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Seizure and Epilepsy

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NAPLEX Pharmacy (Neuro ) Quiz on Seizure and Epilepsy , created by Mark W. on 10/01/2017.
Mark W.
Quiz by Mark W., updated more than 1 year ago
Mark W.
Created by Mark W. over 7 years ago
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Resource summary

Question 1

Question
[blank_start]Seizure[blank_end] is a transient occurrence of signs and symptoms due to abnormal excessive or synchronous neuronal activity in the brain
Answer
  • Seizure

Question 2

Question
[blank_start]Epilepsy[blank_end] is a neurological disease marked by the sudden and recurrent episodes of seizures
Answer
  • Epilepsy

Question 3

Question
A person is considered to have epilepsy if they meet any of the following conditions:
Answer
  • 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

Question 4

Question
More than 30 minutes of: - continuous seizure activity - two or more sequential seizures without full recovery of consciousness between seizures.
Answer
  • Seizure
  • Epilepsy
  • Status Epilepticus

Question 5

Question
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
Answer
  • CNS
  • neurologic
  • toxic
  • digoxin
  • Electrolyte

Question 6

Question
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
Answer
  • Vascular
  • Infections
  • Trauma
  • Autoimmune
  • Metabolic
  • Idiopathic
  • Neoplasm
  • Syndromes
  • Stimulants

Question 7

Question
[blank_start]Seizures[blank_end] are also called the electrical storms in the brain
Answer
  • Seizures

Question 8

Question
[blank_start]GABA[blank_end] is the main inhibitory neurotransmitter [blank_start]Glutamate[blank_end] is the major excitatory neurotransmitter
Answer
  • GABA
  • Glutamate

Question 9

Question
Every individual has a seizure [blank_start]threshold[blank_end], which is the level of excitability at which neurons will discharge abnormally
Answer
  • threshold

Question 10

Question
Patients with epilepsy have a [blank_start]lower[blank_end] seizure threshold
Answer
  • lower

Question 11

Question
[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
Answer
  • Prodrome
  • Aura
  • Ictal phase
  • post-ictal phase

Question 12

Question
[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
Answer
  • Aura

Question 13

Question
[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
Answer
  • Ictal

Question 14

Question
[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)
Answer
  • Post-ictal

Question 15

Question
Every person with seizures will not have every stage or symptom
Answer
  • True
  • False

Question 16

Question
[blank_start]Partial[blank_end] seizures start in one area or side of the brain
Answer
  • Partial

Question 17

Question
[blank_start]Generalized[blank_end] seizures start on both sides of the brain at the same time and usually loss of consciousness is observed
Answer
  • Generalized

Question 18

Question
A partial seizure in which consciousness is not impaired is referred to as a [blank_start]simple[blank_end] partial seizure
Answer
  • simple

Question 19

Question
A partial seizure in which consciousness is impaired is referred to as a [blank_start]complex[blank_end] partial seizure
Answer
  • complex

Question 20

Question
A partial onset evolving to generalized tonic-clonic is referred to as a [blank_start]secondarily generalized[blank_end] seizures
Answer
  • secondarily generalized

Question 21

Question
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
Answer
  • Absence
  • Myoclonic
  • Clonic
  • Tonic

Question 22

Question
Name the type of seizure: Brief shock-like muscular contractions of the face, trunk, and extremities
Answer
  • Absence
  • Myoclonic
  • Clonic
  • Tonic

Question 23

Question
Name the type of seizure: Rhythmic, repetitive, jerking muscle movement
Answer
  • Absence
  • Myoclonic
  • Clonic
  • Tonic

Question 24

Question
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
Answer
  • Absence
  • Myoclonic
  • Clonic
  • Tonic

Question 25

Question
Which of the following statements about Atonic seizures are true?
Answer
  • 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

Question 26

Question
There are NO diagnostic laboratory tests for epilepsy
Answer
  • True
  • False

Question 27

Question
[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.
Answer
  • Prolactin

Question 28

Question
[blank_start]Electroencephalogram (EEG)[blank_end] is very useful in the diagnosis of various seizure disorders (only to confirm a diagnosis)
Answer
  • Electroencephalogram (EEG)
  • Magnetic Resonance Imaging (MRI)
  • Computed Tomography (CT)

