Chapter 18 - Neurologic Emergencies

The spinal cord exits the cranium through the: Select one: A. foramen lamina. B. cauda equina. C. vertebral foramen. D. foramen magnum.

foramen magnum.

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

epilepsy

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: Select one: A. 14 B. 12 C. 15 D. 13

12

Which of the following patients would MOST likely demonstrate typical signs of infection, such as a fever? Select one: A. A 35-year-old female in the later stages of AIDS B. A 17-year-old male with anxiety C. An 88-year-old male with chronic renal problems D. A 3-month-old female who was born prematurely

A 17-year-old male with anxiety

A 58-year-old male presents with confusion, right-sided weakness, and slurred speech. His airway is patent, and his breathing is adequate. His wife is present and is very upset. Which of the following has the MOST immediately priority? Select one: A. Documenting all of his current medications B. Asking his wife when she noticed the symptoms C. Obtaining a complete set of baseline vital signs D. Administering glucose to rule out hypoglycemia

Asking his wife when she noticed the symptoms

Which of the following MOST accurately describes what the patient will experience during the postictal state that follows a seizure? Select one: A. A gradually decreasing level of consciousness B. A rapidly improving level of consciousness C. Hyperventilation and hypersalivation D. Confusion and fatigue

Confusion and fatigue

The frontal lobe of the brain controls: Select one: A. movement. B. touch. C. vision. D. emotion.

emotion

The MOST significant risk factor for a hemorrhagic stroke is: Select one: A. heavy exertion. B. diabetes mellitus. C. hypertension. D. severe stress.

hypertension

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: Select one: A. transport the child to the hospital and reassure the mother en route. B. call medical control and request permission to give the child aspirin. C. cover the child with wet towels and give oxygen via nasal cannula. D. advise the mother to take her child to the doctor the following day.

transport the child to the hospital and reassure the mother en route.

A patient who is experiencing aphasia is: Select one: A. usually conscious but has slurred speech. B. unable to produce or understand speech. C. experiencing a right hemispheric stroke. D. not able to swallow without choking.

unable to produce or understand speech.

Your patient opens his eyes, moans, and pulls away from you when you pinch his trapezius muscle. You should assign a Glasgow Coma Scale (GCS) score of: Select one: A. 6 B. 7 C. 9 D. 8

8

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

A seizure that begins in one extremity

Which of the following MOST accurately describes the cause of an ischemic stroke? Select one: A. Blockage of a cerebral artery B. Rupture of a cerebral artery C. Acute atherosclerotic disease D. Narrowing of a carotid artery

Blockage of a cerebral artery

A 30-year-old male experienced a generalized (tonic-clonic) seizure, which stopped before you arrived at the scene. The patient is conscious, is answering your questions appropriately, and refuses EMS transport. Which of the following would be the MOST compelling reason to disagree with his refusal of transport? Select one: A. He has experienced seizures since he was 20. B. His Glasgow Coma Scale (GCS) score is 15. C. He is currently not prescribed any medications. D. His wife states that this was his "usual" seizure.

He is currently not prescribed any medications

Which of the following conditions is NOT a common cause of seizures? Select one: A. Acute alcohol withdrawal B. Acute hypoglycemia C. Hypotension D. Poisoning or overdose

Hypotension

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

Hypovolemia

Which of the following medications would indicate that a patient has a history of seizures? Select one: A. Metformin (Glucophage) B. Enalapril (Vasotec) C. Levetiracetam (Keppra) D. Hydromorphone (Dilaudid)

Levetiracetam (Keppra)

Which of the following findings should concern the EMT the MOST when assessing a patient who complains of a headache? Select one: A. Slow onset of symptoms B. Neck stiffness or pain C. History of migraines D. Sinus congestion

Neck stiffness or pain

Which of the following is characteristic of a focal-onset aware seizure? Select one: A. Generalized twitching of all muscles B. No change in vision, smell, or taste C. Normal level of consciousness D. Absence of breathing Feedback

Normal level of consciousness

Which of the following is a metabolic cause of a seizure? Select one: A. Poisoning B. Massive stroke C. Head trauma D. Brain tumor

Poisoning

Which of the following conditions would MOST likely affect the entire brain? Select one: A. Respiratory failure or cardiopulmonary arrest B. Reduced blood supply to the left hemisphere C. Ruptured cerebral artery in the occipital lobe D. Blocked cerebral artery in the frontal lobe

Respiratory failure or cardiopulmonary arrest

Which of the following clinical signs is MOST suggestive of a ruptured aneurysm? Select one: A. Sudden, severe headache B. Unilateral hemiparesis C. Nasal discharge of blood D. Confusion and weakness

Sudden, severe headache

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

The pain is worse when bending over.

