Epilepsy and Sleep disorders Flashcards
A 7-year-old girl’s teacher notices that she is less focused in class. She has very
short, but frequent, periods of absence without motor phenomena. The EEG shows 3
Hz periodic spike and sharp wave activity, which is typical for:
a. absence
b. atypical absences
c. complex focal epileptic seizure
d. simple focal epileptic seizure
a. absence
Epileptic seizures will exceptionally be seen in a patient with:
a. early Alzheimer’s dementia
b. frontotemporal dementia
c. vascular dementia
d. patients receiving acetylcholinesterase inhibitors
a. early Alzheimer’s dementia
What is not true for febrile convulsions?
a. triggered by fever
b. generalised tonic-clonic convulsions
c. occurring after the age of 10
d. we do not treat a single attack
c. occurring after the age of 10
Weight loss is a side effect of treatment for:
a. carbamazepine
b. valproate
c. topiramate
d. lamotrigine
c. topiramate
We do not give to an epilepsy patient who has kidney stones:
a. lamotrigine
b. carbamazepine
c. topiramate
d. L-Tyracetam
c. topiramate
What will we not treat epilepsy with in a demented patient?
a. Phenobarbitone
b. Carbamazepine
Why?
c. because it affects higher nervous activity
a. Phenobarbitone
c. because it affects higher nervous activity
The drug of choice for convulsive status epilepticus is a benzodiazepine, which is
administered if possible:
a. per person
b. rectal
c. intravenous
d. intramuscular
If we don’t stop the status, we will use it as a second medicine:
e. alternative benzodiazepine preparation
f. phenytoin
g. anaesthesia with propofol or pentobarbital
h. None of the above If
the attacks have not
stopped:
i. alternative benzodiazepine preparation
j. phenytoin
k. anaesthesia with propofol or pentobarbital
l. none of the above
c. intravenous
f. phenytoin
k. anaesthesia with propofol or pentobarbital
A 23-year-old woman became ill with severe abdominal pain, vomiting, tachycardia
and pain in her limbs after taking carbamazepine for facial pain. She noticed that her
urine had darkened. It was:
a. carbamazepine poisoning
b. necrotizing myositis
c. cholecystitis
d. porphyria attack
d. porphyria attack
A 19-year-old student has been having seizures since the age of 12, when he would
get stuck and be absent for a few moments. He was taking valproate but stopped
because the seizures went away. The morning before an exam, he had a seizure
during which he trembled all over his body and wet himself and bit his tongue. What
will you say to him as a doctor?
a. the seizure is caused by mental stress before the exam
b. from now on you will have different, big seizures, but we have medicines for
those too
c. apparently your current medication isn’t helping, so we’ll have to fix your
brain
a. the seizure is caused by mental stress before the exam
Which is the first-line treatment for a patient with juvenile myoclonic epilepsy?
a. phenytoin
b. ethosuccimide
c. valproate
d. barbiturate
e. vigabatrin
c. valproate
Which drug can cause hyponatraemia?
a. Carbamazepine.
a. Carbamazepine.
In which situation would you introduce antiepileptic therapy after the 1st seizure?
a. alcohol withdrawal
b. brain tumour
c. febrile convulsions
d. hyponatraemia
b. brain tumour
An antiepileptic used exclusively for absence is:
a. ethosuximide
b. valproate
c. lamotrigine
d. carbamazepine
a. ethosuximide
The 50-year-old economist suddenly froze, absent, whimpering. In a short
time, he was conscious again. He has no recollection of the incident. He had:
a. generalised epileptic seizure
b. complex focal epileptic seizure
c. simple focal epileptic seizure
d. neurocardiogenic presyncope
b. complex focal epileptic seizure
Which medicine should not be used for epilepsy?
a. riluzole
b. lamotrigine
c. valproate
d. levetiracetam
a. riluzole
Management of a patient with status epilepticus:
a. first, the airway is supplied
b. first give him lorazepam i.v., then treat the airway
c. first give him lorazepam i.v., then phenytoin i.v.
d. give him propofol first, then levetiracetam
c. first give him lorazepam i.v., then phenytoin i.v.
Which antiepileptic drug is most commonly used in partial epileptic seizures:
a. carbamazepine
b. valproate
c. vigabatrin
a. carbamazepine
What are generalised epileptic seizures:
a. absence
b. Myoclonic
c. generalised tonic-clonic
d. all of the above
e. none of the above
d. all of the above
Juvenile myoclonic epilepsy - what’s wrong?
a. valproate makes it worse
b. most often between 8-18 years
c. absent and generalised myoclonic-tonsuses occur
d. myoclonus is most common in the morning
a. valproate makes it worse
What is prognostically most important in status epilepticus:
a. whether it is partial or generalised
b. to treat it within 5 minutes
c. to treat it within 30 minutes
d. or treated with diazepam
e. or treated with lorazepam
b. to treat it within 5 minutes
. What do we do to break status epilepticus?
