Epilepsy and Sleep disorders

Question 1

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

Answer 1

a. absence

Question 2

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

Answer 2

a. early Alzheimer’s dementia

Question 3

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

Answer 3

c. occurring after the age of 10

Question 4

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

Answer 4

c. topiramate

Question 5

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

Answer 5

c. topiramate

Question 6

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

Answer 6

a. Phenobarbitone
c. because it affects higher nervous activity

Question 7

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

Answer 7

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

Question 8

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

Answer 8

d. porphyria attack

Question 9

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

Answer 9

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

Question 10

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

Answer 10

c. valproate

Question 11

Which drug can cause hyponatraemia?
a. Carbamazepine.

Answer 11

a. Carbamazepine.

Question 12

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

Answer 12

b. brain tumour

Question 13

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

Answer 13

a. ethosuximide

Question 14

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

Answer 14

b. complex focal epileptic seizure

Question 15

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

Answer 15

a. riluzole

Question 16

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

Answer 16

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

Question 17

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

Answer 17

a. carbamazepine

Question 18

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

Answer 18

d. all of the above

Question 19

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

Answer 19

a. valproate makes it worse

Question 20

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

Answer 20

b. to treat it within 5 minutes

Question 21

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

Answer 21

a. diazepam

Question 22

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

Answer 22

a. multiple sclerosis

Question 23

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

Answer 23

a. fast acting

Question 24

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

Answer 24

c. Todd’s Paresis

Question 25

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

Answer 25

b. valproate

Question 26

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%

Answer 26

e. 30-55%

Question 27

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

Answer 27

d. most often caused by a malignant tumour

Question 28

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

Answer 28

b. 30 min

Question 29

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

Answer 29

a. Ca2+ channels

Question 30

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

Answer 30

a. put her in the unconscious position

Question 31

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

Answer 31

c. carbamazepine

Question 31

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

Answer 31

c. eyes closed in a seizure with generalised convulsions

Question 32

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

Answer 32

e. history and eyewitness description of the attack

Question 33

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

Answer 33

a. myoclonic seizures

Question 34

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

Answer 34

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

Question 35

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

Answer 35

e. all of the abov

Question 36

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

Answer 36

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

Question 37

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

Answer 37

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

Question 38

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

Answer 38

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

Question 39

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

Answer 39

a. carbamazepine

Question 40

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

Answer 40

a. EEG

Question 41

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

Answer 41

a. carbamazepine

Question 41

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

Answer 41

a. lamotrigine

Question 42

Petit-mal seizure therapy is: a. ethosuccimide

Answer 42

a. ethosuccimide

Question 43

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

Question 44

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

Answer 44

a. Kearns-Sayre syndrome

Question 45

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.

Answer 45

a. Juvenile myoclonic epilepsy.

Question 46

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

Answer 46

b. benzodiazepine, phenytoin, propofol and then you intubate

Question 47

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

Answer 47

a. hyperventilation

Question 48

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

Answer 48

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

Question 49

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

Answer 49

a. Syncope

Question 50

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

Answer 50

c. psychomotor epilepsies

Question 51

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

Answer 51

d. magnesium sulphate

Question 52

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

Answer 52

b. Activation of T-type calcium channels

Question 53

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

Answer 53

a. lamotrigine

Question 54

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

Answer 54

a. at SAK

Question 55

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

Answer 55

b. Todd's Paresis

Question 56

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

Answer 56

d. post-traumatic

Question 57

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

Answer 57

c. persistent clonic twitching of the left limbs and somnolence

Question 58

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

Answer 58

a. myoclonic epilepsy

Question 59

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

Answer 59

b. 1%

Question 60

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

Answer 60

e. all of the above

Question 61

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

Answer 61

a. Anorexia.

Question 62

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

Answer 62

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