CEP Neurological Emergencies & Stroke Management 1 — Questions and Answers
Question 1: The Cincinnati Prehospital Stroke Scale (CPSS) assesses which three components?
- Facial droop, arm drift, and speech abnormality (Correct answer)
- Pupils, grip strength, and verbal response
- Eye opening, arm weakness, and gait disturbance
- Blood pressure, pulse rate, and respiratory effort
Correct answer: Facial droop, arm drift, and speech abnormality
The CPSS evaluates facial droop, arm drift, and speech abnormality to rapidly identify stroke in the prehospital setting.
Question 2: What is the generally accepted time window from symptom onset for IV tPA administration in acute ischemic stroke?
- Within 1 hour
- Within 3–4.5 hours (Correct answer)
- Within 6 hours
- Within 12 hours
Correct answer: Within 3–4.5 hours
IV tPA (alteplase) is approved within 3 hours of symptom onset, with select guidelines extending to 4.5 hours for eligible patients.
Question 3: A patient with a GCS of 3 has which combination of component scores?
- Eye 1, Verbal 1, Motor 1 (Correct answer)
- Eye 1, Verbal 2, Motor 1
- Eye 2, Verbal 1, Motor 1
- Eye 1, Verbal 1, Motor 2
Correct answer: Eye 1, Verbal 1, Motor 1
A GCS of 3 is the minimum possible score, representing no eye opening (1), no verbal response (1), and no motor response (1).
Question 4: First-line pharmacological treatment for status epilepticus in the prehospital setting is:
- Phenytoin IV
- Benzodiazepines (lorazepam, diazepam, or midazolam) (Correct answer)
- Phenobarbital IM
- Ketamine IV
Correct answer: Benzodiazepines (lorazepam, diazepam, or midazolam)
Benzodiazepines are first-line for status epilepticus due to rapid onset and GABA-mediated seizure termination.
Question 5: Cushing's triad, indicating severely elevated intracranial pressure, includes:
- Hypertension, bradycardia, and irregular respirations (Correct answer)
- Hypotension, tachycardia, and rapid respirations
- Hypertension, tachycardia, and shallow respirations
- Hypotension, bradycardia, and apnea
Correct answer: Hypertension, bradycardia, and irregular respirations
Cushing's triad is hypertension with widened pulse pressure, bradycardia, and irregular respirations, signaling imminent brain herniation.
Question 6: A patient presents with sudden unilateral weakness and slurred speech. Blood glucose is 45 mg/dL. Your first intervention should be:
- Activate stroke protocol and transport immediately
- Administer dextrose or glucagon to correct hypoglycemia (Correct answer)
- Perform a 12-lead ECG to rule out cardiac arrhythmia
- Obtain IV access and infuse normal saline wide open
Correct answer: Administer dextrose or glucagon to correct hypoglycemia
Hypoglycemia mimics stroke; correcting blood glucose must occur before activating stroke protocol, as the symptoms may fully resolve.
Question 7: Which finding is most characteristic of uncal herniation syndrome in a head-injured patient?
- Bilateral pinpoint pupils with hypotension
- Unilateral fixed and dilated pupil with contralateral hemiplegia (Correct answer)
- Bilateral dilated pupils with intact motor function
- Horner syndrome with bilateral upper extremity weakness
Correct answer: Unilateral fixed and dilated pupil with contralateral hemiplegia
Uncal herniation compresses cranial nerve III ipsilaterally, causing a fixed dilated pupil, with contralateral motor deficits from corticospinal tract compression.
CEP Neurological Emergencies & Stroke Management 1
The Cincinnati Prehospital Stroke Scale (CPSS) assesses which three components?