Chapter 17 Neurological emergencies

Which of the following conditions is NOT a common cause of seizures? A. poisoning or overdose B. hypotension C. acute hypoglycemia D. acute alcohol withdraw

B. hypotension

The anterior aspect of the cerebrum controls: A. touch B. emotion C. movement D. vision

B. emotion

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

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

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

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 min D. a core body temp of greater than 103 F

A. severe twitching of all the body's muscles

When you are obtaining medical history from the family of a suspected stroke patient, it is MOST important to determine: A. when the patient last appeared normal. B. if there is a family history of a stroke. C. if the patient has been hospitalized before. D. the patient's overall medication compliance.

A. when the patient last appeared normal. Chapter 17, page 689, Patient Assessment

A patient with a suspected stroke presents with slurred speech that is difficult for you to understand. This is referred to as:​ A. aphasia.​ B. dysphasia.​ C. dysphagia.​ D. dysarthria.

Answer: D​ Rationale: Dysarthria is defined as slurred, poorly articulated speech; it is common in stroke patients. Dysphasia is defined as difficulty speaking; the patient's speech may or may not be slurred. Aphasia is the inability to speak. Dysphagia is defined as difficulty swallowing.

Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a stroke? A. Hypoglycemia B. Hypovolemia C. A postictal state D. Intracranial bleeding

B. Hypovolemia Chapter 17, page 681, Stroke

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)

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

Muscle control and body coordination are controlled by the: A. cerebrum B. cerebellum C. brain stem D. cerebral cortex

B. cerebellum

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

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 the physician D. ask her how long the patient has been taking his medications

B. obtain a description of how the seizure developed

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, facial droop D. facial droop, speech, pupil size

C. arm drift, speech, facial droop

When assessing for arm drift of a patient with a suspected stroke, you should: A. observe movement of the arms for approximately 2 minutes. B. expect to see one arm slowly drift down to the patient's side. C. ask the patient to close his or her eyes during the assessment. D. ask the patient to hold his or her arms up with the palms down.

C. ask the patient to close his or her eyes during the assessment. Chapter 17, page 692, Patient Assessment

Which of the following symptoms would lead the EMT to believe that a patient's headache is caused by sinus congestion? A. The headache began suddenly B. There is associated neck stiffness C. There is numbness in the extremities D. The pain is worse when bending over

D. The pain is worse when bending over Chapter 17, page 677, 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 patients current medications B. obtain a complete set of baseline vitals 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

The three major parts of the brain are the: A. cerebellum, medulla, and occiput. B. brain stem, midbrain, and spinal cord. C. midbrain, cerebellum, and spinal cord. D. cerebrum, cerebellum, and brain stem.

D. cerebrum, cerebellum, and brain stem. Chapter 17, page 675, Anatomy and Physiology

A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he or she: A. has had a prior heart attack. B. is older than 60 years of age. C. has a GCS score that is less than 8. D. has bleeding within the brain.

D. has bleeding within the brain. Chapter 17, page 696, Emergency Medical Care

Which of the following MOST accurately describes a simple partial seizure? A. A seizure that begins in one extremity B. A seizure that causes the patient to stare blankly C. A seizure that is not preceded by an aura D. A generalized seizure without incontinence

A. A seizure that begins in one extremity Chapter 17, page 682, Seizures

A 56-year-old man experienced a sudden, severe headache and then became unresponsive. He has a history of high blood pressure. The MOST likely cause of his condition is a(n):​ A. hemorrhagic stroke.​ B. acute ischemic stroke.​ C. severe migraine headache. ​ D. transient ischemic attack.

Answer: A​ Rationale: Hemorrhagic strokes are typically preceded by a sudden, severe headache (signals the rupture of a cerebral artery), after which the patient becomes unresponsive due to bleeding within the brain. Ischemic strokes and transient ischemic attacks generally do not cause a sudden, severe headache, and migraine headaches typically do not cause a loss of consciousness.

Your patient opens his eyes when you say his name, is making incomprehensible sounds, and withdraws when you pinch his earlobe. What is his GCS score?​ A. 9​ B. 8​ C. 11​ D. 12

Answer: A​ Rationale: The Glasgow Coma Scale gives a score of 3 to a patient who opens his or her eyes in response to speech. "Incomprehensible sounds" has a score of 2, and "withdraws to pain" has a score of 4. When added together, this patient's GCS score is 9.

A 41-year-old man presents with slow, irregular breathing; hypotension; and dilated pupils. These signs MOST likely indicate dysfunction of the:​ A. brain stem.​ B. hypothalamus.​ C. cerebrum.​ D. cerebellum.

Answer: A​ Rationale: The brain stem is responsible for functions such as breathing, blood pressure, and pupil constriction. Brain stem dysfunction would result in abnormal findings with these functions.