Question 29

Question
Which of the following is NOT useful in the diagnosis of seizure disorders?
Answer
  • Electroencephalogram (EEG)
  • Magnetic Resonance Imaging (MRI)
  • Computed Tomography (CT)

Question 30

Question
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
Answer
  • partial seizures
  • primary generalized
  • secondary generalized seizure

Question 31

Question
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
Answer
  • simple partial
  • complex partial

Question 32

Question
Which of the following statements are true in regards to febrile seizures?
Answer
  • 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

Question 33

Question
Which drugs can be used as prophylaxis in the treatment of febrile seizures?
Answer
  • Phenobarbital
  • Valproate
  • Lamotrigine
  • Lorazepam

Question 34

Question
What medications can be given at the time of a febrile seizure?
Answer
  • 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

Question 35

Question
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
Answer
  • risk factors
  • 6-12

Question 36

Question
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
Answer
  • CNS
  • epilepsy
  • EEG
  • childhood
  • brain
  • illegal drugs

Question 37

Question
The probability of a 2nd seizure can be as high as [blank_start]80[blank_end]% after 5 years
Answer
  • 80

Question 38

Question
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.
Answer
  • True
  • False

Question 39

Question
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?
Answer
  • Treatment with anticonvulsants should be initiated
  • Treatment with anticonvulsants should be deferred at this point

Question 40

Question
Which of the following are triggers for seizures?
Answer
  • 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)

Question 41

Question
Diphenhydramine raises the seizure threshold
Answer
  • True
  • False

Question 42

Question
Which of the following factors must be considered when selecting the appropriate AED therapy for a patient?
Answer
  • Seizure type
  • Age
  • Gender (pregnancy)
  • Pharmacokinetic profile
  • Interactions/other medical conditions
  • Efficacy
  • Expected adverse effects
  • Ability to comply with a prescribed regimen
  • Cost

Question 43

Question
An antiepileptic drug should not be considered ineffective unless patient develops an unacceptable ADR with continued seizure
Answer
  • True
  • False

Question 44

Question
Despite appropriate initial treatment, [blank_start]30-35[blank_end]% of patients are refractory to treatment
Answer
  • 30-35
  • 20-30
  • 40-50

Question 45

Question
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
Answer
  • auto-induction

Question 46

Question
Which of the following agents can cause acute hepatic failure, acute pancreatitis, and alopecia?
Answer
  • Phenytoin (Dilantin)
  • Carbamazepine (Tegretol)
  • Valproic Acid (Depakote)
  • Gabapentin (Neurontin)

Question 47

Question
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)
Answer
  • steady state
  • consistent
  • morning
  • trough
  • 8

Question 48

Question
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)
Answer
  • 10
  • 20
  • 30
  • 40

Question 49

Question
What is the most common type of seizure experienced by adults?
Answer
  • partial seizures
  • generalized seizures
  • absence seizures

Question 50

Question
[blank_start]Carbamazepine[blank_end] and phenytoin first line therapy in new-onset partial and generalized seizures
Answer
  • Carbamazepine

Question 51

Question
Of the agents listed below, which received FDA approval for use as monotherapy in patients with partial seizures?
Answer
  • Lamotrigine (Lamictal)
  • Topiramate (Topamax)
  • Oxcarbazepine (Trileptal)
  • Levetiracetam (Keppra)
  • Gabapentin (Neurontin)

Question 52

Question
[blank_start]Lamotrigine[blank_end] was determined to be a cost effective alternative to carbamazepine
Answer
  • Lamotrigine
  • Gabapentin
  • Topiramate

Question 53

Question
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]
Answer
  • Ethosuximide (Zarontin)
  • Valproate (Depakote)
  • Lamotrigine (Lamictal)
  • Valproate (Depakote)
  • Ethosuximide (Zarontin)
  • Lamotrigine (Lamictal)
  • Lamotrigine (Lamictal)
  • Ethosuximide (Zarontin)
  • Valproate (Depakote)

