Which of the following is a probable cause of​ dizziness?
A.
External otitis
B.
Aphasia
C.
Blood loss
D.
Ataxia
C.
Blood loss

Blood loss is a probable cause of dizziness. Aphasia is an inability to speak. Ataxia refers to a loss of muscle​ coordination, as in difficulty walking. Although otitis media​ (inner ear​ infection) typically causes​ dizziness, external otitis is not a cause of dizziness.

A patient who is experiencing a transient ischemic attack​ (TIA) may develop MOST of the same symptoms as a patient who is suffering a stroke. The key difference is that the signs and symptoms of a TIA usually disappear​ within:
A.
two to four weeks.
B.
24 hours.
C.
two to three days.
D.
one week.
B.
24 hours.

Patients who experience a TIA develop most of the same signs and symptoms as those who are experiencing a stroke. The key difference between a stroke and a TIA is that the signs and symptoms of a TIA disappear without any obvious permanent neurological deficits. The signs and symptoms of the TIA will typically resolve within one to two hours after the​ onset; however, they may last up to 24 hours.

The islets of Langerhans are located in​ the:
A.
pancreas.
B.
rear of the thyroid.
C.
kidneys.
D.
anterior neck.
A.
pancreas.

Component of the endocrine​ system, the islets of Langerhans are located in the pancreas and make insulin for the body. The kidneys are the location of the thyroid gland. The anterior neck houses the thyroid gland.

TIA is a commonly accepted abbreviation​ for:
A.
transient ischemic attack.
B.
telephoned in advance.
C.
tube in airway.
D.
transported in ambulance.
A.
transient ischemic attack.

TIA is the medical abbreviation for​ “transient ischemic​ attack.”

When a patient tells you that it feels as though the room is going round and​ round, the specific term for this symptom​ is:
A.
vertigo.
B.
petit mal seizure.
C.
dizziness.
D.
ataxia.
A.
vertigo.

The sensation that the room is spinning is called vertigo. Stroke patients sometimes complain of this sensation. Although the term​ “dizziness” can typically be used to describe​ vertigo, vertigo is the more specific term.​ Ataxia, or uncoordinated muscle​ movement, can result from vertigo. A petit mal seizure usually results in a brief loss of awareness.

A patient who loses the ability to speak or feel sensations is experiencing what type of​ deficit?
A.
Hemorrhagic
B.
Neurological
C.
Urinary
D.
Muscular
B.
Neurological

A neurological deficit is one that causes a change in the​ patient’s mental status or other neurological finding and is caused by some type of disturbance or injury to the neurological system itself.

Which of the following is the medical name of a stroke that is defined as the death or injury of brain tissue that has been deprived of​ oxygen?
A.
Cerebral vascular accident
B.
Carotid vessel aneurysm
C.
Cerebral vascular aneurysm
D.
Carotid vascular accident
A.
Cerebral vascular accident

A cerebral vascular accident​ (CVA) is the medical term for a stroke.

A​ 50-year-old female patient has been found unconscious and unresponsive. She is breathing rapidly and is diaphoretic. Her vital signs are P​ 130, R​ 30, BP​ 140/80. Which of the following conditions would most likely explain these​ findings?
A.
High blood pressure
B.
TIA
C.
Hypoglycemia
D.
​Beta-blocker overdose
C.
Hypoglycemia

Given the​ patient’s signs and​ symptoms, the most likely probable cause is diabetes. Diaphoresis and tachycardia are common findings associated with low blood sugar. A TIA can cause altered mental status but rarely results in frank unconsciousness. A​ beta-blocker overdose would result in a slow heart rate and would be far less common than hypoglycemia.

Your patient is a​ 19-year-old male who was reportedly unconscious for a brief time. You learn that he regained consciousness in about 30 seconds. You find no evidence of drowsiness or neurological deficits. Which of the following is MOST likely the​ cause?
A.
Stroke
B.
Hyperglycemia
C.
Syncope
D.
Status epilepticus
C.
Syncope

On the basis of the​ findings, syncope is the most likely​ cause, as other conditions would likely have a much longer recovery time. Although a seizure would also explain these​ findings, status epilepticus would involve a prolonged seizure​ (longer than 10​ minutes), which does not appear to be the case in this scenario. Hyperglycemia frequently causes altered mental status but not for brief periods. Stroke does not usually lead to unconsciousness.

A​ 69-year-old female complains of​ acute-onset slurred speech. She also notes difficulty moving her right arm. She has no history of diabetes and was feeling fine before the onset. You should suspect​ that:
A.
the patient had a transient ischemic attack the day before.
B.
electrical activity in the brain has caused the cells to conduct nerve impulses.
C.
at least a portion of the​ patient’s brain is not receiving an adequate blood supply.
D.
the amount of glucose in the brain is more than sufficient to support cellular function.
C.
at least a portion of the​ patient’s brain is not receiving an adequate blood supply.

There could be several reasons for the​ patient’s slurred​ speech, but the most likely explanation is that her brain is not receiving an adequate blood supply. The symptoms that she demonstrates indicate ischemia from a stroke. Although hypoglycemia is​ possible, a lack of diabetes makes this less likely.

A​ 19-year-old male is found combative after a prolonged asthma attack. Which of the following reasons would best explain the altered mental status in this​ patient?
A.
Overdose of asthma medications
B.
Acute psychosis
C.
Hypoxia
D.
Fear and anxiety
C.
Hypoxia

In a patient with a prolonged asthma​ attack, any altered mental status should be assumed to be the result of hypoxia. Although​ fear, anxiety and even overdose could explain this​ finding, each of these explanations is significantly less likely than hypoxia. Psychosis would not be a likely explanation.

Which of the following would be an appropriate description of the reticular activating​ system?
A.
React and move center
B.
Feed or breed center
C.
Vegetative and thought center
D.
Wake and sleep center
D.
Wake and sleep center

The RAS is often referred to as the wake and sleep center or the​ on/off center because it determines whether the patient remains awake and aware of his or her surroundings or not. The RAS is continuously transmitting impulses about the​ patient’s surroundings to the brain for constant stimulation and response.

The basic primary fuel for the cell​ is:
A.
glucose.
B.
glucagon.
C.
oxygen.
D.
carbon dioxide.
A.
glucose.

Cellular​ metabolism, also known as cellular​ respiration, is the process in​ which, normally, molecules of glucose are broken down to produce energy for the body. There are two types of cellular​ metabolism: aerobic and anaerobic. Although oxygen is a necessary component in aerobic​ metabolism, it is not the primary fuel. Carbon dioxide is a byproduct of metabolism. Glucagon is a hormone.

