranial nerves are responsible for airway control, EXCEPT the:

abducens

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 one minute, after which the child's condition rapidly improved. This clinical presentation is MOST consistent with a/an _____________ seizure.

absence

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.

Myelin functions by:

allowing the neuron to send its signal consistently along the axon without losing its electricity.

A patient who is unable to use a common object is said to be:

apraxic

In contrast to a benign neoplasm, a malignant neoplasm

can metastasize to other parts of the body.

A loss of balance and equilibrium suggests injury to the:

cerebellum

A staggering gait is MOST suggestive of damage to the:

cerebellum

A rhythmic contraction and relaxation of muscle groups that is commonly observed during a seizure is called __________ activity.

clonic

Hyperventilating a patient who has increased intracranial pressure (ICP) will:

constrict the cerebral vasculature and decrease cerebral perfusion.

Among other functions, the medulla oblongata:

controls blood pressure and heart rate.

When communicating with a geriatric man who has dementia, you should:

determine how much change has occurred in his level of consciousness.

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.

A 35-year-old athletic man experiences a stroke that completely incapacitates him, while a 55-year-old man who does not exercise and is sedentary gets a clean bill of health from his physician. The 35-year old man MOST likely had a/an:

genetic predisposition.

Common signs and symptoms of a cerebral abscess include:

high-grade fever, persistent localized headache, confusion, and focal impairment.

The MOST immediate and significant complication associated with a hemorrhagic stroke is:

increased intracranial pressure.

A patient with a GCS score of 8 or less:

intubate

Decerebrate posturing:

is a more severe finding than decorticate posturing, as it indicates damage in or near the brain stem.

A stroke to the right cerebral hemisphere would MOST likely cause:

left-sided weakness and a right-sided facial droop.

Because the facial nerve does not decussate, a stroke to the right cerebral hemisphere would MOST likely cause

left-sided weakness and a right-sided facial droop.

Emotions such as rage and anger are generated in the:

limbic system.

A patient with a unilateral eyelid droop when smiling

may be experiencing Bell palsy.

A patient who is experiencing agnosia:

may call a knife a fork when he or she is asked to name the object

A patient with a Glasgow Coma Scale score of 8 or less

may require definitive airway control.

Spasmodic torticollis is characterized by:

neck muscle contraction, which twists the head to one side.

Chemicals that relay electrically conducted signals from one neuron to another are called:

neurotransmitters

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.

Common causes of trismus in an unresponsive patient include all of the following, EXCEPT:

opiate toxicity

A 39-year-old woman presents with signs and symptoms of an acute hemorrhagic stroke. She is responsive to deep painful stimuli only and has bilaterally dilated and sluggishly reactive pupils. Her respirations are slow and irregular, blood pressure is 80/50 mm Hg, and pulse is 40 and bounding. Initial treatment for this patient involves:

positive-pressure ventilatory support.

A 56-year-old diabetic woman presents with numbness and tingling to both of her hands that have gradually intensified over the past few weeks. Your assessment reveals stable vital signs, adequate breathing, and a blood glucose level of 190 mg/dL. The cardiac monitor reveals a normal sinus rhythm. The patient tells you that she has eaten but has not taken her insulin yet. You should:

provide supportive care and safely transport her to the hospital

A person's level of consciousness is regulated by the:

reticular activating system.

Patients with trismus often require:

sedation or chemical paralysis to facilitate airway control.

The peripheral nervous system is responsible for:

sending messages to and receiving messages from the brain.

Management for a patient with a neurologic emergency begins by:

taking deliberate actions to ensure personal safety.

Increased intracranial pressure hydrocephalus occurs when:

the movement of CSF decreases, but the production of CSF does not.

A patient experiences severe, shock-like or stabbing pain to one side of the face. This is consistent with:

trigeminal neuralgia