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9 free EMT practice questions: Neurological Emergencies

These are real questions from the same bank the app draws from. Each one is written to the NREMT EMT content specifications and kept inside the EMT scope of practice. Pick an answer and you get the full rationale, including why the other three options are wrong.

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Question 1 of 9

A 44-year-old patient is found sitting on a bathroom floor with a severe headache and repeated vomiting. The patient keeps both eyes closed against the hallway light, pulls away when the EMT gently brings the chin toward the chest, and is drowsy but follows simple commands. The vital signs are BP 148/88 mmHg, P 96/min, R 18/min, and SpO₂ 98% on room air. The EMT has not yet taken a temperature and cannot tell whether this is meningitis or bleeding inside the skull. Which history question would best help separate the two?

Show the answer and rationale

Correct answer · Whether the patient had chills and aching joints before the headache

Asking about chills and aching joints is going to separate meningitis from a bleed. This patient has a severe headache, vomiting, light sensitivity, a neck that resists the chin moving down, and drowsiness. Meningitis and bleeding inside the skull can each cause every one of those findings. You need a finding that only one of the two has. A bleed causes a severe headache, vomiting, and a falling level of consciousness, because the pressure inside the skull is rising. Chills and aching joints are not part of a bleed. Chills and joint pain are on the meningitis list, right next to fever. They come from an infection in the whole body, not from pressure in the skull. A yes to chills and aching joints points you to meningitis.

Why the others are wrong

Whether the patient felt nauseated once the headache began: Nausea is on the meningitis list. Nausea also happens with a bleed when the pressure inside the skull rises. This patient is already vomiting, so a yes or a no about nausea does not help separate the two.

Whether the patient has become more drowsy since waking: Getting more drowsy tells you how serious this is, and this patient is seriously ill. An altered mental status is on the meningitis list. A bleed can raise the pressure fast enough to cause drowsiness too. The question asks which condition this is, not how sick the patient is.

Whether the patient has kept fluids down since the vomiting began: Keeping fluids down matters for a stomach illness and for hydration. Vomiting is on the meningitis list and is part of a bleed too. Whether fluids stayed down tells you about hydration, not about which of the two this is.

Question 2 of 9

A 45-year-old patient is standing in a checkout line when they suddenly feel lightheaded, nauseated, and describe tunnel vision just before witnesses see them slump to the floor. The patient regains consciousness within seconds of being placed supine and is immediately alert, oriented, and asking what happened. There is no incontinence and no tongue trauma noted. The vital signs are BP 108/64 mmHg, P 58/min, R 16/min, SpO₂ 98% on room air, and a blood glucose level of 94 mg/dL. What is the most likely differential diagnosis for this presentation?

Show the answer and rationale

Correct answer · Syncope

This patient had syncope, which is fainting. The patient is fully alert and oriented within seconds of being laid flat. Syncope is a short drop in blood flow to the brain. Lying flat brings the blood flow back, and the patient wakes up with no confusion left over. The patient also had the warning signs first, with lightheadedness, nausea, and tunnel vision. A seizure would leave the patient confused for several minutes, and this patient woke up alert and oriented. This patient does not need airway protection for a long period of altered mental status.

Why the others are wrong

Seizure: A seizure would come with little or no warning, jerking movements, and several minutes of postictal confusion before the patient is back to normal. This patient had the warning signs of a vasovagal faint and was oriented right after lying flat. The slow recovery of a seizure is missing.

Hypoglycemia: The patient cleared up once supine without any glucose, and the blood glucose level is 94 mg/dL, which is normal. Hypoglycemia causes altered mental status and sweating with a low reading that only gets better after you give glucose.

Cardiac arrest: a patient who is unresponsive with no pulse and no normal breathing. Cardiac arrest needs CPR and an AED right away. This patient has a pulse of 58, is breathing normally, and woke up within seconds.

Question 3 of 9

An EMT asks a 68-year-old patient with sudden weakness to smile and show the teeth. Which part of the stroke screen is the EMT checking?

Show the answer and rationale

Correct answer · Facial droop

Asking the patient to smile checks the Face in F.A.S.T. When the patient smiles, a facial droop shows as one side of the mouth drooping or not lifting. Each part of F.A.S.T. has its own check. The patient smiles for the face, holds both arms out with the eyes closed for arm drift, and repeats a simple sentence for speech. For time, the EMT finds out when the patient was last known well. That's why a request to smile means the EMT is checking for facial droop.

