Deck 19: Seizures and Syncope

Question 1

When an EMT performs the secondary assessment on a postictal seizure patient with a known history of seizures, what assessment finding would be of most concern?

A) Confused mental status
B) Heart rate of 136
C) Loss of bowel and bladder control
D) Bruise on the forehead

Answer 1

D

Question 2

While placing a 52-year-old female on the stretcher, she begins to seize. Your immediate action would be to:

A) quickly move her to the ambulance for rapid transport.
B) perform a jaw-thrust maneuver and insert an oropharyngeal airway.
C) loosely apply the straps and raise the side rails.
D) remove her from the stretcher and place her on the ground.

Answer 2

C

Question 3

A postictal patient is awake but has trouble answering your questions correctly. Given this presentation, the EMT would recognize that:

A) the airway is open.
B) another seizure is coming.
C) the patient has a seizure history.
D) high-concentration oxygen is indicated.

Answer 3

A

Question 4

You have been called to a public bus station for a behavioral emergency. On scene you find a disheveled male in his forties sitting up against a wall. He is confused and incontinent. Bystanders state that he suddenly began to stumble around, shouting obscenities, and then fell to the ground spitting and shaking. From this description, the EMT should be suspicious of what condition?

A) Generalized seizure
B) Alcohol intoxication
C) Absence seizure
D) Syncopal episode

Question 5

As a general rule, a postictal patient should be placed on the stretcher and transported in what position?

A) Supine
B) Semi-Fowler's
C) Lateral recumbent
D) Prone

Question 6

When performing the secondary assessment on a confused patient, which one of the following signs would be most suggestive of a seizure?

A) Bruises to the arms
B) Bleeding tongue
C) Pinpoint pupils
D) Warm skin

Question 7

You are caring for a postictal male patient with a known history of seizures. He is confused and cannot remember his 8-year-old son's name. His son tearfully asks you if his father will ever remember him. Your response would be:

A) "I do not know. We will have to let the doctor help him first."
B) "I am not sure, but at least your mother remembers your name."
C) "Although he is confused now, he should remember your name in a little bit."
D) "I do not feel comfortable in telling you yes, since there is a chance he may not."

Question 8

When obtaining a medical history from the family of a seizure patient, what question is most important for the EMT to ask first?

A) "How long has he had his seizure condition?"
B) "Why do you think that his tongue is bleeding?"
C) "Does he take his seizure medications as prescribed?"
D) "Was he grunting and breathing hard during the seizure?"

Question 9

After a lengthy response, you arrive at the home of a 62-year-old female who is still seizing. Your immediate action would be to:

A) assess the patient's airway and breathing.
B) determine if the patient has a seizure history.
C) determine the total duration of the seizure.
D) move her to the ambulance for assessment and transport.

Question 10

You are to transport a 46-year-old male who has had multiple seizures throughout the morning. Currently, he is on your stretcher and is postictal. He has a history of seizures for which he takes anticonvulsant medications. He also suffers from diabetes and kidney failure. Of the equipment listed below, which one is most essential to have ready during transport of this patient?

A) Padded tongue blade
B) Automated external defibrillator
C) Oral glucose
D) Suction device

Question 11

As you approach a female patient, she appears unresponsive with her arms and legs jerking violently. On the prehospital care report, you would document that the patient was found in what phase of a generalized seizure?

A) Tonic
B) Absence
C) Syncopal
D) Clonic

Question 12

The initial part of a generalized seizure experienced by some patients is called the:

A) syncopal stage.
B) aura.
C) clonic phase.
D) postictal state.

Question 13

You are called to a residence to assess a child. The panicked parents state that their 3-year-old son was playing with his brother when he suddenly "blanked out" and would not respond to them for several seconds. When asked, they deny any convulsing-like movement as well as a history of medical problems. Based on this description, you would be suspicious of what type of seizure?

