Seizures Flashcards
A 20-year-old man presents with sudden, involuntary jerking movements of both arms occurring upon waking. EEG shows high-frequency bursts of neuronal firing. What is the likely underlying cause?
A) Increased GABAergic inhibition
B) Increased excitatory neurotransmission
C) Impaired synaptic vesicle release
D) Decreased NMDA receptor activity
B
A 35-year-old man reports experiencing a sudden burning rubber smell before losing awareness. EEG shows abnormal activity in the temporal lobe. What is the most likely diagnosis?
A) Absence seizure
B) Focal seizure
C) Myoclonic seizure
D) Atonic seizure
B
A 28-year-old woman experiences sudden limb stiffening followed by rhythmic jerking lasting 1 minute. She is confused for several minutes afterward. What describes the period of muscle contractions?
A) Ictal
B) Postictal
C) Prodromal
D) Interictal
A
A 40-year-old man has a seizure with full-body stiffening followed by rhythmic jerking. After the episode, he remains confused for 15 minutes. Which of the following features best explains this?
A) Persistent neuronal hyperactivity
B) Neuronal inhibition and exhaustion
C) Ongoing seizure activity
D) Increased dopamine release
B
B) Neuronal inhibition and exhaustion (Postictal state occurs due to GABA-mediated inhibition after excessive neuronal firing).
A 30-year-old woman experiences sudden lip smacking, staring spells, and unresponsiveness lasting 2 minutes. EEG shows activity in the left medial temporal lobe. What is the most likely seizure type?
A) Absence seizure
B) Myoclonic seizure
C) Focal impaired awareness seizure
D) Tonic-clonic seizure
C
A patient reports a sudden feeling of déjà vu, followed by rhythmic twitching of his right arm while remaining fully aware. What is the most likely seizure type?
A) Focal aware seizure
B) Tonic-clonic seizure
C) Absence seizure
D) Myoclonic seizure
A
A 28-year-old woman has seizures where she repeatedly picks at her clothes and does not respond to commands. She appears confused afterward. What is the most likely seizure type?
A) Absence seizure
B) Focal impaired awareness seizure
C) Myoclonic seizure
D) Atonic seizure
B
A 6-year-old girl frequently stops mid-sentence and stares blankly for 10 seconds. EEG shows 3 Hz spike-and-wave discharges. What is the most likely diagnosis?
A) Absence seizure
B) Myoclonic seizure
C) Complex partial seizure
D) Tonic-clonic seizure
A
A teenager experiences sudden, brief jerks of both arms upon awakening. No loss of awareness occurs. What is the likely seizure type?
A) Myoclonic
B) Tonic-clonic
C) Absence
D) Focal seizure
A
A 26-year-old man is brought to the emergency department after losing consciousness and experiencing rhythmic jerking movements of his arms and legs for about 90 seconds. His girlfriend reports that he let out a loud cry before collapsing, then became stiff, followed by jerking movements. After the episode, he was confused and drowsy for 15 minutes. He also lost control of his bladder. Which of the following findings is most specific for his condition?
A) 3-Hz spike-and-wave pattern on EEG
B) Lip smacking during the episode
C) No postictal confusion
D) Lateral tongue biting
E) Hypersomnia without seizure activity
D
A 58-year-old man with a history of stroke develops sudden episodes where he becomes completely rigid for several seconds before abruptly regaining normal muscle tone. He remains conscious during the episodes and has no postictal confusion. Which type of seizure is this?
A) Myoclonic seizure
B) Absence seizure
C) Tonic seizure
D) Atonic seizure
E) Focal impaired awareness seizure
C
A 5-year-old boy is brought to the pediatric clinic after multiple episodes in which he suddenly falls to the ground without warning. His parents note that he immediately regains consciousness after each episode. There is no history of dizziness or prodromal symptoms. Which of the following is the most likely diagnosis?
A) Vasovagal syncope
B) Absence seizure
C) Atonic seizure
D) Narcolepsy
E) Psychogenic nonepileptic seizure
C
A 3-year-old boy is brought to the emergency department after experiencing a seizure lasting 2 minutes. His parents report that he had a fever of 39°C (102.2°F) earlier in the day. He has no history of seizures, and his neurological exam is normal after the event. What is the most appropriate next step in management?
A) Start antiepileptic medication
B) Perform EEG
C) Perform MRI brain
D) Reassurance and observation
E) Perform lumbar puncture
D
D) Reassurance and observation – Febrile seizures are common in young children and do not require antiepileptic treatment unless there are atypical features.
A 22-year-old woman with a history of epilepsy is brought to the emergency department after experiencing continuous seizures for 8 minutes. She has not regained consciousness between episodes. What is the first-line treatment for this condition?
A) Phenytoin
B) Valproic acid
C) Ethosuximide
D) Lorazepam
E) Carbamazepine
D) Lorazepam – Benzodiazepines (e.g., lorazepam, diazepam) are first-line treatment for acute status epilepticus due to their rapid onset and efficacy.
A 28-year-old woman with a history of depression and anxiety is brought to the emergency department after an episode in which she fell to the floor, began shaking, and remained unresponsive for over 3 minutes. Her eyes remained closed throughout, and she was noted to flail her arms and legs. After the episode, she was alert and oriented without confusion. A recent EEG was normal. Which of the following is the most likely diagnosis?
A) Tonic-clonic seizure
B) Absence seizure
C) Psychogenic nonepileptic event
D) Atonic seizure
E) Myoclonic seizure
C
C) Psychogenic nonepileptic event – Features that suggest PNES include a prolonged seizure-like episode, lack of a postictal phase, eyes tightly closed during the episode (unlike real seizures, where eyes are open), and normal EEG.
A 50-year-old man presents with a new-onset focal seizure. Brain MRI shows a ring-enhancing lesion in the parietal lobe. He recently emigrated from Mexico. What is the most likely cause of his seizure?
A) Glioblastoma
B) Neurocysticercosis
C) Multiple sclerosis
D) Brain abscess
E) Herpes encephalitis
Adults (18-65 years)
“Adults 18-65 — tumor, trauma, stroke, infection.”
Tumor: Primary brain tumors (e.g., glioblastoma, meningioma) or metastatic lesions can cause focal or generalized seizures.
Trauma: Post-traumatic epilepsy can develop after head injuries.
Stroke: Ischemic or hemorrhagic stroke can cause seizures due to cortical irritation.
Infection: CNS infections (e.g., neurocysticercosis, herpes encephalitis, bacterial meningitis) can trigger seizures.
A 72-year-old woman with a history of hypertension and atrial fibrillation presents with sudden-onset confusion and right-arm twitching. MRI shows an infarct in the left middle cerebral artery territory. What is the most likely cause of her seizures?
A) Hypoglycemia
B) Stroke
C) Neurocysticercosis
D) Alzheimer’s disease
E) Multiple sclerosis
B) Stroke – Ischemic stroke is the most common cause of new-onset seizures in the elderly due to cortical irritation from infarcted brain tissue.
A 34-year-old woman presents with episodes of blurred vision, dizziness, and right arm weakness that resolve after a few days. Brain MRI shows multiple white matter lesions. CSF analysis shows oligoclonal bands. She has one episode of focal seizures. What is the best treatment to slow disease progression?
A) Levetiracetam
B) Phenytoin
C) Natalizumab
D) Ethosuximide
E) Carbamazepine
C
C) Natalizumab – Multiple sclerosis (MS) causes demyelinating lesions in the CNS that can trigger focal seizures. Disease-modifying therapy (e.g., natalizumab, β-interferon, glatiramer acetate) is used to slow progression.
