Mehl. bullet Epilepsy + drugs epilepsy/hypnotics

Question 1

M. 56M + 3-day Hx of cutting from 12 beers a day down to 4; develops tremulousness; Tx?

Answer 1

chlordiazepoxide (delirium tremens);

Question 1

M. classic vignette is guy has surgery + two days later has tachycardia, tremulousness, and hallucinations, Dx?

Answer 1

alcoholic hallucinosis

Question 2

M. 6M + ECG shows miscellaneous arrhythmia + seizure-like episode; Dx?

Answer 2

Adam-Stokes attack –> not true seizure disorder as per EEG; arrythmia leads to hypoxia of brainstem –> seizure-like fits ensue.

Question 3

M. 75M + episodes of loss of consciousness (LoC) for 2 years + tonic-clonic-like episodes + becomes pale
and sweaty + Hx of MI; Dx?

Answer 3

answer = “syncope” on the NBME (convulsive syncope).

Question 4

M. What is simple vs complex seizure?

Answer 4

simple = no LoC;
complex = LoC;

patient staring off into space not aware of surroundings = LoC.

Question 5

M. What is partial vs generalized seizure?

Answer 5

partial = affecting one part of the brain;

generalized =
involves the wholes of both cerebral hemispheres.

Question 6

M. What is myoclonic seizure?

Answer 6

jerks in muscle or group of muscles; no LoC.

Question 7

M. 13M + tonic-clonic seizure + 4-month Hx of hypnagogic/hypnopompic jerking of left arm + uncle has epilepsy; Dx?

Answer 7

juvenile myoclonic epilepsy; genetic with unclear inheritance pattern; characterized by myoclonic jerks (usually hypnagogic and/or hypnopompic) that progress to tonic- clonic seizures after several months; age of onset is usually 10-16, but can also start in adulthood;

Question 8

M. 13M + tonic-clonic seizure + 4-month Hx of hypnagogic/hypnopompic jerking of left arm + uncle has epilepsy; Tx?

Answer 8

Dx = juvenile myoclonic epilepsy;

Tx = valproic acid

Question 9

M. 4F + few-month Hx of near-daily seizures + seizures typically occur while she’s sleeping + has started putting objects in her mouth and making less eye contact + seizures not responding to anti-epileptic meds; Dx?

Answer 9

Lennox-Gastaut syndrome

severe childhood-onset epilepsy characterized by near-daily seizures and cognitive decline (hyperoralism is a sign of cognitive regression [babies put things in their mouths]); poor prognosis, with 5% mortality rate in childhood; 80-90% persistence of seizures into adulthood.

Question 10

M. 10-month old boy + jerking movements of the limbs + EEG shows chaotic high-amplitude spikes with no recognizable pattern; Dx?

Answer 10

West syndrome (infantile spasms)

triad of spasms + hypsarrhythmia on EEG (no recognizable pattern with high amplitude spikes) + developmental regression; international definition of the diagnosis requires two out of three; starts age 3-12 months; seen in 1-5% of Down syndrome kids;

Question 11

M. 10-month old boy + jerking movements of the limbs + EEG shows chaotic high-amplitude spikes with no recognizable pattern; Tx?

Answer 11

Dx = West syndrome (infantile spasms)

Tx = Tx = ACTH, prednisolone, or vigabatrin; ACTH is thought to act by two mechanisms: 1) stimulates steroid (cortisol) release; 2) direct (cortisol-independent) effect on melanocortin receptors.

Question 12

M. 32M + fear of flying; Dx + Tx?

Answer 12

specific phobia; Tx with benzo.

Question 13

M. 32M + fear of public speaking (glossophobia); Dx + Tx?

Answer 13

social phobia, not specific phobia; Tx =
atenolol (propranolol also OK).

Question 14

25F + fear of flying + must fly soon; Tx?

Answer 14

Lorazepam -> specific phobia.

Question 15

M. 27M + asthma + very anxious about speech he needs to make soon; Tx?

Answer 15

Psych NBME wants lorazepam, not propranolol (because asthma patient).

Question 16

M. 27M + very anxious about speech he needs to make soon; Tx?

Answer 16

Psych NBME wants propranolol, not lorazepam. (because no asthma - safe give BAB)