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STEP 1 > Seizures, HA, Sleep > Flashcards

Seizures, HA, Sleep Flashcards

1
Q

List 2 Focal onset seizures (involves a single cerebral hemisphere at onset)

A

Aware

Impaired awareness

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2
Q

List 4 drugs used for focal onset seizures

A

Carbamazepine
Levetiracetam
Lamotrigine
Phenytoin

(CLLaP)

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3
Q

List 3 General onset seizures (involves both cerebral hemisphere at onset)

A

Tonic-Clonic (grand mal)
Myoclonic
Absence (petite mal)

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4
Q

How are
Tonic-Clonic & Myoclonic
seizures treated?

A

Valproic Acid

Levetiracetam

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5
Q

How is an Absence seizure treated?

A

Ethosuxamide (1st line)

Valproic Acid

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6
Q 
Seizure is characterized by:
No loss of consciousness
No postictal state
\+/– automatisms – motor symptoms
Autonomic, Sensory or Cognitive symptoms
A

Aware (Focal)

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7
Q

Seizure is characterized by:
looks Awake, but consciousness is altered (blank stare).
Has a postictal state
May have automatic, repetitive motions or sounds
(Lip smacking)

A

Impaired awareness (Focal)

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8
Q 
Seizure is characterized by:
Loss of consciousness
Has a postictal state
Diffuse muscle contractions of limbs (Tonic) followed by
Rhythmic jerking (clonic)
A

Tonic-clonic

Generalized

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9
Q

Seizure is characterized by:
No loss of consciousness
No postictal state
Brief jerking movements

A

Myoclonic (Generalized)

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10
Q

Seizure is characterized by:
Brief episodes of altered consciousness (blank stare)
Usually no postictal state
May have automatic, repetitive motions or sounds
(Lip smacking)

A

Absence (Generalized)

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11
Q

Sudden impaired consciousness (staring spells)

Preserved muscle tone

Unresponsive to tactile/verbal stimuli

Short < 20 sec

+/- Automatism

Easily provoked by hyperventilation

A

Absence (Generalized)

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12
Q

EEG: 3Hz spike waves during seizure

*Electroencephalogram

A

Absence (Generalized)

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13
Q

Patients are awake and interactive, but have symptoms corresponding to the involved area of the brain

Face & limb Twitching/ jerking = Frontal lobe motor cortex

Auditory/ Olfactory hallucinations = Temporal lobe

Visual phenomena = Occipital lobe

A

Focal Aware seizures

simple partial

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14
Q

Patients are awake, but not interactive and engage in frequent repetitive automatisms (lip smacking, hand wringing, repeating words)

A

Focal impaired awareness

complex partial

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15
Q

The most common

recurrent seizure disorder is

A

Focal impaired awareness

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16
Q

Focal seizures with impaired awareness are the typical manifestation of ____ epilepsy

A

temporal lobe

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17
Q

Seizures are often preceded by a distinctive aura (uneasy epigastric sensation, unpleasant olfactory hallucinations) that localizes the origin of the epileptiform discharges to the

A

mesial temporal lobe (eg, hippocampus, amygdala, parahippocampal gyrus).

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18
Q

Focal seizures with impaired awareness is usually due to underlying _____ which is associated with childhood febrile seizures.

A

hippocampal sclerosis
(mesial temporal sclerosis)
most common etiology

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19
Q

Focal seizures with impaired awareness is usually due to underlying hippocampal sclerosis which is associated with childhood ____.

A

febrile seizures

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20
Q

The ____ lobe plays a role in nonverbal spatial mapping and orientation.

A seizure affecting this part of the brain can cause:

distortions in a patient’s sense of position (a feeling of floating, changes in posture) or

visual interpretation (the size of objects).

A

nondominant parietal

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21
Q

Seizures that originate in the ____ lobe characteristically have visual auras

(flashing lights, visual distortions, complex hallucinations).

A

occipital

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22
Q

High fevers due to viral infection in infants can precipitate

A

febrile seizures

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23
Q

febrile seizures are caused by _____ induced neuronal dysfunction.

