AMLS Neurological Emergencies 2 — Questions and Answers
Question 1: A diabetic patient presents with altered mental status, diaphoresis, and tachycardia. Blood glucose is 38 mg/dL. What is the priority treatment?
- IV dextrose 50% (D50) 25 g (Correct answer)
- Oral glucose gel
- Glucagon 1 mg IM
- Normal saline 500 mL bolus
Correct answer: IV dextrose 50% (D50) 25 g
IV D50 is the fastest and most effective treatment for symptomatic hypoglycemia in a patient with IV access.
Question 2: Which AMLS assessment finding is most consistent with a lesion in the brainstem?
- Abnormal respiratory patterns and cranial nerve deficits (Correct answer)
- Hemiplegia with preserved consciousness
- Cortical blindness only
- Aphasia without motor deficits
Correct answer: Abnormal respiratory patterns and cranial nerve deficits
Brainstem lesions typically cause abnormal respiratory patterns, cranial nerve deficits, and altered consciousness due to the reticular activating system.
Question 3: What does a GCS score of 8 or less indicate regarding airway management?
- The patient likely cannot protect their airway and may need intubation (Correct answer)
- No intervention is needed if the patient is breathing
- Apply nasal cannula oxygen only
- Perform jaw thrust without airway adjunct
Correct answer: The patient likely cannot protect their airway and may need intubation
A GCS of 8 or less is a widely used threshold indicating inability to protect the airway and is an indication for intubation.
Question 4: Which medication is first-line for treatment of benzodiazepine-responsive seizures in the prehospital and emergency setting?
- Lorazepam IV or midazolam IM (Correct answer)
- Phenytoin IV
- Levetiracetam IV
- Phenobarbital IV
Correct answer: Lorazepam IV or midazolam IM
Benzodiazepines such as lorazepam IV or midazolam IM are first-line agents for acute seizure termination.
Question 5: Wernicke's encephalopathy is classically caused by a deficiency of which vitamin?
- Thiamine (B1) (Correct answer)
- Pyridoxine (B6)
- Cobalamin (B12)
- Niacin (B3)
Correct answer: Thiamine (B1)
Wernicke's encephalopathy results from thiamine (B1) deficiency, commonly seen in alcoholism, and presents with the classic triad of ataxia, ophthalmoplegia, and confusion.
Question 6: Which finding on the AMLS primary survey is most concerning for spinal cord injury at the C3-C5 level?
- Diaphragmatic breathing with loss of intercostal muscle function (Correct answer)
- Flaccid lower extremities only
- Loss of bladder control alone
- Decreased sensation below the knee
Correct answer: Diaphragmatic breathing with loss of intercostal muscle function
Injuries at C3-C5 affect the phrenic nerve origin (C3-C5), impairing intercostal muscles but potentially sparing diaphragm, resulting in diaphragmatic-only breathing.
AMLS Neurological Emergencies 2
A diabetic patient presents with altered mental status, diaphoresis, and tachycardia.
Blood glucose is 38 mg/dL.
What is the priority treatment?