Which of the following events will MOST likely result in a​ patient’s rapid loss of​ consciousness?
A.
Hyperglycemia
B.
Acidosis
C.
Dizziness
D.
Hypoglycemia
D.
Hypoglycemia

The brain does not tolerate a lack of sugar and has no capacity to store sugar.​ Therefore, hypoglycemia tends to occur quite suddenly. Acidosis and hyperglycemia can also cause altered mental status but occur more chronically.

Which of the following is the BEST explanation of how dehydration leads to altered brain​ function?
A.
Water is essential to keep the brain fully expanded.
B.
Water is necessary to remove waste products from the brain.
C.
Water is necessary for the electrical signals to travel throughout the brain.
D.
Water is necessary to keep brain tissue hydrated.
D.
Water is necessary to keep brain tissue hydrated.

​Oxygen, glucose, and water are essential for proper brain function. Water is necessary to keep the brain tissue properly hydrated.

Which of the following statements about patients with altered mental status is​ CORRECT?
A.
You may assume that the patient is still responsive even if there is no response to a painful stimulus.
B.
Place the unresponsive patient on his or her side if no spinal injury is suspected.
C.
Always insert an oropharyngeal​ airway, as patients with altered mental status have no gag reflex.
D.
Remember that​ high-concentration oxygen may be detrimental to the patient.
B.
Place the unresponsive patient on his or her side if no spinal injury is suspected.

A patient with an altered mental status is at risk for airway aspiration. To help prevent​ this, the EMT should place the patient in the lateral recovery position if there are no contraindications to that position. Although you should titrate oxygen to maintain a normal​ saturation, high concentration is not dangerous. Some patients will indeed have a gag reflex.

A​ 29-year-old male has been found lethargic and confused. You note that he is slightly cyanotic. Which of the following steps should be taken during the primary​ assessment?
A.
Obtain an oxygen saturation.
B.
Administer oxygen.
C.
Assess pupils.
D.
Obtain blood pressure.
B.
Administer oxygen.

Altered mental status and cyanosis indicate hypoxia. During the primary​ assessment, your goal is to find and manage​ life-threatening conditions. Hypoxia is certainly a life threat.​ Therefore, you should immediately initiate oxygen therapy. You do not require a pulse oximeter to identify this need.

Which of the following statements about altered mental status in pediatric patients is​ CORRECT?
A.
Parents are usually the best judges of their​ child’s mental status.
B.
Parents are usually poor historians regarding their children.
C.
Assess mentation in children just as you would for an adult.
D.
Altered mentation in pediatric patients will be obvious.
A.
Parents are usually the best judges of their​ child’s mental status.

Children often cannot answer questions as adults​ can, and altered mental status can sometimes be difficult to find in children. Parents are usually the best judges of their​ child’s mentation.

In managing a patient who you have decided has an AVPU of​ “U”, it will be important​ to:
A.
administer oxygen by nasal cannula.
B.
place an airway adjunct.
C.
use the Cincinnati Prehospital Stroke Scale.
D.
apply a pressure bandage
B.
place an airway adjunct.

An assignment of​ “U” means​ “unresponsive.” All unresponsive patients should receive either an OPA or NPA to help maintain airway​ patency, since they will be unlikely able to maintain it on their own.

Which of the following situations would MOST likely lead to​ hyperglycemia?
A.
A patient forgets to​ self-administer insulin.
B.
A patient​ self-administers too much insulin.
C.
A patient overexercises after​ self-administering insulin.
D.
A patient fails to eat adequately after​ self-administering insulin.
A.
A patient forgets to​ self-administer insulin.

If a patient forgets to​ self-administer insulin, hyperglycemia could likely result. Too much​ insulin, failure to eat​ adequately, or overexercising would likely lead to hypoglycemia.

Which of the following conditions is another term for high blood​ sugar?
A.
Hyperglycemia
B.
Insulin shock
C.
Hyperkalemia
D.
Hypoglycemia
A.
Hyperglycemia

Hyperglycemia is a high blood sugar. Hypoglycemia is low blood sugar. Insulin shock is an older term meaning low blood sugar. Hyperkalemia is a term meaning high potassium levels.

Why does diabetic ketoacidosis cause​ dehydration?
A.
The high glucose level in the bloodstream causes oversaturation in the brain cells. This leads to a form of euphoric instability marked by the​ patient’s inability to care for himself or herself.
B.
The ketoacidosis begins breaking down adipocytes and releasing their water stores into the bloodstream. The kidneys then remove this influx of water from the body in urine.
C.
The ketones bind with the​ cells’ receptors, preventing water from being absorbed into the cytosol.
D.
The lack of insulin creates an excess of​ glucose, which attracts large amounts of water from the body before being expelled in urine.
D.
The lack of insulin creates an excess of​ glucose, which attracts large amounts of water from the body before being expelled in urine.

As the excess glucose is eliminated by the​ kidneys, it takes a large amount of water with it. This​ will, over​ time, cause hypovolemia and dehydration.

A dysfunction of the pancreas may result in what kind of endocrine​ emergency?
A.
Diabetic ketoacidosis
B.
​Cushing’s syndrome
C.
Thyrotoxicosis
D.
Hypoglycemic encephalopathy
A.
Diabetic ketoacidosis

Diabetic ketoacidosis​ (DKA) is a serious complication associated with type I diabetes. It occurs when there is profound insulin deficiency​ (in use or​ production) from damaged​ insulin-secreting cells of the pancreas. It may occur as the initial presentation of severe​ diabetes, as a result of patient noncompliance with insulin​ injections, or as the result of physiological stress.

Which of the following statements BEST describes the role of insulin in the​ body?
A.
Insulin aids in the digestion of fat.
B.
Insulin activates the acinar cells of the pancreas.
C.
Insulin enables glucose to enter most of the​ body’s cells.
D.
Insulin causes a breakdown of stored fat in the liver and muscle.
C.
Insulin enables glucose to enter most of the​ body’s cells.

Insulin is critical to enable glucose to enter the cells. Although the pancreas creates insulin and aids in fat​ digestion, insulin is a separate​ hormone, not related to the latter process. Insulin does not break down fat.

Which of the following findings are commonly associated with diabetic ketoacidosis​ (DKA)?
A.
Slow and shallow breathing
B.
Rapid and deep breathing
C.
Low blood sugar
D.
Overhydration
B.
Rapid and deep breathing

DKA is caused by high blood glucose levels. It results in profound dehydration and shock. The associated acidosis also leads to the accumulation of​ ketones, which in turn leads to rapid​ breathing, which is intended to​ “blow off” carbon dioxide.

In diabetic ketoacidosis​ (DKA), shock is usually caused​ by:
A.
Dehydration
B.
Blood loss
C.
Vasoconstriction
D.
Vasodilation
A.
Dehydration

DKA results in severe dehydration as the body attempts to compensate for high levels of blood glucose. Although these patients are profoundly​ hypovolemic, they have not lost any blood. Vasodilation or vasoconstriction are not common factors associated with DKA.

