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Neurology > Epilepsy and Sleep disorders > Flashcards

Epilepsy and Sleep disorders Flashcards

1
Q

A 7-year-old girl’s teacher notices that she is less focused in class. She has very
short, but frequent, periods of absence without motor phenomena. The EEG shows 3
Hz periodic spike and sharp wave activity, which is typical for:
a. absence
b. atypical absences
c. complex focal epileptic seizure
d. simple focal epileptic seizure

A

a. absence

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2
Q

Epileptic seizures will exceptionally be seen in a patient with:
a. early Alzheimer’s dementia
b. frontotemporal dementia
c. vascular dementia
d. patients receiving acetylcholinesterase inhibitors

A

a. early Alzheimer’s dementia

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3
Q

What is not true for febrile convulsions?
a. triggered by fever
b. generalised tonic-clonic convulsions
c. occurring after the age of 10
d. we do not treat a single attack

A

c. occurring after the age of 10

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4
Q

Weight loss is a side effect of treatment for:
a. carbamazepine
b. valproate
c. topiramate
d. lamotrigine

A

c. topiramate

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5
Q

We do not give to an epilepsy patient who has kidney stones:
a. lamotrigine
b. carbamazepine
c. topiramate
d. L-Tyracetam

A

c. topiramate

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6
Q

What will we not treat epilepsy with in a demented patient?
a. Phenobarbitone
b. Carbamazepine
Why?
c. because it affects higher nervous activity

A

a. Phenobarbitone
c. because it affects higher nervous activity

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7
Q

The drug of choice for convulsive status epilepticus is a benzodiazepine, which is
administered if possible:
a. per person
b. rectal
c. intravenous
d. intramuscular
If we don’t stop the status, we will use it as a second medicine:
e. alternative benzodiazepine preparation
f. phenytoin
g. anaesthesia with propofol or pentobarbital
h. None of the above If
the attacks have not
stopped:
i. alternative benzodiazepine preparation
j. phenytoin
k. anaesthesia with propofol or pentobarbital
l. none of the above

A

c. intravenous
f. phenytoin
k. anaesthesia with propofol or pentobarbital

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8
Q

A 23-year-old woman became ill with severe abdominal pain, vomiting, tachycardia
and pain in her limbs after taking carbamazepine for facial pain. She noticed that her
urine had darkened. It was:
a. carbamazepine poisoning
b. necrotizing myositis
c. cholecystitis
d. porphyria attack

A

d. porphyria attack

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9
Q

A 19-year-old student has been having seizures since the age of 12, when he would
get stuck and be absent for a few moments. He was taking valproate but stopped
because the seizures went away. The morning before an exam, he had a seizure
during which he trembled all over his body and wet himself and bit his tongue. What
will you say to him as a doctor?
a. the seizure is caused by mental stress before the exam
b. from now on you will have different, big seizures, but we have medicines for
those too
c. apparently your current medication isn’t helping, so we’ll have to fix your
brain

A

a. the seizure is caused by mental stress before the exam

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10
Q

Which is the first-line treatment for a patient with juvenile myoclonic epilepsy?
a. phenytoin
b. ethosuccimide
c. valproate
d. barbiturate
e. vigabatrin

A

c. valproate

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11
Q

Which drug can cause hyponatraemia?
a. Carbamazepine.

A

a. Carbamazepine.

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12
Q

In which situation would you introduce antiepileptic therapy after the 1st seizure?
a. alcohol withdrawal
b. brain tumour
c. febrile convulsions
d. hyponatraemia

A

b. brain tumour

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13
Q

An antiepileptic used exclusively for absence is:
a. ethosuximide
b. valproate
c. lamotrigine
d. carbamazepine

A

a. ethosuximide

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14
Q

The 50-year-old economist suddenly froze, absent, whimpering. In a short
time, he was conscious again. He has no recollection of the incident. He had:
a. generalised epileptic seizure
b. complex focal epileptic seizure
c. simple focal epileptic seizure
d. neurocardiogenic presyncope

A

b. complex focal epileptic seizure

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15
Q

Which medicine should not be used for epilepsy?
a. riluzole
b. lamotrigine
c. valproate
d. levetiracetam

A

a. riluzole

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16
Q

Management of a patient with status epilepticus:
a. first, the airway is supplied
b. first give him lorazepam i.v., then treat the airway
c. first give him lorazepam i.v., then phenytoin i.v.
d. give him propofol first, then levetiracetam

A

c. first give him lorazepam i.v., then phenytoin i.v.

