DCAS Neurological Emergencies 1 — Questions and Answers
Question 1: Which component is NOT part of the Glasgow Coma Scale (GCS)?
- Eye opening
- Verbal response
- Motor response
- Pupil reactivity (Correct answer)
Correct answer: Pupil reactivity
The GCS assesses eye opening, verbal response, and motor response only; pupil reactivity is assessed separately.
Question 2: A patient presents with sudden facial drooping on the right side, right arm weakness, and slurred speech. Which mnemonic best helps identify this as a stroke?
- SAMPLE
- FAST (Correct answer)
- OPQRST
- AEIOU-TIPS
Correct answer: FAST
FAST (Face drooping, Arm weakness, Speech difficulty, Time to call) is the primary stroke recognition tool used in pre-hospital care.
Question 3: A patient is in active tonic-clonic seizure lasting more than 5 minutes. What is the first-line pre-hospital treatment?
- IV phenytoin 15 mg/kg
- IM/IV midazolam or IV diazepam (Correct answer)
- IV lorazepam 4 mg only
- Oral diazepam
Correct answer: IM/IV midazolam or IV diazepam
Benzodiazepines (midazolam IM or diazepam IV) are the first-line treatment for status epilepticus in the pre-hospital setting.
Question 4: A 60-year-old male presents with sudden-onset confusion, diaphoresis, and focal weakness. Blood glucose reads 2.1 mmol/L. What is the priority intervention?
- Administer aspirin 300 mg
- Activate stroke protocol
- Administer IV dextrose 50% or glucagon IM (Correct answer)
- Perform a 12-lead ECG
Correct answer: Administer IV dextrose 50% or glucagon IM
Hypoglycemia can mimic stroke; with a glucose of 2.1 mmol/L, correcting hypoglycemia with dextrose or glucagon is the priority before any stroke workup.
Question 5: Which of the following best describes a Transient Ischaemic Attack (TIA)?
- A stroke with permanent deficit lasting over 24 hours
- A neurological deficit that resolves completely within 24 hours without infarction (Correct answer)
- A haemorrhagic event in the cerebellum
- A seizure mimicking stroke symptoms
Correct answer: A neurological deficit that resolves completely within 24 hours without infarction
A TIA is a temporary episode of neurological dysfunction caused by focal brain ischaemia that resolves completely, typically within minutes to hours, with no evidence of infarction.
Question 6: A postictal patient is unresponsive but breathing adequately. What is the most appropriate position?
- Supine with legs elevated
- Recovery (lateral) position (Correct answer)
- Seated upright at 90 degrees
- Prone position
Correct answer: Recovery (lateral) position
The recovery (lateral) position protects the airway from aspiration and maintains airway patency in a breathing but unresponsive postictal patient.
Question 7: When assessing spinal cord injury in the field, which finding suggests a complete spinal cord injury at the cervical level?
- Paraplegia with preserved upper limb function
- Loss of sensation below the umbilicus only
- Tetraplegia with loss of sensation in all four limbs (Correct answer)
- Isolated loss of bladder control
Correct answer: Tetraplegia with loss of sensation in all four limbs
Tetraplegia (all four limbs affected) with sensory loss is consistent with a complete cervical spinal cord injury, as the cervical cord controls upper and lower limb function.
DCAS Neurological Emergencies 1
Which component is NOT part of the Glasgow Coma Scale (GCS)?