Pregunta 1
Pregunta
[blank_start]Seizure[blank_end] is a transient occurrence of signs and symptoms due to abnormal excessive or synchronous neuronal activity in the brain
Pregunta 2
Pregunta
[blank_start]Epilepsy[blank_end] is a neurological disease marked by the sudden and recurrent episodes of seizures
Pregunta 3
Pregunta
A person is considered to have epilepsy if they meet any of the following conditions:
Respuesta
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At least two unprovoked (or reflex) seizures occurring greater than 24 hours apart
-
One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years
-
Diagnosis of an epilepsy syndrome
-
Have an single unprovoked seizure event
Pregunta 4
Pregunta
More than 30 minutes of:
- continuous seizure activity
- two or more sequential seizures without full recovery of consciousness between seizures.
Respuesta
-
Seizure
-
Epilepsy
-
Status Epilepticus
Pregunta 5
Pregunta
Some seizures occur as single events
- Withdrawal of [blank_start]CNS[blank_end] depressants
- During acute [blank_start]neurologic[blank_end] illnesses
- Systemic [blank_start]toxic[blank_end] conditions
- Cocaine use
- Overdosing on [blank_start]digoxin[blank_end]
- [blank_start]Electrolyte[blank_end] disturbances
- Hypoglycemia
Respuesta
-
CNS
-
neurologic
-
toxic
-
digoxin
-
Electrolyte
Pregunta 6
Pregunta
Causes of seizures
[blank_start]Vascular[blank_end]: stroke, post-stroke, AV malformations
[blank_start]Infections[blank_end]: meningitis, Lyme disease, brain abscess, HIV related
[blank_start]Trauma[blank_end]: Brain injury
[blank_start]Autoimmune[blank_end]: SLE
[blank_start]Metabolic[blank_end]: hypoglycemia, electrolyte disturbances (Na⁺, Ca⁺⁺, Mg⁺⁺)
[blank_start]Idiopathic[blank_end]: versus cryptogenic
[blank_start]Neoplasm[blank_end]: primary brain tumor or metastatic
[blank_start]Syndromes[blank_end]: Down’s Syndrome
[blank_start]Stimulants[blank_end]: IV drug use, cocaine, ephedrine, herbal remedies
Respuesta
-
Vascular
-
Infections
-
Trauma
-
Autoimmune
-
Metabolic
-
Idiopathic
-
Neoplasm
-
Syndromes
-
Stimulants
Pregunta 7
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[blank_start]Seizures[blank_end] are also called the electrical storms in the brain
Pregunta 8
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[blank_start]GABA[blank_end] is the main inhibitory neurotransmitter
[blank_start]Glutamate[blank_end] is the major excitatory neurotransmitter
Pregunta 9
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Every individual has a seizure [blank_start]threshold[blank_end], which is the level of excitability at which neurons will discharge abnormally
Pregunta 10
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Patients with epilepsy have a [blank_start]lower[blank_end] seizure threshold
Pregunta 11
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[blank_start]Prodrome[blank_end] is feelings, sensations, or changes of behavior hours or days before a seizure
- warning that a seizure is coming
- not considered part of the seizure
Respuesta
-
Prodrome
-
Aura
-
Ictal phase
-
post-ictal phase
Pregunta 12
Pregunta
[blank_start]Aura[blank_end] or warning is the first symptom of a seizure
- Changes in smells, sounds, tastes, vision, “strange” feelings, racing thoughts, fear/panic, headache, nausea, numbness or tingling in part of the body
- Considered part of the seizure
Pregunta 13
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[blank_start]Ictal[blank_end] phase is the middle of a seizure
- Correlates with the electrical activity in the brain
- Where the symptoms are observed
Pregunta 14
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[blank_start]Post-ictal[blank_end] phase is the end of a seizure
- Recovery period after the seizure (immediate or can take minutes to hours)
Pregunta 15
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Every person with seizures will not have every stage or symptom
Pregunta 16
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[blank_start]Partial[blank_end] seizures start in one area or side of the brain
Pregunta 17
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[blank_start]Generalized[blank_end] seizures start on both sides of the brain at the same time and usually loss of consciousness is observed
Pregunta 18
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A partial seizure in which consciousness is not impaired is referred to as a [blank_start]simple[blank_end] partial seizure
Pregunta 19
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A partial seizure in which consciousness is impaired is referred to as a [blank_start]complex[blank_end] partial seizure
Pregunta 20
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A partial onset evolving to generalized tonic-clonic is referred to as a [blank_start]secondarily generalized[blank_end] seizures
Pregunta 21
Pregunta
Name the type of the seizure:
Generally occurs in young children
Sudden onset, interruption of ongoing activity
Blank stare
Possibly a brief upward rotation of the eyes
Respuesta
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Absence
-
Myoclonic
-
Clonic
-
Tonic
Pregunta 22
Pregunta
Name the type of seizure:
Brief shock-like muscular contractions of the face, trunk, and extremities
Respuesta
-
Absence
-
Myoclonic
-
Clonic
-
Tonic
Pregunta 23
Pregunta
Name the type of seizure:
Rhythmic, repetitive, jerking muscle movement
Respuesta
-
Absence
-
Myoclonic
-
Clonic
-
Tonic
Pregunta 24
Pregunta
Name the type of seizure:
Flexion, extension, and adduction of extremities
Extension of back and neck
Contraction of thoracic and abdominal muscles (may become apneic)
Upward eye movement and mouth partially open
May cry out as air is forced from the lungs
Respuesta
-
Absence
-
Myoclonic
-
Clonic
-
Tonic
Pregunta 25
Pregunta
Which of the following statements about Atonic seizures are true?
