Deck 3: Neurology

Question 1

Your patient is a 76-year-old female who was initially lethargic but responded to verbal stimuli. According to family members, the patient experienced a sudden decrease in responsiveness. She had a left-sided facial droop, aphasia, a dilated and nonreactive right pupil, and a flaccid left arm. Lung sounds are decreased bilaterally. HR = 58, BP = 172/102, RR = 6 and shallow, SaO₂ = 88%. As you start to treat her, the patient has a generalized seizure lasting about 30 seconds. She is now unresponsive. Which of the following is most appropriate?

A) Intubation, IV of normal saline at a keep open rate, cardiac monitor, blood glucose determination, sublingual nitroglycerin spray, transport without delay
B) Hyperventilate by bag-valve mask, IV of normal saline at a keep open rate, check blood glucose level, administer 25 gm of dextrose if needed, administer naloxone and thiamine, intubate if no improvement, transport without delay
C) Intubation, IV of normal saline at a keep open rate, cardiac monitor, blood glucose determination, transport without delay
D) Hyperventilate by bag-valve mask, IV of normal saline at a keep open rate, diazepam 5 mg IV, intubate if no improvement, transport without delay

Answer 1

Intubation, IV of normal saline at a keep open rate, cardiac monitor, blood glucose determination, transport without delay

Question 2

Your patient is a 48-year-old female who is alert and oriented after a possible seizure. Her friends state they witnessed her slump to the floor and "shake" for about 15 seconds. She awoke in less than 1 minute and was "a bit groggy" for a few minutes. She does not believe she had a seizure but thinks she may have fainted. Which of the following questions is least important when differentiating seizure and syncope?

A) "Are you allergic to any medications?"
B) "What kind of medications do you take?"
C) "Do you have a history of seizures?"
D) "What happened just before the event?"

Answer 2

"Are you allergic to any medications?"

Question 3

Your patient is a 55-year-old male with a history of seizures who is on the floor and experiencing tonic-clonic motor activity. His jaw is clenched, he has peripheral cyanosis, and there are frothy secretions in his airway. HR = 130, RR = 4 and shallow, SaO₂ = 88%. Which of the following is most appropriate?

A) Suctioning the airway, inserting a nasopharyngeal airway, assisting respirations by bag-valve-mask device with 100 percent oxygen
B) Immediate nasal intubation and hyperventilation with 100 percent oxygen
C) An IV of normal saline at a keep open rate, check blood glucose level, administer 3 mg of lorazepam, IV
D) An IV of normal saline at a keep open rate, check blood glucose level, administer 5 mg of diazepam, IV

Answer 3

Suctioning the airway, inserting a nasopharyngeal airway, assisting respirations by bag-valve-mask device with 100 percent oxygen

Question 4

Which three cranial nerves are involved in the cardinal positions of gaze?

A) I, III, and VI
B) VI, VII, and X
C) III, IV, and VI
D) I, III, and IV

Question 5

Your patient is a 62-year-old female who is alert and oriented and sitting at her kitchen table. Her husband describes an episode of slurred speech and facial drooping that lasted about 10 minutes and resolved just before your arrival. Physical examination is unremarkable. She has no significant medical history and takes no medications. HR = 78, BP = 134/78, RR = 12, SaO₂ = 99%. Which of the following is most likely?

A) Absence seizure
B) Stroke
C) Ménière's disease
D) Transient ischemic attack

Question 6

A patient tells you that she experienced an episode of involuntary "shaking" in her arm. She describes a 1- to 2-minute-long episode of muscular jerking and contracting of her entire left arm. She retained consciousness, lacked an aura, and had no pain associated with the episode. This most indicates a(n) ________ seizure.

A) psychosomatic
B) simple partial
C) petit mal
D) absence

Question 7

Your patient states that he often experiences a painful cramping and "freezing up" of his hands and feet while handwriting or walking, respectively. This best describes:

A) torticollis.
B) dystonia.
C) palsy.
D) myoclonus.

Question 8

Which of the following is a risk factor for stroke?

A) Atrial fibrillation
B) Premature atrial contractions
C) First-degree heart block
D) Sinus arrhythmia

Question 9

Which of the following is caused by unilateral paralysis of cranial nerve VII?

