1. Which one of the following is associated with petit mal epilepsy?

a. Involving all parts of the brain

b. Abnormality of EEG wave shows 3-Hz generalized, symmetric spike-wave
complex.
c. Onset at 20th age.
d. Cannot be detect by electroencephalogram
e. Appear as generalized tonic-clonic seizure
2. The most important differential diagnosis of epilepsy are
a. Syncope and pseudoseizure
b. Malingering and tension-type headache
c. Stroke and brain death
d. Myocard infark and TIA
e. Encephalitis and syncope
3. A 9-year-old boy is brought to your clinic by his parents because he has begun to have
episodes of eye fluttering lasting several seconds. Sometimes he loses track of his
thoughts in the middle of a sentence. There was one fall off a bicycle that may have been
related to one of these events. There are no other associated symptoms, and the episodes
may occur up to 20 or more times per day. The boys development and health have been
normal up until this point. He did have two head injuries as a young child: the first when
he fell off a tricycle onto the ground, and the second when he fell off of a playset onto his
head. Both episodes resulted in a brief loss of consciousness and he did not think clearly
for part of the day afterward, but had no medical intervention. The test most likely to
confirm this patients diagnosis is
a. Brain CT scan
b. Brain MRI
c. Electroencephalogram/EEG
d. Lumbar puncture
e. Nerve conduction study
4. A 56-year-old man with epilepsy is brought into the emergency room. He has been
having continuous generalized tonic-clonic seizures for the past 30 min. He is treated
with 2 mg of IV lorazepam. Most physicians recommend using a high dose of
intravenous benzodiazepine as part of the management of status epilepticus because of
its
a. Ability to suppress seizure activity for more than 24 h after one injection
b. Lack of respiratory depressant action
c. Rapid onset of action after intravenous administration
d. Lack of hypotensive effects
e. Lack of dependence on hepatic function for its metabolism and clearance

5. The patients seizing does not stop. A second intravenous drug is given. Infusing which of
the following antiepileptic drugs at more than 50 mg/min in an adult may evoke a cardiac
arrhythmia?
a. Carbamazepine
b. Diazepam
c. Phenobarbital
d. Clonazepam
e. Phenytoin
6. A 4-year-old boy has the onset of episodes of loss of body tone, with associated falls, as
well as generalized tonic-clonic seizures. His cognitive function has been deteriorating.
EEG shows 1.5- to 2-Hz spike-and-wave discharges. The most likely diagnosis is
a. Landau-Kleffner syndrome
b. Lennox-Gastaut syndrome
c. Juvenile myoclonic epilepsy
d. Mitochondrial encephalomyopathy
e. Febrile seizures
7. A 27-year-old man begins to experience infrequent episodes of nausea, warmth rising
through his body, and an unusual odor like rotting fish. His girlfriend notices that
afterward he may develop twitching of the left side of his face and an inability to speak
for several minutes. Afterward the man appears dazed and cannot remember what has
occurred. He has otherwise been well. Magnetic resonance imaging (MRI) of his brain is
most likely to show a lesion in which area of the brain?
a. Left frontal lobe
b. Right frontal lobe
c. Cribriform plate
d. Uncus
e. Left parietal lobe
8. A patient with intractable complex partial seizures due to cortical dysplasia undergoes left
temporal lobectomy. He is most likely to develop which of the following problems after
surgery?
a. Right superior quadrantanopsia
b. Right inferior quadrantanopsia
c. Right homonymous hemianopsia
d. Right hand weakness
e. Aphasia
1. The answer is B
2. The answer is c

3. The answer is c. (Victor, p 335.) This is a common presentation for primary generalized
epilepsy of childhood. An electroencephalogram showing the classic 3-Hz spike-andwave pattern would confirm this diagnosis. Brain MRI and CT are useful for evaluating
brain anatomy. Anatomic problems can cause seizures, but these tests will not tell
anything about brain electrical activity. Lumbar puncture is useful for measuring
cerebrospinal fluid pressure and looking for central nervous system inflammation or
infection. Central nervous system inflammation or infection may cause seizures. Nerve
conduction study is useful to evaluate peripheral nerve injuries such as nerve entrapment.
4. The answer is c. (Bradley, pp 17601761.) Until recently, the most popular
benzodiazepine for use in status epilepticus was diazepam (Valium), which has a rapid
onset of action but is cleared relatively quickly. Because of this property, patients needed
additional medications, such as phenytoin, to protect them from recurrent seizure activity
as early as 20 min after diazepam injection. A longer-acting benzodiazepine, lorazepam
(Ativan), has the advantage of being rapid-acting like diazepam but being cleared more
slowly from the body
5. The answer is e. ( Bradley, p 1761.) Rapid infusion of phenytoin may produce a
conduction block or other basis for cardiac arrhythmia. Phenytoin should not be
administered at rates greater than 50 mg/min in adults or 1 mg/(kg_min) in children to
reduce the chances of this reaction occurring. Thus, it usually requires approximately 20
min to administer a 1000- to 1500-mg standard loading dose of phenytoin in an emergent
setting such as status epilepticus. Fosphenytoin, a water-soluble prodrug of phenytoin that
has recently become available, has the advantage of causing fewer infusion site reactions.
It can be given at doses of up to 150 mg/min in an adult, with risks of cardiac
dysrhythmia similar to those of phenytoin. Another advantage of fosphenytoin is that it
can be administered intramuscularly when intravenous access is problematic.
Carbamazepine is not administered intravenously at all. Rapid infusion of phenobarbital
may produce hypotension or respiratory arrest, but is much less likely to depress cardiac
activity. Diazepam and clonazepam are safer than phenobarbital, but rapid infusion of
excessively high doses may depress blood pressure and other autonomic functions.
6. The answer is b. (Bradley, p 1758.) Lennox-Gastaut syndrome is a disturbance seen in
children. It is often difficult to control the seizures that develop in children with this
combination of retardation and slow spike-and-wave discharges on EEG. Many affected

children have a history of infantile spasms (West syndrome). Infants and children with
infantile spasms exhibit paroxysmal flexions of the body, waist, or neck and usually have
a profoundly disorganized EEG pattern called hypsarrhythmia.
7. The answer is d. (Victor, p 338.) Many patients with complex partial seizures have a
preseizure phenomenon (the aura) that alerts them to an impending seizure. This patients
aura includes an olfactory hallucination, which is usually associated with lesions of the
mesial temporal lobe, particularly the uncus or parahippocampal gyrus. Diseases that can
affect that region include tumors, trauma, and mesial temporal sclerosis.
8. The answer is a. (Patten, p 25.) The most common complication of temporal lobectomy

is a visual field defect due to interruption of fibers from the optic tracts passing over the
temporal horn of the lateral ventricles. Superior quadrantanopsia is more common than
hemianopsia. Some deficits may improve if the injury does not completely damage the
nerves. Language deficits, particularly dysnomia, occur less frequently. Hemiparesis is
uncommon (<2%), because the surgery is performed at a distance from the motor fibers
of the corticospinal tract. Other neurological problems that can occur include diplopia
due to extraocular nerve deficits, and facial paresis.