Epilepsy

Question 1

Efficacy of pharmacotherapy in the epilepsy population:
A) 30%
B) 40%
C) 70%
D) 99%
E) 15%

Answer 1

C) 70%

Question 2

NOT a characteristic of psychogenic non-epileptic seizures:
A) closed eyes
B) variable seizure duration
C) lateral tongue biting
D) variable seizure symptoms
E) paroxysmal motor phenomena

Answer 2

C) lateral tongue biting

Question 3

Oral and manual automatisms are characteristics for:
A) absence
B) complex partial seizures
C) generalized tonic-clonic seizures
D) sensomotor Jacksonian seizure
E) tetany

Answer 3

B) complex partial seizures

Question 4

Epileptic aura is:
A) an antiepileptic side effect
B) a risk factor for status epilepticus
C) always accompanied by loss of consciousness
D) the first sign of a focal seizure
E) the first sign of an absence seizure

Answer 4

D) the first sign of a focal seizure

Question 5

Antiepileptic drug with a specific indication:
A) TSH
B) L-dopa
C) acetylcholine
D) ACTH
E) digitalis

Answer 5

D) ACTH

Question 6

NOT effective in focal epilepsy:
A) carbamazepine
B) diphenylhydantoin
C) vigabatrin
D) ethosuximide
E) oxcarbazepine

Answer 6

D) ethosuximide

Question 7

First-choice drug in idiopathic generalized epilepsy:
A) valproate
B) dyphenylhydantoin
C) diazepam
D) Vitamin B6
E) carbamazepine

Answer 7

A) valproate

Question 8

NOT a characteristic of convulsive syncope:
A) open eyes
B) jerking
C) sweating
D) pallor
E) lateral tongue biting

Answer 8

E) lateral tongue biting

Question 9

In pregnant women taking antiepileptic drugs:
A) an abortion is recommended
B) 1000 mg/day Vitamin C is recommended
C) 1–5 mg/day folic acid is recommended
D) Vitamin K should be given during the whole pregnancy period
E) bed rest is recommended during the 3rd trimester

Answer 9

C) 1–5 mg/day folic acid is recommended

Question 10

Major fetal (congenital) malformations caused by antiepileptic drugs can be detected by:
A) measuring CPK level
B) Ultrasound examination
C) antinuclear antibody test
D) measuring estrogen level
E) measuring progesterone level

Answer 10

B) Ultrasound examination

Question 11

If a grand mal seizure appears during pregnancy:
A) cesarean section is indicated
B) antiepileptic drug dosage should be reduced
C) new antiepileptic drugs should be introduced in small dosage
D) measuring serum level of antiepileptic drugs is recommended the dosage should be modified accordingly
E) bed rest is recommended

Answer 11

D) measuring serum level of antiepileptic drugs is recommended the dosage should be modified accordingly

Question 12

The most frequently used type of epilepsy surgery is:
A) parietal lobectomy
B) temporal lobectomy
C) callosotomy
D) hemispherectomy
E) multiple subpial transection

Answer 12

B) temporal lobectomy

Question 13

Epileptic seizures are NOT characteristics of:
A) epilepsy
B) alcohol withdrawal
C) benzodiazepine withdrawal
D) sinus thrombosis
E) myasthenia gravis

Answer 13

E) myasthenia gravis

Question 14

NOT an antiepileptic drug:
A) moclobemide
B) clobazam
C) lamotrigine
D) gabapentin
E) levetiracetam

Answer 14

A) moclobemide

Question 15

NOT an antiepileptic drug:
A) carbamazepine
B) vigabatrin
C) valproate
D) levetiracetam
E) alprazolam

Answer 15

E) alprazolam

Question 16

Interictal EEG sign suggesting epilepsy:
A) vertex potential in sleep
B) 3 Hz spike-and-wave complex
C) 6–14 Hz positive discharges
D) none of them
E) all of them

Answer 16

B) 3 Hz spike-and-wave complex

Question 17

Side effect of valproate:
A) hair loss
B) weight gain
C) tremor
D) all of them
E) none of them

Answer 17

D) all of them

Question 18

An epileptic patient taking antiepileptic drugs:
A) is permitted to drive a car if he/she is long-term seizure free
B) is permitted to drive a car but only after withdrawal of antiepileptic drugs
C) is not permitted to drive a car
D) is permitted to drive a car but only under supervision

