Chapter 16- Neurologic Emergencies

With regard to potential treatment in the hospital, which of the following questions is MOST important to ask the spouse of a 66-year-old female who presents with signs and symptoms of an acute ischemic stroke?

"When did you first notice the symptoms?"

To minimize the amount of brain-cell damage that occurs following an ischemic stroke, fibrinolytic therapy must be administered within:

3 hours after the onset of symptoms.

Routine treatment for a patient who has just experienced a generalized tonic-clonic seizure and is postictal includes all of the following EXCEPT:

50% dextrose via IV administration.

Which of the following scenarios is MOST descriptive of an absence seizure?

A 6-year-old male who is conscious, but will not respond to his mother; symptoms subside spontaneously within a few minutes.

You are assessing a 45-year-old male who experienced a syncopal episode. He is conscious and alert, and complains only of slight weakness. He denies any medical problems or drug allergies. His blood pressure is 140/90 mm Hg, pulse is 40 beats/min, and respirations are 22 breaths/min. What is the MOST likely cause of this patient's syncopal episode?

Acute bradycardia

________________ is a disorder of the brain in which blood flow to a portion of the brain is suddenly disrupted, resulting in brain cell death.

Cerebral infarction

A 30-year-old male presents with a partial seizure to his left arm. His wife denies that he has ever had seizures in the past. Which of the following conditions would be the LEAST likely cause of this patient's seizure?

Idiopathic epilepsy

A 45-year-old female is found semiconscious by a neighbor. She is incontinent of urine and is bleeding from her mouth. Which of the following medications found in her residence would lead you to suspect that she experienced a seizure?

Lamictal

Which of the following conditions would MOST likely mimic the signs and symptoms of an acute ischemic stroke?

Low BGL

A degenerative cerebral disease is an example of a(n) ______________ cause of a seizure.

Structural

Which of the following statements regarding the twelve cranial nerves is correct?

They arise from the brain and innervate the head and face.

A hemorrhagic stroke occurs as a result of:

a ruptured cerebral artery.

A 20-year-old female with a history of chronic epilepsy, who is compliant with her anticonvulsant medication, experiences a "breakthrough" seizure. This usually happens when:

a seizure occurs despite a therapeutic medication blood level.

A 57-year-old female with a history of peripheral vascular disease presents with an acute onset of confusion, aphasia, left-sided hemiparesis, and loss of muscle control to the right side of her face. You should suspect an:

arterial blockage in the right cerebral hemisphere.

A 70-year-old male presents with acute aphasia, unilateral weakness, and confusion. In addition to administering 100% oxygen, it is important to:

assess his blood glucose level to rule out hypoglycemia.

You are called to the county jail for a 50-year-old male who is "drunk." When you assess him, you note the smell of alcohol on his breath and a markedly decreased level of consciousness. The sheriff's deputy tells you that this patient is a "regular." On the basis of the information that you have obtained, you should:

assess the patient's blood glucose and suspect intracranial bleeding.

A 69-year-old female is found to be semiconscious, hypertensive, and bradypneic. You should:

assist ventilations and start an IV set to keep the vein open.

You are assessing a 59-year-old male with an altered mental status. You should suspect an acute ischemic stroke versus hypoglycemia if the patient:

attempts to communicate with you.

You are dispatched to an assisted-living center for a 67-year-old male with "mental status changes." You arrive at the scene and begin to assess the patient. He is responsive to painful stimuli only, has rapid and shallow breathing, and a slow radial pulse. You should:

begin assisting the patient's ventilations.

An ischemic stroke is MOST often the result of a(n):

blocked cerebral artery.

The spinal nerves branch out from the spinal cord and:

carry signals to and from the body.

Located just behind the brainstem, the ___________ controls muscle and body coordination.

cerebellum

Patients with a hemorrhagic stroke typically experience a rapidly declining level of consciousness because of:

increasing intracranial pressure.

In most people, speech is controlled by the:

left hemisphere.

You respond to a call for a 39-year-old female with an altered mental status. Your primary assessment reveals that she is conscious but confused, has a heart rate of 88 beats/min, and has respirations of 22 breaths/min with adequate tidal volume. After administering supplemental oxygen, you should:

perform a focused history and physical exam.

You are dispatched to a local convenience store for a 30-year-old male who is actively seizing. Upon your arrival, the patient is confused and combative. This is indicative of the ___________ phase.

postictal

A 68-year-old male presents with confusion, left-sided hemiparesis, and decreased muscle tone to the right side of his face. You administer oxygen, start an IV, and begin transport to the hospital. En route, the patient becomes more coherent and slowly regains use of his left arm. These findings are MOST suggestive of:

temporary ischemia to the right side of the brain.

The hypertension that is commonly observed in patients with an intracerebral hemorrhage is usually the result of:

the body's attempt to shunt blood to the brain

A transient ischemic attack (TIA) occurs when:

the body's normal processes destroy a cerebral thrombus.

During a seizure, neurons are in a hypermetabolic state. This means that:

they are using large amounts of glucose and producing lactic acid.

An idiopathic seizure is a seizure:

without an identifiable etiology.

__________ brain cells receive a minimal supply of oxygen and are unable to function normally.

Ischemic

You are assessing the arm drift of an elderly male with a suspected stroke and note that both of his arms drift toward the ground. You should:

ensure the patient understood your instructions and repeat the test.

You are dispatched to an assisted-living center for a 67-year-old male with "mental status changes." You arrive at the scene and begin to assess the patient. He is responsive to painful stimuli only, has rapid and shallow breathing, and has a slow radial pulse. You should:

begin assisting the patient's ventilations.

The largest part of the brain is the:

cerebrum.

Migraine headaches are thought to be caused by:

changes in blood vessel size within the base of the brain.

When using the Cincinnati Stroke Scale to assess a 59-year-old female with a suspected stroke, you note a left-sided facial droop when you ask her to smile. You should:

determine if the patient has dysarthria or is unable to speak.

In addition to supplemental oxygen, treatment for a conscious and alert patient who is experiencing a migraine headache includes:

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

Following a head injury, a patient is verbally abusive and combative. He MOST likely has an injury to the ___________ lobe of the brain.

frontal

A patient with a possible stroke is a potential candidate for fibrinolytic therapy unless he or she:

is experiencing an intracranial hemorrhage.

A patient experiencing status epilepticus:

is having a prolonged generalized motor seizure.

The clonic phase of a generalized motor seizure is characterized by:

muscle contraction and relaxation occurring in rapid succession.

A 60-year-old male with a history of poorly controlled hypertension complains of a sudden, severe headache. Within a few minutes, his level of consciousness rapidly deteriorates. This is MOST suggestive of a(n):

ruptured cerebral artery.

Your 23-year-old female patient complains of pain to the superior portion of her face. She tells you that the pain has persisted for the past few days and gets worse when she bends down to pick something up. This is MOST consistent with a:

sinus headache.

You respond to a residence for a 27-year-old male with an altered mental status. As you are assessing him, his girlfriend tells you that he does not have any medical problems that she is aware of; however, he did fall two days ago and struck his head. These clinical and historical findings should make you MOST suspicious for:

subdural hemorrhaging.

The __________, which is present wherever a nerve cell terminates, connects to the next cell via__________.

synapse, neurotransmitters