You are assessing a 49-year-old man who, according to his wife, experienced a sudden, severe headache and then passed out. He is unresponsive and has slow, irregular breathing. His blood pressure is 190/94 mm Hg, and his pulse rate is 50 beats/min. His wife tells you that he has hypertension and diabetes. He has MOST likely experienced: Select one: A. a ruptured cerebral artery. B. a complex partial seizure. C. an occluded cerebral artery. D. acute hypoglycemia.

a ruptured cerebral artery.

When caring for a patient with documented hypoglycemia, you should be MOST alert for: Select one: A. a seizure. B. an acute stroke. C. a febrile convulsion. D. respiratory distress.

a seizure

A transient ischemic attack (TIA) occurs when: Select one: A. signs and symptoms resolve spontaneously within 48 hours. B. a small clot in a cerebral artery causes temporary symptoms. C. a small cerebral artery ruptures and causes minimal damage. D. medications are given to dissolve a cerebral blood clot.

a small clot in a cerebral artery causes temporary symptoms

An area of swelling or enlargement in a weakened arterial wall is called: Select one: A. atherosclerosis. B. an embolism. C. a thrombus. D. an aneurysm.

an aneurysm.

Febrile seizures: Select one: A. are usually benign but should be evaluated. B. often result in permanent brain damage. C. are also referred to as absence seizures. D. occur when a child's fever rises slowly.

are usually benign but should be evaluated.

Components of the Cincinnati Prehospital Stroke Scale include: Select one: A. facial droop, speech, and pupil size. B. arm drift, memory, and grip strength. C. arm drift, speech, and facial droop. D. speech, pupil reaction, and memory.

arm drift, speech, and facial droop.

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

ask the patient to close his or her eyes during the assessment.

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: Select one: A. place a bite block in her mouth in case she has a seizure and transport at once. B. assist ventilations, perform a rapid exam, and prepare for immediate transport. C. apply oxygen via nonrebreathing mask and transport her for a blood-alcohol test. D. apply oxygen via a nonrebreathing mask, place her on her left side, and transport.

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

The most basic functions of the body, such as breathing, blood pressure, and swallowing, are controlled by the: Select one: A. cerebellum. B. cerebral cortex. C. cerebrum. D. brain stem.

brain stem.

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

cerebellum

Interruption of cerebral blood flow may result from all of the following, EXCEPT: Select one: A. a thrombus. B. cerebral vasodilation. C. an embolism. D. an acute arterial rupture.

cerebral vasodilation

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

cerebrum, cerebellum, and brain stem.

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 seems 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: Select one: A. applying warm compresses to the back of his neck and transporting with lights and siren. B. assisting him with his migraine medication and transporting without lights and siren. C. placing him in a supine position and transporting with lights and siren to a stroke center. D. dimming the lights in the back of the ambulance and transporting without lights and siren.

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

A patient whose speech is slurred and difficult to understand is experiencing: Select one: A. dysphasia. B. dysphagia. C. aphasia. D. dysarthria.

dysarthria

During the primary assessment of a semiconscious 70-year-old female, you should: Select one: A. insert a nasopharyngeal airway and assist ventilations. B. immediately determine the patient's blood glucose level. C. ensure a patent airway and support ventilation as needed. D. ask family members if the patient has a history of stroke.

ensure a patent airway and support ventilation as needed.

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

has bleeding within the brain.

You are dispatched to a residence for a 66-year-old male who, according to family members, has suffered a massive stroke. Your primary assessment reveals that the patient is unresponsive, apneic, and pulseless. You should: Select one: A. perform CPR for 5 minutes before applying the AED. B. obtain a blood glucose sample to rule out hypoglycemia. C. assess the patient for a facial droop and hemiparesis. D. initiate CPR and attach an AED as soon as possible.

initiate CPR and attach an AED as soon as possible.

The mental status of a patient who has experienced a generalized seizure: Select one: A. is easily differentiated from that of acute hypoglycemia. B. is likely to improve over a period of 5 to 30 minutes. C. progressively worsens over a period of a few hours. D. typically does not improve, even after several minutes.

is likely to improve over a period of 5 to 30 minutes.