Answer 18

A) is permitted to drive a car if he/she is long-term seizure free

Question 19

Which seizure type can NOT appear after a traumatic brain injury?
A) generalized tonic-clonic seizure
B) absence
C) complex partial seizure
D) focal motor seizure
E) Jacksonian seizure

Answer 19

B) absence

Question 20

Which is NOT true for epilepsy?
A) diagnosis of epilepsy does not exclusively based on the EEG
B) focal EEG abnormality is an indication for a CT or MRI examination
C) after cessation of seizures, the antiepileptic drugs can be stopped immediately
D) the underlying etiology should also be treated in cases of symptomatic epilepsy
E) most antiepileptic drugs require a slow titration

Answer 20

C) after cessation of seizures, the antiepileptic drugs can be stopped immediately

Question 21

A 55 year-old man was admitted to the emergency department due to the first epileptic seizure in his life. Neurological examination revealed a mild left-sided (central) facial paresis and left-sided hemiparesis. MRI showed a space-occupying lesion in the right frontal lobe. What is the most probable diagnosis?
A) occlusion of the right-sided internal carotid artery
B) medulloblastoma
C) cerebellar astrocytoma
D) provoked seizure due to alcohol withdrawal
E) glioma

Answer 21

E) glioma

Question 22

Epilepsy can be established if the patient has:
A) 1 proven epileptic seizure
B) 2 epileptic seizures 1 hour after a severe brain injury
C) 1 epileptic seizure and a family history of epilepsy
D) recurrent non-provoked epileptic seizures
E) all of the above
F) only A and B is true
G) only C and D is true

Answer 22

D) recurrent non-provoked epileptic seizures

Question 23

Prevalence of epilepsy in industrialized countries:
A) 0.04-0.05%
B) 0.02%
C) 0.5–1%
D) 5–6%
E) 10–12%
F) 8–10%

Answer 23

C) 0.5–1%

Question 24

The following statement is NOT true for epilepsy:
A) carbamazepine is one of the first drugs of choice in epilepsy
B) monotherapy is preferred
C) surgery is one of the options in drug-resistant focal epilepsy
D) measuring serum level of antiepileptic drugs can be useful
E) epilepsy treatment is based on the EEG
F) some antiepileptic drugs in combination can reduce each other’s effects

Answer 24

E) epilepsy treatment is based on the EEG

Question 25

Oral contraceptive drugs: A) frequently provoke epileptic seizures B) are not recommended in epilepsy C) are recommended only in seizure-free epilepsy patients D) enhance the effect of antiepileptic drugs E) some antiepileptic drugs can reduce the effect of oral contraceptives

Answer 25

E) some antiepileptic drugs can reduce the effect of oral contraceptives

Question 26

Disorder(s) which can mimic epilepsy: A) psychogenic seizures B) convulsive syncope C) parasomnia D) none of them E) all of them

Answer 26

E) all of them

Question 27

Seizures with „jamais vu” usually occur in: A) frontal lobe epilepsy B) temporal lobe epilepsy C) parietal lobe epilepsy D) occipital lobe epilepsy

Answer 27

B) temporal lobe epilepsy

Question 28

Postictal exhaustion of the brain can manifest in: 1) tenebrosity 2) Todd-paresis 3) terminal sleep 4) aphasia A) 1., 2. and 3. answers are correct B) 1. and 3. answers are correct C) 2. and 4. answers are correct D) only answer 4 is correct E) all of the answers are correct

Answer 28

E) all of the answers are correct

Question 29

An option in epilepsy treatment: 1) vagus nerve stimulation 2) ketogenic diet 3) benzodiazepines 4) deep brain stimulation A) 1., 2. and 3. answers are correct B) 1. and 3. answers are correct C) a 2. and 4. answers are correct D) only answer 4 is correct E) all 4 answers are correct

Answer 29

E) all 4 answers are correct

Question 30

Hepatic enzyme inducers: 1) carbamazepine 2) levetiracetam 3) diphenylhydantoin 4) gabapentin A) 1., 2. and 3. answers are correct B) 1. and 3. answers are correct C) 2. and 4. answers are correct D) only 4. answer is correct E) all of the answers are correct

