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11. NMSP Exam 2 > Clin med 8: Seizures/Syncope > Flashcards

Clin med 8: Seizures/Syncope Flashcards

1
Q

Epilespsy is generally defined as?

A

2 or more unprovoked seizures

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2
Q

What continues to be a problem worldwide for patients with epilepsy based on longstanding stigma?

Stricter laws when compared to?

A
  • Unemployment and underemployment of these pt’s continues to be a problem
  • Driving restrictions - in most states stricter laws for pt who has had a seizure when compared to persons w/ DUI convictions!
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3
Q

Which type of seizure is nearly always picked up (90%) as a positive finding on a single EEG?

A

Petit mal (with Hyperventilation)

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4
Q

How many sleep-deprived EEG’s are necessary for positive findings in 85% of all types of epilepsy?

A

3 sleep-deprived EEG’s

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5
Q

What is the single most important piece of information alongside EEG in the diagnosis of epilepsy? (this is going to be a test Q)

A

HISTORY of the event(s) - preferably by witness

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6
Q

Where does the seizure activity begin with Partial Seizures?

A

Activity begins on one side of the brain

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7
Q

What are 3 types of Parial Seizures and how does each manifest?

A
  1. Simple partial: pt is aware (conscious)
  2. Complex partial: pt loses consciousness
  3. Secondarily generalized (partial onset): symptoms that are initially associated with a preservation of consciousness that then evolves into a loss of consciousness and convulsions
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8
Q

What parts of the brain involved with generalized seiures?

A

Both sides of the brain

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9
Q

What are the 7 types of generalized seizures?

A
  1. Absence (petit mal)
  2. Tonic-clonic (grand mal)
  3. Myoclonic
  4. Tonic
  5. Clonic
  6. Atonic
  7. Clonic-tonic-clonic
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10
Q

What is the difference between a tonic and a clonic seizure?

A
  • Tonic = Muscle stiffness, rigidity (think increased tone)
  • Clonic = Repetitive, jerking movements
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11
Q

Which type of seizure is characterized by focal motor or sensory activity, no LOC, lasting only seconds and no post-ictal state?

A

Simple partial seizure

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12
Q

What are the characteristic of a complex partial seizure (i.e., signs/symptoms, time-line, consciousness post-ictal)?

A
  • Nonresponsive staring, possible preceding aura
  • Automatisms (action performed unconsciously or involuntarily)
  • Loss of consciousness
  • Last 1-3 mins
  • Post-ictal state
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13
Q

What is a secondary generalized (partial onset) seizure (symptoms, consciousness, timeline, post-ictal)?

A
  • Starts on one side of brain and then progresses to bilateral tonic-clonic activity
  • Loss of consciousness
  • Lasts 1-3 mins
  • Post-ictal state
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14
Q

What is seen with an Absence (petit mal) seizure, how long does it last, how does the patient feel after?

A
  • Nonresponsive staring, rapid blinking, chewing, clonic hand motions
  • Loss of consciousness
  • Lasts 10-30 sec
  • No post-ictal state

*Abrupt onset and abrupt end

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15
Q

What is seen with a tonic-clonic seizure, how long does it last, and how does the patient feel afterwards?

A
  • Bilateral extension followed by symmetrical jerking of extremities
  • Loss of consciousness
  • Lasts 1-3 mins
  • Post-ictal state
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16
Q

What is seen with an Atonic seizure, duration, and how does patient feel after?

A
  • Sudden loss of muscle tone –> head drops or patient collapses
  • Loss of consciousness
  • Variable duration
  • Post-ictal state
17
Q

What is seen with a Myoclonic Seizure, duration, and how does patient feel after?

A
  • Brief, rapid symmetrical jerking of extremities and/or torso
  • Loss of consciousness
  • Lasts < few seconds
  • Minimal post-ictal state
18
Q

Which drug is used to treat Absence (petit mal) seizures, if this is the only type of seizure the person has experienced?

A

Ethosuxamide (absence only)

19
Q

Which combination of AED’s has been shown to be synergistic in treatment of epilepsy (especially for primary generalized seizures)?

A

Valproic acid and Lamotrigine

20
Q

What is Status Epilepticus?

A

Condition characterized by prolonged seizure (generally >10 minutes) or repeated seizures w/o recovery in between

21
Q

What is the general treatment for Status Epilepticus?

A
  • A, B, C’s; establish IV
  • Try to gain history; seizure previously, allergies to seizure meds
  • Labs: accucheck, CBC, chemistry panel, drug levels
  • Non-contrast CT head
  • Give benzodiazepine
22
Q

What type of imaging should be taken with Status Epilepticus?

A

Non-contrast CT head

23
Q

Which drug should be given for initial treatment of Status Epilepticus?

What is the purpose?

A
  • Benzodiazepine (i.e., lorazepam 2-4 mg IV)
  • This buys time, but must give longer lasting AED
24
Q

What are 3 general principles/considerations in the treatment of patients with epilepsy?

A
  1. Try to use monotherapy
  2. Consider drug interactions, i.e., OC’s w/ carbamazepine
  3. Consider long-term side effects, i.e., bone loss with carbamazepine or phenytoin
25
Q

All woman of child-bearing age with epilepsy should be on what?

Which drug should be avoided?

A
  • Should be on a multivitamin w/ 1 mg Folic acid; many of the AED’s are folate-depleting
  • Avoid valproic acid in pregnancy
26
Q

What is the drug of choice for a woman with epilepsy?

A

Whichever drug BEST controls her seizures (no one size fits all)

27
Q

What are common associated signs with Syncope?

A
  • Pallor
  • Sweating
  • Abnormal head sensation
  • Lightheadedness
  • Positionally related
  • Slow onset
  • Brief unconsciousness
28
Q

What are 4 common signs/symptoms seen with a seizure that are distinct from syncope?

A
  • Urinary or bowel incontinence
  • Tongue injury
  • Tonic/clonic movements
  • Post-ictal state
29
Q

What is Transient Global Amnesia?

Typical patient presentation and how long do they episodes last?

Recurrence?

A
  • Sudden, temporary, isolated episode of loss of memory (amnesia)
  • No other neurologic symptoms or signs
  • Patient knows self and close family friends, but may not recognize others
  • Usually lasts a few hours, then resolves
  • Usually doesn’t recur

11. NMSP Exam 2 (18 decks)

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