SCRN STUDY GUIDE: HYPERACUTE
CARE EXAM 2025 QUESTIONS AND
ANSWERS 100% CORRECT.
Communicate effectively with pre-hospital personnel. - ANSWERWhen stroke victim
activates EMS the time to imaging , neuro exam, ED MD evaluation is shorter. This
should be emphasized in the community. The greatest time delay is from symptom
onset to ED arrival.
EMS alerts the hospital, advance notification by EMS has shown to increase the use of
TpA
EMS evaluation primary goals - ANSWERObtain last seen normal
Obtain blood glucose
ABCD score - ANSWERA: age B: blood C: clinical features D: Duration of TIA
symptoms
Establish ABC's - ANSWERAirway -Breathing: O2 for SpO2< 94%
Circulation: ECG, BP assessment & IV/Labs (√BG)
D (Neuro): NIHSS or Canadian Neurological Scale (CNS), Neuro Exam & Neuro MD
Posterior stroke - ANSWERThere are important differences between posterior and
anterior circulation stroke. The differences include the value of screening instruments,
optimum diagnostic modalities, and clinical features. The face arm speech test (FAST),
a widely used prehospital stroke recognition screening instrument, is less sensitive for
detecting posterior circulation stroke than for anterior circulation stroke
Symptoms of Posterior Circulation Stroke - ANSWERMotor deficits (weakness,
clumsiness, or paralysis of any combination of arms and legs, up to quadriplegia,
sometimes changing from one side to another in different attacks)
"Crossed" syndromes, consisting of ipsilateral cranial nerve dysfunction and
contralateral long motor or sensory tract dysfunction are highly characteristic of
posterior circulation stroke
Sensory deficits (numbness, including loss of sensation or paraesthesia in any
combination of extremities, sometimes including all four limbs or both sides of the face
or mouth)
Homonymous hemianopia—a visual field defect affecting either the two right or the two
left halves of the visual fields of both eyes
, Ataxia, imbalance, unsteadiness, or disequilibrium
Vertigo, with or without nausea and vomiting
Diplopia as a result of ophthalmoplegia
Dysphagia or dysarthria
Isolated reduced level of consciousness is not a typical stroke symptom but can result
from bilateral thalamic or brainstem ischaemia (especially from rostral basilar artery
occlusion)
Posterior stroke: Lateral medulla (intracranial vertebral artery infarct, also known as
Wallenberg syndrome) - ANSWERNystagmus, vertigo, ipsilateral Horner's syndrome,
ipsilateral facial sensory loss, dysarthria, hoarseness, and dysphagia
Contralateral hemisensory loss in the trunk and limb—pain and temperature
posterior stroke: Medial medulla - ANSWERIpsilateral tongue weakness and later
hemiatrophy of the tongue
Contralateral hemiparesis of the arm and leg
Hemisensory loss—touch and proprioception
posterior stroke: Pons - ANSWERHemiparesis or hemisensory loss, ataxic hemiparesis,
dysarthria, horizontal gaze palsy
Complete infarction causes "locked-in syndrome" with quadriparesis, loss of speech, but
preserved awareness and cognition, and sometimes preserved eye movements
posterior stroke:Top of the basilar (distal basilar occlusion) - ANSWERSomnolence,
confusion (from thalamic infarction)
Bilateral loss of vision, unawareness or denial of blindness (from bilateral occipital
infarction)
posterior stroke: Posterior inferior cerebellar artery - ANSWERTruncal ataxia, vertigo
(limb ataxia may occur, especially if the inferior cerebellar peduncle is affected)
posterior stroke: Posterior cerebral artery - ANSWERContralateral homonymous
hemianopia (from occipital infarction)
Hemisensory loss—all modalities (from thalamic infarction)
Hemi-body pain—pain (usually with a burning quality) down one side of the body (face,
arm, and leg) as a result of thalamic infarction
CARE EXAM 2025 QUESTIONS AND
ANSWERS 100% CORRECT.
Communicate effectively with pre-hospital personnel. - ANSWERWhen stroke victim
activates EMS the time to imaging , neuro exam, ED MD evaluation is shorter. This
should be emphasized in the community. The greatest time delay is from symptom
onset to ED arrival.
EMS alerts the hospital, advance notification by EMS has shown to increase the use of
TpA
EMS evaluation primary goals - ANSWERObtain last seen normal
Obtain blood glucose
ABCD score - ANSWERA: age B: blood C: clinical features D: Duration of TIA
symptoms
Establish ABC's - ANSWERAirway -Breathing: O2 for SpO2< 94%
Circulation: ECG, BP assessment & IV/Labs (√BG)
D (Neuro): NIHSS or Canadian Neurological Scale (CNS), Neuro Exam & Neuro MD
Posterior stroke - ANSWERThere are important differences between posterior and
anterior circulation stroke. The differences include the value of screening instruments,
optimum diagnostic modalities, and clinical features. The face arm speech test (FAST),
a widely used prehospital stroke recognition screening instrument, is less sensitive for
detecting posterior circulation stroke than for anterior circulation stroke
Symptoms of Posterior Circulation Stroke - ANSWERMotor deficits (weakness,
clumsiness, or paralysis of any combination of arms and legs, up to quadriplegia,
sometimes changing from one side to another in different attacks)
"Crossed" syndromes, consisting of ipsilateral cranial nerve dysfunction and
contralateral long motor or sensory tract dysfunction are highly characteristic of
posterior circulation stroke
Sensory deficits (numbness, including loss of sensation or paraesthesia in any
combination of extremities, sometimes including all four limbs or both sides of the face
or mouth)
Homonymous hemianopia—a visual field defect affecting either the two right or the two
left halves of the visual fields of both eyes
, Ataxia, imbalance, unsteadiness, or disequilibrium
Vertigo, with or without nausea and vomiting
Diplopia as a result of ophthalmoplegia
Dysphagia or dysarthria
Isolated reduced level of consciousness is not a typical stroke symptom but can result
from bilateral thalamic or brainstem ischaemia (especially from rostral basilar artery
occlusion)
Posterior stroke: Lateral medulla (intracranial vertebral artery infarct, also known as
Wallenberg syndrome) - ANSWERNystagmus, vertigo, ipsilateral Horner's syndrome,
ipsilateral facial sensory loss, dysarthria, hoarseness, and dysphagia
Contralateral hemisensory loss in the trunk and limb—pain and temperature
posterior stroke: Medial medulla - ANSWERIpsilateral tongue weakness and later
hemiatrophy of the tongue
Contralateral hemiparesis of the arm and leg
Hemisensory loss—touch and proprioception
posterior stroke: Pons - ANSWERHemiparesis or hemisensory loss, ataxic hemiparesis,
dysarthria, horizontal gaze palsy
Complete infarction causes "locked-in syndrome" with quadriparesis, loss of speech, but
preserved awareness and cognition, and sometimes preserved eye movements
posterior stroke:Top of the basilar (distal basilar occlusion) - ANSWERSomnolence,
confusion (from thalamic infarction)
Bilateral loss of vision, unawareness or denial of blindness (from bilateral occipital
infarction)
posterior stroke: Posterior inferior cerebellar artery - ANSWERTruncal ataxia, vertigo
(limb ataxia may occur, especially if the inferior cerebellar peduncle is affected)
posterior stroke: Posterior cerebral artery - ANSWERContralateral homonymous
hemianopia (from occipital infarction)
Hemisensory loss—all modalities (from thalamic infarction)
Hemi-body pain—pain (usually with a burning quality) down one side of the body (face,
arm, and leg) as a result of thalamic infarction