A) Dystonia
B) Bell's palsy
C) Autonomic dysreflexia
D) Myoclonus

Question 10

A series of two or more generalized motor seizures without an intervening period of consciousness is known as:

A) status epilepticus.
B) hypertonic seizures.
C) a complex partial seizure.
D) a petit mal seizure.

Question 11

Which of the following should be suspected as a potential cause of syncope?

A) Hypovolemia
B) Cardiac arrhythmia
C) Unknown cause
D) All of the above

Question 12

Your patient is a 32-year-old female who is alert but in significant distress, complaining of a migraine. She has a history of migraines, describes a gradual onset of headache this morning, and is now experiencing nausea and intense throbbing pain behind her temples. She is lying on a couch in a dim room and keeps her eyes closed while talking to you in a low voice. HR = 100, BP = 148/100, RR = 12, SaO₂ = 99%. Which of the following is most appropriate in the prehospital management of this patient?

A) Morphine sulfate, IV in 2 mg increments, up to 10 mg
B) NTG SL, 0.4 mg, up to 3 tablets or a diastolic blood pressure of 80 mmHg
C) A calm, quiet environment and dim lights
D) Lorazepam, 2 mg

Question 13

Your patient is a 24-year-old male who is alert and oriented, complaining of severe "dizziness" and an earache for two days. He states that any movement of his head causes him to become very dizzy and nauseated. The patient's skin is warm and dry, his pupils are equal and reactive, and there is no gross neurological deficit. HR = 82, BP = 120/82, RR = 12, SaO₂ = 99%. Which of the following is most likely?

A) Subdural hematoma
B) Transient cerebral attack
C) Hypersensitivity of the carotid sinus
D) Labyrinthitis

Question 14

You suspect your patient is experiencing a hemorrhagic stroke. He is confused, has a respiratory rate of 20, and a blood pressure of 178/88. Which of the following additional findings would most increase your suspicion of increased intracranial pressure?

A) Slurred speech
B) Hallucinations
C) Anterograde amnesia
D) Heart rate of 50

Question 15

You should most highly suspect that a patient with tremors, periodic muscular rigidity, slowed movement, and impaired balance and coordination suffers from:

A) peripheral neuralgia.
B) amyotrophic lateral sclerosis.
C) autonomic dysreflexia.
D) Parkinson's disease.

Question 16

A seizure that begins as an electrical discharge in a small area of the brain but spreads to include the entire cerebral cortex is a ________ seizure.

A) complex partial
B) myoclonic
C) generalized
D) simple partial

Question 17

You are transporting a male patient to the hospital for an evaluation after a possible seizure when you notice the patient's loss of consciousness. His muscles start to contract so that he is arching his back. This best describes the ________ phase of a generalized seizure.

A) hypertonic
B) postictal
C) clonic
D) tonic

Question 18

Which of the following infectious childhood diseases would most likely result in paralysis?

A) Spina bifida
B) German measles
C) Rubella
D) Poliomyelitis

Question 19

The most common cause of dementia is:

A) Bell's palsy.
B) stroke.
C) Alzheimer's disease.
D) Korsakoff's psychosis.

Question 20

Your patient is a 45-year-old female type I diabetic with a history of a nonhealing foot ulcer. On examination, you find that her pedal pulse is present, but she lacks sensation in her foot. This is most likely due to:

A) Brown-Séquard syndrome.
B) Raynaud's disease.
C) peripheral neuropathy.
D) claudication.

Question 21

Your patient has a history of epilepsy and is experiencing loss of consciousness, tonic-clonic muscle activity, and erratic ocular movement. Based on this, you might also expect to find all of the following EXCEPT:

A) pinpoint pupils.
B) urinary incontinence.
C) impaired respiration.
D) increased oral secretions.

Question 22

A type of generalized seizure characterized by a rapid loss of consciousness and motor coordination, muscle spasms, and jerking motions is known as a(n):

A) simple partial seizure.
B) absence.
C) tonic-clonic seizure.
D) complex partial seizure.

Question 23

The postsynaptic neurotransmitter of the sympathetic nerves is:

A) dopamine.
B) acetylcholine.
C) norepinephrine.
D) epinephrine.

Question 24

Which of the following is NOT characteristic of a migraine?

A) Vomiting
B) Low back pain
C) Photosensitivity
D) Throbbing headache

Question 25

Which of the following is characterized by involuntary muscle twitching?

A) Ataxia
B) Trismus
C) Myoclonus
D) Dystonia

Question 26

Which of the following is a collection of genetic diseases characterized by progressive muscle weakness and skeletal muscle degeneration?