A

hypethermia

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24
Q

Temporal lobe epilepsy can also be caused by

A

congenital malformations, Strokes, Tumors (structural abnormalities)

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25
Q

EEG: epileptiform waves

A

Temporal lobe epilepsy (Impaired aware focal)

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26
Q

Temporal lobe seizures can evolve into secondary

A

generalized seizures

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27
Q

a neuropathic disorder that typically presents with episodic, severe, unilateral, electric shock-like or stabbing-like pain in the distribution of CN V of the face.

A 
trigeminal neuralgia 
(tic douloureux)
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28
Q

carbamazepine, a neuroleptic medication that inhibits neuronal high-frequency firing by reducing the ability of ____ channels to recover from inactivation.

A

sodium

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29
Q

Carbamazepine can cause _____ suppression; therefore, complete ____ should be monitored periodically

A

bone marrow
CBC (complete blood cell counts)

*may lead to anemia, agranulocytosis, thrombocytopenia

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30
Q

The first-line treatment for trigeminal neuralgia is

A

carbamazepine

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31
Q

Ethosuximide blocks T-type Ca2+ channels and decreases calcium current in thalamic neurons.

Major side effects include (2)

A

gastrointestinal symptoms

drowsiness

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32
Q

Carbamazepine can cause

A

SIADH

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33
Q

Gingival hyperplasia is a common side effect of

A

phenytoin

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34
Q

an anticonvulsant effective in the treatment of grand mal (tonic-clonic) seizures, partial seizures, and status epilepticus.

A

Phenytoin

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35
Q

Treatment for narcolepsy includes ____ for daytime sleepiness.

A

psychostimulants (Modafinil)

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36
Q

Narcolepsy is characterized by episodes of irresistible sleep during the day and usually one or more REM sleep–related phenomena such as

cataplexy (sudden weakness/sleep triggered by strong emotions)

hypnagogic/hypnopompic hallucinations (hallucinations while falling asleep or awakening, respectively)

& _____

A

sleep paralysis

(physiologic sleep paralysis that persists on awakening/falling asleep).

37
Q

Carbamazepine is used to treat (3)

A

seizures
bipolar disorder
trigeminal neuralgia

38
Q

This young man with throbbing, UNILATERAL l periorbital headache associated with conjunctival injection, lacrimation and miosis has

A

cluster headaches

39
Q

Can present with Ipsilateral autonomic symptoms (lacrimation, rhinorrhea, flushing, diaphoresis) due to

parasympathetic hyperactivity and include nasal congestion, ptosis, miosis, and conjuntival injection.

The headaches typically last 15-180 minutes and tend to occur in clusters over a period of several weeks.

A

cluster headaches

  • most prevalent in MEN
40
Q

Typically presents with severe, pulsatile, unilateral headache often associated with photophobia, phonophobia, nausea, and vomiting.

A

Migraine

with/without aura

41
Q

Typically occurs in patients with thrombophilia (malignancy, antithrombin deficiency) or as a septic thrombosis related to a sinus infection or facial cellulitis.

Periorbital swelling, fever, and proptosis. Orbital pain is worsened with eye movement.

A

Cavernous sinus thrombosis

42
Q

Headache lasts 4 to 72 hours and is most prevalent in women

A

Migraine

43
Q

Dull, tight & persistent pain
Band-like distribution around the head (bilateral)
Muscle tenderness in the head, neck, or shoulders
Precipitated possibly by stress
Can last 30 minutes to months
Affects women slightly more

A

Tension headache

44
Q

Patients typically develop fever, generalized lymphadenopathy, facial swelling/edema, diffuse/confluent skin rash, EOSINOPHILIA, and internal organ dysfunction after starting a new medication

A

DRESS

drug reaction with eosinophilia and systemic symptoms

*can have liver (ALTs), Kidney (creatine), and lung (dyspnea) failure

45
Q

DRESS syndrome typically occurs 2-8 weeks after exposure to high-risk drugs such as:

A

Sulfonamides (sulfasalazine)
Anticonvulsants (phenytoin, carbamazepine)
Antibiotics (minocycline, vancomycin)
Allopurinol

DRESS SAAA

46
Q

Act as antiemetics and pain relievers for severe migraine headache associated with nausea and vomiting.