Diabetic problems are a common cause of altered mental status. Which of the following statements is TRUE about diabetes​ mellitus?
A.
​Hypoglycemia, or low blood​ sugar, results from too much​ insulin, which causes glucose to be used up by the cells too rapidly.
B.
Type I diabetes is usually acquired in adulthood and is often controlled by diet and oral medication.
C.
All patients with type II diabetes require insulin to maintain an appropriate blood sugar level.
D.
Insulin is a hormone secreted by the liver that is needed to move glucose from the blood into the cells.
A.
​Hypoglycemia, or low blood​ sugar, results from too much​ insulin, which causes glucose to be used up by the cells too rapidly.

If the patient has taken too much​ insulin, it will cause the glucose in the bloodstream to enter the​ cells, thereby dropping the BGL to a dangerous level. Type II diabetes typically occurs in adulthood and is most commonly managed with diet and oral medication. Not all type II diabetics will require insulin. Insulin is secreted by the​ pancreas, not the liver.

What is the underlying pathophysiology of​ DKA?
A.
Too much glycogen
B.
Not enough glucagon
C.
Too much insulin
D.
Not enough insulin
D.
Not enough insulin

The underlying pathology of DKA is that either the​ body’s pancreas is not making enough insulin or the insulin that is being created is not working effectively. The result is a clinical condition of elevating blood glucose.

After properly measuring a​ patient’s blood glucose​ level, the glucometer displays a reading that displays the word​ “low”. This finding would​ indicate:
A.
normal blood glucose level
B.
hypoxemia
C.
hypoglycemia
D.
hyperglycemia
C.
hypoglycemia

A reading of​ “low” would be considered an abnormal blood glucose level and would indicate lower than normal blood​ glucose, or hypoglycemia. Hyperglycemia would refer to high blood glucose levels. Hypoxemia would be low oxygen levels in the blood.

Under what circumstance can an EMT use a glucometer to determine a​ patient’s blood glucose​ level?
A.
Only if no higher level of EMS is available
B.
Under no circumstance
C.
If the patient allows it and signs a release first
D.
Only if allowed by medical direction and local protocols
D.
Only if allowed by medical direction and local protocols

Portable blood glucose​ meters, commonly referred to as​ glucometers, are available to both the EMS crew and the diabetic patient. These devices can fairly accurately determine the blood glucose level. Medical control and local protocol determine their use by EMTs.

A​ 39-year-old female is in the postictal phase following a​ tonic-clonic seizure. She is conscious but slightly confused about the events. Her vital signs are P​ 100, R​ 20, BP​ 180/90. You find her glucose level to be 48​ mg/dl. You should​ NEXT:
A.
insert an oral airway.
B.
not give​ glucose, as this is a normal blood sugar level.
C.
consider oral glucose per local protocol.
D.
locate the​ patient’s insulin pump.
C.
consider oral glucose per local protocol.

On the basis of the​ patient’s LOC and blood glucose​ level, she may be a candidate for oral glucose. Follow local protocol. Locating the insulin pump may identify a diabetic history but is not a necessary step in the moment. You should not insert an oral airway into a conscious person.

Which of the following readings on a glucometer would be of concern to the​ EMT?
A.
108​ mg/dl
B.
118​ mg/dl
C.
58​ mg/dl
D.
78​ mg/dl
C.
58​ mg/dl

A reading of 58​ mg/dl would be considered hypoglycemia​ and, if other signs are​ present, indicative of a diabetic emergency.

Which of the following disorders frequently creates signs and symptoms that are similar to those associated with a​ stroke?
A.
Hypoglycemia
B.
A transitional hemorrhage
C.
Congestive heart failure
D.
Hyperglycemia
A.
Hypoglycemia

When a patient becomes​ hypoglycemic, there are often signs that seem similar to those of a stroke. This is why it is important for the EMT to assess the blood glucose level of all patients who are believed to be having a stroke. Although both congestive heart failure and hyperglycemia can cause altered mental​ status, they typically do not mirror neurological findings associated with stroke.

Which of the following findings is commonly caused by​ hypoglycemia?
A.
Seizures
B.
Intense​ thirst, abdominal​ pain, and vomiting
C.
Acetone breath
D.
​Warm, red, and dry skin
A.
Seizures

Although seizure activity is actually associated more with hyperglycemic​ episodes, a patient with low blood sugar may also experience a seizure.​ Essentially, anything that irritates the brain can cause a seizure.​ Warm, red, dry​ skin; acetone​ breath; and intense thirst are typically caused by hyperglycemia.

One clinical indication that a patient may be experiencing a hypoglycemic emergency​ is:
A.
flushed skin.
B.
shallow breathing.
C.
an altered mental status.
D.
a loss of appetite.
C.
an altered mental status.

Because the brain cannot store any​ glucose, if it becomes depleted in the​ bloodstream, there will be an almost immediate change in mental status. Along with this​ finding, the EMT should confirm the​ patient’s blood sugar level. Although​ skin, breathing, and appetite changes can also be associated with diabetic​ issues, mental status is by far the most important finding.

Which of the following is TRUE about the ongoing assessment of a patient with altered mental status and a history of​ medication-controlled diabetes?
A.
If the​ patient’s breathing becomes​ inadequate, apply​ high-concentration oxygen by a nonrebreather mask.
B.
If the patient has not taken insulin​ today, medical direction may order you to administer it while en route to the hospital.
C.
If the​ patient’s mental status deteriorates to​ unconsciousness, give additional oral glucose.
D.
It may take several minutes before you start seeing improvement in the​ patient’s mental status after administering oral glucose.
D.
It may take several minutes before you start seeing improvement in the​ patient’s mental status after administering oral glucose.

The oral glucose that is administered to a patient must be absorbed across the oral membranes and into the bloodstream before you see an effect. Although this occurs​ quickly, it is not immediate. You should not give oral glucose to an unconscious patient. EMTs do not typically administer​ insulin, and inadequate breathing is treated with a bag mask​ device, not a nonrebreather.

Contraindications to the use of oral glucose in a patient with altered mental status and a history of​ medication-controlled diabetes​ include:
A.
the patient being unable to swallow.
B.
the patient taking insulin today but not eating.
C.
not knowing whether the patient has taken insulin today.
D.
a history of type II diabetes.
A.
the patient being unable to swallow.

A patient whose mental status is too altered to control his or her airway is at risk for aspiration. The use of oral glucose in this patient would be contraindicated if the patient were unable to swallow.

An​ 18-year-old male has been found unconscious. Which of the following findings would indicate that his altered mental status has been caused by​ hyperglycemia?
A.
Rapid onset of symptoms
B.
Urinary retention
C.
​Cool, moist skin
D.
A fruity odor on the breath
D.
A fruity odor on the breath

Hyperglycemic patients may have a fruity odor on the breath due to ketone bodies that build up as the body converts​ non-carbohydrates into glucose. Hyperglycemia usually occurs slowly and presents with frequent urination. It is also associated with​ hot, dry skin.