A) Multiple sclerosis
B) Myasthenia gravis
C) Muscular dystrophy
D) Amyotrophic lateral sclerosis

Question 27

All of the following may cause a transient ischemic attack EXCEPT:

A) intracranial hemorrhage.
B) cerebrovascular spasm.
C) hypotension.
D) a small embolus.

Question 28

A patient with speech impairment following a stroke would have involvement in the ________ lobe of the brain.

A) frontal
B) parietal
C) temporal
D) occipital

Question 29

Your patient is a 57-year-old male who is alert and oriented and complaining of a slight headache. His coworker states the patient "fainted." The patient describes feeling weak and lightheaded before the incident and "came to" lying on the floor. Medical history includes cardiovascular disease with a history of angina and hypertension. Medications include clopidogrel (Plavix), nitroglycerin, and metoprolol. Which of the following is least helpful when formulating a field impression for this patient?

A) Pulse oximetry
B) Neurological exam
C) Cardiac monitoring
D) Orthostatic vital signs

Question 30

The most common cause of dementia in the elderly is:

A) cerebrovascular disease.
B) Alzheimer's disease.
C) multi-infarct dementia.
D) Parkinson's disease.

Question 31

During a domestic disturbance your patient experienced a sudden onset of violent, bizarre movements of the extremities followed by unresponsiveness to verbal stimuli. On your arrival the bizarre movements begin again but stop suddenly when you firmly say, "Stop!" This most indicates ________ seizure.

A) absence
B) simple partial
C) complex partial
D) pseudo

Question 32

A seizure that remains confined to a limited portion of the brain, causing localized dysfunction, is a(n) ________ seizure.

A) tonic
B) absence
C) partial
D) petit mal

Question 33

The most common cause of lower back pain is:

A) sciatica.
B) arthritis.
C) idiopathic.
D) osteomyelitis.

Question 34

A 35-year-old male complains of a "pressure"-type headache to the back of his head and neck. He states that he woke up with the discomfort this morning, and the pain has steadily gotten worse through the day. He denies any radiation of the pain and denies photophobia but states that he is slightly nauseated. Based on this clinical presentation, the paramedic should be suspicious of what type of headache?

A) Migraine
B) Vascular
C) Cluster
D) Tension

Question 35

Your female patient is experiencing sharp, stabbing, right-sided face pain of her upper and lower lips, cheek, and around her orbit. This best describes:

A) a cluster headache.
B) temporomandibular joint syndrome.
C) trigeminal neuralgia.
D) Bell's palsy.

Question 36

Which of the following diseases involves inflammation followed by demyelination of the brain and spinal cord nerve fibers?

A) Myasthenia gravis
B) Muscular dystrophy
C) Multiple sclerosis
D) Alzheimer's disease

Question 37

An eight-year-old male child is alert and oriented after a brief episode of eyelid fluttering and slight loss of muscle tone, which caused him to slump in his chair. His teacher reports that the child was inattentive for 15 to 20 seconds during the episode but was fine after. This most indicates a(n) ________ seizure.

A) generalized
B) absence
C) pseudo
D) simple partial

Question 38

Which of the following should NOT be part of the general management of a patient with altered mental status?

A) Thiamine
B) 50 percent dextrose
C) IV with saline lock
D) Hyperventilation with 100 percent oxygen

Question 39

The dorsal roots of the spinal cord contain afferent fibers that transmit impulses from ________ to ________.

A) the central nervous system, motor nerves
B) sensory nerves, central nervous system
C) the central nervous system, sensory nerves
D) motor nerves, the central nervous system

Question 40

Which of the following complaints is most typical for a patient suffering an exacerbation of multiple sclerosis?

A) "Each night I seem to get a fever and break out in a sweat."
B) "I have no feeling in either my arms or my legs."
C) "I cannot remember my address or phone number."
D) "My legs feel heavy, and I am having trouble walking."

Question 41

While you are caring for a patient on the floor of her kitchen, she begins to have a generalized seizure. Which of the following is the most appropriate first action?

A) Move objects away from her and wait to see if the seizure stops.
B) Insert an oropharyngeal airway.
C) Restrain her so she does not injure herself.
D) Start an IV, and administer 5 mg diazepam.

Question 42

Which of the following diseases is most likely to cause dementia in the patient?