A

Dopamine (D2) receptor blockers

metoclopramide, prochlorperazine

47
Q

Dopamine blockade treatment for migraines can result in excess cholinergic activity.

____ can be co-administered to prevent these reactions due to its anticholinergic activity.

A

diphenhydramine

48
Q

patient with a normal neurologic examination has unilateral headache associated with nausea and vomiting, and photophobia features that are consistent with

A

migraine headache

49
Q

Severe migraine headache with nausea and vomiting is typically treated with ___ & ___ to abort the migraine and treat associated n/v.

A

serotonin 1B/1D AGONIST
(– triptans)

Dopamine (D2) receptor blocker
(metoclopramide, prochlorperazine)

50
Q

List 4 medications for ABORTIVE migraine treatment

A

Serotonin 1B/1D AGONIST (– triptans)
(D2) receptor blocker (antiemetics)
NSAIDs/ Acetaminophen
Ergotamine (vasoconstrictor)

51
Q

List 4 medications for Preventative migraine treatment

A

Anticonvulsants (Topiramate, Valproate)
Beta Blockers
Antidepressants (–TCAs, venlafaxine)

52
Q

Characteristic histopathologic findings of atrophy of the hippocampal neurons with marked reactive gliosis (astrocyte proliferation in response to injury).

A

Temporal lobe epilepsy

53
Q

Hemosiderin-laden microglial cells are associated with prior

A

intracerebral hemorrhage

54
Q

Form when cells of microglia surround a neuron and phagocytize it.

Are most commonly seen in viral CNS infection (particularly HIV).

A

Microglial nodules

55
Q

Electroencephalography reveals periodic sharp-wave complexes

Spongiform changes in the brain

A

Cruetzfeldt-Jacob

Kuru

56
Q

The pathogenesis of migraines involves a GENETIC predisposition to increased cerebral EXCITABILITY (cortical spreading depression), which leads to release of Trigeminal nerve afferent ______, a neuropeptide involved in pain transmission.

A

calcitonin gene-related peptide (CGRP)

  • CGRP also causes local vasodilation and increased neurogenic inflammation
57
Q

causes headache and decreased vision associated with elevated intraocular pressures. Patients are typically older (age >60), and have severe eye pain and conjunctival erythema are common.

A

Acute angle-closure glaucoma

58
Q

a demyelinating disorder that causes unilateral vision loss, that progresses over a period of weeks.

Eye pain (worse with movement)
color vision is often affected
afferent pupillary defect is present.
A

Optic neuritis

59
Q

Orexin receptor antagonism is the mechanism of action for this insomnia medication

A

suvorexant

60
Q

Serotonin receptor agonism is the mechanism of action of ____ used to treat migraine headaches and of psychedelics (LSD)

A

–Triptans

61
Q

Are GABAa receptor agonist used for insomnia

They are primarily hypnotics and do not produce the anxiolytic, muscle relaxant, or anticonvulsant effects associated with benzodiazepines.

A

Nonbenzodiazepine medications (zolpidem, zaleplon, eszopiclone)

62
Q

Older children with absence seizures may also develop generalized _____ seizures.

Although Ethosuximide is effective against ISOLATED absence seizures,
_______ is a broad-spectrum antiepileptic that treats both types of seizures.

A

tonic-clonic OR myoclonic

Valproic acid

63
Q

Patient develops involuntary, rhythmic jerking of her right upper extremity that lasts for about a minute. She remains fully alert during and after the event.

Diagnosis?

A

Focal seizure with retained awareness

*originating in the contralateral motor cortex one hemisphere

64
Q

β-hydroxybutyrate is a

A

ketone

made from/ can make Acetoacetate

65
Q

patient with abdominal pain, vomiting, HYPERGLYCEMIA, anion gap metabolic acidosis, and
elevated beta-hydroxybutyrate (KETONE) has

A

diabetic ketoacidosis

66
Q

Metabolic derangements (hyperglycemia, acidosis) in patients may cause neurologic dysfunction manifesting as:
altered mental status,
FOCAL neurologic deficits,
and/or

A

seizures

67
Q

This patient’s initial right arm numbness and paresthesia was likely caused by a focal onset seizure originating in the left

A

primary somatosensory cortex

postcentral gyrus

68
Q

The frontal eye field is the region of the cerebral cortex that controls _____ eye movement.

