Seizures

Chapter 57 Seizures

Clinical Case Problem 1 A 22-Year-Old Man Who Suddenly Lost Consciousness, Became Rigid, and Fell to the Ground

A 22-year-old man is brought to the emergency department by his wife. While he was raking leaves in the backyard, he suddenly lost consciousness, became rigid, and fell to the ground. His respirations temporarily ceased. This lasted for approximately 45 seconds and was followed by a period of jerking of all four limbs lasting 2 or 3 minutes. The patient then remained unconscious for 3 or 4 minutes.

On examination, the patient is drowsy. The vital signs are normal. There is a large laceration on his tongue and a small laceration on his lip. The neurologic examination is otherwise normal.

Select the best answer to the following questions

1. What type of seizure is this patient suffering from?

a. simple partial seizure

b. complex partial seizure

c. absence seizure

d. grand mal (tonic-clonic) seizure

e. myoclonic seizure

2. Which of the following medications would not be a drug of first choice for the prevention of further seizures in the patient described?

b. carbamazepine

c. phenobarbital

e. ethosuximide

Clinical Case Problem 2 A 76-Year-Old Woman with a New-Onset Seizure

A 76-year-old woman with hypertension, hypercholesterolemia, coronary artery disease, and chronic obstructive pulmonary disease is transferred to your nursing home service. She is there for subacute rehabilitation after hospitalization for new-onset atrial fibrillation. During her hospitalization, a computed tomography (CT) scan of the brain demonstrated multiple old lacunar infarcts. To prevent further cerebrovascular accidents, she was started on coumadin, and her international normalized ratio is therapeutic. Her rehab stay has been uneventful, her strength is improving, and she is able to ambulate without an assistive device. On day 7 during recreational activities, she experienced a 3-minute lapse of consciousness. The nursing staff returned her to her room and evaluated her.

On examination, her blood pressure is 150/92 mm Hg, her pulse is 96 beats/minute and irregular, her respirations are 16 breaths/minute, and she is afebrile. She is in no acute distress, and her neurologic examination is normal except for some increased somnolence. The rest of her examination is unchanged from admission.

3. Which of the following is the most correct statement regarding this event?

a. there is probably no association with the abnormal CT

b. cardiac issues are the most likely cause

c. cerebrovascular disease is the most common cause of this event

d. the patient has only one risk factor for cerebrovascular disease

e. this is an unusual presentation for seizures in the elderly

4. What is the type of seizure described in this patient?

a. simple partial seizure

b. complex partial seizure

c. absence seizure

d. tonic-clonic (grand mal) seizure

e. myoclonic seizure

5. What is the most common cause of a new-onset seizure in a patient of this age?

a. acute stroke

b. alcohol withdrawal

e. an old stroke

6. Which of the following medications would not be a drug of first choice for the prevention of further seizures in this patient?

b. carbamazepine

c. phenobarbital

d. valproic acid

e. all of the above

7. Which of the following is (are) a likely outcome(s) from the diagnosis of a new seizure disorder?

a. increased falls and fractures

b. decline in activities of daily living

d. decline in cognitive function

e. all of the above

Clinical Case Problem 3 A 12-Year-Old Girl Who Stares into Space

A mother comes to your office with her 12-year-old daughter. The mother states that for the past 6 months, she and the girl’s teacher have frequently noted the child staring into space. This lack of concentration usually lasts only 30 to 45 seconds. Sometimes there appears to be brief twitching of all limbs during this time. The child’s neurologic examination is normal.

8. What is the most likely cause of the symptoms described here?

a. simple partial seizures

b. complex partial seizures

c. absence seizures

d. myoclonic seizures

e. none of the above

9. All of the following may be useful in the treatment of this patient except

a. valproic acid

c. ethosuximide

e. none of the above

10. Which of the following statements regarding the starting and stopping of antiepileptic therapy is (are) true?

a. antiepileptic therapy can be discontinued safely after a seizure-free interval of 1 year

b. every patient who has a seizure should be prescribed antiepileptic medication

c. antiepileptic medication should be started with a combination of two or more antiepileptic agents

d. the decision to stop antiepileptic medication should be guided by the results of electroencephalography (EEG)

11. Which of the following investigations is (are) useful in the initial evaluation of a patient with new-onset seizures?

b. magnetic resonance imaging (MRI) scan of the brain

c. serologic test for syphilis

d. carotid ultrasound

f. a, b, c, and d

12. Which of the following statements regarding the diagnosis and treatment of status epilepticus is (are) true?

a. poor compliance with the anticonvulsant drug regimen is the most common cause of tonic-clonic status epilepticus

b. the mortality rate of status epilepticus may be as high as 20%

c. the establishment of an airway is the first priority in the management of status epilepticus

d. intravenous (IV) diazepam is the drug of first choice in the immediate management of status epilepticus

e. all of the above

13. Which of the following is (are) a cause(s) of nonepileptic seizures?

a. hypocalcemia

b. hypomagnesemia

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Tags: Swansons Family Medicine Review

Oct 1, 2016 | Posted by admin in GENERAL SURGERY | Comments Off

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