7339370
Questão 1
Questão
[blank_start]Seizure[blank_end] is a transient occurrence of signs and symptoms due to abnormal excessive or synchronous neuronal activity in the brain
Responda
-
Seizure
Questão 2
Questão
[blank_start]Epilepsy[blank_end] is a neurological disease marked by the sudden and recurrent episodes of seizures
Responda
-
Epilepsy
Questão 3
Questão
A person is considered to have epilepsy if they meet any of the following conditions:
Responda
-
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
Questão 4
Questão
More than 30 minutes of:
- continuous seizure activity
- two or more sequential seizures without full recovery of consciousness between seizures.
Responda
-
Seizure
-
Epilepsy
-
Status Epilepticus
Questão 5
Questão
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
Responda
-
CNS
-
neurologic
-
toxic
-
digoxin
-
Electrolyte
Questão 6
Questão
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
Responda
-
Vascular
-
Infections
-
Trauma
-
Autoimmune
-
Metabolic
-
Idiopathic
-
Neoplasm
-
Syndromes
-
Stimulants
Questão 7
Questão
[blank_start]Seizures[blank_end] are also called the electrical storms in the brain
Responda
-
Seizures
Questão 8
Questão
[blank_start]GABA[blank_end] is the main inhibitory neurotransmitter
[blank_start]Glutamate[blank_end] is the major excitatory neurotransmitter
Responda
-
GABA
-
Glutamate
Questão 9
Questão
Every individual has a seizure [blank_start]threshold[blank_end], which is the level of excitability at which neurons will discharge abnormally
Responda
-
threshold
Questão 10
Questão
Patients with epilepsy have a [blank_start]lower[blank_end] seizure threshold
Responda
-
lower
Questão 11
Questão
[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
Responda
-
Prodrome
-
Aura
-
Ictal phase
-
post-ictal phase
Questão 12
Questão
[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
Responda
-
Aura
Questão 13
Questão
[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
Responda
-
Ictal
Questão 14
Questão
[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)
Responda
-
Post-ictal
Questão 15
Questão
Every person with seizures will not have every stage or symptom
Responda
- True
- False
Questão 16
Questão
[blank_start]Partial[blank_end] seizures start in one area or side of the brain
Responda
-
Partial
Questão 17
Questão
[blank_start]Generalized[blank_end] seizures start on both sides of the brain at the same time and usually loss of consciousness is observed
Responda
-
Generalized
Questão 18
Questão
A partial seizure in which consciousness is not impaired is referred to as a [blank_start]simple[blank_end] partial seizure
Responda
-
simple
Questão 19
Questão
A partial seizure in which consciousness is impaired is referred to as a [blank_start]complex[blank_end] partial seizure
Responda
-
complex
Questão 20
Questão
A partial onset evolving to generalized tonic-clonic is referred to as a [blank_start]secondarily generalized[blank_end] seizures
Responda
-
secondarily generalized
Questão 21
Questão
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
Responda
-
Absence
-
Myoclonic
-
Clonic
-
Tonic
Questão 22
Questão
Name the type of seizure:
Brief shock-like muscular contractions of the face, trunk, and extremities
Responda
-
Absence
-
Myoclonic
-
Clonic
-
Tonic
Questão 23
Questão
Name the type of seizure:
Rhythmic, repetitive, jerking muscle movement
Responda
-
Absence
-
Myoclonic
-
Clonic
-
Tonic
Questão 24
Questão
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
Responda
-
Absence
-
Myoclonic
-
Clonic
-
Tonic
Questão 25
Questão
Which of the following statements about Atonic seizures are true?
Responda
-
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
Questão 26
Questão
There are NO diagnostic laboratory tests for epilepsy
Responda
- True
- False
Questão 27
Questão
[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.
Responda
-
Prolactin
Questão 28
Questão
[blank_start]Electroencephalogram (EEG)[blank_end] is very useful in the diagnosis of various seizure disorders (only to confirm a diagnosis)
Responda
-
Electroencephalogram (EEG)
-
Magnetic Resonance Imaging (MRI)
-
Computed Tomography (CT)
Questão 29
Questão
Which of the following is NOT useful in the diagnosis of seizure disorders?