Respuesta
-
Sudden loss of muscle tone
-
common in children
-
may present with head drop, dropping of a limb, and slumping to the ground
-
Patients often wear protective headgear to prevent trauma
Pregunta 26
Pregunta
There are NO diagnostic laboratory tests for epilepsy
Pregunta 27
Pregunta
[blank_start]Prolactin[blank_end] levels can be transiently elevated after GTC or CP seizures, however this observation can not be used as a diagnostic marker for epilepsy.
Pregunta 28
Pregunta
[blank_start]Electroencephalogram (EEG)[blank_end] is very useful in the diagnosis of various seizure disorders (only to confirm a diagnosis)
Pregunta 29
Pregunta
Which of the following is NOT useful in the diagnosis of seizure disorders?
Pregunta 30
Pregunta
Focal seizures: previously called [blank_start]partial seizures[blank_end], these start in an area or network of cells on one side of the brain
Generalized seizures: previously called [blank_start]primary generalized[blank_end], these affect both sides of the brain at onset
Unknown onset: is the onset of the seizure is not known
Focal to bilateral seizure: previously called [blank_start]secondary generalized seizure[blank_end], it starts in one side of the brain and spreads to both sides
Pregunta 31
Pregunta
Focal aware: replaces the term [blank_start]simple partial[blank_end]; if awareness remains intact even if person is unable to talk or respond during a seizure
Focal impaired awareness: replaces the term [blank_start]complex partial[blank_end] seizure; if awareness is impaired or affected at any time during a seizure even if a person has a vague idea of what happened
Awareness unknown: for example if person lives alone or has seizures only at night
Generalized seizures: these are all presumed to affect a person’s awareness or consciousness in some way
Respuesta
-
simple partial
-
complex partial
Pregunta 32
Pregunta
Which of the following statements are true in regards to febrile seizures?
Respuesta
-
Children aged 3 months to 6 years may have tonic-clonic seizures when they have a high fever
-
More likely to occur if there is a family history of febrile seizures
-
Most children do not require daily treatment with medications
-
The outlook is excellent; the majority of children will not have seizures without a fever after the age of 5
-
Medications can be considered for children who have repeated episodes of multiple febrile seizures
Pregunta 33
Pregunta
Which drugs can be used as prophylaxis in the treatment of febrile seizures?
Respuesta
-
Phenobarbital
-
Valproate
-
Lamotrigine
-
Lorazepam
Pregunta 34
Pregunta
What medications can be given at the time of a febrile seizure?
Respuesta
-
Diazepam gel or liquid (can be given rectally)
-
clonazepam (placed on the tongue)
-
diazepam tablet (crushed and put between the cheek and gum)
-
lorazepam tablet (crushed and put between the cheek and gum)
-
can be treated with AED's
Pregunta 35
Pregunta
Initiation of AEDs is recommended in the following cases:
After one seizure in patients with [blank_start]risk factors[blank_end]
After two seizures that occurred within a period of [blank_start]6-12[blank_end] months
Pregunta 36
Pregunta
Risk factors for seizures (at least one is need to initiate treatment)
- [blank_start]CNS[blank_end] insult (stroke, head trauma, bleeding)
- Family history of [blank_start]epilepsy[blank_end]
- changes in [blank_start]EEG[blank_end]
- some [blank_start]childhood[blank_end] illness (babies born small for their age, babies who have seizure in the first month of life, babies born with abnormal areas in the brain)
- [blank_start]brain[blank_end] tumor
- autism
- use of [blank_start]illegal drugs[blank_end] such as cocaine
Respuesta
-
CNS
-
epilepsy
-
EEG
-
childhood
-
brain
-
illegal drugs
Pregunta 37
Pregunta
The probability of a 2nd seizure can be as high as [blank_start]80[blank_end]% after 5 years
Pregunta 38
Pregunta
If the probability of a 2nd seizure is less than 10% in the 1st year and 24% after 2 years, you are NOT considered to be at risk and treatment initiation should not begin.