A) Febrile
B) Simple partial
C) Grand mal
D) Absence

Question 14

Friends of a male patient who suffered a generalized seizure are worried because he cannot remember the seizure. You should inform them that this is a(n):

A) concern since most people can remember the seizure.
B) normal finding common among those who suffer this type of seizure.
C) important piece of information that warrants immediate transport to the hospital.
D) unrelated event to the seizure and may indicate a more serious medical problem.

Question 15

You find a patient, who seized for approximately 2 minutes, supine on the kitchen floor. He responds to painful stimuli and has snoring respirations. Emergency Medical Responders are holding manual in-line spinal stabilization and report the following vital signs: heart rate is 124 beats per minute, and his pulse oximetry is 89% on room air. He has cool and clammy skin. Which one of the following should you do first?

A) Suction the airway.
B) Perform a jaw-thrust maneuver.
C) Provide supplemental oxygen.
D) Determine a history of seizures.

Question 16

You have been called for a seizure emergency. On scene you find an adult female actively seizing with bystanders attempting to restrain her. You would:

A) place a padded tongue blade into the patient's mouth.
B) loosen any restrictive clothing the patient is wearing.
C) instruct the bystanders to release the patient.
D) have bystanders to continue restraining while you complete the primary assessment.

Question 17

How would you transport a seizure patient who may have a spinal-cord injury?

A) Supine on the stretcher with straps loosely applied
B) In the lateral recumbent position with a cervical collar in place
C) Immobilized on a spine board with a cervical collar in place
D) Semi-sitting position with a cervical collar in place

Question 18

A young boy tells you that his twin brother suffers from seizures and asks what he can do if he sees his brother convulsing. Your response would be:

A) "Move any movable objects and furniture away from him."
B) "Hold him securely to the floor until he stops seizing or the EMTs arrive."
C) "Insert a spoon into his mouth to keep him from swallowing his tongue."
D) "Call 911 if the seizure lasts more than 5 minutes or if he loses control of his bladder."

Question 19

You are by the side of an alert but confused 41-year-old woman who is diaphoretic and appears exhausted. She informs you that she has a history of seizures and just had a generalized seizure. Despite your urging, she refuses transport to the hospital. Your safest action would be to:

A) transport her despite her refusal to consent.
B) advise medical direction of the situation.
C) contact law enforcement so transport is legal.
D) recognize a seizure history and have patient sign a refusal form.

Question 20

A female patient with a history of seizures has suffered a seizure in a public area and is now refusing further assessment and transport. As you leave, a witness to the entire event tells you that he thinks the patient is "crazy in the head" because right before she seized, she looked up toward the ceiling and kept repeating, "Do you see the birds?" As a knowledgeable EMT, you should recognize that the bystander is describing what condition?

A) Postictal confusion
B) Side effects of seizure medications
C) An aura
D) Syncopal episode

Question 21

A man comes into your station and tells you that he was just diagnosed by his physician as having a syncopal episode the previous week. More specifically, he asks you to explain why he fainted. Which one of the statements that follow would be your best response?

A) "For some reason, there was a temporary decrease in the flow of blood to your brain."
B) "A small clot formed in a blood vessel in your brain, but was quickly broken down by the body."
C) "Your blood sugar most likely dropped very quickly, causing you to faint."
D) "A syncopal episode is a small seizure that runs its course very quickly."

Question 22

Which one of the following offers the best explanation of why a patient experiencing a syncopal episode regains consciousness after falling?

A) The act of falling causes the heart rate to decrease.
B) The supine position allows more blood to perfuse the brain.
C) The trauma of falling causes the blood glucose level to increase.
D) The seizure stops once the patient is supine.

Question 23

The EMT shows that she understands the danger posed by status epilepticus when she states:

A) "Status epilepticus is an extremely dangerous condition because the patient can go into shock from blood loss."
B) "If the patient does not have a history of seizures, he is at greater risk for status epilepticus."
C) "The longer the seizure continues, the greater the opportunity for permanent brain damage."
D) "Status epilepticus indicates that the medications a patient is taking have reached toxic levels in the body."

