Black-outs

Question 1

important history of collapse

Answer 1

before: any trigger? sitting standing?
collapse itself: recollection/conscious? warning symptoms?
after: first recollection. tongue biting. incontinence? muscle pains?

Question 2

what compliment to the patient’s history may be useful

Answer 2

a 3rd party account

Question 3

3 categories of syncope (passing out)

Answer 3

reflex
orthostatic
cardiogenic

Question 4

dehydration is what type of syncope

Answer 4

orthostatic

Question 5

arrhythmia is what type of syncope

Answer 5

cardiogenic

Question 6

what type of syncope occurs when someone sees a needle or blood

Answer 6

reflex

Question 7

what type of syncope is triggered by peeing

Answer 7

reflex

Question 8

endocrine causes of syncope fit into what category

Answer 8

orthostatic

Question 9

how does cardiac syncope cause you do pass out

Answer 9

there is a low cardiac output so poor brain perfusion

Question 10

what is syncope

Answer 10

passing out due to poor brain perfusion

Question 11

how does epilepsy cause a black out

Answer 11

neuronal excitation that is abnormal

Question 12

what is epilepsy

Answer 12

a tendency to recurrent seizures

Question 13

5 primary generalised seizures

Answer 13

Absence
Generalised tonic-clonic 
Juvenile myoclonic
Atonic
Myoclonic
(AGJAM)

Question 14

what is a seizure

Answer 14

sudden, uncontrolled electrical disturbance in the brain

Question 15

what differs in the time preceding a primary generalised seizures vs a focal/partial seizure

Answer 15

primary have no warning; partial can have an aura

Question 16

which seizure type is most common <25 years

Answer 16

primary generalised

Question 17

what is a focal seizure

Answer 17

it is focussed to just one part of the brain

Question 18

features of a generalised tonic clonic seizure

Answer 18

groaning sound
tonic phase (rigid)
clonic phase (jerking of all limbs)
eyes are open, maybe rolled back
foaming
lasts a few minutes but groggy for ~30 after

Question 19

PMH associated with generalisd tonic clonic seizures

Answer 19

complications in birth
brain trauma
meningitis

Question 20

true/false tongue biting and incontinence are common in tonic clonic seizures

Answer 20

true

Question 21

what happens in an absence seizure

Answer 21

sudden arrest of activity maybe with staring or eye-lid fluttering

Question 22

true/false tonic clonic seizure have a trigger

Answer 22

false - they’re unpredictable

Question 23

true/false absence seizures have a trigger

Answer 23

true - commonly hyperventilation or photo stimulation (like how you always think of epilepsy)

Question 24

true/false absence seizures have a trigger

Answer 24

true - commonly hyperventilation or photo stimulation (like how you always think of epilepsy)

Question 25

triggers of juvenile myoclonic epilepsy

Answer 25

alcohol and sleep deprivation

Question 26

when in life does juvenile myoclonic epilepsy present

Answer 26

adolescence/early adulthood

Question 27

features of juvenile myoclonic seizures

Answer 27

can be like absence or GTC seizures

Question 28

a teen keeps on dropping things and experiencing brief jerks in his limbs in the morning. what does he have

Answer 28

juvenile myoclonic epilepsy - this is a features called early morning myoclonus

Question 29

two key types of partial seizure

Answer 29

simple and complex

Question 30

what happens during a simple focal seizure

Answer 30

``` strange feeling intense fear/joy stiffness/twitching in parts of body de ja vu tingling in legs/arms unusual smells/tastes ```

Question 31

what are simple focal seizures also known as

Answer 31

auras

Question 32

what can a simple focal seizure be a sign of

Answer 32

another seizure is about to happen

Question 33

features of a complex focal seizure from patient perspective

Answer 33

- may begin with a simple focal seizure (rising feeling in tummy, de ja vu etc) - seizures occurs and they have no recollection of it - disorientated afterwards

Question 34

which type of seizures do you remain conscious of

Answer 34

simple focal

Question 35

features of a complex focal seizure from witness account

Answer 35

- sudden arrest of activity - staring blankly - lip smacking/picking at clothes

Question 36

investigations that can be done in seizures

Answer 36

EEG CT/MRI (can show a focal lesion) Video-telemetry (EEG + video)

Question 37

22% of people with _____ have epilepsy

Answer 37

learning disabilities

Question 38

first line drug treatment of primary generalised epilepsies

Answer 38

sodium valproate, lamotrigine and levetiracetam

Question 39

first line drug treatment of focal or secondary seizures

Answer 39

lamotrigine, carbamazepine, levetiracetam

Question 40

what drug that may be used to treat trigeminal neuralgia and trigeminal autonomic cephalalgia is used in treatment of focal/secondary seizures

Answer 40

carbamazepine

Question 41

2 drugs used in primary generalised and focal seizures

Answer 41

lamotrigine and levetiracetam

Question 42

ethosuximide is only used in which seizure type

Answer 42

absence seizures

Question 43

when is lorazepam or midazolam used in epilepsy

Answer 43

to treat acutely (and in status epilepticus)

Question 44

what is status epilepticus

Answer 44

prolonged/recurrent tonic clonic seizures lasting <30 mins with no recovery period between

Question 45

1st line treatment of status epilepticus

Answer 45

midazolam, lorazepam, diazepam (same as for normal seizures in acute)

Question 46

2nd line for status epilepticus

Answer 46

valproate

Question 47

3rd line for status epilepticus

Answer 47

anaesthesia

Question 48

how long does someone have to wait after a single seizure to be allowed to drive again

Answer 48

6 months (5 years heavy goods!)

Question 49

true/false to be allowed to drive a heavy goods/public vehicle they must be seizure free for 5 years and be on medication

Answer 49

true

Question 50

when are epileptic patients allowed to drive a car

Answer 50

only when they are seizure free for a year OR have had only post-sleep seizures for a year

Question 51

how long till an epileptic have drive a heavy goods or public vehicle

Answer 51

10 years seizure free!