Matthew Coulson
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Epilepsy given on 14th September 2018

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Matthew Coulson
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Epilepsy

Epilepsy

Frage 1 von 29

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A seizure whereby there is rapid contraction and relaxation of muscles causing an uncontrollable shaking of the body is called a seizure.

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Frage 2 von 29

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affect both brain hemispheres
affect only one brain hemisphere

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    Generalised seizures
    Focal seizures

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Frage 3 von 29

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Types of Generalised Seizure:
- Contraction of limbs followed by their extension & arching of back lasting 10-30s, followed by a shaking of the limbs.
- Constant contraction of the muscles. Person often turns blue as breathing is stopped.
- Shaking of the limbs in unison.
- Brief, shock-like jerks of a muscle or a group of muscles.

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    Myoclonic
    Clonic
    Tonic
    Tonic-clonic

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Frage 4 von 29

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During tonic-clonic seizures, bites to which part of the tongue are more common?

Wähle eine der folgenden:

  • Bites to tip of tongue

  • Bites to side of tongue

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Frage 5 von 29

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If a patient presents after a fall/seizure, it is mandatory to rule out a cardiovascular cause via which investigation?

Wähle eine der folgenden:

  • ECG

  • Echocardiogram

  • Ultrasound

  • Blood Pressure Measurement

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Frage 6 von 29

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DVLA Rules Regarding Seizures - car:

You’ve had a one-off seizure while awake and lost consciousness:

Wähle eine der folgenden:

  • Licence suspended, can reapply after 6 months seizure free

  • Licence suspended, can reapply after 12 months seizure free

  • Licence only suspended after 2nd seizure

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Frage 7 von 29

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DVLA Rules Regarding Seizures - HGV:

You’ve had a one-off seizure while awake and lost consciousness:

Wähle eine der folgenden:

  • Licence suspended, can reapply after 12 months

  • Licence suspended, can reapply after 3 years

  • Licence suspended, can reapply after 5 years

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Frage 8 von 29

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DVLA Rules Regarding Seizures - car:

Diagnosed with epilepsy:

Wähle eine der folgenden:

  • Licence suspended, can reapply after 5 years seizure free

  • Licence suspended, can reapply after 1 year seizure free

  • Licence suspended, can reapply after 3 years seizure free

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Frage 9 von 29

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DVLA Rules Regarding Seizures - HGV:

Diagnosed with epilepsy:

Wähle eine der folgenden:

  • Licence suspended, can reapply after 5 years off medication & seizure free

  • Licence suspended, can reapply after 7 years off medication & seizure free

  • Licence suspended, can reapply after 10 years off medication & seizure free

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Frage 10 von 29

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Primary Generalised Epilepsy often presents ...

Wähle eine der folgenden:

  • In childhood/teenage years

  • In late 20s/early 30s

  • In those over 50

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Frage 11 von 29

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The treatment of choice for primary generalised epilepsy is

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Frage 12 von 29

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If a primary generalised epilepsy patient is unresponsive to Sodium Valproate, which of the following second line treatments is most common?

Wähle eine der folgenden:

  • Lamotrigine

  • Clobazam

  • Gabapentin

  • Pregabalin

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Frage 13 von 29

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Due to the adverse side effects, sodium valproate is not recommended for focal onset epilepsy. Instead, what is the first line treatment for this condition?

Wähle eine der folgenden:

  • Carbamazepine

  • Clobazam

  • Levetiracetam

  • Oxcarbazepine

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Frage 14 von 29

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Sodium Valproate is teratogenic and should not be prescribed to pregnant women

Wähle eins der folgenden:

  • WAHR
  • FALSCH

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Frage 15 von 29

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A 17 year old girl is taken to A&E after having had a generalized seizure.
She had been out partying the night before. No past Hx of note, although her mother reported that she had been a bit clumsy and jerky in the mornings recently, e.g. dropping her hairbrush or coffee cup. Which of the following statements is correct?

Wähle eine der folgenden:

  • The history is suggestive of a secondary generalized fit. The patient
    needs urgent brain scanning.

  • The history suggests a primary generalized epilepsy, and either Sodium
    Valproate or Lamotrigine would be treatment of choice.

  • Treatment of choice for this type of epilepsy is Carbamazepine

  • Juvenile myoclonic epilepsy is associated with hippocampal sclerosis

  • This is probably just an alcohol induced seizure. No further
    investigations or treatment required

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Frage 16 von 29

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What is status epilepticus?

Wähle eine der folgenden:

  • Recurrent epileptic seizures without full recovery of consciousness. Continuous seizures lasting >30 minutes

  • Recurrent epileptic seizures without full recovery of consciousness. Continuous seizures lasting >60 minutes

  • A seizure that can only be halted by high loading with an acute anti-convulsant

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Frage 17 von 29

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Status Epilepticus is a clinical emergency. Whilst they tend to stop by themselves, to prevent further damage anticonvulsants should be given. Which of the following anticonvulsants should be given in an acute situation such as this?

Wähle eine der folgenden:

  • Phenytoin

  • Lamotrigine

  • Sodium Valproate

  • Carbamazepine

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Frage 18 von 29

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A patient in status epilepticus is considered an emergency case. Therefore, urgent blood tests and CT to identify the cause are required.

Wähle eins der folgenden:

  • WAHR
  • FALSCH

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Frage 19 von 29

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What means of investigation is used to differentiate generalised from focal epilepsy?

Wähle eine der folgenden:

  • Electroencephalogram (EEG)

  • Electrocardiogram (ECG)

  • Electroneurogram (ENG)

  • Electrical Seizure Test (EST)

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Frage 20 von 29

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Women on anti-convulsants seeking the contraceptive pill should not use the and should instead be switched to the

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    combined pill (estrogen + progesterone)
    progesterone only pill

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Frage 21 von 29

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The morning after pill is more effective in women taking anti-convulsants and the dose should be titred down accordingly.

Wähle eins der folgenden:

  • WAHR
  • FALSCH

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Frage 22 von 29

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Which anti-convulsant can be given to patients who are obese/have sleep problems due to its weight reducing and sedative effects?

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Frage 23 von 29

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Carbamazepine typically makes Primary Generalised Epilepsy worse

Wähle eins der folgenden:

  • WAHR
  • FALSCH

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Frage 24 von 29

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In the case of Status Epilepticus, patients are generally given benzodiazepines first line to attempt to halt the seizures. Such medications include IV , Buccal and Rectal .
If benzodiazepines fail to halt the seizures, then the anti-convulsant called should be given IV.

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Frage 25 von 29

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Which type of seizure typically causes the patient to experience odd smells?
e.g. every time they drive they experience a "metallic smell"

Wähle eine der folgenden:

  • Focal Seizure

  • Generalised Seizure

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Frage 26 von 29

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Is an absence feature focal or generalised?

Wähle eine der folgenden:

  • Focal Seizure

  • Generalised Seizure

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Frage 27 von 29

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Following a seizure patients typically enter what is known as a state where they feel drowsy and tired for around 15 minutes before they are back to feeling normal again.

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Frage 28 von 29

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Which of the following anticonvulsants is known to induce alopecia?

Wähle eine der folgenden:

  • Sodium Valproate

  • Lamotrigine

  • Carbamazepine

  • Phenytoin

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Frage 29 von 29

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Which anticonvulsant medication is known to cause Stevens-Johnson Syndrome in some rare cases?

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