A) Pick's disease
B) Multiple sclerosis
C) Amyotrophic lateral sclerosis
D) Spina bifida

Question 43

The family members of a 72-year-old female state that the patient complained of a sudden, severe headache; had slurred speech; then became unresponsive. She responds to painful stimuli with decorticate posturing and has snoring respirations at a rate of 10 per minute. Her radial pulse is palpable but grossly irregular. According to her son, she also suffers from congestive heart failure, hypertension, and diabetes. Which of the following should you do first?

A) Attach the cardiac monitor.
B) Manage the airway with a modified jaw-thrust maneuver.
C) Check her blood sugar.
D) Insert an endotracheal tube.

Question 44

Your patient is a 52-year-old female who is alert but slightly confused after a syncopal episode lasting about 1 minute. She has no complaints, and your physical exam reveals no abnormalities aside from slight confusion. She has had a stroke and has a history of type II diabetes and hypertension. HR = 100, BP = 132/84, RR = 12, SaO₂ = 99%. Which of the following is the least likely cause of the patient's episode?

A) Orthostatic hypotension
B) Hypoglycemia
C) Transient ischemic attack
D) Transient cardiac arrhythmia

Question 45

Which of the following is evaluated in the Los Angeles Prehospital Stroke Screen but is not part of the Cincinnati Prehospital Stroke Scale?

A) Facial droop
B) Arm drift
C) Temperature
D) Blood glucose level

Question 46

All of the following are assessed during the Cincinnati Prehospital Stroke Screen EXCEPT:

A) memory.
B) speech.
C) facial droop.
D) arm drift.

Question 47

The father of a 15-year-old male who has had a generalized seizure asks you why his son turned blue during the seizure. Which of the following is the best answer?

A) "The heart slows down and the blood pressure drops during a seizure, causing a lack of circulation to the skin."
B) "The muscles used in breathing cannot work effectively during the seizure, decreasing the amount of oxygen in the blood."
C) "It is a normal part of the seizure process and nothing to worry about."
D) "The brain stem stops working during a seizure, which causes breathing to stop, decreasing the amount of oxygen in the blood."

Question 48

What is the innermost layer of meninges that directly overlies the central nervous system?

A) Pia mater
B) Dura mater
C) Arachnoid membrane
D) Cerebrospinal membrane

Question 49

Your patient is a 19-year-old female who is exhibiting generalized seizure activity. Her roommate states that she had a seizure that lasted about 3 minutes. She remained unresponsive, then started having another seizure about 5 minutes after the first. The patient has peripheral cyanosis and copious oral secretions. Which of the following is of HIGHEST priority for this patient?

A) Starting an IV and administering 5 mg of diazepam
B) Suctioning the airway, applying 15 liters per minute of oxygen by nonrebreathing mask
C) Starting an IV, administering succinylcholine, and intubation
D) Suctioning the airway, assisting ventilations with a bag-valve-mask device

Question 50

Which of the following is least likely to be detrimental when treating a stroke patient?

A) IV of lactated Ringer's solution
B) Hyperventilation with 100 percent oxygen
C) IV of 5 percent dextrose in water
D) Administration of 50 percent dextrose, IV push

Question 51

You are examining a newborn and note that the meninges and spinal cord are protruding through an opening over the lower back. This is known as:

A) a myelomeningocele.
B) a meningocele.
C) spina bifida occulta.
D) poliomyelitis.

Question 52

Epilepsy affects roughly:

A) 1 percent of the population.
B) 5 percent of the population.
C) 10 percent of the population.
D) 15 percent of the population.

Question 53

Your patient is a 49-year-old male complaining of a headache and weakness of his left arm, accompanied by nausea and vomiting. The information that would be most helpful in differentiating a brain abscess from a brain tumor is whether or not the patient:

A) has had a seizure.
B) exhibits nuchal rigidity.
C) has had a change in the level of responsiveness.
D) has a recent history of brain surgery.

Question 54

Pseudoseizures are best controlled by:

A) lorazepam.
B) phenytoin.
C) using physical restraints.
D) a command to stop.

Question 55

Which of the following diseases is characterized by a progressive degeneration of the nerve cells that control voluntary movement, weakness, loss of motor control, difficulty speaking, and cramping?

A) Muscular dystrophy
B) Bell's palsy
C) Multiple sclerosis
D) Amyotrophic lateral sclerosis

Question 56

What neurological problem results in a neural defect in which the fetal vertebrae do not close properly, often resulting in spinal cord dysfunction?

