Quiz 16 - Neurologic and Toxicology Flashcards Preview

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Flashcards in Quiz 16 - Neurologic and Toxicology Deck (50):
1

A 56-year-old diabetic woman presents with numbness and tingling to both of her hands that have gradually intensified over the past few weeks. Your assessment reveals stable vital signs, adequate breathing, and a blood glucose level of 190 mg/dL. The cardiac monitor reveals a normal sinus rhythm. The patient tells you that she has eaten but has not taken her insulin yet. You should:

A. assist her with her prescribed insulin to lower her blood glucose.

B. advise her to take ibuprofen and to follow up with her physician.

C. provide supportive care and safely transport her to the hospital.

D. conclude that she has peripheral neuropathy and give her fentanyl.

C. provide supportive care and safely transport her to the hospital.

2

You respond to a local motel for a young woman who was sexually assaulted. Upon your arrival, you find the patient sitting on the bed talking to a police officer. The last thing she remembers is meeting “some guy” at a nightclub the evening before and then having a few drinks with him. She is conscious, but sleepy. Her respirations are 12 breaths/min and regular, pulse rate is 56 beats/min and strong, and blood pressure is 102/58 mm Hg. The cardiac monitor reveals sinus bradycardia at 50 to 60 beats/min. You should:

A. administer high-flow oxygen, monitor her oxygen saturation, begin transport, and start an IV line en route to the hospital.

B. assist her ventilations with a bag-mask device, start an IV line, administer 0.5 mg of atropine, and transport.

C. conclude that she was unknowingly administered a narcotic analgesic, start an IV line, and give her 2 mg of naloxone.

D. give her supplemental oxygen, conduct a secondary assessment at the scene to collect evidence, and transport her.

A. administer high-flow oxygen, monitor her oxygen saturation, begin transport, and start an IV line en route to the hospital.

3

Common signs and symptoms of a cerebral abscess include:

A. an absence of fever, severe localized headache, and vomiting without nausea.

B. high-grade fever, persistent localized headache, confusion, and focal impairment.

C. paralysis below the waist, high fever, a diffuse headache, and slurred speech.

D. hemiplegia, low-grade fever, hyperactivity, and a diffuse stabbing headache

B. high-grade fever, persistent localized headache, confusion, and focal impairment.

4

You are transporting a young female who intentionally ingested a large quantity of her prescribed Pamelor. She is conscious, but drowsy, and complains of a dry mouth and blurred vision. The cardiac monitor reveals sinus tachycardia at 120 beats/min. You are administering high flow oxygen and have established a patent IV line. With regard to her ECG rhythm, you should be especially alert for:

A. QRS widening.

B. a prolonged PR interval.

C. AV heart block.

D. QT interval narrowing.

A. QRS widening.

5

For any patient with an increase in intracranial pressure, the paramedic must:

A. maintain an adequate blood pressure.

B. avoid administering IV fluid boluses.

C. give glucose to prevent hypoglycemia.

D. take measures to lower blood pressure.

A. maintain an adequate blood pressure.

6

Severe salicylate toxicity produces:

A. bradypnea.

B. metabolic acidosis.

C. increased pH levels.

D. respiratory acidosis.

B. metabolic acidosis.

7

You are dispatched to a local pharmacy, where a 24-year-old woman experienced an apparent seizure. During your assessment, you note that the patient is conscious but combative. The patient's supervisor states that she has a history of seizures and takes Tegretol. The patient's blood pressure is 146/90 mm Hg, pulse rate is 110 beats/min and regular, and respirations are 24 breaths/min with adequate depth. The MOST appropriate treatment for this patient includes:

A. giving her high-flow oxygen, inserting an IO catheter in her proximal tibia, transporting, and observing for further seizure activity.
B. establishing vascular access, administering diazepam or lorazepam to reduce her combativeness, and transporting to the closest hospital.
C. administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren.
D. administering oxygen, restraining her to protect her from further injury, placing a bite block in her mouth in case she seizes again, and transporting.

C. administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren.

8

A 29-year-old woman was found unresponsive by her husband. When you arrive at the scene and begin your assessment, you note that the patient's respirations are slow and shallow, her pulse is slow and weak, and her pupils are markedly dilated. Your partner begins assisting the patient's ventilations as you assess her blood pressure, which is 70/48 mm Hg. The patient's husband hands you an empty bottle of phenobarbital, which was filled the day before, and tells you that his wife takes the medication for seizures. After establishing vascular access, you should:

A. begin a dopamine infusion at 10 μg/kg/min and titrate as needed.

B. instruct your partner to hyperventilate the patient at 24 breaths/min.

C. give her up to 10 mg of naloxone to reverse the effects of the drug.

D. administer crystalloid fluid boluses to improve her blood pressure.

D. administer crystalloid fluid boluses to improve her blood pressure.

9

The foxglove plant contains ______________ and can result in ______________ when it is ingested.

