CEN Neurological Emergencies UPDATED
Exam Questions and CORRECT Answers
To quickly evaluate a child's neurological status, all of the following standard evaluations can be
used EXCEPT:
a. The Epworth Scale.
b. The AVPU scale.
c. The Glasgow Coma Scale.
d. Pupillary responses to light. - CORRECT ANSWER - A. The Epworth Scale is a
measure of sleepiness and is not part of the standard evaluation of a child's neurological exam.
The AVPU and Glasgow Coma scales can be used to evaluate a child's neuro status. Pupillary
size and response should also be checked.
The National Institute of Neurological Disorders and Stokes (NINDS) has set the goal for
immediate general assessment by a stroke team or emergency physician as:
a. Within 1 minute of arrival.
b. Within 10 minutes of arrival.
c. Within 30 minutes of arrival.
d. Within 60 minutes of arrival. - CORRECT ANSWER - B. The goal for general
assessment by an ED or stroke team physician is within 10 minutes of arrival to the ED. Within
the same 10 minutes, an urgent CT without contrast should also be ordered.
The National Institute of Neurological Disorders and Stokes (NINDS) has set the goal for
initiation of fibrinolytic therapy in appropriate patients as:
a. Within 1 hour of hospital arrival.
b. Within 3 hours of hospital arrival.
c. Within 4 hours of hospital arrival.
d. Within 6 hours of hospital arrival. - CORRECT ANSWER - A. NINDS recommends a
goal for initiation of fibrinolytic therapy within 1 hour of arrival to the ED. NINDS also
recommends a goal of door-to-admission time of 3 hours.
, Signs and symptoms of stroke may include all of following EXCEPT:
a. Sudden weakness or numbness of the face, arm or leg.
b. Sudden confusion.
c. Sudden headache with no known cause.
d. Hypotension. - CORRECT ANSWER - D. Hypotension is typically not a sign of acute
stroke. Hypertension, extremity weakness or numbness, confusion and sudden headache are all
symptoms of stroke.
When evaluating the 68-year-old stroke patient for fibrinolytic therapy, the relative
contraindication to fibrinolytic therapy is:
a. Stroke within the last three months.
b. History of previous intracranial hemorrhage.
c. Current use of an anticoagulant with an INR greater than 1.7.
d. Myocardial infarction 2 months ago. - CORRECT ANSWER - D. A myocardial
infarction is a relative exclusion criterion if the MI occurred in the previous 3 months. The others
are all exclusion criteria and should be reported to the ED physician.
Fibrinolytic therapy should be considered in hemorrhagic stroke.
a. True
b. False - CORRECT ANSWER - B. Because of the bleeding risk, fibrinolytics and
anticoagulants should not be used in hemorrhagic strokes, but should be the treatment considered
first for ischemic stroke.
An elderly man with a laceration on his elbow presents to the emergency department. He is
obviously confused and appears to be frightened. His daughter is with him and explains that he
has Stage 2 Alzheimer's disease and that she needs to stay with him. The correct response in this
situation is:
a. Allow the daughter to accompany the patient to his room.
b. Ask the daughter to wait in the waiting room until after the exam is complete.
c. Ask the daughter for a copy of the patient's Power of Attorney for Health Care.
d. Ask the patient if he wants the woman to accompany him to the treatment room. - CORRECT
ANSWER - A. The patient with Alzheimer's disease is likely to be more cooperative and
Exam Questions and CORRECT Answers
To quickly evaluate a child's neurological status, all of the following standard evaluations can be
used EXCEPT:
a. The Epworth Scale.
b. The AVPU scale.
c. The Glasgow Coma Scale.
d. Pupillary responses to light. - CORRECT ANSWER - A. The Epworth Scale is a
measure of sleepiness and is not part of the standard evaluation of a child's neurological exam.
The AVPU and Glasgow Coma scales can be used to evaluate a child's neuro status. Pupillary
size and response should also be checked.
The National Institute of Neurological Disorders and Stokes (NINDS) has set the goal for
immediate general assessment by a stroke team or emergency physician as:
a. Within 1 minute of arrival.
b. Within 10 minutes of arrival.
c. Within 30 minutes of arrival.
d. Within 60 minutes of arrival. - CORRECT ANSWER - B. The goal for general
assessment by an ED or stroke team physician is within 10 minutes of arrival to the ED. Within
the same 10 minutes, an urgent CT without contrast should also be ordered.
The National Institute of Neurological Disorders and Stokes (NINDS) has set the goal for
initiation of fibrinolytic therapy in appropriate patients as:
a. Within 1 hour of hospital arrival.
b. Within 3 hours of hospital arrival.
c. Within 4 hours of hospital arrival.
d. Within 6 hours of hospital arrival. - CORRECT ANSWER - A. NINDS recommends a
goal for initiation of fibrinolytic therapy within 1 hour of arrival to the ED. NINDS also
recommends a goal of door-to-admission time of 3 hours.
, Signs and symptoms of stroke may include all of following EXCEPT:
a. Sudden weakness or numbness of the face, arm or leg.
b. Sudden confusion.
c. Sudden headache with no known cause.
d. Hypotension. - CORRECT ANSWER - D. Hypotension is typically not a sign of acute
stroke. Hypertension, extremity weakness or numbness, confusion and sudden headache are all
symptoms of stroke.
When evaluating the 68-year-old stroke patient for fibrinolytic therapy, the relative
contraindication to fibrinolytic therapy is:
a. Stroke within the last three months.
b. History of previous intracranial hemorrhage.
c. Current use of an anticoagulant with an INR greater than 1.7.
d. Myocardial infarction 2 months ago. - CORRECT ANSWER - D. A myocardial
infarction is a relative exclusion criterion if the MI occurred in the previous 3 months. The others
are all exclusion criteria and should be reported to the ED physician.
Fibrinolytic therapy should be considered in hemorrhagic stroke.
a. True
b. False - CORRECT ANSWER - B. Because of the bleeding risk, fibrinolytics and
anticoagulants should not be used in hemorrhagic strokes, but should be the treatment considered
first for ischemic stroke.
An elderly man with a laceration on his elbow presents to the emergency department. He is
obviously confused and appears to be frightened. His daughter is with him and explains that he
has Stage 2 Alzheimer's disease and that she needs to stay with him. The correct response in this
situation is:
a. Allow the daughter to accompany the patient to his room.
b. Ask the daughter to wait in the waiting room until after the exam is complete.
c. Ask the daughter for a copy of the patient's Power of Attorney for Health Care.
d. Ask the patient if he wants the woman to accompany him to the treatment room. - CORRECT
ANSWER - A. The patient with Alzheimer's disease is likely to be more cooperative and
