1. A 16-year-old female drops her hairbrush in the morning due to sudden arm jerks. EEG shows generalized 4–6 Hz polyspike-and-wave. What is the first-line treatment?
Correct Answer: B. Valproic Acid
This is Juvenile Myoclonic Epilepsy (JME). Valproic acid is the broad-spectrum drug of choice. Sodium channel blockers like Carbamazepine can worsen myoclonic seizures.
2. A 6-year-old boy has frequent "daydreaming" episodes. Hyperventilation triggers a stare with eyelid fluttering. What is the classic EEG finding?
Correct Answer: A. 3 Hz Spike-and-Wave complexes
This is Childhood Absence Epilepsy. The hallmark is the 3 Hz generalized spike-and-wave pattern triggered by hyperventilation.
3. A patient develops a severe blistering rash (Stevens-Johnson Syndrome) two weeks after starting a new AED. Which drug is the most likely culprit?
Correct Answer: C. Lamotrigine
Lamotrigine carries a Black Box Warning for serious skin rashes like SJS, which is why it requires slow titration.
4. A 5-month-old has sudden neck flexion spasms. What is the classic triad of West Syndrome?
Correct Answer: A. Infantile Spasms, Hypsarrhythmia, Developmental Regression
This triad defines West Syndrome. The EEG pattern is Hypsarrhythmia (chaotic, high voltage).
5. A patient is in status epilepticus. Two doses of IV Lorazepam have failed. What is the next step?
Correct Answer: B. IV Fosphenytoin/Levetiracetam
After benzodiazepines fail, you must move to the "Second Therapy Phase" with a long-acting AED like Fosphenytoin, Valproate, or Levetiracetam.
6. A man smells burning rubber and has "gastric rising" nausea, followed by lip-smacking automatisms. Where is the seizure focus?
Correct Answer: C. Temporal Lobe
Olfactory hallucinations (uncinate fits) and gastric auras are classic for Mesial Temporal Lobe Epilepsy.
7. A 9-year-old boy has nocturnal seizures with drooling and inability to speak. What is the prognosis for Benign Rolandic Epilepsy?
Correct Answer: C. Usually benign and resolves by adolescence
Benign Rolandic Epilepsy typically resolves spontaneously by age 15-16.
8. A woman on Valproic Acid plans to get pregnant. What is the best counseling?
Correct Answer: C. Switch to safer alternative
Valproic acid is highly teratogenic. It should be switched to a safer drug (like Lamotrigine or Levetiracetam) prior to conception if possible.
9. A patient has 30-minute seizures with side-to-side head shaking, pelvic thrusting, and forced eye closure. EEG is normal. Diagnosis?
Correct Answer: B. PNES
Forced eye closure, pelvic thrusting, and normal EEG during the event are hallmarks of non-epileptic seizures.
10. A patient has psychosis, dyskinesias, and an "Extreme Delta Brush" on EEG. Which antibody is positive?
Correct Answer: C. Anti-NMDA Receptor
This pattern is pathognomonic for Anti-NMDA Receptor Encephalitis.
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