AEMCA AEMCA - Advanced Emergency Medical Care Assistant Neurological Emergencies Questions and Answers 2 — Questions and Answers
Question 1: A 68-year-old patient presents with sudden painless vision loss in one eye, described as a 'curtain coming down.' What vascular emergency does this suggest?
- Central retinal artery occlusion (Correct answer)
- Acute angle-closure glaucoma
- Retinal detachment
- Optic neuritis
Correct answer: Central retinal artery occlusion
Central retinal artery occlusion presents as sudden, painless, monocular vision loss and is an ocular stroke requiring immediate treatment.
Question 2: Which prehospital intervention is most important for a patient with a suspected large ischemic stroke and last known well time of 1 hour?
- Administer aspirin 324 mg PO
- Rapid transport to a stroke center with pre-notification (Correct answer)
- Establish two large-bore IVs and bolus 1 L NS
- Apply supplemental oxygen regardless of SpO2
Correct answer: Rapid transport to a stroke center with pre-notification
Rapid transport with advance notification to a stroke center minimizes door-to-needle time for tPA or endovascular intervention.
Question 3: Decerebrate posturing (extensor posturing) in a head-injured patient indicates injury at which level?
- Cortex
- Brainstem (midbrain/pons) (Correct answer)
- Spinal cord
- Cerebellum
Correct answer: Brainstem (midbrain/pons)
Decerebrate posturing reflects brainstem injury at the midbrain or pons level and indicates severe neurological compromise.
Question 4: A patient's blood pressure is 220/120 mmHg after an ischemic stroke. In the prehospital setting, what is the correct approach?
- Aggressively lower BP to below 140 systolic
- Administer labetalol 20 mg IV immediately
- Do not treat unless BP exceeds 220/120 or patient is symptomatic beyond stroke (Correct answer)
- Give sublingual nitroglycerin
Correct answer: Do not treat unless BP exceeds 220/120 or patient is symptomatic beyond stroke
In ischemic stroke, permissive hypertension maintains cerebral perfusion; prehospital providers should generally avoid lowering BP unless directed by medical control.
Question 5: Which sign differentiates meningitis from a simple headache in a patient with fever and neck stiffness?
- Kernig's sign
- Babinski's sign
- Brudzinski's sign
- Both Kernig's and Brudzinski's signs (Correct answer)
Correct answer: Both Kernig's and Brudzinski's signs
Both Kernig's sign (resistance to knee extension with hip flexed) and Brudzinski's sign (involuntary hip flexion with neck flexion) indicate meningeal irritation.
Question 6: A 45-year-old diabetic patient is found unresponsive. Blood glucose reads 32 mg/dL. After administering dextrose, the patient does not improve. What should you consider?
- The glucometer is inaccurate
- Administer more dextrose immediately
- Concurrent neurological emergency such as stroke (Correct answer)
- Insulin overdose requiring glucagon
Correct answer: Concurrent neurological emergency such as stroke
When hypoglycemia correction does not restore consciousness, a simultaneous neurological emergency such as stroke or head injury must be considered.
AEMCA AEMCA - Advanced Emergency Medical Care Assistant Neurological Emergencies Questions and Answers 2
A 68-year-old patient presents with sudden painless vision loss in one eye, described as a 'curtain coming down.' What vascular emergency does this suggest?