Answer 30

B) 1. and 3. answers are correct

Question 31

Psychopathological symptoms in epilepsy can be caused by: 1) chronic epileptic dysfunction 2) underlying etiology 3) brain injuries caused by seizures 4) long-term antiepileptic treatment A) 1., 2. and 3. answers are correct B) 1. and 3. answers are correct C) 2. and 4. answers are correct D) only 4. answer is correct E) all of the answers are correct

Answer 31

E) all of the answers are correct

Question 32

Life-threatening complication of epilepsy: 1) Adrenal insufficiency 2) ictal injury 3) hypoglycemic coma 4) status epilepticus A) 1., 2. and 3. answers are correct B) 1. and 3. answers are correct C) a 2. and 4. answers are correct D) only answer 4 is correct E) all 4 answers are correct

Answer 32

C) a 2. and 4. answers are correct

Question 33

Effective in status epilepticus: 1) diazepam iv. 2) clonazepam iv. 3) propofol iv. 4) diphenylhydantoin iv. A) 1., 2. and 3. answers are correct B) 1. and 3. answers are correct C) 2. and 4. answers are correct D) only answer 4 is correct E) all 4 answers are correct

Answer 33

E) all 4 answers are correct

Question 34

Effective in status epilepticus: 1) phenytoin iv. 2) diazepam iv. 3) clonazepam iv. 4) disulfiram iv. A) 1., 2. and 3. answers are correct B) 1. and 3. answers are correct C) a 2. and 4. answers are correct D) only answer 4 is correct E) all 4 answers are correct

Answer 34

A) 1., 2. and 3. answers are correct

Question 35

Characteristics of temporal lobe epilepsy: 1) psychopathological symptoms 2) good response to antiepileptic drugs in comparison with other epilepsy types 3) epileptic aura 4) 3 Hz spike-and-wave discharge on the EEG A) 1., 2. and 3. answers are correct B) 1. and 3. answers are correct C) a 2. and 4. answers are correct D) only answer 4 is correct E) all 4 answers are correct

Answer 35

B) 1. and 3. answers are correct

Question 36

Epileptic seizure can be provoked by: 1) some psychotropic drugs 2) sleep deprivation 3) cocoa consumption 4) alcohol withdrawal 5) infection with fever A) All of them are correct B) Answers 2, 4, 5 are correct C) Answers 2, 3, 4, 5 are correct D) Answers 1, 2, 4 are correct E) Answers 1, 2, 4, 5 are correct

Answer 36

E) Answers 1, 2, 4, 5 are correct

Question 37

Mechanism of action of antiepileptic drugs: 1) GABA-receptor-antagonism 2) GABA-receptor-agonism 3) NMDA-receptor-antagonism 4) NMDA-receptor-agonism 5) serotonin-reuptake inhibition 6) serotonin-reuptake enhancement A) Answers 1, 3 and 5 are true B) Answers 2, 4 and 5 are true C) Answers 2, 3 and 6 are true D) Answers 2, 4 and 6 are true E) Answers 2 and 3 are true

Answer 37

E) Answers 2 and 3 are true

Question 38

Generalized tonic-clonic seizures: 1) tetany 2) provoked epileptic seizures 3) cataplexy 4) seizures of eclampsia in pregnancy A) Answers 1, 2, 3 are true B) Answers 2, 3, 4 are true C) Answers 2 and 4 are true D) Answers 1 and 4 are true E) all of them are true

Answer 38

C) Answers 2 and 4 are true

Question 39

Indication for measuring serum level of antiepileptic drug: 1) suspicion on lack of compliance/adherence 2) suspicion on drug-to-drug interaction 3) evaluation of the individual drug metabolism 4) evaluating the therapeutic effect A) Answers 1, 2, 3 are true B) Answers 2 and 4 are true C) Answers 1 and 2 are true D) Answers 1 and 4 are true E) all of them are true

Answer 39

A) Answers 1, 2, 3 are true

Question 40

Pair the matching items! A) epilepsia partialis continua B) Jacksonian seizure (Jacksonian march) C) absence D) tonic seizure E) sleep attack NEU - 4.41 - Lennox–Gastaut syndrome NEU - 4.42 - 3-Hz spike-and-wave complex on the EEG NEU - 4.43 - focal status epilepticus NEU - 4.44 - focal seizure NEU - 4.45 - narcolepsy