A) Creutzfeldt-Jakob disease
B) Spina bifida
C) Guillain-Barré syndrome
D) Multiple sclerosis

Question 57

A form of spina bifida in which some of the spinal cord and meninges are protruding from a defect in the spine is a(n):

A) meningioma.
B) myelomeningocele.
C) osteogenesis imperfecta.
D) hydrocele.

Question 58

Atrial fibrillation is most associated with ________ strokes.

A) hypoxic
B) thrombotic
C) embolic
D) hemorrhagic

Question 59

You are transporting a male patient with the complaint of expressive aphasia and right upper extremity paralysis to the hospital. When calling the hospital, which of the following pieces of information is it most critical to convey?

A) History of hypertension
B) SaO₂ 94% despite oxygen
C) Time of symptom onset
D) Blood pressure 168/82 mmHg

Question 60

Which of the following is least pertinent in the prehospital setting when obtaining the history of a patient with a suspected transient ischemic attack or stroke?

A) History of diabetes
B) History of cardiovascular disease
C) Allergies
D) Medications

Question 61

When evaluating a patient with a possible neurologic emergency, which acronym can help you remember the causes?

A) TICKLES
B) AVPU
C) AEIOU-TIPS
D) ISAL

Question 62

The primary neurotransmitter of the sympathetic nervous system is:

A) epinephrine.
B) acetylcholine.
C) reteplase.
D) dopamine.

Question 63

The two mechanisms capable of producing alterations in mental state are:

A) structural and toxic-metabolic.
B) structural and RAAS.
C) physiologic and RAS.
D) cranial nervous and the central nervous system.

Question 64

The acronym AVPU is used to quickly assess a patient's:

A) mood.
B) thought.
C) mental status.
D) judgment.

Question 65

One cause of altered mental status that you are able to quickly rule out is:

A) hyperglycemia.
B) hypoglycemia.
C) TIA.
D) CVA.

Question 66

A condition seen in chronic alcoholics that causes ataxia, eye muscle weakness, and mental derangement is known as:

A) Korsakoff's psychosis.
B) Wolff-Parkinson-White syndrome.
C) Wernicke's syndrome.
D) Brugada syndrome.

Question 67

A TIA typically:

A) resolves within 24 hours.
B) never resolves.
C) can be reversible with tPA.
D) is caused by intracranial hemorrhage.

Question 68

You respond to a patient who is complaining of a sudden onset of a severe headache. The patient has a history of hypertension. You should suspect:

A) occlusive stroke.
B) hemorrhagic stroke.
C) migraine.
D) hypertensive urgency.

Question 69

The area that connects the brain to the spinal cord is known as the:

A) cerebellum.
B) medulla oblongata.
C) pons.
D) foramen magnum.

Question 70

You respond to a patient who has an AV shunt in place. You notice that the patient is unresponsive with the following vital signs: blood pressure, 180/100 mmHg; pulse: 48; respirations: 12 and irregular. You suspect:

A) increased intracranial pressure.
B) decreased intracranial pressure.
C) seizure.
D) normal status for an AV shunt patient.

Question 71

The primary neurotransmitter of the parasympathetic nervous system is:

A) epinephrine.
B) acetylcholine.
C) reteplase.
D) dopamine.

Question 72

The nervous system is divided into which two main parts?

A) Central and autonomic
B) Autonomic and cranial
C) Peripheral and autonomic
D) Central and peripheral

Question 73

Increasing PaCO₂ will cause:

A) cerebral vasoconstriction.
B) cerebral vasodilation.
C) hyperventilation syndrome.
D) ataxic respirations.

Question 74

Decreasing PaCO₂ will cause:

A) cerebral vasoconstriction.
B) cerebral vasodilation.
C) hyperventilation syndrome.
D) ataxic respirations.

Question 75

The entire central nervous system is covered by the:

A) dura mater.
B) meninges.
C) peritoneum.
D) pia mater.

Question 76

A tonic-clonic seizure is characterized by:

A) flaccidity.
B) movement of one area of the body.
C) a period of apnea.
D) increased muscle tone and rhythmic jerking.

Question 77

Posturing with the arms flexed and the legs extended is known as:

A) decerebrate position.
B) decorticate position.
C) postictal position.
D) neurogenic shock position.