06-30-2007, 03:16 PM
A 23-year-old woman comes to the office with her husband for evaluation of recent onset of unusual behavior. While providing the clinical history, the patient begins to cry. Shortly after that, the patient's arms start shaking. Gradually, the shaking becomes more pronounced and involves her legs and head. The patient's breathing becomes deep and fast. This continues, off and on, for several minutes. The shaking stops gradually. The patient opens her eyes and states that she has a headache and is very tired and dizzy. Her family history is positive for seizures in her cousin. There has been a significant amount of family stress recently.
Which of the following is the most likely diagnosis?
( A ) Basilar migraine
( B ) Generalized tonic-clonic seizure
( C ) Nonepileptic event (pseudoseizure)
( D ) Partial seizure with secondary generalization
( E ) Syncope
A 67-year-old man who lives alone is found on the floor of his home by his son and is brought to the emergency department within 30 minutes. When last seen by his son 3 days earlier, the patient was in full health. In the emergency department, his blood pressure is 180/100 mm Hg. He is mildly lethargic and has global aphasia, a dense right visual field deficit, right hemiplegia, and no response to painful stimuli on the right side. Computed tomography scan of the head shows a large left ischemic stroke, with mass effect.
Which of the following is the most appropriate next step in the management of this patient?
( A ) Intravenous corticosteroids
( B ) Intravenous heparin
( C ) Intravenous tissue plasminogen activator
( D ) Supportive care
A 26-year-old woman comes to the office because of recurrent episodes of unusual behavior. She usually has a warning”a œweird feeling in her stomach”prior to the episodes. Her husband has witnessed most of the events, and states that the patient suddenly freezes, looks around, smacks her lips, and moves her fingers repetitively. The episodes usually last between 30 seconds and 2 minutes. She has no recollection of the events after the warning. Afterward, the patient is confused and disoriented for as long as 10 minutes. The patient has had at least 10 episodes over the last 2 years.
Which of the following is the most likely diagnosis?
( A ) Absence seizures
( B ) Complex partial seizures
( C ) Migraine
( D ) Nonepileptic events (pseudoseizures)
( E ) Transient global amnesia
Which of the following is the most likely diagnosis?
( A ) Basilar migraine
( B ) Generalized tonic-clonic seizure
( C ) Nonepileptic event (pseudoseizure)
( D ) Partial seizure with secondary generalization
( E ) Syncope
A 67-year-old man who lives alone is found on the floor of his home by his son and is brought to the emergency department within 30 minutes. When last seen by his son 3 days earlier, the patient was in full health. In the emergency department, his blood pressure is 180/100 mm Hg. He is mildly lethargic and has global aphasia, a dense right visual field deficit, right hemiplegia, and no response to painful stimuli on the right side. Computed tomography scan of the head shows a large left ischemic stroke, with mass effect.
Which of the following is the most appropriate next step in the management of this patient?
( A ) Intravenous corticosteroids
( B ) Intravenous heparin
( C ) Intravenous tissue plasminogen activator
( D ) Supportive care
A 26-year-old woman comes to the office because of recurrent episodes of unusual behavior. She usually has a warning”a œweird feeling in her stomach”prior to the episodes. Her husband has witnessed most of the events, and states that the patient suddenly freezes, looks around, smacks her lips, and moves her fingers repetitively. The episodes usually last between 30 seconds and 2 minutes. She has no recollection of the events after the warning. Afterward, the patient is confused and disoriented for as long as 10 minutes. The patient has had at least 10 episodes over the last 2 years.
Which of the following is the most likely diagnosis?
( A ) Absence seizures
( B ) Complex partial seizures
( C ) Migraine
( D ) Nonepileptic events (pseudoseizures)
( E ) Transient global amnesia