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17
Q

Which antiepileptic drug is most commonly used in partial epileptic seizures:
a. carbamazepine
b. valproate
c. vigabatrin

A

a. carbamazepine

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18
Q

What are generalised epileptic seizures:
a. absence
b. Myoclonic
c. generalised tonic-clonic
d. all of the above
e. none of the above

A

d. all of the above

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19
Q

Juvenile myoclonic epilepsy - what’s wrong?
a. valproate makes it worse
b. most often between 8-18 years
c. absent and generalised myoclonic-tonsuses occur
d. myoclonus is most common in the morning

A

a. valproate makes it worse

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20
Q

What is prognostically most important in status epilepticus:
a. whether it is partial or generalised
b. to treat it within 5 minutes
c. to treat it within 30 minutes
d. or treated with diazepam
e. or treated with lorazepam

A

b. to treat it within 5 minutes

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21
Q

. What do we do to break status epilepticus?
a. diazepam

A

a. diazepam

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22
Q

What is the least likely reason for seizures?
a. multiple sclerosis
b. cryptococcal meningitis
c. another kind of meningitis

A

a. multiple sclerosis

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23
Q

Why do neurologists like and give IV benzodiazepines in status epilepticus?
a. fast acting
b. do not cause hypotension
c. do not cause respiratory disturbance

A

a. fast acting

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24
Q

Transient neurological impairment, usually a weakness contralateral to the
epileptic focus, is called :
a. TIA
b. Jacksonian attack
c. Todd’s Paresis
d. complex epilepsy
e. Epilepsy Partialis Continus

A

c. Todd’s Paresis

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25
Q

For absence seizure therapy, we use:
a. carbamazepine
b. valproate
c. Phenobarbitone

A

b. valproate

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26
Q

A single standard EEG test is specifically altered in patients with epilepsy in
only … % of patients with epilepsy:
a. 5-10%
b. 10-15%
c. 15-20%
d. 25-30%
e. 30-55%

A

e. 30-55%

27
Q

Which statement is not true for temporal lobe epilepsy?
a. can start in infancy
b. a history of febrile convulsions is found in 50% of patients
c. surgical treatment is often the best therapeutic option
d. most often caused by a malignant tumour
e. MRI is the best imaging method

A

d. most often caused by a malignant tumour

28
Q

In neurology, status epilepticus refers to an epileptic seizure in which the
convulsions have been ongoing for:
a. 5 min
b. 30 min
c. 1 hour
d. 2 hours

A

b. 30 min

29
Q

For an absence seizure to occur, the antiepileptic must act on:
a. Ca2+ channels

A

a. Ca2+ channels

30
Q

The woman in front of us falls to the ground, what
do we do?
a. put her in the unconscious position.

A

a. put her in the unconscious position

31
Q

Which antiepileptic drug can aggravate withdrawal seizures?
a. sodium valproate
b. clobazam
c. carbamazepine
d. levetiracetam
e. all of the following

A

c. carbamazepine

31
Q

Which of the following is a warning that the observed event is unlikely to be
epileptic seizure?
a. duration of attack less than 1 minute
b. a state of confusion without motor signs
c. eyes closed in a seizure with generalised convulsions
d. seizures look like convulsions, with a fast component to one side and a
slow one to the other.
e. the patient looks very frightened or cries during an attack

A

c. eyes closed in a seizure with generalised convulsions

32
Q

What is the most important diagnostic procedure when diagnosing epileptic
seizures?
a. EEG combined with magnetoencephalography
b. MRI and CT brain
c. neurological status
d. blood tests, especially serum ethanol concentration.
e. history and eyewitness description of the attack

