radiology/seizure

Question 1

Neuroimaging that measures neuronal glucose metabolism (2x)

Answer 1

PET SCAN

Question 2

Pt in ED with sudden HA and collapsing, some lethargy. Exam shows rigid neck, no papilledema, no focal CN or motor signs. The initial test should be?

Answer 2

CT HEAD

Question 3

Which is an advantage for CT head vs MRI?

Answer 3

DIAGNOSING ACUTE EPIDURAL HEMORRHAGE

Question 4

Gadolinium contrast in MRI scans is most specifically useful for diagnosing patients with diseases affecting which of the following structures?

Answer 4

BLOOD BRAIN BARRIER

Question 5

CT is preferable over MRI in which situation?

Answer 5

70 Y/O FEMALE WHO FELL AT HOME AND NOW HAS DEPRESSED LEVEL OF CONSCIOUSNESS

Question 6

CT scan is better than MRI for what?

Answer 6

DIFFERENTIATING HEMORRHAGING FROM EDEMA

Question 7

65 y/o has first generalized tonic-clonic Sz seen by spouse and they have been confused and lethargic since. Episode began w/ repetitive shaking of right arm. Blood tests unremarkable and no hx of other recent symptoms, trauma, or metabolic disorders. What study will likely reveal cause?

Answer 7

BRAIN MRI

Question 8

What does functional MRI measure?

Answer 8

DETECTS BLOOD FLOW

Question 9

Purpose of CT scan when patient suspected of having stroke?

Answer 9

EXCLUDE HEMORRHAGE

Question 10

Which MRI technique most likely reveals early signs of ischemic stroke?

Answer 10

DIFFUSION WEIGHTED MRI

Question 11

16 y/o pt brought to psychiatrist’s attn after having single grand mal sz. Pt’s parents have noted on occasion pt has sudden jerks of entire body, resulting in dropping objects. EEG: rare 4-6 HZ irregular polyspike/wave bursts. Diagnosis? (9x)

Answer 11

JUVENILE MYOCLONIC EPILEPSY

Question 12

Fever, HA, seizures, confusion, stupor, and coma, evolving over several days. EEG with lateralized high-voltage sharp waves arising in the L temporal region w slow wave repeating at 2-3 sec intervals. CT low-density lesion in L temporal lobe. (8x)

Answer 12

HERPES SIMPLEX ENCEPHALITIS

Question 13

8y/o has episodes of staring into space and then blinking for a few seconds. EEG will show? (7x)

Answer 13

3 CYCLES PER SECOND SPIKE AND WAVE ACTIVITY

Question 14

40y/o has episodes of flailing of the arms and tonic postures described as “fencing.” EEG confirms seizure. Which seizure type? (4x)

Answer 14

FRONTAL LOBE

Question 15

10 y/o child freq episodes brief lapses of consciousness without premonitory sxs. Lasts 2-10 seconds, followed by immediate and full resumption of consciousness without awareness of what has happened. These ictal episodes most likely caused by what kind szs? (4x)

Answer 15

ABSENCE

Question 16

EEG that reveals posterior alpha and anterior beta activity is most likely to have been obtained from whom? (4x)

Answer 16

A RELAXED ADULT WITH EYES CLOSED

Question 17

What is the diagnostic value of transient paresis or aphasia after a seizure? (3x)

Answer 17

LOCALIZES THE FOCUS OF SEIZURE

Question 18

28 y/o female referred to psych d/t recent onset episodes of altered behavior lasting 1 to 2 minutes. Husband notes if occurs when cooking pt will place the clean silverware back in dishwasher. Also notes she does drawing movements he is unable to interrupt. Pt has no recollection of the events. MRI scan is normal. Diagnosis? (x2)

Answer 18

COMPLEX PARTIAL SEIZURES

Question 19

1st seizure with focal onset and secondary generalization in a 58 y/o pt is likely the consequence of what? (2x)