Why the others are wrong

Speech clarity: Speech is checked by having the patient repeat a simple sentence and listening for slurring or wrong words. A smile uses the face but no words, so it tells the EMT nothing about speech.

Arm drift: checked with a different request. The patient holds both arms out with the eyes closed, and the EMT watches for one arm drifting down. A smile moves only the face, so it cannot show arm drift.

Time last known well: the T in F.A.S.T., and it is a history question rather than a physical test. The EMT gets it by finding out when the patient was last known well, so no request like a smile can show it.

Question 4 of 9

An EMT responds to a patient who has just completed a generalized tonic-clonic seizure and is now post-ictal. The patient is confused and drowsy but breathing spontaneously at 18 breaths per minute with clear air exchange. The airway is clear of secretions. What is the appropriate immediate management?

Show the answer and rationale

Correct answer · Place the patient in the recovery position and monitor airway, breathing, and circulation

This patient is post-ictal, the confused and drowsy period after a seizure. The patient is breathing on their own at 18 a minute with clear air exchange, and the airway is clear right now. A confused, drowsy patient may not clear secretions or vomit on their own. Roll the patient onto the side, into the recovery position. On the side, secretions and vomit drain out of the mouth instead of into the airway. Suction as needed. Keep monitoring the airway, breathing, and circulation while the confusion clears.

Why the others are wrong

Restrain the patient's limbs to prevent recurrence of seizure activity: Holding the limbs down is not done even while a seizure is still going. During an active seizure, you move things out of the way and pad what you can. Trying to hold the patient still can injure the patient, and force does not stop a seizure. This patient's seizure has already ended.

Immediately obtain IV access and prepare to administer seizure-prevention medication: This patient had one seizure, and the seizure has ended, so there is nothing for seizure medication to treat. Seizure medication is for status epilepticus, a prolonged seizure or seizures that repeat without the patient returning to baseline mental status in between. IV access and seizure medication are also outside EMT scope. For status epilepticus, you call for ALS and transport.

Keep the patient upright and alert by engaging them in conversation during transport: Confused and drowsy after a seizure, this patient may not clear secretions or vomit. Upright, secretions and vomit cannot drain out of the mouth the way they do in the recovery position.

Question 5 of 9

A 55-year-old patient is found seated in a chair at home by family members. Bystanders report the patient stood up from dinner, then suddenly collapsed into the chair. When the EMT arrives 2 minutes later, the patient is alert, oriented, and able to recall the entire event. Vital signs are BP 124/78 mmHg, P 88/min (regular), R 16/min, and SpO₂ 98% on room air. The patient denies chest pain, difficulty breathing, or weakness and has no focal neurological deficits. The patient reports feeling lightheaded for a moment and then 'waking up' in the chair. Which of the following is the most appropriate assessment of this episode?

Show the answer and rationale

Correct answer · The patient had a brief syncopal episode with rapid recovery; transport for evaluation

This patient had a syncopal episode, which means fainting. The patient stood up from dinner, felt lightheaded, and collapsed into the chair. Two minutes later the patient is alert, oriented, and remembers the whole event. The vital signs are normal and there are no focal neurological deficits. Standing up caused a quick drop in blood flow to the brain. The patient passed out, and blood flow came back once the patient was sitting. Fainting can be the only sign of a hidden heart rhythm problem or another serious cause, even when the exam looks normal. That is why this patient still needs transport for evaluation.

Why the others are wrong

The patient is experiencing a stroke requiring immediate neurological assessment: A stroke shows up as a focal deficit, like weakness on one side, a facial droop, or slurred speech. Those deficits stay, and they need a stroke scale and fast transport. This patient has no focal neurological deficits and remembers the whole event. Those findings point away from a stroke.

The patient is having a seizure and must be protected from further injury and given oxygen: A seizure is shaking followed by a postictal period. A postictal patient is confused, cannot remember the event, and is slow to get back to normal. Some also lose bladder control or bite the tongue. This patient remembers the entire episode and was alert and oriented right away. A patient who is alert right away is not postictal. Protecting the patient and giving oxygen are right for a seizure, and this was not a seizure.