During your physical examination of a diabetic​ patient, you discover a small device on the​ patient’s belt. There is a catheter from the device into the​ patient’s abdomen. This device is​ likely:
A.
an implanted glucometer.
B.
a feeding tube.
C.
an insulin pump.
D.
a pacemaker.
C.
an insulin pump.

An insulin pump is a small device that delivers precise doses of insulin via injection. A pacemaker is typically found beneath the skin in a​ patient’s chest. Feeding tubes can be implanted in the abdomen but typically attach to larger machines that are not fastened to the​ patient’s belt.

Which of the following BEST describes the procedure for administration of oral​ glucose?
A.
Place the oral glucose in the back of the throat so that it will migrate to the stomach.
B.
Insert the tube of oral glucose into the right​ nare, as it is the larger one.
C.
Place the oral glucose on the surface of the tongue.
D.
Squeeze the tube of oral glucose between the​ patient’s cheek and gum.
D.
Squeeze the tube of oral glucose between the​ patient’s cheek and gum.

The administration of oral glucose is done either by placing the tube between the cheek and gums and then squeezing out the gel or by placing the gel on a tongue depressor and then depositing it between the cheek and gums.

Which of the following interventions should NOT be provided for a patient with​ DKA?
A.
Summoning ALS for backup
B.
Administration of oxygen
C.
Administration of oral glucose
D.
Placement of the patient in the recovery position
C.
Administration of oral glucose

The patient with DKA already has an elevated blood sugar level. The use of oral glucose in this patient would not be​ beneficial, as the underlying cause is a lack of​ insulin, not a lack of available glucose.

You are caring for a patient with a known history of diabetes and a documented blood glucose level of less than 60​ mg/dl. Although oral glucose is​ indicated, which of the following findings would preclude you from using​ it?
A.
The presence of sonorous breathing
B.
The presence of a room air pulse ox of​ 93%
C.
The presence of tachycardia
D.
The presence of​ cool, diaphoretic skin
A.
The presence of sonorous breathing

If a patient has evidence of the inability to control his or her own airway​ (e.g., sonorous​ breathing), the administration of oral glucose may only worsen the airway status and should be avoided. Contact ALS so that an IV can be initiated and glucose be given via IV push.

A​ 52-year-old female has been found wandering outside. Bystanders suspect that she is intoxicated. You note slurred speech and diaphoretic skin. The​ patient’s vital signs are P​ 118, R​ 24, BP​ 140/83. You should​ NEXT:
A.
administer​ high-concentration oxygen.
B.
contact law enforcement.
C.
assess blood glucose.
D.
administer a Cincinnati Prehospital Stroke assessment.
C.
assess blood glucose.

Diabetic patients often present similarly to intoxicated patients. Never assume that the patient is intoxicated. Consider the possibility of a diabetic​ emergency, and get a blood glucose reading as soon as possible. Although the Cincinnati checklist may be​ appropriate, you should rule out hypoglycemia first. Oxygen may also be​ necessary, but no indications have been seen yet in this scenario.

A​ 62-year-old female was found confused and diaphoretic. Her blood glucose level was assessed to be 35​ mg/dl. After administering a tube of oral​ glucose, you should​ NEXT:
A.
administer a second tube of oral glucose.
B.
make sure the patient can swallow.
C.
perform a reassessment.
D.
initiate transport.
C.
perform a reassessment.

After giving oral glucose​ (or any​ medicine, for that​ matter), the EMT should start a reassessment phase to determine the​ patient’s condition and whether any changes have occurred following administration of the medication. The ability to swallow must be assessed before administering oral​ glucose, not afterward. Transport is​ reasonable, but the patient should be reassessed​ first, as many patients who recover their mental status will not wish to be transported. A second tube should not be administered before reassessing.

If a patient becomes unresponsive during administration of oral​ glucose, the EMT​ should:
A.
repeat the oral glucose.
B.
give oxygen via a nonrebreather mask.
C.
insert a tongue depressor.
D.
reassess the airway and breathing.
D.
reassess the airway and breathing.

Since there is a risk that an obtunded patient may aspirate the thick​ gel, if the patient becomes unresponsive during or after​ administration, the EMT should closely watch the airway to ensure patency.

A​ 15-year-old female has been found unconscious. Her skin is flushed and​ dry, and she is breathing very rapidly and deeply. Her mother states that she has been sick for about a​ week, during which time she complained of frequent urination and intense thirst. You should​ suspect:
A.
parathyroid toxicosis.
B.
hypothyroidism.
C.
diabetic ketoacidosis.
D.
thyroid storm.
C.
diabetic ketoacidosis.

Dry​ skin, frequent​ urination, and intense thirst should make you suspect diabetic ketoacidosis. While thyroid disorders may also lead to​ unresponsiveness, the presence of rapid breathing in the context of the other findings is an indicator that ketones are present. Glucose levels are likely the cause.

You have a patient with an altered mental status that has developed over the past two to three​ days, according to family members. He is wearing a medical alert tag that is inscribed with the letters​ “DM”. What is your initial field​ impression?
A.
Hyperinsulin episode
B.
Hypertension episode
C.
Hyperosmolar episode
D.
Hyperglycemic episode
D.
Hyperglycemic episode

A diabetic patient with a slow onset of mental status changes is more likely hyperglycemic then​ hypoglycemic, owing to the pathology of the disease process and the accumulation of acids that occurs in the hyperglycemic patient.

Which of the following would be considered a common risk factor for​ stroke?
A.
Chronic obstructive pulmonary disease​ (COPD)
B.
High blood pressure
C.
Blunt force trauma to the head
D.
High sodium intake
B.
High blood pressure

Hypertension can wear away the smooth inner lining of the​ artery, leaving rough areas where plaque will likely develop and that are also common sites for clot or thrombus formation. When a thrombus forms inside an​ artery, it can completely block the flow of blood through that artery to the brain. This results in the death of brain​ tissue, which is a stroke.

In which of the following stroke screening methods is arm drift one of the screening​ criteria?
A.
Both the Cincinnati Prehospital Stroke Scale and the Los Angeles Prehospital Stroke Screen
B.
The Los Angeles Prehospital Stroke Screen​ (LAPSS)
C.
The Cincinnati Prehospital Stroke Scale​ (CPSS)
D.
Arm drift is not a criterion for any popular stroke screening system
C.
The Cincinnati Prehospital Stroke Scale​ (CPSS)

Arm drift is an assessment component of both the Cincinnati Prehospital Stroke Scale and the Los Angeles Prehospital Stroke Screen. There is no​ “Universal” or​ “Newport” stroke screen.