A

e. history and eyewitness description of the attack

33
Q

Which type of seizure looks like sudden, rapid spasms or convulsions of the upper
or lower limbs, with no apparent loss of consciousness, which can also cause a
fall?
a. myoclonic seizures
b. tonic seizures
c. synkop
d. clonic or tonic-clonic seizures
e. absence

A

a. myoclonic seizures

34
Q

In the epidemiology of epilepsy, the following statement is true:
a. the lifetime risk of having an epileptic seizure is 1%
b. by the age of 80, around 9% of people have at least one seizure
c. women are more likely to suffer from epilepsy than men
d. the highest incidence of epilepsy is in young adults and middle-aged adults
e. the prevalence of epilepsy is 1 per 400 inhabitants

A

b. by the age of 80, around 9% of people have at least one seizure

35
Q

The differential diagnosis of epileptic seizures includes:
a. Syncope
b. TIA
c. TGA
d. episodes of psychiatric illness
e. all of the abov

A

e. all of the abov

36
Q

What’s wrong with “complex partial seizures”?
a. complex partial seizures are focal seizures during which consciousness
is affected
b. the use of the term “complex partial epileptic seizure” is discouraged by
the International League Against Epilepsy
c. are typical of temporal lobe epilepsies
d. contain automatic behaviour and unresponsiveness, although
sometimes patients may remember the test word given during an
attack
e. complex partial seizures are often used synonymously with
psychomotor seizures

A

d. contain automatic behaviour and unresponsiveness, although
sometimes patients may remember the test word given during an
attack

37
Q

Which of the following statements about the driving ability of people with epilepsy is
correct?
a. People with epilepsy cannot hold a driving licence.
b. People with epilepsy can drive motor vehicles (except lorries and buses) if
they are successfully treated (seizure-free) with no more than one
antiepileptic drug.
c. People with epilepsy can drive motor vehicles (except lorries and
buses) if they have not had an epileptic seizure for two years.
d. People with epilepsy can drive motor vehicles (except trucks and buses) if
their antiepileptic treatment has not changed for 3 years

A

c. People with epilepsy can drive motor vehicles (except lorries and
buses) if they have not had an epileptic seizure for two years.

38
Q

Antiepileptic drugs (AEDs) are usually suggested after a second seizure. After the
first seizure of a lifetime, we suggest PEZ treatment in special cases. In which of the
following cases do we suggest starting treatment after the first, unprovoked seizure?
a. when an MRI of the brain shows a structural change in the brain
b. in children under 12 years of age
c. for pregnant women in the 2nd or 3rd trimester of pregnancy
d. for a person with a valid driving licence

A

a. when an MRI of the brain shows a structural change in the brain

39
Q

It worsens juvenile myoclonic epilepsy:
a. carbamazepine
b. ethosuccimide
c. lorazepam
d. levetiracetam
e. valproate

A

a. carbamazepine

40
Q

Diagnosis of non-convulsive epilepsy:
a. EEG
b. Clinical
c. CT
d. MR

A

a. EEG

41
Q

Therapy of focal symptomatic epilepsy:
a. carbamazepine
b. topiramate
c. valproate

A

a. carbamazepine

41
Q

Therapy of juvenile myoclonic epilepsy:
a. lamotrigine
b. carbamazepine
c. pregabatrin
d. Anything

A

a. lamotrigine

42
Q

Petit-mal seizure therapy is:
a. ethosuccimide

A

a. ethosuccimide

43
Q

Status epilepticus:
a. diazepam i.v. 10-20 mg/kg, then phenytoin i.v. 20 mg/kg, then intubation

A
44
Q

Epileptic seizures are not a sign of which syndrome?
a. Kearns-Sayre syndrome
b. Lennox-Gastaut syndrome
c. West syndrome

A

a. Kearns-Sayre syndrome

45
Q

A 22-year-old student is brought to A&E because she had a generalised seizure after
a sleepless night. Her mother says that recently things have been falling out of her
hands in the morning. What is the diagnosis?
a. Juvenile myoclonic epilepsy.

