Emc103 (chapter 18: Neurolgic Emergencies (pre Q))

56/56

The three major parts of the brain are the:

 

cerebrum, cerebellum, and brain stem.

 

midbrain, cerebellum, and spinal cord.

 

brain stem, midbrain, and spinal cord.

 

cerebellum, medulla, and occiput.

cerebrum, cerebellum, and brain stem

The most basic functions of the body, such as breathing, blood pressure, and swallowing, are controlled by the:

 

cerebral cortex.

 

brain stem.

 

cerebrum.

 

cerebellum.

brain stem.

Muscle control and body coordination are controlled by the:

 

cerebellum.

 

cerebral cortex.

 

cerebrum.

 

brain stem.

cerebellum

The left cerebral hemisphere controls:

 

the right side of the body.

 

the right side of the face.

 

heart rate and pupil reaction.

 

breathing and blood pressure.

the right side of the body

The frontal lobe of the brain controls:

 

touch.

 

emotion.

 

movement.

 

vision.

emotion

The spinal cord exits the cranium through the:

 

cauda equina.

 

foramen lamina.

 

foramen magnum.

 

vertebral foramen.

foramen magnum

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

 

Ruptured cerebral artery in the occipital lobe

 

Blocked cerebral artery in the frontal lobe

 

Respiratory failure or cardiopulmonary arrest

 

Reduced blood supply to the left hemisphere

Respiratory failure or cardiopulmonary arrest

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

 

a thrombus.

 

an acute arterial rupture.

 

an embolism.

 

cerebral vasodilation.

cerebral vasodilation

Which of the following MOST accurately describes the cause of an ischemic stroke?

 

Rupture of a cerebral artery

 

Acute atherosclerotic disease

 

Blockage of a cerebral artery

 

Narrowing of a carotid artery

Blockage of a cerebral artery

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:

 

an occluded cerebral artery.

 

acute hypoglycemia.

 

a ruptured cerebral artery.

 

a complex partial seizure.

a ruptured cerebral artery

The MOST significant risk factor for a hemorrhagic stroke is:

 

diabetes mellitus.

 

heavy exertion.

 

severe stress.

 

hypertension.

hypertension

An area of swelling or enlargement in a weakened arterial wall is called:

 

atherosclerosis.

 

an aneurysm.

 

a thrombus.

 

an embolism.

an aneurysm

Which of the following clinical signs is MOST suggestive of a ruptured aneurysm?

 

Unilateral hemiparesis

 

Nasal discharge of blood

 

Confusion and weakness

 

Sudden, severe headache

Sudden, severe headache

A transient ischemic attack (TIA) occurs when:

 

medications are given to dissolve a cerebral blood clot.

 

signs and symptoms resolve spontaneously within 48 hours.

 

a small cerebral artery ruptures and causes minimal damage.

 

a small clot in a cerebral artery causes temporary symptoms.

a small clot in a cerebral artery causes temporary symptoms

A patient who is experiencing aphasia is:

 

experiencing a right hemispheric stroke.

 

unable to produce or understand speech.

 

usually conscious but has slurred speech.

 

not able to swallow without choking.

unable to produce or understand speech

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

 

dysarthria.

 

dysphasia.

 

dysphagia.

 

aphasia.

dysarthria

Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a stroke?

 

Hypovolemia

 

Intracranial bleeding

 

A postictal state

 

Hypoglycemia

Hypovolemia

Which of the following findings should concern the EMT the MOST when assessing a patient who complains of a headache?

 

History of migraines

 

Slow onset of symptoms

 

Neck stiffness or pain

 

Sinus congestion

Neck stiffness or pain

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

 

There is numbness in the extremities.

 

The pain is worse when bending over.

 

The headache began suddenly.

 

There is associated neck stiffness.

The pain is worse when bending over

A generalized (tonic-clonic) seizure is characterized by:

 

severe twitching of all the body's muscles.

 

a blank stare and brief lapse of consciousness.

