Infections, Tumors, and Other Neurologic Conditions Practice Questions

30 multiple-choice questions on Infections, tumors, and other neurologic conditions for paramedic and EMT students, from Chapter 19 (Neurologic Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. Over a year, a 52-year-old has slowly lost hearing in his left ear, with ringing and mild unsteadiness. Now the left side of his face feels numb. What is the most likely cause?

   1. A. Earwax blocking the ear canal
   2. B. Meniere disease of the inner ear
   3. C. Benign paroxysmal positional vertigo
   4. D. A benign tumor on the hearing nerve
   Show answer

   Answer: D. A benign tumor on the hearing nerve

   An acoustic neuroma (vestibular schwannoma) is a slow-growing benign tumor of the eighth cranial nerve. It causes gradual one-sided hearing loss, tinnitus and imbalance, and as it grows it can press on the trigeminal nerve and cause facial numbness. Earwax causes hearing loss without facial numbness, Meniere disease causes episodic vertigo attacks with fluctuating hearing, and positional vertigo causes brief spinning with head movement.

2. Three weeks after recovering from carbon monoxide poisoning, a 50-year-old has new memory problems, apathy and a slow, shuffling gait. What is the most likely explanation?

   1. A. A new viral encephalitis
   2. B. The expected normal recovery
   3. C. Early Alzheimer disease
   4. D. Delayed brain injury from CO
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   Answer: D. Delayed brain injury from CO

   Some survivors of significant carbon monoxide poisoning develop delayed neurologic problems days to weeks after an apparent recovery, including memory loss, personality change and parkinsonism. This is one reason severe exposures may be treated with hyperbaric oxygen. Encephalitis would cause fever and acute illness, these symptoms are not part of normal recovery, and Alzheimer disease develops over years rather than weeks.

3. A week after a cold, a 4-year-old suddenly cannot lift his right arm, which is floppy with no reflexes. He is alert and his face is normal. What should you suspect?

   1. A. A left hemisphere stroke
   2. B. A pulled elbow (nursemaid's)
   3. C. Acute flaccid myelitis
   4. D. Simple muscle strain
   Show answer

   Answer: C. Acute flaccid myelitis

   Acute flaccid myelitis is a rare spinal cord illness of the gray matter, usually in children after a viral illness. It causes sudden floppy weakness of one or more limbs with lost reflexes and can spread to the breathing muscles, so monitor breathing closely. A stroke usually affects the face and causes increased reflexes later, a pulled elbow causes pain and refusal to use the arm with normal reflexes, and a muscle strain does not remove reflexes.

4. While lying supine, a patient's neck flexion causes his hips and knees to flex. This finding is called:

   1. A. Kernig sign
   2. B. Brudzinski sign
   3. C. Babinski sign
   4. D. Positive Romberg
   Show answer

   Answer: B. Brudzinski sign

   Brudzinski sign is involuntary hip and knee flexion with passive neck flexion and suggests meningeal irritation.

5. A 22-year-old who inhales nitrous oxide from whipped-cream chargers every day has tingling feet, unsteady walking in the dark and an electric sensation down his back when he bends his neck. What is the most likely cause?

   1. A. Guillain-Barre syndrome after a virus
   2. B. A small cerebellar stroke
   3. C. Anxiety from drug use
   4. D. B12-related spinal cord damage
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   Answer: D. B12-related spinal cord damage

   Nitrous oxide inactivates vitamin B12, which the spinal cord needs to maintain myelin. Heavy use damages the dorsal columns, causing numbness, poor position sense (worse in the dark) and an electric sensation down the spine on neck flexion (Lhermitte sign). Guillain-Barre causes ascending weakness with lost reflexes, a cerebellar stroke is sudden, and anxiety does not cause these objective findings.

6. A 3-month-old's head has grown much faster than expected. The fontanelle is tense, and his eyes look downward with white showing above the iris. He vomits often. What should you suspect?

   1. A. Normal infant head growth
   2. B. Dehydration from frequent vomiting
   3. C. Hydrocephalus (excess CSF)
   4. D. Colic with trapped gas pains
   Show answer

   Answer: C. Hydrocephalus (excess CSF)

   In infants, a buildup of CSF (hydrocephalus) enlarges the head because the skull bones have not fused. Signs include rapid head growth, a tense or bulging fontanelle, downward-deviated 'sunset' eyes, vomiting and irritability. Normal growth does not cause these signs, dehydration causes a sunken rather than tense fontanelle, and colic does not cause eye or fontanelle changes.