A

horizontal

*It is located superiorly to Broca motor speech

69
Q

Activation of the LEFT _____ during a seizure would cause the eyes to deviate horizontally to the RIGHT

A

frontal eye field

*After the seizure, eyes may temporarily deviate to the LEFT due to postictal neuroinhibition (aka TOWARDS the “lesion”)

70
Q

A seizure originating from the LEFT primary visual cortex would likely result in visual hallucinations affecting the RIGHT _____ visual fields.

A

homonymous

71
Q 
Normal changes in Elderly sleep patterns include 
decreased total sleep time, 
increased \_\_\_\_\_\_, 
sleepiness earlier in the evening 
earlier morning awakening,
Decreased \_\_\_\_\_ sleep 
increased daytime napping.
Increased sleep \_\_\_\_\_\_
A

nighttime awakenings
REM
Latency

72
Q

Nightmares occur during ____ sleep and are more frequent in the final third of the night when their periods become longer

A

rapid eye movement (REM)

73
Q

REM sleep is characterized by the defining feature of rapid eye movements, vivid dreaming, and ____ due to inhibition of motor neurons.

A

voluntary muscle atonia

74
Q

a non-REM parasomnia characterized by incomplete arousals and lack of recall of dream content.

A

sleep terrors

75
Q

Intravenous ______ are the initial drug of choice for status epilepticus.

A

benzodiazepines (eg, lorazepam)

76
Q

a GABA-B agonist that can treat chronic muscle spasticity (ex: cerebral palsy).

A

Baclofen

77
Q

a dopamine depletion agent that can treat Tourette syndrome, a disorder characterized by motor and phonic tics that persist for >1 year.

A

Tetrabenazine

78
Q

chlorpheniramine is a

A

1st generation antihistamine

79
Q

The clinical diagnosis of narcolepsy can be confirmed by low cerebrospinal fluid levels of ____ or shortened REM sleep latency on polysomnography.

A

hypocretin-1 (orexin A)

made in Lateral Thalamus

80
Q

Abortive Migraine therapy can be induced via stimulation of trigeminovascular seretonin receptors using which drug?

A

–Triptans

81
Q

Sleepwalking and Sleep Terrors occur during _____ which is more prominent during the first half of the night

A

Deep, slow-wave sleep

NR Stage 3
Delta waves

82
Q

EEG pattern during

Non-REM stage 1 (N1)

A

Theta waves (4-7.9 Hz)

Wakefulness-sleep transition
Easy to wake

83
Q

EEG pattern during

Non-REM stage 2 (N2)

A

Theta waves (4-7.9 Hz)
Sleep spindles
K-complexes

*Largest percentage of sleep

84
Q

EEG pattern during

Non-REM stage 3 (N3)

A

Delta waves (<4 Hz)

Prominent 1st half of night
Difficult to wake
Sleep walking & night terrors

85
Q

EEG pattern during

REM sleep

A

EEG resembles wakefulness
Occasional sawtooth waves

Prominent 2nd half of night
DREAMS, REMs, muscle atonia
REM sleep behavior disorder & NIGHTMARES

86
Q

Lamotrigine, used to treat Focal seizures, has what concerning adverse reaction

A

Stevens-Johnson syndrome (Toxic epidermal necrolysis)

Flu-like symptoms
Rash
Widespread mucocutaneous epidermal necrosis.

87
Q

a single seizure lasting >5 minutes or the occurrence of multiple discrete seizures with incomplete recovery of consciousness between episodes.

A

Status epilepticus

88
Q

To treat status epilepticus administer IV Lorazapam (Benzodiazepine) & IV _____ to prevent the recurrence of seizure activity, regardless of patient responsiveness to lorazepam

A

Phenytoin (or fosphenytoin)

STEP 1 (88 decks)

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