Quiz 07/31/2022

A 32-year-old Chinese male is referred to the epilepsy clinic after experiencing two episodes concerning for possible seizures. The first episode was unwitnessed, but the patient states that there was an abrupt loss of consciousness and that he woke up with the side of his tongue bitten and generalized myalgias. The second event was witnessed by his wife who noticed one day that the patient was unresponsive and lip-smacking for 2 minutes before returning back to baseline. MRI brain was performed and showed left-sided mesial temporal sclerosis. Which of the following medications should be avoided for this patient?

Which direction are the patient’s eyes moving at the points marked by the green circles?

An 8-year-old boy with no significant past medical history is brought to the clinic due to difficulties in school. His mother states that over the past year, she has received multiple phone calls from his teacher about his lack of concentration in class. On multiple occasions when asked a question, the patient would blankly stare at the wall and ignore the teacher, but then would return to his normal, talkative self immediately after each episode. An EEG is ordered, which shows 3 Hz generalized spike and wave discharges. The patient would most likely benefit from a medication targeting what?

The electrographic pattern appreciated in the 6th second of this recording likely represents which of the following?

A 26-year-old physics teacher and mother on valproic acid (VPA) for epilepsy presents to your clinic with her husband stating she wishes to try to become pregnant soon. She asks how anti-seizure medications (ASMs) used during pregnancy may impact the intelligence and school performance of her child. Which is the most accurate response?

A 62-year-old man complains of 5 years of vivid dreams. At times this involves punching and kicking, which has hurt his wife. He undergoes a polysomnogram and there is no sleep-disordered breathing and the EEG is normal. What would be the best first-line medication to treat this behavior?

A 45-year-old man suffered a cardiac arrest after a heroin overdose. He received 30 minutes of CPR with an eventual return of spontaneous circulation. After being cooled per post-arrest protocol the patient was rewarmed. 48 hours after being warmed the patient remained in a persistent comatose state with minimal brainstem reflexes. To evaluate the degree of hypoxic-ischemic injury an EEG was ordered. Which of the following EEG patterns carries the worst prognosis after a hypoxic-ischemic injury?

A 28-year-old woman of Chinese descent was recently diagnosed with focal/symptomatic epilepsy. Which of the following medications should best be avoided in the management of her epilepsy?

A morbidly obese patient with a past medical history of brainstem stroke and excessive daytime sleepiness undergoes polysomnography. Polysomnographic testing revealed an average of 8-10 apnea/hypopneas per hour during sleep. During prolonged periods of apnea, there were no out-of-phase movements on plethysmography. Which of the following is the most likely diagnosis?

A 35-year-old male presents to the neurology clinic for the management of seizures. The patient reports having focal to bilateral tonic-clonic seizures (FTBTC) since the age of 15. His seizures are usually preceded by the smell of burning rubber. He will then have left hand automatisms followed by whole-body tonic-clonic activity. Levetiracetam monotherapy was initially effective. However, 1 year ago seizures returned, occurring once every two months. Lacosamide was added 6 months ago but there has been no significant improvement in his seizure frequency. Levels of these two anti-seizure medications (ASMs) are therapeutic and there have been no concerns regarding medication adherence. What is the most appropriate next step in management?

Which of the following EEG artifacts is prominently seen on this EEG?

A 7-year-old boy with no significant past medical history presents to the clinic after declining school performance and daydreaming. A routine EEG is performed and shown below. Which of the following medications is the most appropriate first-line therapy?

A 6-year-old Amish female presents to the emergency department with a 2-month history of gradual cognitive decline and jerking limb movements. A routine EEG was obtained (see below). Which of the following diseases is consistent with these EEG findings?

A 53-year-old man has had increasing difficulty falling and staying asleep over the past 3 months. This is accompanied by hallucinations, delirium, and general clumsiness. He was an orphan as a child and does not know his family’s medical history. If a sleep study is performed, during which stage of sleep would you most likely expect to find an absence of normal sleep architecture?

The combination of lamotrigine and which of the following drugs increases the risk of lamotrigine toxicity?

You are caring for a 1-year-old girl with severe refractory epilepsy with frequent focal seizures. She had normal developmental until 3 months of age when she had seizure onset as well as a loss of milestones. Continuous EEG revealed multiple seizure types, with multiple foci of onset in each hemisphere. The seizures appear to migrate between hemispheres on EEG, and clinically. Which gene is most often associated with this disorder?

A 37-year-old male with the chief complaint of insidious unilateral hearing loss was found to have an acoustic neuroma on MRI. If a brainstem auditory evoked potential (BAEP) was performed which of the following would be most likely found?

A 4-year-old girl with multiple seizure types and intellectual disability has an EEG performed that shows 1.5 Hz to 2.5 Hz spike and wave discharges. Which of the following is the most likely diagnosis?

Which of the following EEG patterns is typically seen over the age of 50?

You are reading a visual evoked potential (VEP) that has a prolonged P100 latency in the right eye and a normal latency in the left eye. Of the following, which pathology is most consistent with this study?