Pregunta 39
Pregunta
A 50 year old male had a documented GTC seizure at 10am this morning. Patient has been recently diagnosed with a brain tumor. What is your recommendation regarding initiating AEDs for this patient?
Pregunta 40
Pregunta
Which of the following are triggers for seizures?
Respuesta
-
Missed medicine
-
Lack of sleep
-
Stress
-
Alcohol
-
Drug abuse (amphetamine, stimulant, marijuana, heroin, nicotine, caffeine)
-
Menstruation (hormonal change, can adjust medication dose in women with regular cycles or prescribe lorazepam (Ativan) for several days around the menstrual cycle
-
Others (OTC agents such as diphenhydramine, some herbal medicines)
Pregunta 41
Pregunta
Diphenhydramine raises the seizure threshold
Pregunta 42
Pregunta
Which of the following factors must be considered when selecting the appropriate AED therapy for a patient?
Pregunta 43
Pregunta
An antiepileptic drug should not be considered ineffective unless patient develops an unacceptable ADR with continued seizure
Pregunta 44
Pregunta
Despite appropriate initial treatment, [blank_start]30-35[blank_end]% of patients are refractory to treatment
Pregunta 45
Pregunta
carbamazepine half-life is variable because of [blank_start]auto-induction[blank_end] which is usually complete 3 to 5 weeks after initiation of a fixed carbamazepine regimen
Pregunta 46
Pregunta
Which of the following agents can cause acute hepatic failure, acute pancreatitis, and alopecia?
Respuesta
-
Phenytoin (Dilantin)
-
Carbamazepine (Tegretol)
-
Valproic Acid (Depakote)
-
Gabapentin (Neurontin)
Pregunta 47
Pregunta
Serum concentrations are useful when optimizing AED therapy, they should be assessed by:
- Checking "[blank_start]steady state[blank_end]": different for each drug (average 1 to 3 weeks)
- Checking at a [blank_start]consistent[blank_end] time: preferably first thing in the [blank_start]morning[blank_end]
- Its best to check a [blank_start]trough[blank_end] level first thing in the morning, [blank_start]8[blank_end] hours after the last dose (lowest level)
Respuesta
-
steady state
-
consistent
-
morning
-
trough
-
8
Pregunta 48
Pregunta
Give the following information, calculate the corrected phenytoin concentration.
(Total phenytoin is 8mcg/mL ; albumin 1mg/dL)
Corrected phenytoin = measured phenytoin / [(0.29 x albumin) + 0.1)
Pregunta 49
Pregunta
What is the most common type of seizure experienced by adults?
Respuesta
-
partial seizures
-
generalized seizures
-
absence seizures
Pregunta 50
Pregunta
[blank_start]Carbamazepine[blank_end] and phenytoin first line therapy in new-onset partial and generalized seizures
Pregunta 51
Pregunta
Of the agents listed below, which received FDA approval for use as monotherapy in patients with partial seizures?
Pregunta 52
Pregunta
[blank_start]Lamotrigine[blank_end] was determined to be a cost effective alternative to carbamazepine
Respuesta
-
Lamotrigine
-
Gabapentin
-
Topiramate
Pregunta 53
Pregunta
Indicate the appropirate drug therapy treatment for absence seizures:
1st line: [blank_start]Ethosuximide (Zarontin)[blank_end]
2nd line: [blank_start]Valproate (Depakote)[blank_end]
3rd line: [blank_start]Lamotrigine (Lamictal)[blank_end]
Respuesta
-
Ethosuximide (Zarontin)
-
Valproate (Depakote)
-
Lamotrigine (Lamictal)
-
Valproate (Depakote)
-
Ethosuximide (Zarontin)
-
Lamotrigine (Lamictal)
-
Lamotrigine (Lamictal)
-
Ethosuximide (Zarontin)
-
Valproate (Depakote)
Pregunta 54
Pregunta
Which of the following agents are infective in absence seizures and can precipitate and increase seizure frequency
Pregunta 55
Pregunta
What is the appropriate therapy to utilize in the treatment of mixed absence and partial or generalized:
Respuesta
-
Valproate (Depakote)
-
Lamotrigine (Lamictal)
-
Tiagabine (Gabitril)
-
Felbamate (Felbatol)
Pregunta 56
Pregunta
[blank_start]Ethosuximide[blank_end] in combination with another AED is a n alternative therapy in the treatment of mixed absence and partial/generalized seizures.