7. Which mosquito-borne virus is a common cause of encephalitis in the United States?

   1. A. Dengue virus
   2. B. Zika virus
   3. C. Chikungunya virus
   4. D. West Nile virus
   Show answer

   Answer: D. West Nile virus

   West Nile virus is the leading cause of mosquito-borne encephalitis in the US and is most severe in older adults. Dengue, Zika and chikungunya are also spread by mosquitoes, but they are mostly acquired in tropical regions, cause fever, rash, joint pain or birth defects, and rarely cause encephalitis in the US.

8. A man was bitten on the hand by a coral snake 30 minutes ago. He has little pain or swelling and feels fine. Why does he still need transport and observation?

   1. A. Paralysis may begin hours later
   2. B. Severe tissue death is expected
   3. C. A bleeding disorder usually follows
   4. D. The main risk is an allergic reaction
   Show answer

   Answer: A. Paralysis may begin hours later

   Coral snake venom is mainly neurotoxic. Bites often cause little local pain or swelling, yet weakness, drooping eyelids, double vision, trouble swallowing and respiratory failure can appear many hours later, so antivenom and observation are needed. Severe local tissue damage and bleeding problems are typical of pit viper bites, and an allergic reaction is not the main risk.

9. Infant botulism has been associated with feeding:

   1. A. Honey
   2. B. Rice cereal
   3. C. Breast milk
   4. D. Apple juice
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   Answer: A. Honey

   Honey may contain Clostridium botulinum spores; infants under 1 year should not be given honey.

10. A patient with a puncture wound 10 days ago has jaw stiffness and painful muscle spasms. You should suspect:

    1. A. Rabies
    2. B. Botulism
    3. C. Bell palsy
    4. D. Tetanus
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    Answer: D. Tetanus

    Tetanus toxin blocks inhibitory neurotransmission, causing trismus (lockjaw), muscle rigidity, and spasms triggered by stimulation.

11. A man was bitten by a bat weeks ago and now has agitation, fear of water, and hypersalivation. Which disease is suspected?

    1. A. Tetanus
    2. B. Botulism
    3. C. Rabies
    4. D. Lyme disease
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    Answer: C. Rabies

    Rabies causes encephalitis with agitation, hydrophobia, and autonomic signs and is almost always fatal once symptomatic, so post-exposure prophylaxis after bites is essential.

12. An IV drug user has fever, severe back pain, and new leg weakness. Which emergency should be suspected?

    1. A. Lumbar muscle strain
    2. B. Spinal epidural abscess
    3. C. Obstructing kidney stone
    4. D. Herniated disk only
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    Answer: B. Spinal epidural abscess

    Fever, back pain, and neurologic deficits in a patient with IV drug use, diabetes, or recent spinal procedure suggest an epidural abscess that can compress the cord.

13. A patient with a brain abscess most commonly has which history?

    1. A. A nearby or blood infection
    2. B. A recent mild bump to the head
    3. C. A recent viral cold
    4. D. A routine dental cleaning
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    Answer: A. A nearby or blood infection

    Brain abscesses usually arise from spread of sinus, ear, or dental infection, endocarditis, or penetrating trauma, presenting with headache, fever, and focal signs. A minor head bump without a penetrating wound and an ordinary viral cold do not seed the brain with bacteria, and a routine dental cleaning is a rare source compared with an untreated dental infection.

14. A 50-year-old with no history of seizures has a first seizure and has had morning headaches for weeks. Which cause should be considered?

    1. A. Febrile seizure
    2. B. Simple migraine
    3. C. Alcohol withdrawal
    4. D. Brain tumor
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    Answer: D. Brain tumor

    New-onset seizures in adults with progressive headaches suggest a structural lesion such as a primary or metastatic brain tumor.

15. Which symptom pattern is typical of a slowly growing brain tumor?

    1. A. Sudden maximal headache
    2. B. Brief deficit lasting minutes
    3. C. Progressive deficits over weeks
    4. D. Rapid recovery without treatment
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    Answer: C. Progressive deficits over weeks

    Tumors usually cause gradually progressive headache, personality change, seizures, or focal deficits, unlike the abrupt onset of stroke.