A

a. Juvenile myoclonic epilepsy.

46
Q

What do you do if a patient is brought to you in generalised status epilepticus?
a. first you intubate and give the O2
b. benzodiazepine, phenytoin, propofol and then you intubate

A

b. benzodiazepine, phenytoin, propofol and then you intubate

47
Q

What do we use when recording an EEG in a patient with epilepsy?
a. hyperventilation

A

a. hyperventilation

48
Q

An 18-year-old boy diagnosed with epilepsy repeatedly loses things. What is it?
a. tonic convulsions
b. atonic convulsions
c. absence
d. myoclonus
What form of epilepsy does she have?
e. Lennox-Gastaut syndrome
f. juvenile myoclonic epilepsy
g. juvenile absence epilepsy
How is epilepsy treated?
h. with valproate
i. with ethosuccimide
j. with carbamazepine

A

d. myoclonus
f. juvenile myoclonic epilepsy
h. with valproate

49
Q

A 23-year-old soldier who blackouts and falls has mild clonus, does not bite his
tongue, and is not incontinent. What is the diagnosis?
a. Syncope
b. psychogenic

A

a. Syncope

50
Q

A man lying on the floor, all limbs outstretched, with only his arms folded, is not a
representation:
a. myoclonus
b. tetanus
c. psychomotor epilepsies
d. psychiatric disorders
e. meningitis

A

c. psychomotor epilepsies

51
Q

What to treat a pregnant woman having a seizure with (video):
a. valproate
b. carbamazepine
c. phenytoin
d. magnesium sulphate
e. propranolol

A

d. magnesium sulphate

52
Q

An antiepileptic by what mechanism would worsen absence?
a. Inhibition of T-type calcium channels
b. Activation of T-type calcium channels
c. Sodium channel blockade
d. Action on GABA-A receptors
e. Increased release of neurotransmitters

A

b. Activation of T-type calcium channels

53
Q

How would you treat myoclonic epilepsy?
a. lamotrigine
b. carbamazepine
c. levetiracetam
d. phenytoin

A

a. lamotrigine

54
Q

When is a symptomatic seizure least likely to occur?
a. at SAK
b. in tumour
c. in cryptococcal meningitis
d. in meningococcal meningitis
e. in multiple sclerosis

A

a. at SAK

55
Q

A 24-year-old student who has epileptic convulsions on her right side. Now, after
a seizure, she notices weakness on the left side of her body. What is it?
a. Jacksonian attack
b. Todd’s Paresis
c. latent paresis
d. Uhthoff’s sign

A

b. Todd’s Paresis

56
Q

Which type of syncope do we not know?
a. Mickey
b. vagovazal
c. Cardiogenic
d. post-traumatic
e. when coughing

A

d. post-traumatic

57
Q

A 75-year-old gentleman is in palliative care at the Hospice. When do we admit a
patient to the hospice:
a. if he has difficulty swallowing
b. if you have a headache
c. persistent clonic twitching of the left limbs and somnolence
d. sopor

A

c. persistent clonic twitching of the left limbs and somnolence

58
Q

The patient retains consciousness, but there are rapid jerks that cause him to fall.
What is it?
a. myoclonic epilepsy

A

a. myoclonic epilepsy

59
Q

The prevalence of epilepsy is:
a. 0.1%
b. 1%
c. 5%
d. 10%

A

b. 1%

60
Q

Features of narcolepsy:
a. cataplexy
b. fall asleep several times during the day
c. are sleepy during the day
d. hypnapompic and hypnagogic states
e. all of the above

A

e. all of the above

61
Q

What is not found in sleep apnoea?
a. Anorexia.

A

a. Anorexia.

62
Q

What would you do for a person who has trouble sleeping without any organic cause?
a. prescribed sleeping pills
b. clean up your hygiene habits
c. regulate hygiene habits, prescribe sleeping pills for a short time and
check the condition later

A

c. regulate hygiene habits, prescribe sleeping pills for a short time and
check the condition later

Neurology (22 decks)

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