The patient is in cardiac arrest and requires CPR immediately: Cardiac arrest means no pulse, no breathing, and no response, and that patient needs CPR right away. This patient is alert, oriented, and talking. The pulse is 88 and regular, respirations are 16, and the SpO₂ is 98%. A patient who is talking to you is not in cardiac arrest.

Question 6 of 9

A 72-year-old patient is found unresponsive by family members. Vital signs are BP 168/94 mmHg, P 54/min, and respirations irregular and slow at 12/min. The patient's pupils are equal and reactive, but the patient does not move spontaneously and does not respond to verbal stimuli. When the EMT applies a painful stimulus, the patient extends both arms and legs rigidly. What do these findings indicate?

Show the answer and rationale

Correct answer · Decerebrate posturing indicates severe brainstem dysfunction and rising ICP

This patient has decerebrate posturing from rising pressure inside the skull. When you apply a painful stimulus, both arms and legs extend out stiff. Decerebrate posturing points to a problem in the midbrain and upper brainstem. The vital signs show Cushing's triad. The blood pressure is high at 168/94, the pulse is slow at 54, and the breathing is slow and irregular at 12 a minute. Rising intracranial pressure (ICP) is squeezing the brainstem, and the brain is starting to herniate. Take control of the airway and support the breathing. Good ventilation keeps carbon dioxide from building up in the blood. Transport rapidly to a hospital that has neurosurgery.

Why the others are wrong

The patient is in a light level of coma and will likely recover consciousness soon: Reactive pupils in a patient who is only unresponsive can look like a milder problem that will clear up on its own. Decerebrate posturing to pain means a deep coma, not a light one. The Cushing's triad of 168/94, a pulse of 54, and irregular breathing at 12 shows a brainstem under more and more pressure. A brainstem under rising pressure does not clear up on its own.

The patient is in cardiac arrest and requires immediate CPR: A slow pulse in a patient who does not respond can look like cardiac arrest is close. This patient has a pulse of 54 and is breathing on their own at 12 a minute, even if the breathing is irregular. CPR is not indicated. A slow pulse with a high blood pressure points to rising pressure in the skull causing a Cushing's response, not a heart that has stopped.

The patient is having a tonic-clonic seizure and requires airway protection: Stiff, straight arms and legs can look like the rigid part of a seizure. A tonic-clonic seizure brings rhythmic, alternating jerking of the limbs. Seizure activity does not hold the limbs stiff and straight only when you apply pain. This patient's posturing is a fixed response to pain, which is decerebrate posturing.

Question 7 of 9

A 44-year-old patient with a history of migraines reports acute onset of right-sided weakness and visual disturbance 15 minutes ago. The patient reports experiencing a similar visual disturbance (shimmering lights at the edge of vision, lasting 20 minutes) about 20 minutes before the weakness began, which is typical for the patient's migraine aura. On examination, the EMT finds the right arm is weak (4/5 strength), but speech is normal and the patient is alert and oriented. The patient has had this exact pattern with migraines at least five times in the past 2 years, always with complete recovery. Vital signs are stable. Which of the following is the most appropriate EMT action?

Show the answer and rationale

Correct answer · Recognize this may be the patient's migraine with aura, but transport urgently because acute stroke must be ruled out

This may be the patient's usual migraine with aura, but you have to treat the weakness as a possible acute stroke. A migraine with aura can cause short-lived focal deficits, like the right arm weakness here, that look just like a stroke. The patient has had this same pattern at least five times and always recovered. An EMT still cannot rule out an acute stroke in the field, no matter how similar the past episodes were. Transport urgently so the hospital can evaluate for a stroke.

Why the others are wrong

Recognize this as the patient's typical migraine with aura, given prior episodes with full recovery; reassure the patient and allow rest at home: Letting the patient rest at home leans completely on the past pattern. You cannot confirm the same thing is happening this time. An EMT cannot rule out an acute stroke in the field, even with a history of the same episodes.

This presentation is definitely a stroke; immobilize for spinal precautions and transport for emergency imaging: Spinal motion restriction is for a patient with an injury mechanism that calls for it. Nothing in this question describes an injury. B also calls this definitely a stroke. A migraine with aura can look just like a stroke, so you cannot call it definite in the field.