16. A patient with known lung cancer has new back pain and progressive leg weakness. You should suspect:

    1. A. Simple lumbar strain
    2. B. Metastatic cord compression
    3. C. Peripheral neuropathy
    4. D. Guillain-Barré syndrome
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    Answer: B. Metastatic cord compression

    Metastatic spinal cord compression is an oncologic emergency; early recognition preserves function. Back pain often precedes weakness and bladder dysfunction.

17. A 60-year-old has a drooping right face that includes the forehead, severe right ear pain and small blisters in the right ear canal. What is the most likely diagnosis?

    1. A. A left hemisphere stroke
    2. B. Ramsay Hunt syndrome
    3. C. Simple Bell palsy
    4. D. Trigeminal neuralgia
    Show answer

    Answer: B. Ramsay Hunt syndrome

    Ramsay Hunt syndrome is reactivation of the varicella-zoster virus in the facial nerve, causing facial palsy with ear pain and blisters in or around the ear, sometimes with hearing loss or vertigo. Early antiviral treatment matters. A stroke usually spares the forehead, Bell palsy has no ear blisters, and trigeminal neuralgia causes brief electric facial pain without weakness.

18. A child with a ventriculoperitoneal shunt has headache, vomiting, and lethargy. You should suspect:

    1. A. Shunt malfunction
    2. B. Viral gastroenteritis
    3. C. Migraine headache
    4. D. Dehydration from vomiting
    Show answer

    Answer: A. Shunt malfunction

    VP shunt obstruction or infection causes increased ICP with headache, vomiting, irritability, and lethargy and requires urgent neurosurgical evaluation. Vomiting can dehydrate a child, but dehydration does not explain headache and lethargy from raised pressure in a child with a shunt.

19. A patient with a spinal cord injury at T4 has a pounding headache, BP of 210/120 mm Hg, and flushing above the injury. The first action is to:

    1. A. Give a 1-liter fluid bolus
    2. B. Lay him completely flat
    3. C. Find and remove the trigger
    4. D. Give IV atropine 1 mg
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    Answer: C. Find and remove the trigger

    Autonomic dysreflexia is triggered by stimuli below the injury such as a full bladder, kinked catheter, or tight clothing. Sit the patient up and remove the cause.

20. Which condition causes rapidly progressive dementia with myoclonus and is caused by prions?

    1. A. Early Alzheimer disease
    2. B. Creutzfeldt-Jakob disease
    3. C. Huntington disease
    4. D. Multi-infarct dementia
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    Answer: B. Creutzfeldt-Jakob disease

    Creutzfeldt-Jakob disease is a fatal prion disease with rapid cognitive decline over months and myoclonic jerks.

21. A hiker has bilateral facial weakness weeks after a tick bite with a target-shaped rash. Which infection is most likely?

    1. A. Lyme disease
    2. B. Rabies
    3. C. Tetanus
    4. D. Food botulism
    Show answer

    Answer: A. Lyme disease

    Lyme disease can cause facial nerve palsy, sometimes bilateral, as well as meningitis and radiculopathy.

22. A patient has severe spinning vertigo with nausea when turning his head in bed, with no other neurologic deficits. The most likely cause is:

    1. A. Cerebellar stroke
    2. B. Acoustic brain tumor
    3. C. Bacterial meningitis
    4. D. Benign positional vertigo
    Show answer

    Answer: D. Benign positional vertigo

    Brief positional vertigo with a normal neurologic exam suggests BPPV. Persistent vertigo with ataxia, diplopia, or dysarthria suggests a posterior circulation stroke.

23. Two weeks after chickenpox, a 3-year-old suddenly walks with a wide, staggering gait and has shaky hands. She is alert, playful and has no fever. What is the most likely cause?

    1. A. A complex febrile seizure
    2. B. Bacterial meningitis
    3. C. Acute cerebellar ataxia
    4. D. Guillain-Barre syndrome
    Show answer

    Answer: C. Acute cerebellar ataxia

    Acute cerebellar ataxia is a post-infectious inflammation of the cerebellum, classically after chickenpox or another viral illness in young children. It causes sudden unsteady gait and tremor with normal alertness and usually resolves over weeks. Toxic ingestion and a posterior fossa lesion still need to be excluded. A febrile seizure causes convulsions, meningitis causes fever and lethargy, and Guillain-Barre causes weakness with lost reflexes rather than ataxia with a normal exam.

