question

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?

answer

He is currently not prescribed any medications

question

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

answer

has bleeding within the brain.

question

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

answer

dysarthria.

question

A patient with an altered mental status is

answer

not thinking clearly or is incapable of being aroused.

question

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

answer

ensure a patent airway and support ventilation as needed.

question

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

answer

cerebral vasodilation.

question

The left cerebral hemisphere controls:

answer

the right side of the body.

question

The MOST significant risk factor for a hemorrhagic stroke is:

answer

hypertension.

question

The three major parts of the brain are the:

answer

cerebrum, cerebellum, and brain stem.

question

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

answer

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

question

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

answer

a seziure

question

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

answer

when the patient last appeared normal.

question

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

answer

Hypovolemia

question

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

answer

Respiratory failure or cardiopulmonary arrest

question

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

answer

A seizure that begins in one extremity

question

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

answer

Confusion and fatigue

question

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

answer

The pain is worse when bending over

question

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:

answer

recovery position and transport

question

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:

answer

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

question

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:

answer

8

question

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

answer

severe twitching of all the body's muscles.

question

The brain is divided in three major parts

answer

1. The brain stem 2. The Cerebellum 3. The cerebrum

question

Function of the brain stem

answer

Controls the most basic functions of the body, such as breathing, blood pressure, swallowing, and pupil constriction.

question

Function of the Cerebellum

answer

Controls muscle and body coordination responsible for coordinating complex tasks that involve many muscles

question

coma

answer

A state of profound unconsciousness from which the patient cannot be roused.

question

The brain is most sensitive to changes in ________, _________, and ________levels

answer

oxygen; glucose; temperature

question

Most common types of headaches are:

answer

Tension headache, migraines, and sinus headaches

question

Tension headaches

answer

Caused by muscle contractions in the head and neck Attributed to stress

question

Migraines

answer

Thought to be caused by changes in blood-vessel size in the base of the brain; often associated with nausea and vomiting and may be preceded by visual warning signs such as flashing lights or partial vision loss.

question

Sinus headaches

answer

Caused by pressure that is the result of fluid accumulation in the sinus cavities

question

Hemorrhagic stroke (bleeding in the brain)

answer

The blood from a ruptured blood vessel irritates the tissues of the brain and can cause increased intracranial pressure.

question

Meningitis

answer

A central nervous system infection in which the patient may complain of a headache, stiff neck, fever, and sensitivity to light

question

cerebrovascular accident (CVA) or Stroke

answer

An interruption of blood flow to the brain that results in the loss of brain function

question

ischemia

answer

A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow; potentially reversible because permanent injury has not yet occurred

question

Two main type of stroke

answer

Ischemic and Hemorrhagic Stroke

question

ischemic stroke

answer

A type of stroke that occurs when blood flow to a particular part of the brain is cut off by a blockage (eg, a blood clot) inside a blood vessel.

question

thrombosis

answer

A blood clot, either in the arterial or venous system. When the clot occurs in a cerebral artery, it may result in the interruption of cerebral blood flow and subsequent stroke.

question

embolus

answer

A blood clot or other substance in the circulatory system that travels to a blood vessel, where it causes a blockage.

question

atherosclerosis

answer

A disorder in which cholesterol and calcium build up inside the walls of the blood vessels, forming plaque, eventually leading to a partial or complete blockage of blood flow; an accumulation of fat and cholesterol in the arteries.

question

hemorrhagic stroke

answer

A type of stroke that occurs as a result of bleeding inside the brain.

question

aneurysm

answer

An abnormal enlargement of the wall of a blood vessel that results from weakening of the vessel wall.

question

transient ischemic attack

answer

A disorder of the brain in which brain cells temporarily stop functioning because of insufficient oxygen, causing stroke-like symptoms that resolve completely within 24 hours of onset.

question

aphasia

answer

The inability to understand and/or produce speech.

question

dysarthria

answer

Slurred speech

question

postictal state

answer

The period following a seizure that lasts 5 to 30 minutes; characterized by labored respirations and some degree of altered mental status.

question

________ affect(s) the entire brain, often causing anxiety, restlessness, and confusion.

answer

Low oxygen levels in the bloodstream will affect the entire brain, often causing anxiety, restlessness, and confusion.

question

seizure

answer

A neurologic episode caused by a surge of electrical activity in the brain; can be a convulsion characterized by generalized, uncoordinated muscular activity, and can be associated with loss of consciousness.