Question 24

You are an EMT who finds an adult male on his living room floor. The scene size-up reveals a very cluttered home that smells of urine. On an end table you find a container of phenytoin (Dilantin) with the patient's name on it. When you pinch his shoulder, the patient responds by moaning and trying to remove your hand from his neck. Based on this information, you should suspect which one of the following conditions?

A) Syncope
B) Allergic reaction
C) Behavioral emergency
D) Seizure

Question 25

You are dispatched to a local mall and are met by bystanders who state that the patient was talking to a customer representative and "passed out." You find an alert and oriented 55-year-old female lying supine on the tile floor. The patient tells you that the back of her head is hurting. Which one of the following actions should you perform first?

A) Open her airway with a jaw-thrust.
B) Obtain a full set of vital signs.
C) Take manual in-line spinal stabilization.
D) Assess the back of the patient's head for injury.

Question 26

While transporting a 41-year-old woman who is not feeling well, she begins to seize. She has no history of seizures and the seizure lasts approximately 90 seconds. After 30 seconds of being postictal and unresponsive, the woman suddenly seizes again for the remainder of the 12-minute transport. The EMT should recognize which one of the following conditions?

A) Undiagnosed epilepsy
B) Hypoglycemic-induced seizures
C) Status epilepticus
D) Partial-motor seizure

Question 27

Which type of seizure occurs in children and is caused by a fever?

A) Idiopathic
B) Hypoglycemic
C) Febrile
D) Eclamptic

Question 28

Of the four patients listed below, which one should be categorized as the highest priority for transport?

A) Young adult with a history of seizures and a fever of 102°F
B) Pregnant female with a history of seizures who is seizing
C) Postictal patient who has stopped taking his seizure medication
D) Adolescent patient who states he recalls seizing earlier in the day

Question 29

Which one of the following patients should be classified as suffering from status epilepticus?

A) 16-year-old male experiencing a partial motor seizure for 7 minutes
B) 89-year-old who seized immediately upon getting out of bed
C) 19-year-old female who briefly seized but has been postictal for 20 minutes
D) 57-year-old female who seized during the entire news program

Question 30

Which one of the following patient statements reinforces your suspicion of syncope?

A) "I think that I may have had a seizure."
B) "Once I hit the floor, I was only out for a few seconds."
C) "I have had a low-grade fever for the past three days."
D) "I was lying on the bed when I passed out."

Question 31

Which one of the following seizure patients is most at risk for problems to the airway and breathing?

A) 32-year-old male who has stopped taking his seizure medications and suffered a seizure
B) 23-year-old female with a history of seizures and has been seizing for 14 minutes
C) 11-year-old postictal boy with no history of seizures but is mentally retarded
D) 76-year-old female who takes anticonvulsant medications and just began seizing

Question 32

Which one of the following statements about seizures is true?

A) "Patients who have seizures are at increased risk for stroke."
B) "All seizures are caused by some form of brain injury."
C) "Seizures may be caused by a variety of medical conditions."
D) "If the cause of a seizure is unknown, it is classified as status epilepticus."

Question 33

Which one of the following statements related to the pathophysiology of seizures is correct?

A) "A seizure occurs when the heart beats irregularly, causing a decreased amount of oxygen-rich blood to reach the brain."
B) "All seizures are caused by epilepsy, which describes a problem somewhere in the body."
C) "A seizure condition describes a muscle problem that causes the arms and legs to jerk."
D) "A seizure occurs when there is a massive and uncoordinated electrical discharge in the brain."

Question 34

Which one of the following statements made by a patient who experienced a syncopal episode should concern the EMT most?

A) "I seemed to get very warm just before passing out."
B) "My chest felt funny right before I passed out."
C) "I remember feeling faint right before I passed out."
D) "The doctor told me to get out of bed slowly, but I didn't."

Question 35

You arrive on scene and find Emergency Medical Responders with a seizing patient. What question should the EMT ask first?