24. A young adult raised in a region where pork tapeworm is common has new seizures; imaging shows cystic brain lesions. The likely cause is:

    1. A. Lyme neuroborreliosis
    2. B. Neurocysticercosis
    3. C. Tetanus infection
    4. D. West Nile virus
    Show answer

    Answer: B. Neurocysticercosis

    Neurocysticercosis, from pork tapeworm larvae, is a leading cause of acquired epilepsy worldwide.

25. After lifting a heavy box, a 40-year-old has low back pain that shoots down the back of his left leg below the knee. He has normal bladder control and no numbness in the groin. What is the most likely cause?

    1. A. Early cauda equina syndrome
    2. B. A deep vein thrombosis in the calf
    3. C. Irritation of a lumbar nerve root
    4. D. A ruptured aortic aneurysm
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    Answer: C. Irritation of a lumbar nerve root

    Pain radiating down the back of the leg below the knee (sciatica) after lifting suggests a herniated lumbar disc irritating a nerve root. Without bladder problems, saddle numbness or progressive weakness, it is usually managed without emergency surgery. Cauda equina syndrome causes saddle numbness and urinary retention, a deep vein thrombosis causes calf swelling, and a ruptured aneurysm causes hypotension and abdominal or back pain in an older patient.

26. Six weeks after a stray dog bit him abroad, a man who did not receive any vaccines now has fever and tingling and itching at the healed bite site. What should you suspect?

    1. A. Normal scar healing
    2. B. A wound infection
    3. C. Early rabies
    4. D. Early tetanus
    Show answer

    Answer: C. Early rabies

    Rabies has an incubation period of weeks to months. Its first symptoms are often fever with pain, tingling or itching at the healed bite site, followed by agitation, fear of water and paralysis. Once symptoms begin it is almost always fatal, which is why vaccination after a bite matters. Normal healing does not cause fever, a wound infection causes redness and pus, and tetanus causes jaw stiffness and muscle spasms.

27. For a patient with suspected herniation who is intubated, many protocols call for brief hyperventilation targeting an ETCO2 of about:

    1. A. 15 to 20 mm Hg
    2. B. 45 to 50 mm Hg
    3. C. 30 to 35 mm Hg
    4. D. 50 to 55 mm Hg
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    Answer: C. 30 to 35 mm Hg

    Mild hyperventilation to an ETCO2 of about 30 to 35 mm Hg is reserved for signs of herniation; excessive hyperventilation causes cerebral vasoconstriction and ischemia.

28. Which statement about steroids and brain tumors is most accurate?

    1. A. They cure most tumors
    2. B. They prevent tumor seizures
    3. C. They raise ICP
    4. D. They reduce tumor edema
    Show answer

    Answer: D. They reduce tumor edema

    Corticosteroids such as dexamethasone reduce vasogenic edema around tumors, often improving headache and deficits. They do not cure tumors, they are not antiseizure drugs, and by reducing edema they lower rather than raise intracranial pressure.

29. A patient had a sudden, painless loss of vision in one eye, like 'a curtain coming down,' that cleared after about 5 minutes. This may represent:

    1. A. Amaurosis fugax
    2. B. A migraine aura
    3. C. Bell palsy
    4. D. Trigeminal neuralgia
    Show answer

    Answer: A. Amaurosis fugax

    Transient monocular vision loss from retinal ischemia (amaurosis fugax) is a TIA equivalent, often from carotid disease, and needs urgent stroke evaluation. A migraine aura usually affects both eyes' visual fields with spreading zigzag lights, Bell palsy affects facial movement, and trigeminal neuralgia causes facial pain, not vision loss.

30. Bacterial meningitis is time-sensitive because:

    1. A. It usually resolves on its own
    2. B. Antibiotic delay raises mortality
    3. C. Field steroids can cure it
    4. D. It is much less dangerous in adults
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    Answer: B. Antibiotic delay raises mortality

    Bacterial meningitis can progress to shock and death within hours, and each hour of delay in antibiotics worsens outcomes, so rapid transport and early notification matter. It does not resolve on its own, steroids are an adjunct given in the hospital with antibiotics and do not cure it, and it is dangerous at every age.