Question 54

Question
Which of the following agents are infective in absence seizures and can precipitate and increase seizure frequency
Answer
  • Phenytoin (Dilantin)
  • Phenobarbital
  • Carbamazepine (Tegretol)
  • Oxcarbazepine (Trileptal)
  • Gabapentin (Neurontin)
  • Tiagabine (Gabitril)
  • Valproate (Depakote)

Question 55

Question
What is the appropriate therapy to utilize in the treatment of mixed absence and partial or generalized:
Answer
  • Valproate (Depakote)
  • Lamotrigine (Lamictal)
  • Tiagabine (Gabitril)
  • Felbamate (Felbatol)

Question 56

Question
[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.
Answer
  • Ethosuximide

Question 57

Question
[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.
Answer
  • Phenytoin
  • Carbamazepine

Question 58

Question
What drugs are alternative in the treatment of tonic-clonic seizures?
Answer
  • Lamotrigine (Lamictal)
  • Topiramate (Topamax)
  • Phenytoin (Dilantin)
  • Gabapentin (Neurontin)

Question 59

Question
Seizure freedom for ≥ 2 years implies overall >[blank_start]60[blank_end]% chance of successful withdrawal in some epilepsy syndromes
Answer
  • 60

Question 60

Question
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
Answer
  • 2
  • 4

Question 61

Question
Sudden discontinuation of AED therapy can precipitate withdrawal seizures and status epilepticus. Especially with benzodiazepines and barbiturates
Answer
  • True
  • False

Question 62

Question
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
Answer
  • sedative
  • slowly

Question 63

Question
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
Answer
  • first
  • Seizures
  • medications
  • teratogenic
  • increases
  • Breastfeeding

Question 64

Question
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)
Answer
  • lowest
  • Folate
  • phenytoin
  • Valproate
  • Lamotrigine
  • folate
  • Vitamin K

Question 65

Question
[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
Answer
  • Brief
  • Prolonged

Question 66

Question
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
Answer
  • 30
  • continuous
  • consciousness

Question 67

Question
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?
Answer
  • hypoxia
  • acidosis
  • hyperthermia
  • hypothermia

Question 68

Question
Types of Status Epilepticus status epilepticus consisting of repeated generalized tonic-clonic (GTC) seizures with persistent neurological depression of neurologic function between seizures
Answer
  • convulsive
  • non-convulsive
  • Repeated partial seizures

Question 69

Question
Types of Status Epilepticus status epilepticus where seizures produce a continuous “ epileptic twilight” state
Answer
  • convulsive
  • non-convulsive
  • repeated partial seizures

Question 70

Question
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
Answer
  • convulsive
  • non-convulsive
  • repeated partial seizures

Question 71

Question
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
Answer
  • Type I
  • Type II

Question 72

Question
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
Answer
  • consciousness
  • Disorientation
  • convulsions
  • Hypothermia
  • compromise
  • Pulmonary
  • organ

Question 73

Question
Which of the following is the proposed interventions for the treatment of Status epilepticus during the stabilization phase (0-5 minutes) ?
Answer

Question 74

Question
Which of the following is the proposed interventions for the treatment of Status epilepticus during the initial therapy phase (5-20 minutes) ?
Answer

Question 75

Question
Which of the following is the proposed interventions for the treatment of Status epilepticus during the second therapy phase (20-40 minutes) ?
Answer

Question 76

Question
Which of the following is the proposed interventions for the treatment of Status epilepticus during the third therapy phase (40-60 minutes) ?
Answer

Question 77

Question
Of the two major ingredients in marijuana, which one causes the psychoactive effect of getting "high"
Answer
  • Tetrahydrocannabinol (or THC)
  • Cannabidiol (or CBD)

Question 78

Question
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)
Answer
  • Epidiolex

Question 79

Question
Which of the following are non-pharmacologic treatment of seizures and epilepsy?
Answer
  • 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

Question 80

Question
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
Answer
  • 24 – 48
  • 4:1
  • 3:1
  • gain
  • Acidosis
  • Vitamin
  • Renal

Question 81

Question
Which of the following statements are true in regards to Vagal Nerve stimulation?
Answer
  • 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)

Question 82

Question
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
Answer
  • epilepsy
  • Failure
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