A) "How long has the patient been seizing?"
B) "What are the patient's vital signs?"
C) "Did the patient lose control of his bladder?"
D) "Do you know what medications the patient is taking?"

Question 36

You have been called for a 47-year-old female who has "passed out." As you enter the patient's apartment, you find her supine on the living room floor with a cool wash cloth on her forehead. She states that she was standing and talking on the telephone when everything went dark. When she came to, she was on the floor. What should be your first action?

A) Immediately sit her upright.
B) Insert a nasopharyngeal airway.
C) Move her to the ambulance for immediate transport.
D) Assess and obtain vital signs while she is supine.

Question 37

Status epilepticus is best differentiated from a generalized seizure by the:

A) duration of the seizure.
B) length of the postictal period.
C) presence of an aura prior to seizing.
D) preexisting seizure history.

Question 38

You are called to a residence for seizure activity. On location the patient's daughter tells you that her diabetic father stated that he suddenly felt dizzy and then he fell to the floor. Within a few seconds, he began asking what had happened and why he was on the floor. Based on this description, the EMT should recognize which one of the following conditions?

A) Generalized seizure
B) Diabetic reaction
C) Aura of a pending seizure
D) Syncopal episode

Question 39

A patient has been actively seizing for 17 minutes. He is cyanotic with shallow respirations. What immediate care should you provide to this patient?

A) Determine if he has a history of seizures.
B) Place him in the lateral recumbent position.
C) Apply the automated external defibrillator.
D) Open the airway and begin positive pressure ventilation.

Question 40

A patient who suffered an apparent syncopal episode refuses transport to the hospital. Prior to the patient signing a refusal, you should make which one of the following statements?

A) "Syncope indicates a serious underlying condition, so please follow up with a doctor."
B) "The most common cause of syncope is diabetes, so follow up with your doctor."
C) "People who experience a syncopal episode are not allowed to drive unless they go on medication."
D) "Syncope is not dangerous and affects almost everyone, but it is still important to follow up with your doctor."

Question 41

A 20-year-old patient is unresponsive with snoring respirations. She is in a public restroom with no family or friends with her. After addressing the airway, breathing, and circulation, you begin the secondary assessment. Which one of the following signs best indicates the patient experienced a seizure?

A) Snoring respirations
B) Urinary incontinence
C) Altered mental status
D) Constricted pupils

Question 42

Which one of the following patient medications is most consistent with a history of seizures?

A) Celexa
B) Prozac
C) Xopenex
D) Depakote

Question 43

You believe that a patient suffered a simple partial (focal motor) seizure. What statement made by the patient would reinforce this suspicion?

A) "I cannot remember anything that happened. I must have passed out!"
B) "I think that I may have lost control of my bladder and bit my tongue."
C) "My left arm would not stop shaking. I did not know what was happening."
D) "I remember my arms and legs shaking, and then I can't remember anything else!"

Question 44

Which one of the following statements about seizures is true?

A) Simple partial seizures do not cause an alteration in mental status.
B) The cause of most seizures is easily identified.
C) Generalized seizures last longer than partial seizures.
D) Complex partial seizures involve both cerebral hemispheres.

Question 45

Which one of the following signs and symptoms would be most helpful in determining that a patient had a syncopal episode rather than a seizure?

A) The extremities twitched, but only for a few moments.
B) There was no period of confusion after the event.
C) The patient has never had a seizure before.
D) The patient complained of headache before the event.

Question 46

You are transporting a patient who has a history of simple partial seizures. During transport she experiences a simple partial seizure involving her right arm. Her pulse is 92, respirations 14 and adequate, blood pressure 168/88 mmHg, and SpO₂ at 98%. Your primary concern would be:

A) administering oxygen by nonrebreather.
B) loss of bowel or bladder control.
C) placing the arm tightly in a sling to prevent injury.
D) progression to a generalized seizure.

Question 47

An 86-year-old male has had a sudden change in mental status and is repeatedly striking a fist against his leg. When you question him, he does not respond. This presentation is most consistent with what condition?