Your patient has experienced a seizure that involves only one cerebral hemisphere and produces jerky muscular activity in one area of the​ body, arm,​ leg, or face. What type of seizure is​ this?
A.
Complex partial seizure
B.
Status epilepticus
C.
Petit mal seizure
D.
Simple partial seizure
D.
Simple partial seizure

A simple partial seizure is one that involves only one cerebral hemisphere. It is also called a Jacksonian motor seizure or focal motor seizure. Complex seizures involve both hemispheres. A petit mal seizure involves both hemispheres but does not typically cause convulsions. Status epilepticus is a prolonged seizure.

A​ five-year-old male was witnessed simply staring off into space. His teacher then saw him fall off his chair and strike his head on his desk. He now has a bleeding laceration above his right eye. His school paperwork indicates that he has absence seizures. The patient is now awake and crying. His vital signs are P​ 100, R​ 24, BP​ 100/60. His blood glucose level is 80​ mg/dl. You should​ NEXT:
A.
apply direct pressure to the bleeding.
B.
administer oral glucose.
C.
administer​ high-concentration oxygen.
D.
perform a Cincinnati Prehospital stroke screen.
A.
apply direct pressure to the bleeding.

Absence or petit mal seizures are characterized by a blank​ stare, begin and end​ abruptly, and last only a few seconds. Although these seizures typically do not affect motor​ function, patients occasionally lose their balance and fall. You should next treat the​ patient’s wound by applying direct pressure. The​ patient’s BGL is​ normal, so no oral glucose in necessary.

Which of the following is the MOST common cause of seizures in​ infants?
A.
Epilepsy
B.
Head injury
C.
Infection
D.
Fever
D.
Fever

Febrile​ seizures, caused by high​ fever, are most common in children between six months and six years of age. About​ 5% of children who have a fever will develop febrile seizures.

A seizure that affects the brain and is evidenced by muscular contraction of all the voluntary muscles is often called what type of​ seizure?
A.
Postictal
B.
Generalized
C.
Jacksonian
D.
Petit mal
B.
Generalized

A generalized​ tonic-clonic seizure was once referred to as a grand mal seizure. This type of seizure usually begins with abnormal electrical activity low in the cerebral cortex that spreads​ upward, affecting both cerebral​ hemispheres, and​ downward, affecting the reticular activating system​ (RAS). The RAS is responsible for​ wake/sleep activity. If the RAS is​ disturbed, the patient will lose consciousness. The involvement of both cerebral hemispheres contributes to the loss of consciousness and produces the characteristic​ jerky, convulsive motor activity of a seizure.

A type of seizure that is most common in children is characterized by a blank stare that lasts only a few seconds. This type of seizure is​ called:
A.
a simple partial seizure.
B.
a febrile seizure.
C.
a complex partial seizure.
D.
an absence seizure.
D.
an absence seizure.

Absence or petit mal​ seizures, which are most common in​ children, are characterized by a blank stare that begins and ends abruptly and lasts only a few seconds. There may be rapid​ blinking, chewing, and lack of attention. The child is unaware of what is occurring during the seizure but then quickly returns to full awareness.

A patient in the postictal state will​ have:
A.
violent movements of the body and possible cyanosis of the face and lips.
B.
altered mental status.
C.
rigidity or stiffening of the muscles and loss of bladder control.
D.
bradycardia and dry skin.
B.
altered mental status.

The postictal patient will have altered mental status. Rigidity and violent movement are typically associated with the tonic and clonic phases. Seizure patients typically do not experience bradycardia unless the seizure is caused by hypoxia or by a bradycardic dysrhythmia.

What is the typical mental status of a patient who is actively experiencing a generalized​ tonic-clonic seizure?
A.
Confused
B.
Unresponsive
C.
Awake
D.
Cyanotic
B.
Unresponsive

A generalized​ tonic-clonic seizure usually begins with abnormal electrical activity low in the cerebral cortex that spreads​ upward, affecting both cerebral​ hemispheres, and​ downward, affecting the reticular activating system​ (RAS). The RAS is responsible for​ wake/sleep activity. If the RAS is​ disturbed, the patient will lose consciousness. The involvement of both cerebral hemispheres also contributes to the loss of consciousness.

Signs and symptoms that are commonly associated with a patient who is diabetic and has an altered mental status from hyperglycemia​ include:
A.
the appearance of​ intoxication, such as staggering or slurred speech.
B.
rapid onset of an altered mental​ status, proceeding to unresponsiveness.
C.
a BGL reading of 210​ mg/dl.
D.
uncharacteristic or bizarre behavior or combativeness.
C.
a BGL reading of 210​ mg/dl.

A blood glucose level of 210​ mg/dl indicates hyperglycemia. The other choices are signs of hypoglycemia.

A​ 55-year-old male has a history of diabetes. He states that he took his insulin in the morning but may have missed his breakfast because he was running late for work. He seems confused. You should​ suspect:
A.
hyperglycemia.
B.
shock.
C.
seizure.
D.
hypoglycemia.
D.
hypoglycemia.

Taking insulin and not eating can lead to hypoglycemia in the diabetic patient. Although shock and seizure can cause​ confusion, the history of diabetes and skipped meal make hypoglycemia more likely.

Most requests for EMS responses to diabetic emergencies are the result of hypoglycemia. Which of the following is TRUE regarding this​ condition?
A.
Altered mental status is not a result of hypoglycemia.
B.
Hypoglycemia is not a serious medical emergency.
C.
The symptoms of hypoglycemia may progress rapidly over 5 to 30 minutes.
D.
Hypoglycemia is caused by too much sugar in the blood.
C.
The symptoms of hypoglycemia may progress rapidly over 5 to 30 minutes.

A hypoglycemic episode can develop as rapidly as in five or so minutes. Remember that as soon as the level of glucose gets​ low, brain dysfunction will begin almost immediately.

Which of the following conditions presents the greatest immediate danger to the​ patient?
A.
​Bell’s palsy
B.
Status epilepticus
C.
Focal motor seizures
D.
Syncope
B.
Status epilepticus

Status epilepticus is a very dangerous type of seizure and requires ALS intervention and rapid transport. Syncope can be a sign of a dangerous​ condition, such as heart attack or​ stroke, but is not as immediately dangerous as status epilepticus.​ Bell’s palsy and focal motor seizures are typically not life threatening.

Which of the following phases of a seizure typically follows convulsions and results in a depressed altered mental​ status?
A.
Tonic phase
B.
Clonic phase
C.
Syncopal phase
D.
Postictal phase
D.
Postictal phase

The postictal phase occurs as convulsions cease and typically caused the patient to be​ confused, disoriented,​ weak, and exhausted. The clonic phase is the initial stiffening that generally precedes convulsions. The tonic phase is the period of convulsions. There is no syncopal phase of seizures.

