West Coast EMT Chapter 17 -- Neurologic Emergencies

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. His Glasgow Coma Scale (GCS) score is 15

B. His wife states that this was his "usual" seizure

C. He has experienced seizures since he was 20

D. He is currently not prescribed any medications

D. He is currently not prescribed any medications

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. has a GCS score that is less than 8.

D. is older than 60 years of age.

B. has bleeding within the brain.

A patient whose speech is slurred and difficult to understand is experiencing:

Select one:

A. paraplegia.

B. dysphagia.

C. dysarthria.

D. aphasia.

C. dysarthria.

A patient with an altered mental status is:

Select one:

A. typically alert but is confused as to preceding events.

B. not thinking clearly or is incapable of being aroused.

C. usually able to be aroused with a painful stimulus.

D. completely unresponsive to all forms of stimuli.

B. not thinking clearly or is incapable of being aroused.

During the primary assessment of a semiconscious 70-year-old female, you should:

Select one:

A. insert a nasopharyngeal airway and assist ventilations.

B. ask family members if the patient has a history of stroke.

C. immediately determine the patient's blood glucose level.

D. ensure a patent airway and support ventilation as needed.

D. ensure a patent airway and support ventilation as needed.

Interruption of cerebral blood flow may result from all of the following, EXCEPT:

Select one:

A. an embolism.

B. cerebral vasodilation.

C. a thrombus.

D. an acute arterial rupture.

B. cerebral vasodilation.

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.

D. the right side of the body.

The MOST significant risk factor for a hemorrhagic stroke is:

Select one:

A. diabetes mellitus.

B. hypertension.

C. heavy exertion.

D. severe stress.

B. hypertension.

The three major parts of the brain are the:

Select one:

A. midbrain, cerebellum, and spinal cord.

B. brain stem, midbrain, and spinal cord.

C. cerebellum, medulla, and occiput.

D. cerebrum, cerebellum, and brain stem.

D. cerebrum, cerebellum, and brain stem.

When assessing for arm drift of a patient with a suspected stroke, you should:

Select one:

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

B. expect to see one arm slowly drift down to the patient's side.

C. observe movement of the arms for approximately 2 minutes.

D. ask the patient to hold his or her arms up with the palms down.

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

When caring for a patient with documented hypoglycemia, you should be MOST alert for:

Select one:

A. a seizure.

B. respiratory distress.

C. an acute stroke.

D. a febrile convulsion.

A. a seizure.

When you are obtaining medical history from the family of a suspected stroke patient, it is MOST important to determine:

Select one:

A. if the patient has been hospitalized before.

B. if there is a family history of a stroke.

C. when the patient last appeared normal.

D. the patient's overall medication compliance.

C. when the patient last appeared normal.

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. A postictal state

C. Hypoglycemia

D. Hypovolemia

D. Hypovolemia

Which of the following conditions would MOST likely affect the entire brain?

Select one:

A. Respiratory failure or cardiopulmonary arrest

B. Ruptured cerebral artery in the occipital lobe

C. Blocked cerebral artery in the frontal lobe

D. Reduced blood supply to the left hemisphere

A. Respiratory failure or cardiopulmonary arrest

Which of the following MOST accurately describes a simple partial seizure?

Select one:

A. A generalized seizure without incontinence

B. A seizure that causes the patient to stare blankly

C. A seizure that begins in one extremity

D. A seizure that is not preceded by an aura

C. A seizure that begins in one extremity

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

D. Confusion and fatigue

Which of the following symptoms would lead the EMT to believe that a patient's headache is caused by sinus congestion?

Select one:

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

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. recovery position and transport.

B. oral glucose gel and transport.

C. high-flow oxygen and transport.

D. ventilatory assistance and transport.

A. recovery position and transport.

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. call medical control and request permission to give the child aspirin.

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. 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.

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. 7.

B. 9.

C. 8.

D. 6.

C. 8.