 

a core body temperature of greater than 103°F (40°C).

 

unconsciousness for greater than 30 minutes.

severe twitching of all the body's muscles

Which of the following is characteristic of a focal-onset aware seizure?

 

No change in vision, smell, or taste

 

Normal level of consciousness

 

Generalized twitching of all muscles

 

Absence of breathing

Normal level of consciousness

Which of the following MOST accurately describes a focal-onset aware seizure?

 

A generalized seizure without incontinence

 

A seizure that begins in one extremity

 

A seizure that is not preceded by an aura

 

A seizure that causes the patient to stare blankly

A seizure that begins in one extremity

The mental status of a patient who has experienced a generalized seizure:

 

progressively worsens over a period of a few hours.

 

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

 

typically does not improve, even after several minutes.

 

is easily differentiated from that of acute hypoglycemia.

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

Which of the following MOST accurately describes what the patient will experience during the postictal state that follows a seizure?

 

Hyperventilation and hypersalivation

 

A gradually decreasing level of consciousness

 

A rapidly improving level of consciousness

 

Confusion and fatigue

Confusion and fatigue

Status epilepticus is characterized by:

 

generalized seizures that last less than 5 minutes.

 

profound tachycardia and total muscle flaccidity.

 

prolonged seizures without a return of consciousness.

 

an absence seizure that is not preceded by an aura.

prolonged seizures without a return of consciousness

Which of the following conditions is NOT a common cause of seizures?

 

Acute hypoglycemia

 

Acute alcohol withdrawal

 

Poisoning or overdose

 

Hypotension

Hypotension

Which of the following is a metabolic cause of a seizure?

 

Massive stroke

 

Brain tumor

 

Poisoning

 

Head trauma

Poisoning

Which of the following medications would indicate that a patient has a history of seizures?

 

Levetiracetam (Keppra)

 

Metformin (Glucophage)

 

Enalapril (Vasotec)

 

Hydromorphone (Dilaudid)

Levetiracetam (Keppra)

Febrile seizures:

 

are usually benign but should be evaluated.

 

are also referred to as absence seizures.

 

occur when a child's fever rises slowly.

 

often result in permanent brain damage.

are usually benign but should be evaluated

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:

 

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

 

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

 

cover the child with wet towels and give oxygen via nasal cannula.

 

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

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:

 

ask her how long the patient has been taking his medication.

 

determine when he was last seen by his physician.

 

obtain a description of how the seizure developed.

 

determine if the patient is a known alcohol abuser.

obtain a description of how the seizure developed.

A patient with an altered mental status is:

 

not thinking clearly or is incapable of being aroused.

 

completely unresponsive to all forms of stimuli.

 

typically alert but is confused as to preceding events.

 

usually able to be aroused with a painful stimulus.

not thinking clearly or is incapable of being aroused

The principal clinical difference between a stroke and hypoglycemia is that patients with hypoglycemia:

 

always take oral medications to maintain normal blood glucose levels.

 

do not present with slurred speech or weakness to one side of the body.

 

are typically alert and attempt to communicate with health care providers.

 

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

usually have an altered mental status or decreased level of consciousness

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

 

respiratory distress.

 

a febrile convulsion.

 

a seizure.

 

an acute stroke.

a seizure.

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:

 

administer one tube of oral glucose and prepare for immediate transport.

 

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

 

give her small cups of water to drink and observe for further seizure activity.

 

place her in the recovery position and transport her with lights and siren.

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

Individuals with chronic alcoholism are predisposed to intracranial bleeding and hypoglycemia secondary to abnormalities in the:

 

pancreas.

 

brain.

 

kidneys.

 

liver.

liver

Which of the following patients would MOST likely demonstrate typical signs of infection, such as a fever?

 

A 17-year-old male with anxiety

 

An 88-year-old male with chronic renal problems

 

A 3-month-old female who was born prematurely

 

A 35-year-old female in the later stages of AIDS

A 17-year-old male with anxiety

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

 

ensure a patent airway and support ventilation as needed.