During your assessment of a patient who is​ unresponsive, you obtain a blood glucose level and find a value of 48​ mg/dl. What medical emergency may this help to​ indicate?
A.
Hypothyroidism
B.
Neurological dysfunction syndrome
C.
Hypoglycemia
D.
Hypotension
C.
Hypoglycemia

A patient may suffer a diabetic emergency if the patient either has taken too much insulin or has overexerted himself or​ herself, resulting in a lowered blood glucose level. While thyroid disorders may also lead to​ unresponsiveness, the presence of hypoglycemia indicates that inadequate glucose levels may be the cause.

A​ 52-year-old male complains of not feeling well. Family members state that upon awakening this​ morning, they noticed that the patient had​ right-sided facial droop and was slurring his words slightly. The patient states that he is a​ diabetic, and five minutes ago his blood glucose was 88​ mg/dl. After completing the primary​ assessment, you should​ NEXT:
A.
recheck the​ patient’s blood glucose.
B.
complete a Cincinnati Prehospital stroke assessment.
C.
administer​ high-concentration oxygen.
D.
administer oral glucose.
B.
complete a Cincinnati Prehospital stroke assessment.

Although the patient is a​ diabetic, his blood glucose level was within normal limits. You should next complete a Cincinnati Prehospital Stroke assessment. Oxygen is not necessary unless the patient is found to be hypoxic.

Syncope due to GI bleeding is especially common​ in:
A.
younger patients.
B.
diabetic patients.
C.
older patients.
D.
otherwise healthy patients.
C.
older patients.

GI bleeding is common in the older patient population and can be a cause of syncope.

Which of the following is an unusual sensation that precedes a​ seizure?
A.
Clonic phase
B.
Tonic phase
C.
Aura
D.
Postictal phase
C.
Aura

The aura serves as a warning that a seizure is going to begin and involves some type of sensory perception by the patient. The aura may be a​ sound, an abnormal​ twitch, anxiety,​ dizziness, a smell or​ odor, an unpleasant feeling in the​ stomach, a visual​ disturbance, or an odd taste. Many patients will tell you that they knew they were going to seize because of the aura. The postictal phase occurs after a seizure. The tonic and clonic phases are parts of the seizure.

Which of the following is a common finding associated with a postictal​ patient?
A.
Inadequate breathing
B.
Inadequate circulation
C.
Disorientation
D.
A compromised airway
C.
Disorientation

The postictal patient is most often​ confused, disoriented,​ weak, and exhausted but typically has an open​ airway, is breathing​ adequately, and has adequate circulation.

The phase of the seizure in which muscles become contracted and tense is called​ the:
A.
postictal phase.
B.
tonic phase.
C.
preictal phase.
D.
clonic phase.
B.
tonic phase.

The tonic phase is characterized by muscle rigidity. The​ patient’s muscles become contracted and​ tense, and the patient exhibits extreme muscular rigidity with arching of the back. The clonic phase usually involves convulsions. The postictal phase is a period of depressed altered mental status following the clonic phase.

The MOST common cause of seizures in adults​ is:
A.
fever or infection.
B.
hypoglycemia.
C.
failure to take prescribed antiseizure medications.
D.
cerebral hypoxia.
C.
failure to take prescribed antiseizure medications.

Although any of these issues can cause​ seizures, the most common cause is failure to take prescribed medications.

The family of a​ 30-year-old male states that the patient recently had a​ tonic-clonic seizure. The event lasted 5​ minutes, and the family notes that the patient has no previous history of seizures. The family also states that the patient has no past medical history of any kind. Which of the following causes MOST likely explain the previous​ findings?
A.
Recent head trauma
B.
Hyperoxia
C.
Hypoglycemia
D.
Anxiety
A.
Recent head trauma

Although hypoglycemia is a common cause of​ seizures, this patient has no past history. Even though hypoglycemia is possible without​ diabetes, it is unlikely.​ Therefore, of the choices​ listed, head trauma is the most likely cause.

You witness an adult patient experiencing a seizure in which a progressive twitching of his right arm leads to his entire body twitching. What can you reasonably say about the​ seizure’s origin?
A.
The seizure was caused by a stroke on the right side of the brain.
B.
It was a partial seizure that became generalized to the entire body.
C.
The seizure focus likely began in the right hemisphere of his brain.
D.
The beginning of the seizure in the arm has no clinical relevance.
B.
It was a partial seizure that became generalized to the entire body.

The localized twitching indicates that the seizure began in only one hemisphere. Therefore you may reasonably conclude that this was a partial seizure that became generalized to the entire body. Remember that the effects of one hemisphere are usually seen on the opposite side of the body. So a problem in the right hemisphere would most commonly be seen on the left side.

A​ 12-year-old boy experienced a​ tonic-clonic seizure after being struck in the head with a baseball. Which of the following would most likely be the cause of the​ seizure?
A.
Epilepsy
B.
Hypoxia
C.
Traumatic brain injury
D.
Toxins
C.
Traumatic brain injury

Given the most recent trauma to the​ head, you should first suspect traumatic brain injury. Although each of the other issues can cause​ seizures, here the mechanism of injury specifically points to traumatic brain injury.

To prevent additional injuries during repeated​ seizures, you​ should:
A.
move objects away from the patient.
B.
bind the​ patient’s hands and feet.
C.
immediately transport the patient.
D.
place a bite stick into the​ patient’s mouth.
A.
move objects away from the patient.

If the patient is still seizing when you​ arrive, you will frequently find bystanders who are attempting to restrain the​ patient’s jerky body movements. The​ patient’s movements should always be​ guided, rather than​ restrained, to prevent further injury. It may also be necessary to move objects away from the patient.

A​ 17-year-old female has been actively seizing for over 5 minutes. The​ patient’s jaw is​ clenched, and you note that she is cyanotic around her lips. Her vitals are P​ 130, R​ 8, BP​ 180/92. You are unable to insert an OPA. You should​ next:
A.
insert a nasopharyngeal airway and initiate​ positive-pressure ventilation.
B.
begin CPR.
C.
protect the patient from injuring herself until the seizure stops.
D.
apply​ high-concentration oxygen by a nonrebreather mask.
A.
insert a nasopharyngeal airway and initiate​ positive-pressure ventilation.

If the patient is in status epilepticus and appears not to be breathing​ adequately, you should open the airway with a​ head-tilt, chin-lift maneuver and insert a nasopharyngeal airway. Begin​ positive-pressure ventilation with supplemental oxygen. Immediately begin​ transport, and continuously reassess the patient en route to the medical facility. You should also protect the patient from injury.​ However, dealing with the airway is more important.