A. lantadene A, renal failure

B. caladium oxalate crystals, bradycardia

C. solanine, severe gastroenteritis

D. cardiac glycosides, dysrhythmias

D. cardiac glycosides, dysrhythmias

10

The MOST common sign of an infectious disease is the presence of

A. seizures.

B. a fever.

C. tachycardia.

D. a headache.

B. a fever.

11

A 29-year-old man, who was recently prescribed an antipsychotic medication, presents with an acute onset of bizarre contortions of the face. Treatment should include:

A. ondansetron, 4 mg.

B. diphenhydramine, 25 mg.

C. diazepam, 5 mg.

D. promethazine, 25 mg.

B. diphenhydramine, 25 mg.

12

Alcohol potentiates Valium. This means that:

A. alcohol enhances the effects of Valium.

B. Valium makes alcohol a toxic substance.

C. alcohol antagonizes the effects of Valium.

D. the use of alcohol negates the use of Valium.

A. alcohol enhances the effects of Valium.

13

Which of the following cardiac medications has a small therapeutic window and the GREATEST propensity to reach toxic levels?

A. Lisinopril

B. Cardizem

C. Digoxin

D. Vasotec

C. Digoxin

14

If you are treating a patient with a suspected benzodiazepine overdose and find that the patient is hypotensive, bradycardic, and comatose:

A. you should consider concomitant overdose with another CNS depressant.

B. you should rapidly administer 2 mg of naloxone via the IV, IO, or IM route.

C. avoid administering flumazenil and transport the patient immediately.

D. it is likely that the patient is also under the influence of methamphetamine.

A. you should consider concomitant overdose with another CNS depressant.

15

Any sympathomimetic drug will cause:

A. hypothermia.

B. hallucinations.

C. tachycardia.

D. ataxia.

C. tachycardia.

16

You are dispatched to a residence for a 61-year-old woman with flu-like symptoms. Upon your arrival, the patient greets you at the door. She complains of a headache and nausea, and tells you that she has vomited twice. Her husband, who is lying on the couch in the living room, began experiencing the same symptoms at about the same time. You should:

A. immediately open all of the windows in the house.

B. carefully assess the residence for any unusual findings.

C. suspect that both patients have been exposed to cyanide.

D. remove both patients from the residence at once.

D. remove both patients from the residence at once.

17

Common signs and symptoms of a tricyclic antidepressant overdose include:

A. altered mental status and tachycardia.

B. excessive salivation and diarrhea.

C. constricted pupils and AV heart block.

D. tachypnea and severe hypertension.

A. altered mental status and tachycardia.

18

A patient with suspected meningitis involuntarily flexes her knees when her head is flexed toward her chest. This is called:

A. Kernig sign.

B. Cullen sign.

C. Grey Turner sign.

D. Brudzinski sign.

D. Brudzinski sign.

19

Applying pressure to the supraorbital foramen of a patient with a neurologic insult is intended to:

A. elicit a response to painful stimuli.

B. determine if the spinal cord is intact.

C. assess for an orbital skull fracture.

D. stimulate the vagus nerve.

A. elicit a response to painful stimuli.

20

Among other functions, the medulla oblongata:

A. directly regulates body temperature.

B. communicates with the pituitary gland.

C. sends messages to move skeletal muscles.

D. controls blood pressure and heart rate.

D. controls blood pressure and heart rate.

21

Emotions such as rage and anger are generated in the:

A. limbic system.

B. thalamus.

C. diencephalon.

D. hypothalamus.

A. limbic system.

22

Inadvertent lithium toxicity would MOST likely occur in a patient who is taking:

A. SSRIs.

B. any medication used to control blood pressure.

C. NSAIDs.

D. a tricyclic antidepressant.

C. NSAIDs.

23

Which of the following ECG abnormalities is MOST suggestive of cocaine toxicity?

A. Marked flattening of the T wave

B. Narrowing of the PR interval

C. Narrowing of the QRS complex

D. Prolongation of the QT interval

D. Prolongation of the QT interval

24

Poisoning with ________________ is MOST often the result of improper food storage or canning.