Pregunta 57
Pregunta
[blank_start]Phenytoin (Dilantin)[blank_end] is the traditional treatment for tonic-clonic seizures. [blank_start]Carbamazepine (Tegretol)[blank_end] and Valproate (Depakote) are equally efficacious and have less side effects.
Pregunta 58
Pregunta
What drugs are alternative in the treatment of tonic-clonic seizures?
Respuesta
-
Lamotrigine (Lamictal)
-
Topiramate (Topamax)
-
Phenytoin (Dilantin)
-
Gabapentin (Neurontin)
Pregunta 59
Pregunta
Seizure freedom for ≥ 2 years implies overall >[blank_start]60[blank_end]% chance of successful withdrawal in some epilepsy syndromes
Pregunta 60
Pregunta
Patients who are seizure free:
[blank_start]2[blank_end] years: Absence
[blank_start]4[blank_end] years: simple partial, complex partial, tonic-clonic seizures
Pregunta 61
Pregunta
Sudden discontinuation of AED therapy can precipitate withdrawal seizures and status epilepticus. Especially with benzodiazepines and barbiturates
Pregunta 62
Pregunta
When converting to monotherapy from polytherapy:
Eliminate [blank_start]sedative[blank_end] drugs first
Withdraw antiepileptic agents [blank_start]slowly[blank_end] over several months
Pregunta 63
Pregunta
AEDs and Pregnancy
- AED teratogenicity is related to exposure in the [blank_start]first[blank_end] trimester of pregnancy
- [blank_start]Seizures[blank_end] may be deleterious to the fetus
- Risks from seizures are greater than risks from [blank_start]medications[blank_end]
- All antiepileptic patient drugs carry [blank_start]teratogenic[blank_end] risks
- Polytherapy of AED's [blank_start]increases[blank_end] risk
- [blank_start]Breastfeeding[blank_end] is encouraged and can be done safely, advise the mother to take the AED immediately after breastfeeding
Respuesta
-
first
-
Seizures
-
medications
-
teratogenic
-
increases
-
Breastfeeding
Pregunta 64
Pregunta
AEDs and Pregnancy
Before pregnancy:
- Attempt AED monotherapy with [blank_start]lowest[blank_end] effective dose
- [blank_start]Folate[blank_end] supplementation (at least 1mg/day orally)
During pregnancy:
- Avoid use of: Barbiturates, [blank_start]phenytoin[blank_end], carbamazepine,
- Limit dose of [blank_start]Valproate (Depakote)[blank_end] during the 1st trimester (1,400 mg/day)
- [blank_start]Lamotrigine (Lamictal)[blank_end] is considered safe
- Continue [blank_start]folate[blank_end] supplementation (1mg/day)
- Consider [blank_start]Vitamin K[blank_end] (10mg/day) starting at 36 weeks (baby should receive 1 mg IM at birth)
Respuesta
-
lowest
-
Folate
-
phenytoin
-
Valproate
-
Lamotrigine
-
folate
-
Vitamin K
Pregunta 65
Pregunta
[blank_start]Brief[blank_end] seizures are defined as lasting less than 5 minutes
[blank_start]Prolonged[blank_end] seizure are defined as lasting between 5 and 30 minutes
Pregunta 66
Pregunta
Status epilepticus (SE) is defined as more than [blank_start]30[blank_end] minutes of either
(1) A [blank_start]continuous[blank_end] seizure activity
(2) Two or more sequential seizures without full recovery of [blank_start]consciousness[blank_end] in between seizures
Respuesta
-
30
-
continuous
-
consciousness
Pregunta 67
Pregunta
The 30-minute definition is based on the duration of convulsive status epilepticus that may lead to permanent neuronal injury. What are some of the adverse consequences?