The MOST important reason for promptly transporting a stroke patient to the hospital is: ​ A. a transient ischemic attack can be ruled out. ​ B. medications may be given to reverse the stroke. ​ C. the clot in the coronary artery may be dissolved. ​ D. he or she needs close blood pressure monitoring.

Answer: B​ Rationale: Fibrinolytic medications (clot busters) have been shown to reverse the symptoms of a stroke by dissolving the clot that is blocking the cerebral artery. However, for the patient to be eligible for this therapy, it must be initiated within 3 hours after the onset of symptoms. For this reason, prompt transport of the stroke patient is critical.

Unlike an ischemic stroke, a transient ischemic attack is characterized by all of the following, EXCEPT:​ A. symptoms that resolve within 24 hours. ​ B. symptoms that persist for longer than ​24 hours. ​ C. weakness or paralysis to one side of the body.​ D. an acute onset of confusion and slurred speech.

Answer: B​ Rationale: Signs and symptoms of a transient ischemic attack (TIA) are usually identical to those of an acute ischemic stroke (eg, hemiparesis, slurred speech, confusion, facial droop). Unlike the ischemic stroke, however, the symptoms of a TIA usually resolve within 24 hours.

Which of the following are components of the Cincinnati Prehospital Stroke Scale? ​ A. Arm drift, blood pressure, speech​ B. Speech, pupil response, arm drift​ C. Facial symmetry, speech, arm drift​ D. Pupil response, facial droop, speech

Answer: C​ Rationale: The three components of the Cincinnati Prehospital Stroke Scale are facial symmetry, speech, and arm drift. Both sides of the patient's face should move symmetrically (equally) when he or she smiles. The patient's speech should be easily understandable and without slurring. The patient should be able to hold both arms out in front of his or her body—with eyes closed and palms up—without one arm drifting down to his or her side.

If a patient complains of a severe migraine, how should she be transported?​ A. In a brightly lit ambulance so she can see while her vision is impaired​ B. With loud sirens so she can get to the hospital as soon as possible​ C. Without lights and sirens​ D. This patient should not be transported.

Answer: C​ Rationale: Treatment of a migraine headache is supportive; however, you should always assess the patient for other signs and symptoms that might indicate a more serious condition. Applying high-flow oxygen, if tolerated, may help ease the patient's condition. When possible, provide a darkened and quiet environment because patients are sensitive to light and sound. Do not use lights and sirens during transport.

A type of seizure that is characterized by severe twitching of all the body's muscles and lasts for several minutes or longer is called a(n):​ A. partial seizure. ​ B. absence seizure.​ C. tonic-clonic seizure.​ D. generalized seizure.

Answer: D​ Rationale: Generalized seizures are characterized by generalized severe twitching of all of the body's muscles; they often last for several minutes or longer. An absence seizure is characterized by a blank stare; generalized muscle twitching is absent.

An acute ischemic stroke is caused by:​ A. a ruptured cerebral artery. ​ B. increased intracranial pressure.​ C. an acute rise in a person's blood pressure. ​ D. a blocked cerebral artery.

Answer: D​ Rationale: There are two types of stroke—hemorrhagic and ischemic. A hemorrhagic stroke is caused by a ruptured cerebral artery (aneurysm), which causes bleeding within the brain and increased intracranial pressure. An ischemic stroke is caused by a blocked cerebral artery—either from a clot that grows locally (thrombus) or that travels to the brain from another part of the body (embolus).

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

You respond to a residence for a child who is having a seizure. Upon arrival at the scene, you enter the residence and find the mother holding her child, a 2-year-old male. The child is conscious and crying. According to the mother, the child had been running a high fever and then experienced a seizure that lasted approximately 3 minutes. You should: A. cover the child with wet towels and give oxygen via nasal cannula. B. transport the child to the hospital and reassure the mother en route. C. advise the mother to take her child to the doctor the following day. D. call medical control and request permission to give the child aspirin.

B. transport the child to the hospital and reassure the mother en route. Chapter 17, page 684, Seizures

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 case she has seizure and transport at once B. apply oxygen via NRB mask, place her on her side, and transport C. assist ventilations, perform a rapid exam, and prepare for immediate transport D. apply oxygen vis NRB mask and transport her for a blood-alcohol level

C. assist ventilations, perform a rapid exam, and prepare for immediate transport

The left cerebral hemisphere controls: A. the right side of the face. B. heart rate and pupil reaction. C. the right side of the body. D. breathing and blood pressure.

C. the right side of the body. Chapter 17, page 676, Anatomy and Physiology

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

A patient with an altered mental status is: A. completely unresponsive to all forms of stimuli. B. typically alert but is confused as to preceding events. C. usually able to be aroused with a painful stimulus. D. not thinking clearly or is incapable of being aroused.

D. not thinking clearly or is incapable of being aroused. Chapter 17, page 685, Altered Mental Status

Status epilepticus is characterized by: A. generalized seizures that last fewer than 5 min B. an absence 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

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

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