Responda
-
Electroencephalogram (EEG)
-
Magnetic Resonance Imaging (MRI)
-
Computed Tomography (CT)
Questão 30
Questão
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
Responda
-
partial seizures
-
primary generalized
-
secondary generalized seizure
Questão 31
Questão
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
Responda
-
simple partial
-
complex partial
Questão 32
Questão
Which of the following statements are true in regards to febrile seizures?
Responda
-
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
Questão 33
Questão
Which drugs can be used as prophylaxis in the treatment of febrile seizures?
Responda
-
Phenobarbital
-
Valproate
-
Lamotrigine
-
Lorazepam
Questão 34
Questão
What medications can be given at the time of a febrile seizure?
Responda
-
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
Questão 35
Questão
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
Responda
-
risk factors
-
6-12
Questão 36
Questão
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
Responda
-
CNS
-
epilepsy
-
EEG
-
childhood
-
brain
-
illegal drugs
Questão 37
Questão
The probability of a 2nd seizure can be as high as [blank_start]80[blank_end]% after 5 years
Responda
-
80
Questão 38
Questão
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.
Responda
- True
- False
Questão 39
Questão
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?
Responda
-
Treatment with anticonvulsants should be initiated
-
Treatment with anticonvulsants should be deferred at this point
Questão 40
Questão
Which of the following are triggers for seizures?
Responda
-
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)
Questão 41
Questão
Diphenhydramine raises the seizure threshold
Responda
- True
- False
Questão 42
Questão
Which of the following factors must be considered when selecting the appropriate AED therapy for a patient?
Responda
-
Seizure type
-
Age
-
Gender (pregnancy)
-
Pharmacokinetic profile
-
Interactions/other medical conditions
-
Efficacy
-
Expected adverse effects
-
Ability to comply with a prescribed regimen
-
Cost
Questão 43
Questão
An antiepileptic drug should not be considered ineffective unless patient develops an unacceptable ADR with continued seizure
Responda
- True
- False
Questão 44
Questão
Despite appropriate initial treatment, [blank_start]30-35[blank_end]% of patients are refractory to treatment
Responda
-
30-35
-
20-30
-
40-50
Questão 45
Questão
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
Responda
-
auto-induction
Questão 46
Questão
Which of the following agents can cause acute hepatic failure, acute pancreatitis, and alopecia?
Responda
-
Phenytoin (Dilantin)
-
Carbamazepine (Tegretol)
-
Valproic Acid (Depakote)
-
Gabapentin (Neurontin)
Questão 47
Questão
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)
Responda
-
steady state
-
consistent
-
morning
-
trough
-
8
Questão 48
Questão
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)
Responda
-
10
-
20
-
30
-
40
Questão 49
Questão
What is the most common type of seizure experienced by adults?
Responda
-
partial seizures
-
generalized seizures
-
absence seizures
Questão 50
Questão
[blank_start]Carbamazepine[blank_end] and phenytoin first line therapy in new-onset partial and generalized seizures
Responda
-
Carbamazepine
Questão 51
Questão
Of the agents listed below, which received FDA approval for use as monotherapy in patients with partial seizures?
Responda
-
Lamotrigine (Lamictal)
-
Topiramate (Topamax)
-
Oxcarbazepine (Trileptal)
-
Levetiracetam (Keppra)
-
Gabapentin (Neurontin)
Questão 52
Questão
[blank_start]Lamotrigine[blank_end] was determined to be a cost effective alternative to carbamazepine
Responda
-
Lamotrigine
-
Gabapentin
-
Topiramate
Questão 53
Questão
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]
Responda
-
Ethosuximide (Zarontin)
-
Valproate (Depakote)
-
Lamotrigine (Lamictal)
-
Valproate (Depakote)
-
Ethosuximide (Zarontin)
-
Lamotrigine (Lamictal)
-
Lamotrigine (Lamictal)
-
Ethosuximide (Zarontin)
-
Valproate (Depakote)
Questão 54
Questão
Which of the following agents are infective in absence seizures and can precipitate and increase seizure frequency
Responda
-
Phenytoin (Dilantin)
-
Phenobarbital
-
Carbamazepine (Tegretol)
-
Oxcarbazepine (Trileptal)
-
Gabapentin (Neurontin)
-
Tiagabine (Gabitril)
-
Valproate (Depakote)
Questão 55
Questão
What is the appropriate therapy to utilize in the treatment of mixed absence and partial or generalized:
Responda
-
Valproate (Depakote)
-
Lamotrigine (Lamictal)
-
Tiagabine (Gabitril)
-
Felbamate (Felbatol)
Questão 56
Questão
[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.
