CEN Neurological Emergencies
Questions and Answers Updated
2026
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. - AnswerA. 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. - AnswerB. 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. - AnswerA. 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. - AnswerD. 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. - AnswerD. 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 - AnswerB. 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. - AnswerA. The
patient with Alzheimer's disease is likely to be more cooperative and calmer if he is accompanied by
a familiar face. The request for legal paperwork can occur at any point in the stay. An evaluation of
whether or not the patient has been abused should be based on the physical exam since this patient
is unlikely to be able to give you an accurate history.
Which of the following may cause coup-contrecoup injuries?
a. Rotational forces
b. Deformation forces
c. Deceleration forces
Questions and Answers Updated
2026
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. - AnswerA. 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. - AnswerB. 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. - AnswerA. 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. - AnswerD. 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. - AnswerD. 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 - AnswerB. 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. - AnswerA. The
patient with Alzheimer's disease is likely to be more cooperative and calmer if he is accompanied by
a familiar face. The request for legal paperwork can occur at any point in the stay. An evaluation of
whether or not the patient has been abused should be based on the physical exam since this patient
is unlikely to be able to give you an accurate history.
Which of the following may cause coup-contrecoup injuries?
a. Rotational forces
b. Deformation forces
c. Deceleration forces