Answer 19

GLIOBLASTOMA MULTIFORME

Question 20

The EEG finding of 4-6 hz irregular polyspike activity in a patient with generalized seizures is characteristic of which of the following forms of epilepsy? (2x)

Answer 20

JUVENILE MYOCLONIC

Question 21

Which of the following surgical procedures can be used in the treatment of epilepsy refractory to meds? (2x)

Answer 21

ELECTRICAL STIMULATION OF THE VAGUS NERVE

Question 22

What EEG findings are expected in a comatose pt with hepatic encephalopathy? (2x)

Answer 22

TRIPHASIC WAVES

Question 23

3 days s/p cardiac arrest and CPR, 73 y/o man is comatose. His eyes are open but he does not fix and follow with his eyes. Doll’s eyes elicits full horizontal eye movements. His spontaneous limb movements are symmetrical. Reflexes: mildly hyperactive. The EEG shows? (2x)

Answer 23

BURST SUPPRESSION PATTERN

Question 24

Pt with seizure has flailing arms and tonic postures of “fencing.” What seizure type?

Answer 24

FRONTAL LOBE

Question 25

Absence seizure EEG?

Answer 25

THREE CYCLE PER SECOND SPIKE-AND- WAVE

Question 26

Seizures get controlled, then has paranoid delusions, what type of seizure

Answer 26

COMPLEX PARTIAL

Question 27

Dx for pt w/ new-onset sz, multiple subQ nodules, freckling of axilla?

Answer 27

NF TYPE I

Question 28

40 yo new-onset sz b/l thrashing movement. What suggests non-epileptic cause?

Answer 28

FOLLOWING COMMANDS

Question 29

Which of the following best describes the characteristics of the normal adult alpha rhythm seen on an EEG recording?

Answer 29

INTERMITTENT AND POSTERIOR DOMINANT

Question 30

EEG-biofeedback training is efficacious for what d/o?

Answer 30

GAD

Question 31

49 y/o pt develops seizure disorder that is difficult to control. CSF shows lymphocytic pleocytosis and many RBC's. MRI: T2 hyperintensity in the Left temporal lobe, with gadolinium enhancement in this area in T1 weighted image. EEG: periodic discharges. Dx?

Answer 31

HERPES SIMPLEX ENCEPHALITIS

Question 32

Typical feature of epileptic activity in alcoholic pt with seizure 12h after EtOH cessation

Answer 32

MULTIPLE EPISODES

Question 33

Distinguishing absence seizures from partial complex seizures:

Answer 33

LACK OF POSTICTAL MANIFESTATIONS

Question 34

Which procedure confirms the diagnosis of non-epileptic seizures? Video telemetry or EEG between episodes?

Answer 34

EEG VIDEO TELEMETRY

Question 35

Antiepileptic for juvenile myoclonic epilepsy:

Answer 35

VALPROIC ACID

Question 36

Complex partial seizures are differentiated from simple partial seizures by:

Answer 36

SIMPLE SEIZURES HAVE NO LOSS OF CONSCIOUSNESS BUT HAVE ALTERED RESPONSIVENESS TO OUTSIDE STIMULI.

Question 37

24 y/o pt w/ hx of epilepsy since childhood has several seizures in rapid succession. Following Szs, pt developed paranoia and hallucination, but resolved over a matter of days. Dx:

Answer 37

INTERICTAL PSYCHOSIS

Question 38

Convulsive episode with leftward eye deviation, tonic contracture of left side. Postictally, eyes deviate to right w/ hemiparesis of left side

Answer 38

SEIZURE FOCUS RIGHT FRONTAL REGION

Question 39

28 y/o F w/ HA, hyperventilates, asynchronous tonic-clonic sz, no LOC during Sz:

Answer 39

PSYCHOGENIC SEIZURE

Question 40

In young pt w/ epilepsy, Tx depression w/:

Answer 40

PROZAC

Question 41

Why is there a relatively high rate of suicide in epileptics?

