NREMT - National Registry of Emergency Medical Technicians Neurological Emergencies & Stroke Care 1

Question 1

A 62-year-old patient describes the sudden onset of 'the worst headache of my life,' with a stiff neck and sensitivity to light. This presentation is most suspicious for:

Accepted Answer

Subarachnoid hemorrhage from a ruptured aneurysm

Answer

A sudden, severe 'thunderclap' headache — especially with nuchal rigidity and photophobia — is the hallmark presentation of subarachnoid hemorrhage. Ischemic stroke rarely causes headache of this severity, and migraine is a diagnosis of exclusion in this context.

Question 2

When transporting a conscious, hemodynamically stable stroke patient without respiratory distress, the most appropriate position is:

Accepted Answer

Semi-Fowler's with the head elevated 15–30 degrees

Answer

A slight head elevation (15–30 degrees) in a conscious stroke patient helps reduce intracranial pressure while maintaining adequate cerebral perfusion pressure. Trendelenburg and leg elevation can worsen intracranial hypertension.

Question 3

During an active generalized tonic-clonic seizure, the EMT's MOST important intervention is:

Accepted Answer

Protecting the patient's head and maintaining airway patency

Answer

During an active seizure the priority is preventing injury — especially head trauma — and keeping the airway clear. Nothing should be placed in the patient's mouth, and limb restraint risks injury to both patient and rescuer. Oxygen can be applied when feasible but is secondary to safety.

Question 4

A patient's blood pressure is 210/118 mmHg, heart rate is 44 bpm, and respirations are irregular. The patient is unresponsive with unequal pupils. These findings together are most consistent with:

Accepted Answer

Increasing intracranial pressure (Cushing's triad)

Answer

Cushing's triad — hypertension, bradycardia, and irregular respirations — is a late, ominous sign of rising intracranial pressure causing brainstem herniation. Unequal pupils further confirm herniation. This is a true emergency requiring immediate transport.

Question 5

A patient tells you they experienced left-arm weakness and slurred speech that completely resolved on its own about 20 minutes ago. The patient now feels fine and refuses transport. The EMT's best course of action is to:

Accepted Answer

Encourage transport urgently, explaining that a TIA significantly raises the short-term risk of stroke

Answer

A transient ischemic attack (TIA) is a neurological emergency even when symptoms resolve completely. The risk of a subsequent — potentially disabling — stroke is highest in the hours to days following a TIA. Patients must be strongly encouraged to accept transport for urgent evaluation.

NREMT Practice Test

NREMT Practice Test

NREMT - National Registry of Emergency Medical Technicians Neurological Emergencies & Stroke Care 1