Active Learning Multiple Choice

Question 1

A 9-year-old child is having learning difficulties at school. He has brief lapses of awareness with eyelid fluttering that occur every 5-10 minutes. EEG studies reveal brief 3-Hz spike and wave discharges appearing synchronously in all leads. Which drug would be effective for this child without the disadvantages of excessive sedation or tolerance development?

Answer 1

Ethosuximide—most benefit and least negative side effect

Question 2

Why when treating a patient with Phenytoin who is not responding to treatment, would you want to switch meds rather than keep upping the dose?

Answer 2

Zero order kinetics
Increasing the dose doesn’t lead to improvement, just increases risk of side effects. This drug DOES NOT work for this patient. Stop it and use something else. WILL BE ON TEST.
PHENYTOIN HAS ZERO ORDER.

Question 3

A 24-year-old man is started on carbamazepine for management of seizures characterized by tonic rigidity of the extremities followed in 15-30 seconds by tremor progressing to massive jerking of his body lasting 1-2 minutes. Based on the mechanism of action for this drug, what is the reason it is effective in management of seizures?

Answer 3

Decreases axonal conduction and synaptic transmission

(We are talking about a Jacksonian March Seizure. Caramezepine blocks Na channels and inhibits high frequency repetitive firing.)

Question 4

A 17-year-old has recurrent episodes characterized by abnormal taste and olfactory hallucinations, lip smacking, sense of epigastric fullness, and nausea that generally resolve over seconds. Today he experienced a similar sensation that was followed by transient loss of consciousness, without other symptoms. After about 1 minute he awoke and seemed confused. What is the most appropriate classification for today’s seizure?

Answer 4

Focal, complex

Focal (can point to specific symptom)

Complex- (loss of consciousness)

Question 5

At the end of a long day, your sleep-deprived professor experiences repeated episodes of staring into space associated with transient inattention and altered consciousness. You suspect absence seizures. Which of the following is required for seizures to occur?

1. Absence of sustained neuronal depolarization
2. Asynchronous neuronal firing
3. Decreased GLUtaminergic activity
4. Increased GABAnergic activity
5. Pathologically excitable neurons

Answer 5

5. Pathologically excitable neurons