FCCS FCCS Neurological Assessment 2 — Questions and Answers
Question 1: Status epilepticus is defined as continuous seizure activity lasting longer than how many minutes?
- 2 minutes
- 5 minutes (Correct answer)
- 10 minutes
- 30 minutes
Correct answer: 5 minutes
Status epilepticus is defined as seizure activity lasting ≥ 5 minutes or two or more seizures without return to baseline consciousness, requiring urgent treatment.
Question 2: What is the first-line pharmacologic treatment for status epilepticus?
- Phenytoin IV
- Benzodiazepines (lorazepam or diazepam) (Correct answer)
- Levetiracetam
- Propofol infusion
Correct answer: Benzodiazepines (lorazepam or diazepam)
IV benzodiazepines (lorazepam or diazepam) are first-line for status epilepticus due to their rapid onset GABA-A agonist activity that terminates seizure activity.
Question 3: Which pupillary finding is associated with opioid toxicity?
- Dilated pupils (mydriasis)
- Pinpoint pupils (miosis) (Correct answer)
- Unequal pupils
- Mid-position fixed pupils
Correct answer: Pinpoint pupils (miosis)
Opioids stimulate the Edinger-Westphal nucleus via mu receptors, causing parasympathetic pupil constriction (miosis/pinpoint pupils).
Question 4: The FOUR Score assesses which neurological domains?
- Eyes, verbal, motor, breathing
- Eyes, motor, brainstem reflexes, respiration (Correct answer)
- Orientation, memory, attention, language
- Cognition, reflex, motor, sensory
Correct answer: Eyes, motor, brainstem reflexes, respiration
The FOUR Score (Full Outline of UnResponsiveness) evaluates eye responses, motor responses, brainstem reflexes, and respiratory pattern, providing more detail than GCS.
Question 5: Decorticate posturing indicates injury at which level of the nervous system?
- Brainstem below the pons
- Above the midbrain (hemispheric/internal capsule) (Correct answer)
- Spinal cord at C4
- Peripheral nerve level
Correct answer: Above the midbrain (hemispheric/internal capsule)
Decorticate posturing (arm flexion, leg extension) reflects disruption of corticospinal tracts above the midbrain, releasing primitive brainstem reflexes.
Question 6: Which benzodiazepine reversal agent should be used cautiously in patients with chronic benzodiazepine use?
- Naloxone
- Flumazenil (Correct answer)
- Neostigmine
- Physostigmine
Correct answer: Flumazenil
Flumazenil can precipitate acute withdrawal seizures in chronically benzodiazepine-dependent patients and should be used with extreme caution.
FCCS FCCS Neurological Assessment 2
Status epilepticus is defined as continuous seizure activity lasting longer than how many minutes?