Responda
-
Ethosuximide
Questão 57
Questão
[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.
Responda
-
Phenytoin
-
Carbamazepine
Questão 58
Questão
What drugs are alternative in the treatment of tonic-clonic seizures?
Responda
-
Lamotrigine (Lamictal)
-
Topiramate (Topamax)
-
Phenytoin (Dilantin)
-
Gabapentin (Neurontin)
Questão 59
Questão
Seizure freedom for ≥ 2 years implies overall >[blank_start]60[blank_end]% chance of successful withdrawal in some epilepsy syndromes
Responda
-
60
Questão 60
Questão
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
Responda
-
2
-
4
Questão 61
Questão
Sudden discontinuation of AED therapy can precipitate withdrawal seizures and status epilepticus. Especially with benzodiazepines and barbiturates
Responda
- True
- False
Questão 62
Questão
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
Responda
-
sedative
-
slowly
Questão 63
Questão
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
Responda
-
first
-
Seizures
-
medications
-
teratogenic
-
increases
-
Breastfeeding
Questão 64
Questão
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)
Responda
-
lowest
-
Folate
-
phenytoin
-
Valproate
-
Lamotrigine
-
folate
-
Vitamin K
Questão 65
Questão
[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
Responda
-
Brief
-
Prolonged
Questão 66
Questão
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
Responda
-
30
-
continuous
-
consciousness
Questão 67
Questão
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?
Responda
-
hypoxia
-
acidosis
-
hyperthermia
-
hypothermia
Questão 68
Questão
Types of Status Epilepticus
status epilepticus consisting of repeated generalized tonic-clonic (GTC) seizures with persistent neurological depression of neurologic function between seizures
Responda
-
convulsive
-
non-convulsive
-
Repeated partial seizures
Questão 69
Questão
Types of Status Epilepticus
status epilepticus where seizures produce a continuous “ epileptic twilight” state
Responda
-
convulsive
-
non-convulsive
-
repeated partial seizures
Questão 70
Questão
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
Responda
-
convulsive
-
non-convulsive
-
repeated partial seizures
Questão 71
Questão
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
Responda
-
Type I
-
Type II
Questão 72
Questão
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
Responda
-
consciousness
-
Disorientation
-
convulsions
-
Hypothermia
-
compromise
-
Pulmonary
-
organ
Questão 73
Questão
Which of the following is the proposed interventions for the treatment of Status epilepticus during the stabilization phase (0-5 minutes) ?
Responda
Questão 74
Questão
Which of the following is the proposed interventions for the treatment of Status epilepticus during the initial therapy phase (5-20 minutes) ?
Responda
Questão 75
Questão
Which of the following is the proposed interventions for the treatment of Status epilepticus during the second therapy phase (20-40 minutes) ?
Responda
Questão 76
Questão
Which of the following is the proposed interventions for the treatment of Status epilepticus during the third therapy phase (40-60 minutes) ?
Responda
Questão 77
Questão
Of the two major ingredients in marijuana, which one causes the psychoactive effect of getting "high"
Responda
-
Tetrahydrocannabinol (or THC)
-
Cannabidiol (or CBD)
Questão 78
Questão
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)
Responda
-
Epidiolex
Questão 79
Questão
Which of the following are non-pharmacologic treatment of seizures and epilepsy?
Responda
-
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
Questão 80
Questão
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
Responda
-
24 – 48
-
4:1
-
3:1
-
gain
-
Acidosis
-
Vitamin
-
Renal
Questão 81
Questão
Which of the following statements are true in regards to Vagal Nerve stimulation?
Responda
-
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)
Questão 82
Questão
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
Responda
-
epilepsy
-
Failure
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