A​ 24-year-old male has regained consciousness after a​ tonic-clonic seizure and is now alert. He is fatigued and complains of generalized muscle pain. You note that he is slightly cyanotic and breathing rapidly. His vital signs are P​ 116, R​ 28, BP​ 174/88. You should​ NEXT:
A.
place the patient in the recovery position.
B.
initiate rapid transport.
C.
administer a tube of oral glucose.
D.
administer supplemental oxygen.
D.
administer supplemental oxygen.

A prolonged seizure can frequently result in hypoxia. You should next administer supplemental oxygen​ (especially given that the patient is​ cyanotic). Because he is​ alert, he probably does not require the recovery position. Transport would be important but not more important than resolving the hypoxia. Oral glucose is not indicated unless hypoglycemia is found.

If your patient is actively​ seizing, it may be necessary​ to:
A.
insert a tongue depressor.
B.
insert a bite block.
C.
suction the airway.
D.
forcibly restrain the patient.
C.
suction the airway.

An actively seizing patient frequently has secretions in the upper airway that require suctioning. You should not insert any other object into a seizing​ patient’s mouth.

Which of the following statements is CORRECT about a seizure that is unusually long in​ duration?
A.
Patients with prolonged seizures should be suspected of being off their antiseizure medication.
B.
Prolonged seizures can be life threatening.
C.
Prolonged seizures mean that the patient has a history of seizures.
D.
Patients with prolonged seizures have a history of epilepsy and often require no medical care.
B.
Prolonged seizures can be life threatening.

It is important for the EMT to recognize that seizures that are prolonged or are associated with​ life-threatening conditions or injuries such as head injury or stroke are abnormal and dangerous. Your prompt intervention in the prolonged or abnormal seizure may be lifesaving.

An​ 89-year-old female nursing home patient was witnessed to have a​ tonic-clonic seizure. The seizure has now stopped. You find her now with altered mental status. Staff members note that she has been treated for an upper respiratory infection for the last week but has been getting sicker. You note that the patient is lethargic and febrile. She is breathing rapidly but has no radial pulse. Her carotid pulse is 130. Her blood glucose level is 134. You should​ suspect:
A.
sepsis.
B.
diabetic ketoacidosis.
C.
hypoglycemia.
D.
acute myocardial infarction.
A.
sepsis.

Decline following a known infection should make you suspect sepsis. The rapid heart rate and tachypnea should also help you to confirm this suspicion. Although an AMI is​ possible, the presentation makes sepsis more likely. Given that her blood sugar is relatively​ normal, you should not suspect DKA or hypoglycemia as the cause.

Which of the following signs of stroke is MOST​ common?
A.
Seizures
B.
Headache
C.
Paralysis
D.
Hemiparesis
D.
Hemiparesis

Hemiparesis is one of the most common signs of stroke. The other signs and symptoms listed are less common.

If a patient had a​ long-standing vascular malformation in her brain that went unrecognized for years but finally​ burst, what type of stroke will she likely present​ with?
A.
An ischemic stroke with bilateral deficits
B.
Vascular malformations occur all the time and rupture with no clinical evidence
C.
An ischemic stroke on the opposite side of the brain
D.
A subarachnoid hemorrhagic stroke
D.
A subarachnoid hemorrhagic stroke

​”Burst vasculature” means ruptured blood vessel. This would be a hemorrhagic stroke. Ischemic strokes are caused by blockages in the blood vessels.

Which of the following conditions is MOST likely to lead to a​ stroke?
A.
​Long-standing high blood pressure
B.
Low blood pressure
C.
Anemia
D.
Asthma
A.
​Long-standing high blood pressure

​Long-standing high blood pressure is a common cause of stroke.

Which type of stroke often presents with hemiparesis and altered mental status but no​ headache?
A.
Ischemic stroke
B.
Transient stroke
C.
Herniated stroke
D.
Hemorrhagic stroke
A.
Ischemic stroke

As a person​ ages, platelets adhere to the roughened surface and can create a blood clot that blocks the blood flow through the cerebral artery. Symptoms of thrombotic stroke generally develop more slowly than those of a hemorrhagic stroke. Ischemic strokes and hemorrhagic strokes are frequently​ similar, but headaches tend to occur more with bleeding.

Over which of the following factors that affect the survivability of a stroke patient does the EMT have the MOST​ influence?
A.
Intubation of the trachea
B.
Reduction of blood pressure
C.
Initiation of an IV by ALS providers
D.
Time to treatment
D.
Time to treatment

Time is a critical factor in the emergency care of stroke.​ Therefore, EMS plays a major role in the management of the stroke patient. One of the most significant factors that make a difference in the care and prognosis of the patient is early recognition of the stroke. Early recognition of a stroke leads to early transport and treatment in the ED.

A​ 76-year-old male patient has been found with facial droop and paralysis to the left side of his body. His vital signs are P​ 88, R​ 20, BP​ 210/100. His oxygen saturation is​ 90%. You administer oxygen and initiate transport to the local stroke center. Ten minutes​ later, you note that he has recovered fully. You should​ NEXT:
A.
discontinue the oxygen.
B.
return the patient to his home.
C.
divert to the nearest hospital.
D.
continue to the stroke center.
D.
continue to the stroke center.

Although this patient is most likely having a​ TIA, you should continue treating him as if he were having a stroke. Continue to the stroke​ center, which will have the appropriate imaging capabilities to rule out the worst neurological problems. Oxygen should be​ continued, as you found the patient hypoxic.

Which of the following terms describes the condition of being unable to​ speak?
A.
Aphasia
B.
Polydipsia
C.
Dysphagia
D.
Cognitive paralysis
A.
Aphasia

Aphasia is a term that is used to describe an inability to speak. Dysphagia is difficulty swallowing. Polydipsia is excessive thirst.

A​ 66-year-old female displays two new findings from the Cincinnati Prehospital Stroke Scale. What do these findings​ indicate?
A.
A​ 70% chance of an acute stroke
B.
Very little chance of an acute stroke
C.
A previous stroke
D.
A​ 100% chance of an acute stroke
A.
A​ 70% chance of an acute stroke

At least one finding on the Cincinnati stroke scale indicates a​ 70% chance of an acute stroke. New findings help to differentiate a previous stroke from the acute issues. Although the Cincinnati Prehospital Stroke Scale has a high​ sensitivity, it does not provide a​ 100% certainty.

While transporting an unresponsive stroke​ patient, you notice that the​ patient’s respirations are becoming slow and irregular and that the pulse ox now reads​ 90% when earlier it read​ 98%. You​ should:
A.
place the patient supine and elevate his or her legs.
B.
downgrade the transport​ urgency, as this patient is now improving.
C.
start​ positive-pressure ventilation.
D.
take off the nasal cannula and put on a nonrebreather mask.
C.
start​ positive-pressure ventilation.

