EMS Neurological Emergencies 2 — Questions and Answers
Question 1: A patient is found confused with a blood glucose of 38 mg/dL. What is the most likely cause of the altered mental status?
- Ischemic stroke
- Hypoglycemia (Correct answer)
- Absence seizure
- Hypertensive encephalopathy
Correct answer: Hypoglycemia
A blood glucose below 60 mg/dL (hypoglycemia) is a common and reversible cause of altered mental status that must always be checked in neurological emergencies.
Question 2: Status epilepticus is defined as a seizure or series of seizures without recovery lasting longer than:
- 5 minutes (Correct answer)
- 10 minutes
- 15 minutes
- 30 minutes
Correct answer: 5 minutes
A seizure lasting more than 5 minutes is classified as status epilepticus and requires immediate intervention due to the risk of permanent neurological damage.
Question 3: Cushing's triad is a late sign of increased intracranial pressure. Which combination of findings defines it?
- Hypotension, tachycardia, and tachypnea
- Hypertension, bradycardia, and irregular respirations (Correct answer)
- Hypotension, bradycardia, and tachypnea
- Hypertension, tachycardia, and shallow respirations
Correct answer: Hypertension, bradycardia, and irregular respirations
Cushing's triad—hypertension, bradycardia, and irregular/agonal respirations—indicates dangerous brain herniation and imminent brainstem compromise.
Question 4: A patient presents with aphasia, right-sided facial droop, and right arm weakness. Which area of the brain is most likely affected?
- Right cerebral hemisphere
- Cerebellum
- Left cerebral hemisphere (Correct answer)
- Brainstem only
Correct answer: Left cerebral hemisphere
The left cerebral hemisphere controls motor function and speech for the right side of the body; deficits on the right with aphasia indicate a left-sided lesion.
Question 5: The Glasgow Coma Scale (GCS) evaluates which three components?
- Pupils, motor response, and verbal response
- Eye opening, verbal response, and motor response (Correct answer)
- Consciousness level, pupil reaction, and deep tendon reflexes
- Heart rate, respiratory effort, and eye opening
Correct answer: Eye opening, verbal response, and motor response
The GCS scores eye opening (1-4), verbal response (1-5), and motor response (1-6) for a maximum total of 15 points.
Question 6: Which medication is commonly given intramuscularly by EMTs for a hypoglycemic patient who is unconscious and has no IV access?
- Glucagon (Correct answer)
- 50% dextrose solution
- Insulin
- Epinephrine
Correct answer: Glucagon
Glucagon 1 mg IM stimulates hepatic glycogen breakdown to raise blood glucose and is safe for unconscious hypoglycemic patients when IV access cannot be obtained.
Question 7: Decorticate posturing (abnormal flexion) in a neurological patient indicates a lesion most likely located:
- In the spinal cord below C5
- Above the brainstem, involving the cerebral hemispheres or internal capsule (Correct answer)
- In the peripheral nervous system
- In the cerebellum only
Correct answer: Above the brainstem, involving the cerebral hemispheres or internal capsule
Decorticate posturing indicates a lesion in the cerebral hemispheres or internal capsule above the brainstem, while decerebrate posturing suggests brainstem involvement.
EMS Neurological Emergencies 2
A patient is found confused with a blood glucose of 38 mg/dL.
What is the most likely cause of the altered mental status?