Respuesta
-
hypoxia
-
acidosis
-
hyperthermia
-
hypothermia
Pregunta 68
Pregunta
Types of Status Epilepticus
status epilepticus consisting of repeated generalized tonic-clonic (GTC) seizures with persistent neurological depression of neurologic function between seizures
Pregunta 69
Pregunta
Types of Status Epilepticus
status epilepticus where seizures produce a continuous “ epileptic twilight” state
Pregunta 70
Pregunta
Types of Status Epilepticus
manifested as focal motor signs, focal sensory symptoms, or focal impairment of function (e.g. aphasia) not associated with loss of consciousness
Pregunta 71
Pregunta
Causes of Status Epilepticus
[blank_start]Type I[blank_end]; no structural lesion: infection, CNS infection, metabolic, low AED levels, alcohol, idiopathic
[blank_start]Type II[blank_end]; structural lesion (poor prognosis): anoxia/hypoxia, CNS tumors, CVA, drug overdose, hemorrhage, trauma
Pregunta 72
Pregunta
Clinical Presentation of Generalized Convulsive SE
Symptoms:
Impaired [blank_start]consciousness[blank_end]
[blank_start]Disorientation[blank_end] once is controlled
Pain associated with injuries
Early signs:
Generalized [blank_start]convulsions[blank_end]
Acute injuries/CNS insults that cause extensor or flexor posturing
[blank_start]Hypothermia[blank_end]/fever suggestive of inter-current illnesses
Incontinence
Normal blood pressure/hypotension and respiratory [blank_start]compromise[blank_end]
Late signs:
Clinical seizures/may not be apparent
[blank_start]Pulmonary[blank_end] edema with respiratory failure
Cardiac failure, hypotension or hypertension
Disseminated intravascular coagulation, multisystem [blank_start]organ[blank_end] failure
Rhabdomyolysis
Respuesta
-
consciousness
-
Disorientation
-
convulsions
-
Hypothermia
-
compromise
-
Pulmonary
-
organ
Pregunta 73
Pregunta
Which of the following is the proposed interventions for the treatment of Status epilepticus during the stabilization phase (0-5 minutes) ?
Pregunta 74
Pregunta
Which of the following is the proposed interventions for the treatment of Status epilepticus during the initial therapy phase (5-20 minutes) ?
Pregunta 75
Pregunta
Which of the following is the proposed interventions for the treatment of Status epilepticus during the second therapy phase (20-40 minutes) ?
Pregunta 76
Pregunta
Which of the following is the proposed interventions for the treatment of Status epilepticus during the third therapy phase (40-60 minutes) ?
Pregunta 77
Pregunta
Of the two major ingredients in marijuana, which one causes the psychoactive effect of getting "high"
Pregunta 78
Pregunta
Medical Marijuana and Epilepsy
Currently open-labeled studies in the U.S. of [blank_start]Epidiolex[blank_end] produced by GW Pharmaceuticals, a drug derived from CBD (99% oil-based extract)
Pregunta 79
Pregunta
Which of the following are non-pharmacologic treatment of seizures and epilepsy?
Respuesta
-
Lifestyle modifications (adequate sleep, avoid alcohol & stimulants), avoid precipitants, use stress reduction techniques)
-
Ketogenic diet ( high in fats, low in proteins and carbs)
-
vagal nerve stimulation
-
surgery
Pregunta 80
Pregunta
Ketogenic Diet
Traditionally started gradually in the hospital after a [blank_start]24 – 48[blank_end] hour fast
Ratio (fat: carbs and proteins)
- [blank_start]4:1[blank_end] more strict
- [blank_start]3:1[blank_end] for infants, adolescents
- Vitamins and minerals are supplemented
Side effects: due to large amount of fat consumption
-Constipation
-Weight [blank_start]gain[blank_end]
-[blank_start]Acidosis[blank_end] when ill
- [blank_start]Vitamin[blank_end] deficiency (if unsupplemented)
- [blank_start]Renal[blank_end] stones
- Impaired weight and height
- Dyslipidemia
- Gastrointestinal upset
Requires strict control and patient compliance
Respuesta
-
24 – 48
-
4:1
-
3:1
-
gain
-
Acidosis
-
Vitamin
-
Renal
Pregunta 81
Pregunta
Which of the following statements are true in regards to Vagal Nerve stimulation?
Respuesta
-
Intermittent programmed electrical stimulation of left vagus nerve
-
FDA approved for partial onset seizures in patients >12 years old refractory to AEDs
-
Implanted Medical Device
-
Adverse effects local, related to stimulus (hoarseness, throat discomfort, dyspnea, cough, voice alteration)
-
May allow antiepileptic drug reduction (dose or number)
Pregunta 82
Pregunta
National Institute of Health Consensus Conference:
3 requirements for surgery:
(1) Absolute diagnosis of [blank_start]epilepsy[blank_end]
(2) [blank_start]Failure[blank_end] on adequate trial of drug therapy
(3) Definition of the electro clinical syndrome