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Epilepsy SBAQs- Kirsty Genfi 1. A 22-year-old man is brought into A and E by ambulance. He is accompanied by his sister who reports that “he fell suddenly” followed by around 2 minutes of violent jerking movements of his limbs. On examination he is drowsy and confused and has no memory of the event. What is the most likely diagnosis? a) Myoclonic seizure b) Cortico-basal degeneration c) Atonic seizure d) Tonic-clonic seizure e) Reflex anoxic seizure 2. I am a drug which binds to GABA transaminase enzyme in presynaptic GABAergic neurons to prevent the breakdown of GABA and increase inhibitory activity on post synaptic neurons. What drug am I? a) Diazepam b) Sodium Valproate c) Lamotrigine d) Ethosuximide e) Levetiracetam 3. A 26-year-old woman begins taking Lamotrigine to treat her epilepsy syndrome. She wants to start taking the combined oral contraceptive pill (COCP). What effect, if any, will the COCP have on Lamotrigine? a) Decreased Lamotrigine absorption b) Increased Lamotrigine excretion c) Increased Lamotrigine metabolism d) Decreased Lamotrigine absorption e) Decreased Lamotrigine metabolism 4. What is the result of Diazepam binding to the GABA A receptors on the post synaptic neuron? a) Decreased Na ion influx into post synaptic neuron + b) Decreased K ion influx into post synaptic neuron c) Increased Cl ion influx into presynaptic neuron d) Increased Na ion influx presynaptic neuron e) Increased Cl influx into postsynaptic neuron 5. What effect does Levetiracetam have on the presynaptic neuron? a) Increases glutamate secretion b) Increases GABA breakdown c) Decreases glutamate breakdown d) Decreases glutamine secretion e) Decreases glutamate secretion6. Which of the following is NOT true about simple Focal seizures? a) Patients often lose consciousness b) Post ictal symptoms do not occur c) Can be treated with Lamotrigine d) May experience visual symptoms before seizure e) Can be treated with carbamazepine 7. A 32-year-old woman has been brought into A and E by ambulance after suffering continuous tonic-clonic seizures which started around 35 minutes ago. What should the first step in her treatment be? a) Get an EEG b) Call the anesthetist c) Give Lamotrigine d) Give IV Lorazepam e) Give Phenytoin 8. Whilst eating dinner with his family, an 11-year-old boy suddenly drops his cutlery and begins to stare blankly into space. His eyelids begin to flutter, his eyes roll upwards, and this continues for 10 seconds. His dad notices the event and asks him about it, but he can’t remember what happened. What drug must you avoid prescribing for the type of seizure this is describing? a) Ethosuximide b) Lamotrigine c) Levetiracetam d) Sodium Valproate e) Carbamazepine 9. Which of the following is NOT true about the mechanism of ac on of Leve racetam? a) Decreases glutamate concentra ons in the synapse b) Interacts with the combined oral contracep ve pill c) Decreases glutamate secre on d) Inhibits SV2A on excitatory presynap c vesicles e) Requires good renal func on 10. Whilst playing with her family, a 9-year-old girl suddenly drops her toys and begins to stare blankly into space. Her eyelids begin to flu er, her eyes roll upwards, and this con nues for 10 seconds. Her mother no ces the event and asks her about it, but she can’t remember what happened. What is the first line drug to treat the type of seizure this is describing? Ethosuximide a) b) Lamotrigine c) Levetiracetam d) Sodium Valproate e) TopiramateAnswers 1. D 2. B 3. C 4. E 5. E 6. A 7. C 8. E 9. B 10.A