A. Toxoplasma

B. Clostridium botulinum

C. Listeria

D. Salmonella

B. Clostridium botulinum

25

A person who is “speedballing” is:

A. using heroin to withdraw or detoxify himself or herself from cocaine by gradually increasing the amounts of heroin taken while decreasing the amounts of cocaine
used.

B. using cocaine in combination with heroin, by injecting them either underneath the skin or directly into a vein, in order to regulate the high.

C. highly addicted to methamphetamine, cocaine, and marijuana and mixes all three drugs together to achieve various levels of euphoria.

D. packaging cocaine in small plastic bags and swallowing them for the purpose of transporting the cocaine from one location to another location.

B. using cocaine in combination with heroin, by injecting them either underneath the skin or directly into a vein, in order to regulate the high.

26

Carboxyhemoglobin:

A. is hemoglobin combined with carbon monoxide.

B. is a combination of oxygen and hemoglobin.

C. is the chemical by-product of cyanide poisoning.

D. effectively carries oxygen to the body's cells.

A. is hemoglobin combined with carbon monoxide.

27

An unresponsive middle-aged man ingested a half-full bottle of Valium approximately 20 minutes ago. His respirations are slow and shallow, his pulse is slow and weak, and his blood pressure is significantly low. The cardiac monitor reveals sinus bradycardia. You should:

A. administer oxygen via nonrebreathing mask, start an IV line, and give 150 mg of amiodarone to prevent lethal ventricular dysrhythmias.

B. immediately intubate his trachea, hyperventilate him to minimize acidosis, establish vascular access, and administer up to 10 mg of flumazenil.

C. assist his ventilations, administer flumazenil via slow IV push if allowed by protocol, and consider that he likely ingested another type of CNS depressant.

D. insert a Combitube, establish vascular access, administer up to 4 liters of normal saline, and give him 0.1 mg/kg of naloxone.

C. assist his ventilations, administer flumazenil via slow IV push if allowed by protocol, and consider that he likely ingested another type of CNS depressant.

28

All of the following cranial nerves are responsible for airway control, EXCEPT the:

A. abducens.

B. hypoglossal.

C. trigeminal.

D. glossopharyngeal.

A. abducens.

29

Spray paints and lacquer thinner contain __________, and typically cause __________________ when they are inhaled recreationally.

A. methylene chloride, pulmonary edema

B. carbon tetrachloride, CNS depression

C. toluene, hallucinations and mania

D. benzene, drunken behavior and dizziness

C. toluene, hallucinations and mania

30

You arrive at the scene of an unknown drug-related emergency. Law enforcement is present and has ensured scene security. The patient, a young male, is found sitting at the kitchen table. He is laughing uncontrollably and tells you, “Life sure is good!” Your partner finds a basin of water and an empty box of baking soda on the counter. You should be MOST suspicious that this patient:

A. has smoked crack cocaine.

B. is speedballing.

C. has injected heroin.

D. was snorting cocaine.

A. has smoked crack cocaine.

31

During your assessment of a 33-year-old woman who you suspect is under the influence of a drug, the patient tells you that she was “listening to the painting on the wall” before you arrived. Her pulse rate and blood pressure are both elevated. This clinical presentation is MOST consistent with the use of:

A. marijuana.

B. methamphetamine.

C. LSD.

D. PCP.

C. LSD.

32

You are dispatched to an apartment complex for a suicide attempt. While you are en route, an on-scene law enforcement officer advises you that the patient, who is unresponsive, ingested an unknown quantity of an unknown drug. Upon arriving at the scene, you should:

A. identify what the patient took before providing treatment.

B. safely gain access to the patient while looking for an egress route.

C. gain rapid access to the patient and begin your assessment.

D. ask the police officer to bring the patient to the ambulance.

B. safely gain access to the patient while looking for an egress route.

33

A known alcoholic man is found unresponsive by a law enforcement officer. An empty container of antifreeze was found near him. Your assessment reveals that his respirations are deep and rapid, his pulse rate is rapid and weak, and his pupils are dilated and sluggishly reactive. As your partner administers high flow oxygen to the patient, you should:

A. start an IV line and give 1 mEq/mg of sodium bicarbonate.

B. give him 100 mg of thiamine IM and assess his blood pressure.

C. assess his blood glucose level and apply a cardiac monitor.

D. start an IV line and begin administering a saline fluid bolus.

C. assess his blood glucose level and apply a cardiac monitor.

34

Gamma-hydroxybutyrate is MOST commonly used to:

A. treat chronic coughing.

B. induce euphoria.

C. enhance the senses.

D. facilitate sexual assault.

D. facilitate sexual assault.

35

You are transporting a patient who is under the influence of methamphetamine. The patient, who is clearly anxious, has a blood pressure of 160/90 mm Hg, a pulse rate of 140 beats/min, and a respiratory rate of 24 breaths/min. The patient suddenly becomes violent and begins thrashing around, trying to get off the stretcher. After asking your partner to stop the ambulance to assist you with the patient, you should:

A. assess his blood glucose level.

B. administer IM haloperidol.

C. start an IV line and give him morphine.

D. administer a beta blocker and reassess.

B. administer IM haloperidol.

36

As intracranial pressure rises

A. the brain becomes hypocarbic.

B. cerebral herniation may occur.

C. mean arterial pressure decreases.

D. the heart rate acutely increases.

B. cerebral herniation may occur.

37

A 22-year-old man experienced an acid chemical burn to his left forearm. He complains of intense pain and tingling in his fingers. He is conscious and alert, and denies any other symptoms. You should:

A. begin immediate irrigation with water.

B. administer oxygen via nonrebreathing mask.

C. apply a light coat of baking soda to the burn.

D. cover the burn and transport at once.

A. begin immediate irrigation with water.

38

The emotional state of craving a drug to maintain a feeling of well-being is called:

A. habituation.

B. physical dependence.

C. addiction.

D. psychological dependence.

D. psychological dependence.

39

A loss of balance and equilibrium suggests injury to the:

A. cerebrum.

B. midbrain.

C. thalamus.

D. cerebellum.

D. cerebellum.

40

A 69-year-old man presents with confusion, a headache, dyspnea, and palpitations after he rescued his two grandchildren from their burning house. During your assessment, you note that he has an odd odor on his breath; however, he denies being diabetic. You should:

A. administer 1 to 2 g of pralidoxime infused with normal saline solution over a 5- to 10-minute period.

B. have him inhale amyl nitrate for 20 seconds and then 100% oxygen for 40 seconds out of each minute.

C. start an IV line, sedate and chemically paralyze the patient, and then perform endotracheal intubation.

D. start an IV line of normal saline and administer 10 mL of a 10% solution of calcium chloride

B. have him inhale amyl nitrate for 20 seconds and then 100% oxygen for 40 seconds out of each minute.

41

Which of the following is an example of receptive aphasia?

A. You ask a patient who the president is and he or she says, “January.”

B. A patient with slurred speech is able to tell you his or her name.

C. A patient responds with “no” when asked if he or she has hypertension.

D. You hand a patient a pencil and he or she tries to cut paper with it.

A. You ask a patient who the president is and he or she says, “January.”

42

A neoplasm is MOST accurately defined as a:

A. normal cell.

B. damaged cell.

C. cancerous tumor.

D. new growth.

D. new growth.

43

During a generalized tonic/clonic seizure, the patient is rigid and his back is arched. This represents the _________ phase of the seizure.

A. tonic

B. clonic

C. hypertonic

D. postictal

C. hypertonic

44

A patient with a unilateral eyelid droop when smiling:

A. has a condition called miosis.

B. likely has an intracerebral hemorrhage.

C. may be experiencing Bell palsy.

D. is experiencing transient cerebral ischemia.

C. may be experiencing Bell palsy.

45

A patient experiences severe, shock-like or stabbing pain to one side of the face. This is consistent with:

A. an acoustic neuroma.

B. glossopharyngeal neuralgia.

C. hemifacial spasm.

D. trigeminal neuralgia.

D. trigeminal neuralgia.

46

Organophosphates exert their effect by:

A. blocking the parasympathetic nervous system.

B. stimulating the cholinergic nervous system.

C. destroying the body's acetylcholine.

D. agonizing the sympathetic nervous system.

B. stimulating the cholinergic nervous system.

47

LSD is classified as a:

A. psychedelic.

B. sympatholytic.

C. hallucinogen.

D. sedative/hypnotic

C. hallucinogen.

48

Which of the following cardiac rhythm disturbances MOST commonly results from inadvertent overdose of a prescribed cardiac medication?

A. Tachycardia

B. Atrial flutter

C. Bradycardia

D. Atrial fibrillation

C. Bradycardia

49

A synapse is:

A. the point where a nerve cell terminates.

B. a slight gap between nerve cells.

C. the body's main neurotransmitter.

D. a cluster of sensory nerve cells.

B. a slight gap between nerve cells.

50

Which of the following cranial nerves regulates movement of the head and shoulders?

A. Trigeminal

B. Abducens

C. Accessory

D. Hypoglossal

C. Accessory