Answer 41

COMORBID PSYCHIATRIC DISORDERS

Question 42

Lack of prolactin elevation after szs suggests what kind of szs:

Answer 42

NON-EPILEPTIC

Question 43

Drug-addicted healthcare professional experiences seizure that is not a withdrawal phenomenon. Cause?

Answer 43

MEPERIDINE

Question 44

Complex partial epilepsy aura has what symptom?

Answer 44

LIP SMACKING

Question 45

Head & eyes deviate to right and right arm extends immediately before a generalized tonic- clonic seizure. Seizure focus:

Answer 45

LEFT CEREBRAL HEMISPHERE

Question 46

Gustatory special sensory seizures (auras) localize where?

Answer 46

INSULAR CORTEX

Question 47

Pt w/ episodes of altered behavior lasting 1-2 minutes. During episodes pt makes chewing movements. Pt has no recollection. MRI is normal. Dx?

Answer 47

COMPLEX PARTIAL SEIZURES

Question 48

32 Pt reports AH of someone not present, then stops moving, stares blankly, repetitively picks clothing, and does not respond for several minutes. Symptoms resolve after 15min but pt has no recollection of events. This represents what type of seizure?

Answer 48

COMPLEX PARTIAL

Question 49

16 y/o pt w/ new onset tonic clonic seizures. Pt reports having jerky movements which cause him to drop objects. EEG shows polyspike pattern. Which antiepileptic medication?

Answer 49

VALPROIC ACID

Question 50

15 y/o has hx of seizures beginning at the age of 9years, followed by prolonged motor or sensory deficits lasting days to weeks. The pattern of the seizures and the focal deficits has changed over time. The pt also has hemicranial headaches. No family hx of similar symptoms. Most likely diagnosis?

Answer 50

MITOCHONDRIAL ENCEPHALOMYOPATHY, LACTIC ACIDOSIS AND STROKE.

Question 51

What is the medication for adequate initial treatment of absence seizures in children?

Answer 51

VALPROIC ACID

Question 52

Gelastic seizures are a/w which brain foci?

Answer 52

HYPOTHALAMUS

Question 53

An increase in beta frequency during an awake EEG is caused by what type of medication?

Answer 53

SEDATIVES

Question 54

Most common EEG finding in metabolic encephalopathy? (question requires assigning diagnosis to EEG)

Answer 54

GENERALIZED SLOWING

Question 55

15 y/o pt w/ partial complex seizures w/ secondary generalization, mental retardation, and adenoma sebaceum. Dx?

Answer 55

TUBEROUS SCLEROSIS

Question 56

Pt w/ h/o Depression and well--controlled epilepsy responded to bupropion after failing on several antidepressants. Pt had not tried imipramine, nortriptyline, duloxetine, and selegiline. No Sz have occurred on bupropion 100mg BID. Insurance recommends changing med due to reduced sz threshold with bupropion. What is appropriate response from psychiatrist?

Answer 56

CONTINUE BUPROPION

Question 57

54 y/o pt with gastric ulcer undergoes emergent surgery and 30 hrs post-op becomes confused, agitated and responds to internal stimuli and suffers a generalized tonic-clonic seizure: Dx:

Answer 57

DELIRIUM TREMENS

Question 58

A child with intellectual disability is free of seizures but develops epilepsy in adolescence. Pattern of onset is often seen with?

Answer 58

AUTISM SPECTRUM DISORDER

Question 59

Test for psychogenic tremor by:

Answer 59

TLL PATIENT TO TAP HAND AND SEE IF TREMOR CHANGES

Question 60

Pt p/w limb-shaking episodes lasting >3min. Pt is conscious, talking, and is briefly able to suppress movements during these episodes. Which is a risk factor for poor prognosis?

Answer 60

INSIDIOUS ONSET OF SYMPTOMS