Seizure/EEG
16 yo brought to psychiatrist’s attention afer having a single grand mal seizure. Pt’s parents have noted on occasion pt has sudden jerks of the entire body, resulting in dropping objects. EEG: rare 4-6 HZ irregular polyspike/wave bursts. Dx? (10x)
Juvenile myoclonic epilepsy
EEG that reveals posterior alpha and anterior beta activity is most likely to have been obtained from whom? (4x)
28F referred to psych for recent onset episodes of altered behavior lasting 1 to 2 minutes. Husband notes if it occurs when cooking pt will place the clean silverware back in the dishwasher. Also notes she does drawing movements he is unable to interrupt. Pt has no recollection of the events. MRI scan is normal. Dx? (2x)
Complex partial seizures
Characterisic change on polysomnogram associated w/ MDD (8x)
SHORT REM LATENCY/REDUCED LATENCY TO REM SLEEP
5 yo w/ screaming/crying for no reason about 1 hour after falling asleep. Sits up in bed with eyes open, trembling, sweating, mother can‘t gain his attention for 5 min. No new stressors. Boy has no memory of the event. PE normal. Dx? (4x)
Sleep terror
Fever, HA, seizures, confusion, stupor, and coma, evolving over several days. EEG with lateralized high-voltage sharp waves arising in the L temporal region w/ slow wave repeating at 2-3 sec intervals. CT shows low-density lesion in L temporal lobe. Dx? (8x)
Herpes simpex encephalitis
Diagnostic value of transient paresis or aphasia after a seizure: (3x)
Localizes the focus of seizure
1st seizure with local onset and secondary generalization in a 58 yo is likely the consequence of what? (2x)
Glioblastoma multiforme
Paralysis when awakening, lasts several minutes. Can see/hear but can't move during episodes. Disappears spontaneously or when called by his wife. No hallucinations, nightmares, daytime sleepiness or h/o falls. Neuro exam normal. Dx? (4x)
Sleep Paralysis
REM sleep is first evident at which stage of development? (3x)
In utero
8 yo has episodes of staring into space and then blinking for a few seconds. EEG would show what? (7x)
3 cycles per second spike and wave activity
What is the most common comorbid psych d/o in pts w/ epilepsy? (3x)
MDD
Surgical procedure that can be used in the tx of epilepsy refractory to meds: (2x)
Electrical stimulation of the vagus nerve
What sleep stage is most important in restoring the altered functions that result from prolonged sleep deprivation? (3x)
Stage 4, non-REM
Finding on multiple sleep latency test (MSLT) that confirms narcolepsy (3x)
Decreased REM latency
40 yo has episodes of flailing arms and tonic postures described as “fencing.” EEG confirms seizure. Which seizure type? (5x)
Frontal lobe
3 days s/p cardiac arrest and CPR, 73M is comatose. Eyes are open but doesn‘t fix and follow w/ his eyes. Doll’s eyes elicit full horizontal eye movements. Spontaneous limb movements are symmettrical. Reflexes are mildly hyperactive. The EEG shows? (2x)
Burst suppression pattern
Expected EEG in a comatose pt w/ hepatic encephalopathy: (2x)
Triphasic waves
Pt reports insomnia, frequent nightme awakenings, and excessive daytime sleepiness. Sleep study reveals brief lower external jerks w/ brief repeated arousals. Pt is unaware of these movements. Likely dx? (3x)
Periodic limb movement disorder
Disorder associated with hypocretin-1 deficiency? (3x)
Narcolepsy
An increase in beta frequency during an awake EEG is caused by what type of medication? (2x)
Sedatives
Lack of prolactin elevation after seizures suggests what kind of seizure? (2x
Non-epileptic
Antiepileptic for juvenile myoclonic epilepsy: (2x)
Valproic acid
What aspect of sleep is increased in older adults? (3x)
Duration of awakening
Pt presents w/ hx of irresistible episodic sleepiness that is accompanied by a vivid, dream-like state at the onset of an episode. Additional sleep symptom likely to be present? (2x)
Sleep paralysis