Answer 40

41- D 42- C 43- A 44- B 45- E

Question 41

Every patient with epilepsy had at least 1 epileptic seizure, therefore all patients with epileptic seizures have an epilepsy. A) both parts are correct, causative relation exists B) both parts are correct, causative relation does not exist C) first part is correct, the second is incorrect D) first part is incorrect, second part is correct E) both parts are incorrect

Answer 41

C) first part is correct, the second is incorrect

Question 42

Multiple antiepileptic drugs should be administrated if various seizure types are present, therefore a dose reduction is recommended. A) both parts are correct, causative relation exists B) both parts are correct, causative relation does not exist C) first part is correct, the second is incorrect D) first part is incorrect, second part is correct E) both parts are incorrect

Answer 42

E) both parts are incorrect

Question 43

Alcohol withdrawal can provoke epileptic seizures, therefore these patients had an epilepsy. A) both parts are correct, causative relation exists B) both parts are correct, causative relation does not exist C) first part is correct, the second is incorrect D) first part is incorrect, second part is correct E) both parts are incorrect

Answer 43

C) first part is correct, the second is incorrect

Question 44

Ethosuxumide is the first drug of choice in absence epilepsy, because the EEG shows a 3-Hz spike-and-wave activity during absence seizures. A) both parts are correct, causative relation exists B) both parts are correct, causative relation does not exist C) first part is correct, the second is incorrect D) first part is incorrect, second part is correct E) both parts are incorrect

Answer 44

B) both parts are correct, causative relation does not exist

Question 45

Grand mal seizure is always accompanied by enuresis, because grand mal is always accompanied by loss of consciousness. A) both parts are correct, causative relation exists B) both parts are correct, causative relation does not exist C) first part is correct, the second is incorrect D) first part is incorrect, second part is correct E) both parts are incorrect

Answer 45

D) first part is incorrect, second part is correct

Question 46

Pathological EEG is always a proof of epilepsy, because every epileptic patient has a pathological EEG. A) both parts are correct, causative relation exists B) both parts are correct, causative relation does not exist C) first part is correct, the second is incorrect D) first part is incorrect, second part is correct E) both parts are incorrect

Answer 46

E) both parts are incorrect

Question 47

Some of the antiepileptic drugs can be teratogenic, therefore an abortion is indicated in pregnant women with epilepsy. A) both parts are correct, causative relation exists B) both parts are correct, causative relation does not exist C) first part is correct, the second is incorrect D) first part is incorrect, second part is correct E) both parts are incorrect

Answer 47

C) first part is correct, the second is incorrect

Question 48

Some of the antiepileptic drugs can be teratogenic, therefore folic acid substitution is recommended during and before pregnancy. A) both parts are correct, causative relation exists B) both parts are correct, causative relation does not exist C) first part is correct, the second is incorrect D) first part is incorrect, second part is correct E) both parts are incorrect

Answer 48

A) both parts are correct, causative relation exists

Question 49

Diagnosis: A 18-year-old young man had grand mal seizures since age 14. No provoking factors were revealed. The patient reported that he also had involuntary jerking in the mornings. A) focal epilepsy B) juvenile myoclonic epilepsy C) chorea major D) psychogenic epilepsy

Answer 49

B) juvenile myoclonic epilepsy

Question 50

Frist drug of choice: A 18-year-old young man had grand mal seizures since age 14. No provoking factors were revealed. The patient reported that he also had involuntary jerking in the mornings. A) phenobarbital B) valproate C) clobazam D) ethosuximide E) carbamazepine

Answer 50

B) valproate

Question 51

Follow-up and prognosis: A 18-year-old young man had grand mal seizures since age 14. No provoking factors were revealed. The patient reported that he also had involuntary jerking in the mornings. A) Lobectomy will never be a therapeutic option. B) The patient should probably take antiepileptic drugs for > 10 years. C) Taking appropriate antiepileptic drugs will probably result in complete seizure freedom. D) in case of a long-term seizure freedom, the patient is permitted to drive a car. E) all of them

Answer 51

E) all of them