a. diazepam
a. diazepam
What is the least likely reason for seizures?
a. multiple sclerosis
b. cryptococcal meningitis
c. another kind of meningitis
a. multiple sclerosis
Why do neurologists like and give IV benzodiazepines in status epilepticus?
a. fast acting
b. do not cause hypotension
c. do not cause respiratory disturbance
a. fast acting
Transient neurological impairment, usually a weakness contralateral to the
epileptic focus, is called :
a. TIA
b. Jacksonian attack
c. Todd’s Paresis
d. complex epilepsy
e. Epilepsy Partialis Continus
c. Todd’s Paresis
For absence seizure therapy, we use:
a. carbamazepine
b. valproate
c. Phenobarbitone
b. valproate
A single standard EEG test is specifically altered in patients with epilepsy in
only … % of patients with epilepsy:
a. 5-10%
b. 10-15%
c. 15-20%
d. 25-30%
e. 30-55%
e. 30-55%
Which statement is not true for temporal lobe epilepsy?
a. can start in infancy
b. a history of febrile convulsions is found in 50% of patients
c. surgical treatment is often the best therapeutic option
d. most often caused by a malignant tumour
e. MRI is the best imaging method
d. most often caused by a malignant tumour
In neurology, status epilepticus refers to an epileptic seizure in which the
convulsions have been ongoing for:
a. 5 min
b. 30 min
c. 1 hour
d. 2 hours
b. 30 min
For an absence seizure to occur, the antiepileptic must act on:
a. Ca2+ channels
a. Ca2+ channels
The woman in front of us falls to the ground, what
do we do?
a. put her in the unconscious position.
a. put her in the unconscious position
Which antiepileptic drug can aggravate withdrawal seizures?
a. sodium valproate
b. clobazam
c. carbamazepine
d. levetiracetam
e. all of the following
c. carbamazepine
Which of the following is a warning that the observed event is unlikely to be
epileptic seizure?
a. duration of attack less than 1 minute
b. a state of confusion without motor signs
c. eyes closed in a seizure with generalised convulsions
d. seizures look like convulsions, with a fast component to one side and a
slow one to the other.
e. the patient looks very frightened or cries during an attack
c. eyes closed in a seizure with generalised convulsions
What is the most important diagnostic procedure when diagnosing epileptic
seizures?
a. EEG combined with magnetoencephalography
b. MRI and CT brain
c. neurological status
d. blood tests, especially serum ethanol concentration.
e. history and eyewitness description of the attack
e. history and eyewitness description of the attack
Which type of seizure looks like sudden, rapid spasms or convulsions of the upper
or lower limbs, with no apparent loss of consciousness, which can also cause a
fall?
a. myoclonic seizures
b. tonic seizures
c. synkop
d. clonic or tonic-clonic seizures
e. absence
a. myoclonic seizures
In the epidemiology of epilepsy, the following statement is true:
a. the lifetime risk of having an epileptic seizure is 1%
b. by the age of 80, around 9% of people have at least one seizure
c. women are more likely to suffer from epilepsy than men
d. the highest incidence of epilepsy is in young adults and middle-aged adults
e. the prevalence of epilepsy is 1 per 400 inhabitants
b. by the age of 80, around 9% of people have at least one seizure
The differential diagnosis of epileptic seizures includes:
a. Syncope
b. TIA
c. TGA
d. episodes of psychiatric illness
e. all of the abov
e. all of the abov
What’s wrong with “complex partial seizures”?
a. complex partial seizures are focal seizures during which consciousness
is affected
b. the use of the term “complex partial epileptic seizure” is discouraged by
the International League Against Epilepsy
c. are typical of temporal lobe epilepsies
d. contain automatic behaviour and unresponsiveness, although
sometimes patients may remember the test word given during an
attack
e. complex partial seizures are often used synonymously with
psychomotor seizures
d. contain automatic behaviour and unresponsiveness, although
sometimes patients may remember the test word given during an
attack
Which of the following statements about the driving ability of people with epilepsy is
correct?
a. People with epilepsy cannot hold a driving licence.
b. People with epilepsy can drive motor vehicles (except lorries and buses) if
they are successfully treated (seizure-free) with no more than one
antiepileptic drug.
c. People with epilepsy can drive motor vehicles (except lorries and
buses) if they have not had an epileptic seizure for two years.
d. People with epilepsy can drive motor vehicles (except trucks and buses) if
their antiepileptic treatment has not changed for 3 years
c. People with epilepsy can drive motor vehicles (except lorries and
buses) if they have not had an epileptic seizure for two years.
