Question 1

A seizure occurs when the cerebral cortex is hyperexcitable, caused by:&#10;A) A decrease in excitatory neurotransmission, an increase in inhibitory neurotransmission, or a disturbance in brain circuitry&#10;B) An increase in excitatory neurotransmission, a decrease in inhibitory neurotransmission, or a disturbance in brain circuitry&#10;C) An increase in excitatory neurotransmission, an increase in inhibitory neurotransmission, or a disturbance in brain circuitry&#10;D) A decrease in excitatory neurotransmission, a decrease in inhibitory neurotransmission, or a disturbance in brain circuitry

Accepted Answer

Seizures are typically caused by an imbalance in neurotransmission, specifically an increase in excitatory neurotransmission and a decrease in inhibitory neurotransmission, leading to hyperexcitability in the cerebral cortex.

Question 2

A seizure may be provoked by:&#10;A) Hyponatremia&#10;B) Withdrawal from alcohol&#10;C) Fever&#10;D) All of the above

Accepted Answer

All of the listed conditions—hyponatremia, withdrawal from alcohol, and fever—can provoke seizures.

Question 3

Your patient's husband reports that during her 1-minute seizures, she wanders, smacks her lips, picks at her clothes, and loses awareness of her surroundings. What kind of seizure is she most likely having?

A) Focal seizure with loss of consciousness (complex partial)
B) Focal seizure without loss of consciousness (simple partial)
C) Generalized tonic-clonic
D) Absence

A

Accepted Answer

The symptoms described, such as wandering, lip-smacking, and picking at clothes, along with loss of awareness, are characteristic of a focal seizure with loss of consciousness, also known as a complex partial seizure.

Question 4

A 29-year-old lawyer was recently diagnosed with focal seizures. Her provider prescribed lamotrigine and she has been tolerating it well at 150 mg BID. It has, so far, controlled her seizures; however, she is anxious that she may have another. She asks you what she can do to avoid seizures. Which is not a common seizure trigger?

A) Sleep deprivation
B) Missing medication
C) Exercising
D) Stress

Accepted Answer

Exercising is generally not a common trigger for seizures and can actually be beneficial for overall health and stress reduction.

Question 5

Ms. Smith tried phenytoin 300 mg daily, but stopped it because it made her dizzy and didn't stop her seizures. She was then asked to try levetiracetam, which she started at 500 mg BID; however, her insurance did not cover it; therefore it was discontinued. She is now taking zonisamide 200 mg at night (higher doses made her drowsy). As she is still having some seizures, she should be referred to an epilepsy center.

Accepted Answer

If a patient continues to have seizures despite trying multiple medications, referral to an epilepsy center is recommended for specialized evaluation and management.

Question 6

Which are causes of epilepsy?&#10;A) Brain tumors&#10;B) Strokes&#10;C) Congenital malformations&#10;D) All of the above

Accepted Answer

Epilepsy can be caused by various factors including brain tumors, strokes, and congenital malformations, among others.

Question 7

Which medication has a narrow therapeutic index:&#10;A) Levetiracetam&#10;B) Clobazam&#10;C) Phenytoin&#10;D) Lamotrigine

Accepted Answer

Phenytoin has a narrow therapeutic index, meaning there is a small range between therapeutic and toxic doses, requiring careful monitoring of blood levels.

Question 8

A patient has a history of kidney stones. Which medication would you avoid prescribing?&#10;A) Zonisamide&#10;B) Lamotrigine&#10;C) Levetiracetam&#10;D) Clobazam

Accepted Answer

Zonisamide is known to increase the risk of kidney stones, so it should be avoided in patients with a history of kidney stones.

Question 9

A patient with epilepsy can have a normal EEG and normal MRI.

Accepted Answer

It is possible for a patient with epilepsy to have a normal EEG and MRI because these tests may not capture the abnormal brain activity or structural changes at the time of testing.

Question 10

A patient is on carbamazepine 600 mg BID and comes to you complaining of nausea, vomiting, headache, and fatigue. He is also having more seizures. What would you do?&#10;A) Increase the carbamazepine dose.&#10;B) Check carbamazepine levels.&#10;C) Check sodium levels.&#10;D) b and c

Accepted Answer

The symptoms of nausea, vomiting, headache, and fatigue, along with increased seizures, could indicate either toxicity or subtherapeutic levels of carbamazepine. Checking both carbamazepine levels and sodium levels is important, as carbamazepine can cause hyponatremia.

Question 11

Which of the following is a clinical management goal when titrating antiepileptic medications?&#10;A) Titrate the patient to the maximum recommend dose even if they experience side effects.&#10;B) Attempt to arrive at medication monotherapy, if possible&#10;C) Combine two medications at low doses.&#10;D) Achieve seizure-free status with the highest possible dosage of antiepileptic drug therapy.

Accepted Answer

The answer of Which of the following is a clinical...

Deck 55: Epilepsy