A) Seizure
B) Dementia
C) Stroke
D) Delirium

Question 48

The EMT would recognize that a 49-year-old male has suffered a primary seizure when his wife states:

A) "He has never had a seizure before, this is the first seizure."
B) "He had seizures in the past, but they are not sure what causes them."
C) "The doctors said that his seizure come from one spot in his brain."
D) "His arms and legs were jerking and he would not talk to me."

Question 49

A young male with a seizure history is postictal in his bed. His airway is patent, breathing labored and forced, and radial pulse strong and fast. Vital signs are pulse 140, respirations 20, blood pressure 158/92 mmHg, and SpO₂ 96% on room air. At this time, what action would be most appropriate?

A) Provide high-concentration oxygen.
B) Insert an oropharyngeal airway.
C) Start positive pressure ventilation.
D) Place in a side-lying position.

Question 50

It is important that the EMT recognize that a complex partial (psychomotor) seizure can easily be mistaken for a(n):

A) asthma exacerbation.
B) left-sided stroke.
C) absence (petit mal) seizure.
D) alcohol intoxication.

Question 51

A 72-year-old male with a history of depressed thyroid function and a brain tumor is suffering a psychomotor seizure. As you enter the room, you find him to be standing up and walking in a circle. He is awake but does not respond to your questions. Family members state that he has had three similar episodes over the past six months, which his physician diagnosed as complex partial seizures. Vital signs are pulse 112, respirations 16, blood pressure 166/68, and SpO₂ at 98%. Which one of the following actions would be most appropriate in the care of this patient?

A) Determine if a durable power of attorney exits.
B) Restrain the patient and apply high-concentration oxygen.
C) Proceed with a nonemergency transport.
D) Insert a nasopharyngeal airway to ensure airway patency.

Question 52

You have been called to an alcoholic rehabilitation center for a 56-year-old male patient whose left arm suddenly began to shake uncontrollably. He is alert and oriented, and he is terrified that he cannot stop his arm from moving. What type of seizure should you suspect?

A) Complex partial
B) Generalized
C) Simple partial
D) Psychomotor

Question 53

A 36-year-old diabetic male with hypertension has suffered a secondary seizure. The patient responds to verbal stimuli with garbled speech and his airway, breathing, and circulation are intact. Vital signs are: pulse 128, respirations 20 and adequate, blood pressure 158/96 mmHg, and SpO₂ 97% on room air. At this time, it is important that the EMT:

A) administer oral glucose.
B) position the patient supine on the stretcher and transport.
C) check the patient's blood sugar.
D) administer high-concentration oxygen.

Question 54

When treating a patient who has had a seizure, the most important aspect of providing care is to:

A) ensure that the patient does not bite his or her tongue.
B) identify the type and duration of seizure, as well as a history of seizures.
C) provide high-concentration oxygen to ensure adequate oxygenation of the brain.
D) assess for and manage any life-threatening condition found.

Question 55

The EMT would recognize a focal motor seizure when she observes:

A) jerky muscular activity of a single extremity.
B) repetitive actions like lip smacking or finger rolling.
C) blank staring which begins and ends abruptly.
D) abrupt personality changes including fits of rage.

Question 56

You have been called for a 71-year-old male with seizure activity. At the patient's side, you find him lying motionless on the floor of his bedroom with a family member performing chest compression only CPR. In this situation, your immediate action would be to:

A) open the airway and begin positive pressure ventilation.
B) stop CPR and feel for a carotid pulse.
C) take over CPR and attach the automated external defibrillator.
D) continue CPR and call for advanced life support assistance.

Question 57

Regarding a generalized tonic-clonic (grand mal) seizure, which statement is true regarding the different stages?

A) The aura comes before a loss of consciousness.
B) The patient is postictal prior to convulsion activity.
C) A loss of consciousness occurs after the clonic (convulsion) phase.
D) The patient becomes postictal just before the hypertonic phase.