The specific fix for inadequate breathing is artificial ventilation. This should be provided with supplemental oxygen to ensure that the patient is receiving sufficient oxygen. A nonrebreather mask would not be enough for this patient. This patient is not improving but in fact is worsening.

Why is it necessary to take the patient to the hospital if the symptoms of a stroke have subsided by the time you arrive on the​ scene?
A.
The patient is likely to start seizing.
B.
The patient will need to get an​ X-ray.
C.
The patient will probably need to be given insulin.
D.
The patient is at significant risk for developing a stroke.
D.
The patient is at significant risk for developing a stroke.

Patients who have had a TIA are likely to have a major stroke within the next 12 months unless managed. TIAs are also sometimes very difficult to distinguish from an actual stroke. You should always err on the side of caution.

While assessing a patient using the Cincinnati Prehospital Stroke​ Scale, you note that the patient has​ acute-onset facial droop on the left side. This​ indicates:
A.
that the patient had a previous stroke.
B.
the likelihood that the patient experienced a seizure.
C.
a normal finding for older patients.
D.
a likelihood that the patient is experiencing a stroke.
D.
a likelihood that the patient is experiencing a stroke.

An abnormal finding in the Cincinnati Prehospital Stroke Scale indicates a strong likelihood of a stroke. The acute onset means that the facial droop is not from a previous stroke.

In assessing a possible stroke patient for arm​ drift, it is important to have the​ patient:
A.
keep both eyes open.
B.
blink rapidly.
C.
close both eyes.
D.
keep one eye open.
C.
close both eyes.

The patient should close both eyes during assessment for arm drift.

A​ 73-year-old female complains of a new onset of vertigo and states that she almost passed out when she tried to stand. She is alert but weak. Her vital signs are P​ 70, R​ 20, BP​ 100/60. Her pulse oximeter reads​ 95%. You​ should:
A.
administer oral glucose.
B.
transport the patient lying flat.
C.
ask the patient to stand to assess her vertigo.
D.
administer fluids by mouth to rehydrate.
B.
transport the patient lying flat.

Syncope can indicate significant underlying​ problems, including AMI and stroke. The patient should be transported lying flat if possible. The patient should not be asked to​ stand, as this could cause another syncopal episode and subsequent injury. You should not administer fluids by mouth because of the risk of vomiting.

Which of the following is a symptom that is sometimes caused by a decreased blood supply to the​ brain?
A.
Tachycardia
B.
Tachypnea
C.
Dizziness
D.
Hypertension
C.
Dizziness

Dizziness is a common​ symptom, not a​ sign, which can be caused by an interruption in the blood supply to the brain.​ Tachycardia, hypertension, and tachypnea are​ signs, not symptoms.

Which of the following is a hypovolemic cause of​ syncope?
A.
Hypoxia
B.
Seizure
C.
Internal bleeding
D.
Cardiac dysrhythmia
C.
Internal bleeding

Dehydration and internal bleeding are common hypovolemic causes of syncope.​ Dysrhythmias, hypoxia, and seizures are not hypovolemic causes.

A​ 70-year-old male was sitting comfortably when he suddenly had a brief syncopal episode. His vital signs are P​ 46, R​ 20, BP​ 96/60. Which of the following do you suspect caused the syncopal​ episode?
A.
DKA
B.
Hypovolemia
C.
Hypertension
D.
Cardiac dysrhythmia
D.
Cardiac dysrhythmia

The patient has a slow heart rate on your arrival. This bradycardia is a likely cause of syncope. His blood pressure is not hypertensive. He may be​ hypovolemic, but the dysrhythmia is more likely. No signs of DKA are present.

A​ 24-year-old female reports increasing dizziness that is made worse by standing up. She has a rapid pulse rate and is diaphoretic. She has no history and takes no medications. What is the most likely source of her​ dizziness?
A.
Use of recreational drugs
B.
Low blood sugar
C.
Hypovolemia
D.
Stroke
C.
Hypovolemia

While there are a few​ possibilities, hypovolemia is the most likely cause. Although hypoglycemia is​ possible, her lack of diabetes makes this less likely. Drugs are a possible cause but are also less likely. A stroke is​ possible, but there are no other neurological findings.

A​ 19-year-old female has lost consciousness while traveling home from a house party. Friends note that she vomited and then​ “passed out.” They note this has never happened before. The patient is unresponsive but has a patent airway and is breathing adequately. Which of the following questions would be considered MOST relevant to this​ situation?
A.
Does the patient take any​ medications?
B.
Does the patient have any​ allergies?
C.
Has the patient been drinking​ alcohol?
D.
What was the​ patient’s last​ meal?
C.
Has the patient been drinking​ alcohol?

Although all the SAMPLE history questions are​ relevant, questioning about alcohol would provide a reason for the loss of​ consciousness, as intoxicated patients frequently experience altered mental status.

A​ 16-year-old male athlete suffered a syncopal episode while playing soccer on a​ hot, humid day. You find him lying supine and complaining of dizziness. He has no apparent injuries. You​ should:
A.
apply​ high-concentration oxygen and transport in Trendelenburg position.
B.
ask the patient to stand while you take his pulse and blood pressure.
C.
keep the patient supine and allow him to slowly recover. Consider ALS​ and/or transport.
D.
initiate​ high-priority transport to the nearest hospital and intercept with ALS.
C.
keep the patient supine and allow him to slowly recover. Consider ALS​ and/or transport.

The best treatment plan would be to keep the patient​ supine, allow him to​ recover, and consider ALS​ and/or transport. He should not​ stand, as standing may cause another syncopal episode. He does not require​ high-priority transport, but he should be seen at the hospital. There is no demonstrated benefit to the Trendelenburg position.

Which of the following is the MOST common toxicological cause of​ syncope?
A.
Nerve agent
B.
Pesticides
C.
Suicide attempt
D.
Alcohol
D.
Alcohol

Although all of the choices are toxicological causes of​ syncope, alcohol is the most commonly used drug and often affects level of consciousness.

A​ 56-year-old male patient who remains unconscious from a syncopal episode is breathing shallowly at 14 times a minute. His pulse is 48 and​ irregular, and his blood pressure is​ 80/50 while supine. What should be your GREATEST suspicion as to the​ cause?
A.
Hypoglycemia
B.
Hypovolemia
C.
Vasovagal syncope
D.
Cardiac dysrhythmia
D.
Cardiac dysrhythmia

Although a few causes may be​ considered, the most likely cause is cardiac dysrhythmia due to the bradycardia and hypotension.

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aura right before a seizure where there is a smell, sound, or general feeling causes of seizure hypoxia, stroke, traumatic brain injury, toxins, hypoglycemia, brain tumor, congenital brain defects, infection, metabolic, idiopathic WE WILL WRITE A CUSTOM ESSAY SAMPLE ON …

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