Here are some epilepsy scenario-based multiple-choice questions with answers
A 25-year-old man presents with episodes of staring, unresponsiveness, and lip smacking that last for a few seconds. During these episodes, he is unaware of his surroundings. These episodes occur several times a day, and he is concerned about their impact on his daily activities. What is the most likely diagnosis?
a) Absence seizures
b) Complex partial seizures
c) Generalized tonic-clonic seizures
d) Myoclonic seizures
Answer: b) Complex partial seizures
A 14-year-old girl is brought to the emergency department by her parents because she had a generalized tonic-clonic seizure lasting 3 minutes. She has never had a seizure before, and there is no family history of epilepsy. Her physical examination and laboratory investigations are unremarkable. What is the most appropriate next step in her management?
a) Initiate antiepileptic medication
b) Order a brain MRI
c) Observe and follow-up in outpatient clinic
d) Order a lumbar puncture
Answer: b) Order a brain MRI
A 35-year-old woman with a history of epilepsy presents with complaints of breakthrough seizures despite being on antiepileptic medication. She reports that her seizures have changed, and she now experiences an unpleasant odor before the seizures occur. What is the most likely diagnosis?
a) Complex partial seizures
b) Absence seizures
c) Generalized tonic-clonic seizures
d) Myoclonic seizures
Answer: a) Complex partial seizures
A 50-year-old man presents with a new-onset seizure that occurred during a family gathering. He had no prior history of seizures, and his physical examination and laboratory investigations are unremarkable. He reports that he had consumed a large amount of alcohol before the seizure. What is the most likely diagnosis?
a) Alcohol withdrawal seizure
b) Idiopathic epilepsy
c) Febrile seizure
d) Metabolic disturbance
Answer: a) Alcohol withdrawal seizure
A 65-year-old woman with a history of epilepsy presents with complaints of increased frequency of seizures despite being on antiepileptic medication. She reports that her seizures occur predominantly in the morning and are associated with palpitations and sweating. What is the most likely diagnosis?
a) Complex partial seizures
b) Absence seizures
c) Generalized tonic-clonic seizures
d) Frontal lobe seizures
Answer: d) Frontal lobe seizures
A 25-year-old male presents to the emergency department with a history of convulsive seizures lasting for 5 minutes. He has no past history of seizures or any underlying medical conditions. The initial management of this patient would include:
A. Immediate EEG
B. MRI brain
C. CT head
D. Lumbar puncture
Answer: C. CT head
Explanation: A CT scan of the head is the initial investigation of choice for a patient with suspected seizure activity to rule out any structural abnormalities like hemorrhage, tumors or infections which could be causing the seizures. EEG would be done after the CT head to confirm diagnosis and provide further management.
A 40-year-old female with a past history of epilepsy is on phenytoin 300mg daily for the past 5 years. She has recently been experiencing breakthrough seizures. The most likely cause for the breakthrough seizures in this patient would be:
A. Noncompliance to medication
B. Toxic levels of phenytoin
C. Overdose of phenytoin
D. Decrease in the efficacy of phenytoin due to interactions with other medications
Answer: D. Decrease in the efficacy of phenytoin due to interactions with other medications
Explanation: Breakthrough seizures in a patient with a history of epilepsy who has been on long-term antiepileptic medication could be due to decreased efficacy of the medication. This could be due to interactions with other medications like oral contraceptives, antibiotics, antipsychotics, or antiepileptic drugs, resulting in lower plasma levels of the medication and decreased efficacy.
A 30-year-old pregnant female with a past history of epilepsy presents to the neurology clinic for management of her seizures during pregnancy. Which of the following antiepileptic medications would be contraindicated during pregnancy?
A. Carbamazepine
B. Valproic acid
C. Levetiracetam
D. Phenobarbital
Answer: B. Valproic acid
Explanation: Valproic acid is known to be teratogenic and is associated with an increased risk of neural tube defects and cognitive impairment in the fetus. Carbamazepine, levetiracetam and phenobarbital are relatively safe antiepileptic medications during pregnancy.
A 50-year-old male with a history of epilepsy is started on a new antiepileptic medication. He develops a skin rash and fever a week after starting the medication. The most likely cause for this would be:
A. Seizure-induced fever
B. Drug hypersensitivity reaction
C. Infection
D. Seizure medication toxicity
Answer: B. Drug hypersensitivity reaction
Explanation: A drug hypersensitivity reaction could present as a skin rash and fever, which could occur after starting a new medication. This could be a potentially life-threatening condition and the medication should be discontinued immediately.
A 65-year-old female presents with a history of non-convulsive seizures. The initial investigation for this patient would include:
A. EEG
B. CT head
C. MRI brain
D. Lumbar puncture
Answer: A. EEG
Explanation: EEG is the investigation of choice for a patient with suspected non-convulsive seizures, as it can help in the diagnosis and classification of the type of seizure activity. CT or MRI head would be done if there is any suspicion of structural abnormalities in the brain. Lumbar puncture would be done if there is a suspicion of infections like meningitis or encephalitis.
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