Individuals with chronic alcoholism are predisposed to intracranial bleeding and hypoglycemia secondary to abnormalities in the: Select one: A. kidneys. B. pancreas. C. liver. D. brain. Feedback

liver

You arrive at the residence of a 33-year-old woman who is experiencing a generalized (tonic-clonic) seizure. She has a small amount of vomitus draining from the side of her mouth. After protecting her from further injury, you should: Select one: A. wait for the seizure to stop, manually open her airway, insert an oropharyngeal airway, and assess her oxygen saturation with the pulse oximeter. B. place a bite block in between her teeth, apply high-flow oxygen via a nonrebreathing mask, and consider inserting a nasopharyngeal airway. C. restrain her extremities to prevent her from injuring herself, suction her airway to remove the vomitus, and assist her ventilations with a bag-mask device. D. maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a nasopharyngeal airway, and administer high-flow oxygen.

maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a nasopharyngeal airway, and administer high-flow oxygen.

You arrive at a local grocery store approximately 5 minutes after a 21-year-old female stopped seizing. She is confused and disoriented; she keeps asking you what happened and tells you that she is thirsty. Her brother, who witnessed the seizure, tells you that she takes valproate (Depakote) for her seizures, but has not taken it in a few days. He also tells you that she has diabetes. In addition to administering oxygen, you should: Select one: A. place her in the recovery position and transport her with lights and siren. B. monitor her airway and breathing status and assess her blood glucose level. C. administer one tube of oral glucose and prepare for immediate transport. D. give her small cups of water to drink and observe for further seizure activity.

monitor her airway and breathing status and assess her blood glucose level.

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

not thinking clearly or is incapable of being aroused.

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: Select one: A. ask her how long the patient has been taking his medication. B. determine when he was last seen by his physician. C. obtain a description of how the seizure developed. D. determine if the patient is a known alcohol abuser.

obtain a description of how the seizure developed.

Status epilepticus is characterized by: Select one: A. generalized seizures that last less than 5 minutes. B. prolonged seizures without a return of consciousness. C. an absence seizure that is not preceded by an aura. D. profound tachycardia and total muscle flaccidity.

prolonged seizures without a return of consciousness.

You are caring for a 68-year-old man with sudden onset of left-sided paralysis and slurred speech. His airway is patent, his respirations are 14 breaths/min with adequate depth, and his oxygen saturation is 98%. Treatment for this patient should include: Select one: A. high-flow oxygen and transport. B. oral glucose gel and transport. C. ventilatory assistance and transport. D. recovery position and transport.

recovery position and transport.

When transporting a stable stroke patient with a paralyzed extremity, place the patient in a: Select one: A. supine position with the legs elevated 6″ to 12″. B. recumbent position with the paralyzed side down. C. recumbent position with the paralyzed side up. D. sitting position with the head at a 45° to 90° angle.

recumbent position with the paralyzed side down

You are assessing the arm drift component of the Cincinnati Prehospital Stroke Scale on a 60-year-old woman. When she holds both of her arms out in front of her and closes her eyes, both of her arms immediately fall to her sides. You should: Select one: A. repeat the arm drift test, but move the patient's arms into position yourself. B. instruct the patient to keep her eyes open and then repeat the arm drift test. C. defer this part of the test and assess her for facial droop and slurred speech. D. repeat the arm drift test and ensure that her palms are facing downward.

repeat the arm drift test, but move the patient's arms into position yourself.

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

severe twitching of all the body's muscles.

You are caring for a 70-year-old female with signs and symptoms of an acute stroke. She is conscious, has secretions in her mouth, is breathing at a normal rate with adequate depth, and has an oxygen saturation of 96%. You should: Select one: A. suction her oropharynx and transport immediately. B. assist her ventilations with a bag-valve mask. C. insert an oral airway, apply oxygen, and transport. D. administer one tube of oral glucose and transport.

suction her oropharynx and transport immediately.

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

the right side of the body.

Successful treatment of a stroke depends on whether: Select one: A. medications are given to restore the function of infarcted cells. B. thrombolytic therapy is given within 3 hours of symptoms beginning. C. surgical intervention is performed to remove obstructive clots. D. the stroke occurs within the left or right hemisphere of the brain.

thrombolytic therapy is given within 3 hours of symptoms beginning.

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

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

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

when the patient last appeared normal.