question

epilepsy

answer

A disorder in which abnormal electrical discharges occur in the brain, causing seizure and possible loss of consciousness.

question

aura

answer

A sensation experienced before a seizure; serves as a warning sign that a seizure is about to occur.

question

status epilepticus

answer

A condition in which seizures recur every few minutes or last longer than 30 minutes.

question

partial (focal) seizure

answer

A seizure affecting a limited portion of the brain.

question

generalized (tonic-clonic) seizure

answer

A seizure that features rhythmic back-and-forth motion of an extremity and body stiffness, or extreme twitching of all of the body's muscles, that may last several minutes or more; formerly known as a grand mal seizure.

question

febrile seizures

answer

Seizures that result from sudden high fevers; most often seen in children.

question

hypoglycemia

answer

An abnormally low blood glucose level.

question

Medications used most often to treat seizures include:

answer

Levetiracetam (Keppra) Phenytoin (Dilantin) Phenobarbital Carbamazepine (Tegretol) Valproate (Depakote) Topiramate (Topamax) Clonazepam (Klonopin)

question

incontinence

answer

Loss of bowel and/or bladder control; may be the result of a generalized seizure.

question

hemiparesis

answer

Weakness on one side of the body

question

syncope

answer

A fainting spell or transient loss of consciousness, often caused by an interruption of blood flow to the brain

question

Causes of altered mental status

answer

Hypoglycemia, Delirium, unrecognized head injury, sever alcohol intoxication, psychologic disorders and medication, infections (in brain), drug overdose, and/or poisoning

question

Stroke Assessment Tools include:

answer

3-Item Stroke Severity Scale (LAG Scale); FAST: and Glasgow Coma Scale

question

When you are assessing for a stroke, which of the following neurologic tests should be included in the assessment as a minimum?

answer

Facial movement, arm movement, and speech

question

You are treating a patient who is exhibiting slurred speech, facial droop, and an inability to move his left arm. Which neurologic examination emphasizes these possible stroke signs?

answer

The Cincinnati Prehospital Stroke Scale looks at facial droop, arm lift, and speech.

question

What is the name of the condition when the patient forgets about the injured side after a stroke?

answer

Neglect

question

What happens when blood flow to a particular part of the brain is cut off by a blockage, resulting in tissue damage?

answer

Ischemic stroke

question

What criteria must be met for a patient to have status epilepticus?

answer

seizures that recur every few minutes or last longer than 30 minutes.

question

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

answer

Hypoglycemia is a metabolic cause of seizures.

question

Which of the following mimics a stroke and also causes a seizure?

answer

Hypoglycemia

question

What is the difference between a stroke and a transient ischemic attack?

answer

A TIA resolves completely within 24 hours of onset.

question

You are examining a patient whose signs include lip smacking, jerking of the left arm, and agitation. Based on these signs, what type of seizure is this patient experiencing?

answer

complex partial seizure.

question

You are dispatched to a home where you find a 70-year-old man. He is exhibiting facial drooping and, when you ask him to tell you what day it is, he says "January." Which part of the brain is most likely to have been affected?

answer

Aphasia is the inability to produce or understand speech. This occurs when the left hemisphere of the cerebrum is impacted by a stroke.

question

A 40-year-old patient without a history of seizures experiences a generalized (tonic-clonic) seizure. The LEAST likely cause of this seizure is:

answer

epilepsy

question

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

answer

hypotension

question

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

answer

usually have an altered mental status or decreased level or consciousness

question

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:

answer

ask his wife when she noticed symptoms

question

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

answer

sudden severe headache

question

The anterior aspect of the cerebrum controls:

answer

emotion

question

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

answer

history of migraines

question

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:

answer

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

question

Muscle control and body coordination are controlled by the:

answer

cerebellum

question

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:

answer

obtain a description of how the seizure developed

question

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

answer

A 17-year-old male with anxiety

question

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

answer

Levetiracetam (Keppra)

question

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:

answer

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

question

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

answer

Blockage of a cerebral artery

question

Components of the Cincinnati Prehospital Stroke Scale include:

answer

arm drift, speech, and facial droop.

question

Successful treatment of a stroke depends on whether:

answer

thrombolytic therapy is given within 3 hours of symptoms beginning.

question

A patient who is experiencing aphasia is:

answer

unable to produce or understand speech.

Chapter 17 Neurological Emergencies – Flashcards

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