Diagnose this as a migraine aura and administer oxygen to reverse the neurological deficits: Oxygen treats neither a migraine aura nor a stroke, so oxygen will not reverse the right arm weakness or the visual disturbance. Giving oxygen is also no substitute for urgent transport and a hospital evaluation.

Question 8 of 9

A 41-year-old patient has an altered mental status. Bystanders report the patient was confused and stumbling before collapsing. The vital signs are BP 88/56 mmHg, P 104/min, R 12/min and shallow, and SpO₂ 88% on room air. The patient is unresponsive to verbal stimulus but grimaces to pain. The history indicates type 2 diabetes treated with metformin. The blood glucose level is 52 mg/dL. What is the most appropriate immediate action?

Show the answer and rationale

Correct answer · Withhold oral glucose, insert a nasopharyngeal airway, assist ventilations with a BVM and oxygen, and transport rapidly

This patient has hypoglycemia with a level of consciousness too low to protect the airway, and the breathing is not adequate. The glucose is 52 mg/dL. The patient does not respond to voice and only grimaces to pain. At this level of consciousness, you cannot trust the patient to swallow or protect the airway. Anything you put in the mouth, glucose included, can block the airway or be aspirated. That's why you hold the oral glucose. The respirations are 12/min, which is a normal rate, but each breath is shallow. Shallow breaths do not move enough air, and the SpO2 of 88% shows it. Breathing that shallow needs assisted ventilations, not just oxygen. A patient who still grimaces to pain may still have a gag reflex, so a nasal airway is the adjunct to use. Assist ventilations with a BVM and oxygen, and transport fast. A higher level of care can then give IV dextrose.

Why the others are wrong

Administer 15 g of oral glucose gel and monitor for response: A glucose of 52 mg/dL is true hypoglycemia. Oral glucose gel is the standard EMT treatment when the patient is awake enough to swallow and handle secretions. This patient does not respond to voice and only grimaces to pain, so you cannot trust the airway. Gel in this patient's mouth risks aspiration instead of fixing the low sugar.

Attempt to have the patient swallow glucose tablets with water and recheck glucose in 5 minutes: Glucose tablets with water are for a patient alert enough to chew and swallow safely. This patient responds only to pain, so tablets and water can be aspirated. Waiting 5 minutes to recheck also delays care for breathing that is already too shallow.

Administer 25 mL of 50% dextrose intravenously and establish an intravenous line: IV dextrose, 25 mL of 50%, is the definitive fix for hypoglycemia. IV dextrose is an AEMT and paramedic intervention, and starting an IV is outside EMT scope. As the EMT, your job here is the airway, the breathing, and fast transport.

Question 9 of 9

A 67-year-old patient has sudden onset right facial droop, slurred speech, and right-sided weakness that started 45 minutes ago. The EMT recognizes a possible acute stroke. A family member says, "Please take us to General Hospital. That's where our family doctor is." The nearest hospital, Central Medical, is 10 minutes away and has a certified stroke center. General Hospital is 25 minutes away and does not have stroke capability. What is the appropriate transport decision?

Show the answer and rationale

Correct answer · Transport to Central Medical, the stroke center, for time-critical stroke care

This patient is having an acute stroke. The right facial droop, the slurred speech, and the right-sided weakness started 45 minutes ago. Part of the brain has lost its normal blood flow. You cannot tell a clot from a bleed in the field, and you do not need to. The hospital treatments for stroke only work within a limited time. If a clot is the cause, the hospital can give clot-busting medicine. That medicine has to start within hours of when the patient was last known well, up to 4.5 hours in some patients. Every minute of delay costs brain tissue. Take this patient to the closest stroke-capable hospital and call ahead so the team is ready. Central Medical is 10 minutes away and is a certified stroke center.

Why the others are wrong

Honor the family's request and transport the patient to General Hospital: General Hospital has no stroke capability, and these stroke symptoms started 45 minutes ago. The destination follows what the patient needs medically, not what the family prefers.

Transport to General Hospital; the extra 15 minutes will not change the outcome: After the 25-minute drive to General Hospital, this patient would still need a transfer to a stroke center, because General has no stroke capability at all. That transfer loses far more than 15 minutes.

Delay transport until medical direction confirms the appropriate destination facility: Central Medical, the closest hospital, is already a certified stroke center, so there is nothing for medical direction to settle. Waiting on scene for a confirmation only uses up treatment time.

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