Antiepileptic drugs (AEDs) are usually suggested after a second seizure. After the
first seizure of a lifetime, we suggest PEZ treatment in special cases. In which of the
following cases do we suggest starting treatment after the first, unprovoked seizure?
a. when an MRI of the brain shows a structural change in the brain
b. in children under 12 years of age
c. for pregnant women in the 2nd or 3rd trimester of pregnancy
d. for a person with a valid driving licence
a. when an MRI of the brain shows a structural change in the brain
It worsens juvenile myoclonic epilepsy:
a. carbamazepine
b. ethosuccimide
c. lorazepam
d. levetiracetam
e. valproate
a. carbamazepine
Diagnosis of non-convulsive epilepsy:
a. EEG
b. Clinical
c. CT
d. MR
a. EEG
Therapy of focal symptomatic epilepsy:
a. carbamazepine
b. topiramate
c. valproate
a. carbamazepine
Therapy of juvenile myoclonic epilepsy:
a. lamotrigine
b. carbamazepine
c. pregabatrin
d. Anything
a. lamotrigine
Petit-mal seizure therapy is:
a. ethosuccimide
a. ethosuccimide
Status epilepticus:
a. diazepam i.v. 10-20 mg/kg, then phenytoin i.v. 20 mg/kg, then intubation
Epileptic seizures are not a sign of which syndrome?
a. Kearns-Sayre syndrome
b. Lennox-Gastaut syndrome
c. West syndrome
a. Kearns-Sayre syndrome
A 22-year-old student is brought to A&E because she had a generalised seizure after
a sleepless night. Her mother says that recently things have been falling out of her
hands in the morning. What is the diagnosis?
a. Juvenile myoclonic epilepsy.
a. Juvenile myoclonic epilepsy.
What do you do if a patient is brought to you in generalised status epilepticus?
a. first you intubate and give the O2
b. benzodiazepine, phenytoin, propofol and then you intubate
b. benzodiazepine, phenytoin, propofol and then you intubate
What do we use when recording an EEG in a patient with epilepsy?
a. hyperventilation
a. hyperventilation
An 18-year-old boy diagnosed with epilepsy repeatedly loses things. What is it?
a. tonic convulsions
b. atonic convulsions
c. absence
d. myoclonus
What form of epilepsy does she have?
e. Lennox-Gastaut syndrome
f. juvenile myoclonic epilepsy
g. juvenile absence epilepsy
How is epilepsy treated?
h. with valproate
i. with ethosuccimide
j. with carbamazepine
d. myoclonus
f. juvenile myoclonic epilepsy
h. with valproate
A 23-year-old soldier who blackouts and falls has mild clonus, does not bite his
tongue, and is not incontinent. What is the diagnosis?
a. Syncope
b. psychogenic
a. Syncope
A man lying on the floor, all limbs outstretched, with only his arms folded, is not a
representation:
a. myoclonus
b. tetanus
c. psychomotor epilepsies
d. psychiatric disorders
e. meningitis
c. psychomotor epilepsies
What to treat a pregnant woman having a seizure with (video):
a. valproate
b. carbamazepine
c. phenytoin
d. magnesium sulphate
e. propranolol
d. magnesium sulphate
An antiepileptic by what mechanism would worsen absence?
a. Inhibition of T-type calcium channels
b. Activation of T-type calcium channels
c. Sodium channel blockade
d. Action on GABA-A receptors
e. Increased release of neurotransmitters
b. Activation of T-type calcium channels
How would you treat myoclonic epilepsy?
a. lamotrigine
b. carbamazepine
c. levetiracetam
d. phenytoin
a. lamotrigine
When is a symptomatic seizure least likely to occur?
a. at SAK
b. in tumour
c. in cryptococcal meningitis
d. in meningococcal meningitis
e. in multiple sclerosis
a. at SAK
A 24-year-old student who has epileptic convulsions on her right side. Now, after
a seizure, she notices weakness on the left side of her body. What is it?
a. Jacksonian attack
b. Todd’s Paresis
c. latent paresis
d. Uhthoff’s sign
b. Todd’s Paresis
Which type of syncope do we not know?
a. Mickey
b. vagovazal
c. Cardiogenic
d. post-traumatic
e. when coughing
d. post-traumatic
A 75-year-old gentleman is in palliative care at the Hospice. When do we admit a
patient to the hospice:
a. if he has difficulty swallowing
b. if you have a headache
c. persistent clonic twitching of the left limbs and somnolence
d. sopor
c. persistent clonic twitching of the left limbs and somnolence
The patient retains consciousness, but there are rapid jerks that cause him to fall.
What is it?
a. myoclonic epilepsy
a. myoclonic epilepsy
The prevalence of epilepsy is:
a. 0.1%
b. 1%
c. 5%
d. 10%
b. 1%
Features of narcolepsy:
a. cataplexy
b. fall asleep several times during the day
c. are sleepy during the day
d. hypnapompic and hypnagogic states
e. all of the above
e. all of the above
What is not found in sleep apnoea?
a. Anorexia.
a. Anorexia.
What would you do for a person who has trouble sleeping without any organic cause?
a. prescribed sleeping pills
b. clean up your hygiene habits
c. regulate hygiene habits, prescribe sleeping pills for a short time and
check the condition later
c. regulate hygiene habits, prescribe sleeping pills for a short time and
check the condition later
