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Seizure part 1

Total questions: 15

Worksheet time: 15mins

Name
Class
Date
1.

15 y/o girl presents with history of two episodes (six and four months ago) of generalized body stiffening and shaking upon waking up in the morning, each lasting for about one minutes during which she was unresponsive and confused for half hour afterwards. 
Her older sister has had a few episodes of shaking and loss of consciousness as well. 
There is no history of drug/alcohol use, no history of head trauma.
Birth and development history are normal.
Neurological exam is normal. Brain MRI is normal. EEG show 4-6 Hz generalized epileptic discharge
What is the most likely cause of her symptoms?

a)

Temporal lobe focal epilepsy

b)

Idiopathic or genetic epilepsy

c)

Occipital lobe epilepsy

d)

West syndrome

e)

Lennox–Gastaut syndrome

2.

26 y/o woman presents with hx of stereotyped events characterized by repetitive right arm movement and lip smacking for 2-3 minutes. She seems slow and distracted and does not respond to questions during the event and does not recall the episode afterwards. No tonic-clonic movement, she does not fall or lose consciousness during the event. She remains confused for 7-8 minutes afterwards and then returns to her baseline. ​
The description is most consistent with which of the following seizure types?

a)

Myoclonic

b)

Simple partial

c)

Generalized tonic–clonic

d)

Complex partial

e)

Absence

3.

67-year-old man with past medical history significant for hypertension and chronic smoking (50 pack yr hx)  presented with a two-month history of episodic repetitive left arm shaking lasting for 2-3 minutes.  He is fully conscious and aware during these episodes.  He sometimes feels that his left arm is weak for a few minutes after it stops shaking.
The episodes are most suggestive of this seizure type:

a)

Absence

b)

Generalized tonic clonic

c)

Complex partial

d)

Myoclonic

e)

Simple partial

4.

67-year-old man with past medical history significant for hypertension and chronic smoking (50 pack yr hx)  presented with a two-month history of episodic repetitive left arm shaking lasting for 2-3 minutes.  He is fully conscious and aware during these episodes.  He sometimes feels that his left arm is weak for a few minutes after it stops shaking.

a)

Brain tumor

b)

Vascular malformation

c)

Idiopathic epilepsy

d)

Drug use

e)

Congenital malformation

5.

A 54-year-old man presents with paroxysmal episodes described as suddenly stopping whatever he is doing, staring off into space, at times exhibiting chewing movements of his mouth and repetitive picking at his clothes with the left hand lasting ~ 1-2 minutes. 
During these episodes he does not respond to verbal commands. 
He has no recollection of the events only recognizing an abnormal smell and then losing track of time briefly.
Episodes have been occurring once or twice a month for the last year.
The episodes are most suggestive of this seizure type:

a)

Simple partial

b)

Complex partial

c)

Absence

d)

Myoclonic

e)

Generalized tonic clonic

6.

All of the following are helpful in differentiating between absence and complex partial seizure EXCEPT?

a)

Preceding aura

b)

Duration

c)

Post-ictal confusion

d)

EEG findings

e)

Age of onset

7.

15 y/o girl presents with history of two episodes (six and four months ago) of generalized  body stiffening and shaking upon waking up in the morning, each lasting for about one minutes during which she was unresponsive and confused for half hour afterwards. 
The description best fit into which of the seizure types :

a)

Absence

b)

Atonic

c)

Complex partial

d)

Generalized tonic clonic

e)

Simple partial motor

8.

15 y/o girl presents with history of two episodes (six and four months ago) of generalized  body stiffening and shaking upon waking up in the morning, each lasting for about one minutes during which she was unresponsive and confused for half hour afterwards. 
All of the following could be possible cause/etiology of seizure in this case
EXCEPT:

a)

Ateriovenous malformation (AVM)

b)

Cerebrovascular disease

c)

Drug abuse

d)

Idiopathic (genetic epilepsy

9.

An 18 year old girl presents with history of episodic headaches since age 12.   She has no past medical history except severe motion sickness in childhood.  The headaches are unilateral, throbbing in character, associated with nausea and photophobia, worse before her periods. There is history of similar headaches in her mother and younger sister.  

What is the most likely cause of her headaches?

a)

Brain tumor

b)

CSF hypotension syndrome

c)

Migraine

d)

Temporal arteritis

e)

Pseudotumor cerebri

10.

She reports that she has been having more frequent headaches for past few months requiring her to take almost daily ibuprofen. She does not take any medication except for birth control pill that she started taking six month ago.  She has been under stress lately and has not been sleeping well.

All of the following will be helpful in managing her headaches EXCEPT:

a)

Switching to an alternative oral contraceptive

b)

Sleep hygiene

c)

Nortriptyline (tricyclic antidepressant)

d)

Sumatriptan

e)

Minimizing analgesic use

11.

The patient is counseled on avoiding analgesic overuse and switched to progestin only oral contraceptive.  Her headaches improve within 3 months.
She returns after ten years later with new headache that she has had for past three months.  The headache is generalized and has been more or less constant, but worse in the morning.  She has also had blurry vision, dizziness, and nausea (with occasional vomiting) for past few weeks. Of note, she has gained 20 pounds since last year due to poor dietary habits and lack of regular physical activity. 

Which of the following is the LEAST LIKELY  cause of her headache?

a)

Cerebral venous sinus thrombosis

b)

Pseudotumor cerebri

c)

Brain tumor

d)

Migraine

12.

The brain MRI and MR venogram obtained later are found to be normal.  She is referred to an ophthalmologist for blurry vision and undergoes a dilated fundus exam.  The fundus photograph is shown below. 

What should be the next diagnostic test to help confirm the diagnosis?

a)

Brain biopsy

b)

Spinal tap

c)

CT angiogram

d)

EEG

13.

Which one of the following is MOST LIKELY to be associated with papilledema and left hemiparesis?

a)

Brain tumor

b)

CSF hypotension syndrome

c)

Migraine

d)

Pseudotumor cerebri

e)

Tension headache

14.

A 42 year old woman presents with a two week history of generalized moderate to severe occipital headache, dizziness, and neck pain.  The headache is constant, pulling in character, worse upon standing or walking and is relieved on lying down. The headache also gets worse with coughing  or sneezing.   There is no history of fever or head trauma.  There is no prior or family history of headache.
The general exam in normal; she is afebrile.  The neurological exam  is normal.  There is mild neck stiffness.
All of the following diagnoses will be reasonable to consider in this case EXCEPT:

a)

Arnold–Chiari malformation

b)

Aseptic meningitis

c)

Migraine

d)

CSF leak

e)

Sentinel subarachnoid bleed

15.

Which one of the following medications is used for abortive treatment of migraine?

a)

Metoclopramide

b)

Propranolol

c)

Tricyclic antidepressants

d)

Topiramate

e)

Valproic acid