Epilepsy

Question 1

Cardiovascular side effects of phenytoin?

Answer 1

Heart block, bradycardia and PAN

Question 2

Which drugs may make myoclonic seizures worse?

Answer 2

Carbamazepine

Oxcarbazepine

Question 3

Intoxication with most AED’s causes what?

Answer 3

Nystagmus, drowsiness and unsteadiness

Question 4

Common side effect of carbamazepine/phenytoin/lamotrigine

Answer 4

Skin rash

Question 5

REALLY BAD EFFECT OF CARBAMAZEPINE

Answer 5

BLOOD DYSCRASIAS

Question 6

Which AED is reaaaaaally teratogenic?

Answer 6

Sodium valproate - causes neural tube defects

Question 7

What vitamins/minerals should pregnant epileptic mother take?

Answer 7

Folic acid 5mg before conception and during first trimester

-Vitamin K during month before delivery to prevent NEONATAL HAEMORRHAGE

Question 8

Where do complex partial seizures usually arise from?

Answer 8

The temporal lobe (60%) or the frontal lobe

Question 9

Sometime complex partial seizures have a pro-drome, what would this consist of?

Answer 9

Rising epigastric sensation and nausea with a wide variety of possible psychic phenomena (often hard for patient to describe) or hallucinations:

• Jamais vu
• deja vu
• olfactory hallucinations
• formed visual hallucinations or misperceptions (i.e. objects may appear bigger/smaller in real life)
• FEAR (MAY BE MISTAKEN FOR PANIC ATTACKS)

Question 10

Mandatory investigation if someone presents with a seizure

Answer 10

ECG

Question 11

If you have 1 seizure, how long can you not drive for? (car and HGV)

Answer 11

Car - 6 months

HDV - 5 years

Question 12

If you have epilepsy how long are you not allowed to drive for?

Answer 12

Car = 1 year (or 3 years during sleep)
HGV = 10 years

Question 13

1st line for generalised tonic-clonic seizures?

Answer 13

Sodium valproate
(2nd line = lamotrigine, carbamazepine)

Question 14

Treatment for absence seizures?

Answer 14

Sodium valproate or ethosuximide

sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy

Question 15

1st line for myoclonic seizures?

Answer 15

Sodium valproate

2nd line = clonazepam, lamotrigine

Question 16

1st line for partial seizures?

Answer 16

Carbamazepine

Lamotrigine, sodium valproate

Question 17

Which drug may exacerbate absence seizures?

Answer 17

Carbamazepine

Question 18

Medications safe for N&V in pregnancy?

Answer 18

Cyclizine
Metoclopramide
Prochlorperazine
Promethazine
Chlorpromazine
Domperidone
Ondansetron

Question 19

Antibiotics for UTI in pregnancy?

Answer 19

Nitrofurantoin generally first line (but avoid at term)
Then trimethoprim (but avoid in first semester)

Question 20

Cholestasis

Answer 20

Bile cannot flow from the liver to the duodenum

Question 21

What does the bishops score predict?

Answer 21

Whether induction of labour will be required or not

A score of 5 or less suggests that labour is unlikely to start without induction

Question 22

What happens if you have a bishops score of less than 5?

Answer 22

Will require vaginal PGE2 for cervical ripening and induction of labour

(bishops score of less than 5 = labour unlikely to start without induction)
(a score of 8 or more indicates a ‘favourable’ cervix. Spontaneous labour is more likely with a score of greater than 8)

Question 23

If someone has headache on the OCP what should you switch them to?

Answer 23

Should switch immediately - POP

the oestrogen in the OCP is what increases risk of ischaemic stroke = POP only one that doesn’t contain oestrogen

Question 24

Medication you could give for benzodiazepine overdose?

Answer 24

Flumazenil

Question 25

Medication you could give for TCA overdose?

Answer 25

IV bicarbonate

Question 26

Medication if you have heparin overdose?

Answer 26

Protamine sulphate

Question 27

Management of TCA overdose?

Answer 27

• IV bicarbonate may reduce the risk of seizures and arrhythmias in severe toxicity
• dialysis is ineffective in removing tricyclics

Question 28

Management of TCA overdose

Answer 28

-Activated charcoal if ingested

Question 29

Management of opioid/opiate overdose

Answer 29

Naloxone

Question 30

Differentiating parkinson’s tremor from essential tremor

Answer 30

Essential tremore is usually eased by alcohol

Difficulty initiating movement (bradykinesia), postural instability and unilateral symptoms (initally) are typical symptoms of Parkinson’s

Question 31

A woman has a pre-labour rupture of membranes at term, what can you offer her?

Answer 31

You can offer induction of labour at 24 hours later or you can manage expectantly
(Induction is often with vaginal PGE2)

Question 32

Infertility affects how many couples?

Answer 32

Approximately 1 in 7

-Around 84% of couple who have regular sex will conceive within 1 year, and 92% within 2 years

Question 33

Basic investigations for infertility

Answer 33

Semen analysis

Serum progesterone 7 days prior to expected next period

Question 34

What level of progesterone indicates ovulation?

Answer 34

> 30 mmol/l

Question 35

Helpful advice for trying to get pregnant

Answer 35

• folic acid
• aim for BMI 20-25
• advise regular sexual intercourse every 2-3 days
• smoking/drinking advice

Question 36

If you diagnose syncope, what examinations are very important?

Answer 36

Cardiovascular examination

L + S BP

Question 37

If someone has fallen, what investigation is mandatory?

Answer 37

ECG !!

Question 38

Driving and epilepsy

Answer 38

First seizure:
can’t drive a car for 6 months (HGV - 5 years)

Epilepsy
Car 1 year (sleeping 3 years)
HGV - 10 years off medication