 

insert a nasopharyngeal airway and assist ventilations.

 

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

 

immediately determine the patient's blood glucose level.

ensure a patent airway and support ventilation as needed

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:

 

assess the patient for a facial droop and hemiparesis.

 

perform CPR for 5 minutes before applying the AED.

 

obtain a blood glucose sample to rule out hypoglycemia.

 

initiate CPR and attach an AED as soon as possible.

initiate CPR and attach an AED as soon as possible

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:

 

recovery position and transport.

 

high-flow oxygen and transport.

 

ventilatory assistance and transport.

 

oral glucose gel and transport.

recovery position and transport

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:

 

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

 

place a bite block in her mouth in case she has a seizure and transport at once.

 

apply oxygen via a nonrebreathing mask, place her on her left side, and transport.

 

apply oxygen via nonrebreathing mask and transport her for a blood-alcohol test.

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

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:

 

administer one tube of oral glucose and transport.

 

assist her ventilations with a bag-valve mask.

 

suction her oropharynx and transport immediately.

 

insert an oral airway, apply oxygen, and transport.

suction her oropharynx and transport immediately

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:

 

wait for the seizure to stop, manually open her airway, insert an oropharyngeal airway, and assess her oxygen saturation with the pulse oximeter.

 

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

 

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.

 

place a bite block in between her teeth, apply high-flow oxygen via a nonrebreathing mask, and consider inserting a nasopharyngeal airway.

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

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

 

the patient's overall medication compliance.

 

if there is a family history of a stroke.

 

when the patient last appeared normal.

 

if the patient has been hospitalized before.

when the patient last appeared normal.

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?

 

Asking his wife when she noticed the symptoms

 

Documenting all of his current medications

 

Administering glucose to rule out hypoglycemia

 

Obtaining a complete set of baseline vital signs

Asking his wife when she noticed the symptoms

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 serious infection.

 

intracranial bleeding.

 

epilepsy.

 

a brain tumor.

epilepsy

Components of the Cincinnati Prehospital Stroke Scale include:

 

speech, pupil reaction, and memory.

 

facial droop, speech, and pupil size.

 

arm drift, speech, and facial droop.

 

arm drift, memory, and grip strength.

arm drift, speech, and facial droop

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

 

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

 

observe movement of the arms for approximately 2 minutes.

 

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

 

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

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

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:

 

defer this part of the test and assess her for facial droop and slurred speech.

 

instruct the patient to keep her eyes open and then repeat the arm drift test.

 

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

 

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

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:

 

7

 

8

 

9

 

6

8

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:

 

14

 

12

 

13

 

15

12

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:

 

assisting him with his migraine medication and transporting without lights and siren.

 

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

 

applying warm compresses to the back of his neck and transporting with lights and siren.

 

placing him in a supine position and transporting with lights and siren to a stroke center.

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

When transporting a stable stroke patient with a paralyzed extremity, place the patient in a:

 

sitting position with the head at a 45° to 90° angle.

 

supine position with the legs elevated 6″ to 12″.

 

recumbent position with the paralyzed side up.

 

recumbent position with the paralyzed side down.

recumbent position with the paralyzed side down

A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he or she:

 

has had a prior heart attack.

 

has bleeding within the brain.

 

has a GCS score that is less than 8.

 

is older than 60 years of age.

has bleeding within the brain

Successful treatment of a stroke depends on whether:

 

thrombolytic therapy is given within 3 hours of symptoms beginning.

 

the stroke occurs within the left or right hemisphere of the brain.

 

medications are given to restore the function of infarcted cells.

 

surgical intervention is performed to remove obstructive clots.

thrombolytic therapy is given within 3 hours of symptoms beginning

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?

 

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

 

He is currently not prescribed any medications.

 

He has experienced seizures since he was 20.

 

His Glasgow Coma Scale (GCS) score is 15.

He is currently not prescribed any medications