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The Epilepsy exam has 220 questions and runs 4 hours.
These 10 free Epilepsy questions are organized by exam domain, so you can see how each part of the Certification in Epilepsy blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Epilepsy and episodic disorders (74-86%)
Question 1
A 17-year-old is evaluated after a first tonic-clonic seizure following an all-night study session. When asked about earlier events, she describes sudden bilateral arm jerks shortly after awakening that have made her drop her toothbrush or breakfast plate for the past year. She remains conscious during the jerks. Development and neurologic examination are normal. EEG shows a normal background with generalized 4-Hz polyspike-and-wave discharges. Which syndrome best accounts for the history and EEG?
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Correct answer: C - Juvenile myoclonic epilepsy
Question 2
Over the past week, a 5-month-old with confirmed tuberous sclerosis complex has developed clusters of brief symmetric flexion movements after awakening and has stopped reaching for toys. Video-EEG captures epileptic spasms, with a markedly disorganized high-amplitude interictal background and multifocal spikes. No antiseizure treatment has been given. For this etiology, which medication is preferred as the initial treatment of the spasms?
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Correct answer: D - Vigabatrin
Question 3
An 80-kg adult continues to convulse after two appropriately timed 4-mg intravenous doses of lorazepam. Glucose is 104 mg/dL, and airway support and cardiorespiratory monitoring are in place. The team selects intravenous levetiracetam as the next agent using the ESETT regimen. No nonbenzodiazepine antiseizure loading dose has yet been administered. Which order should be given now?
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Correct answer: B - Levetiracetam 4,500 mg intravenously over 10 minutes
Question 4
Before pregnancy, a woman with focal epilepsy was seizure-free for two years on lamotrigine, with a reproducible trough concentration of 6.0 mg/L. At 20 weeks of gestation, she reports two habitual focal seizures despite confirmed adherence, unchanged dosing, and no vomiting or interacting medications. A correctly timed trough is now 2.2 mg/L; the laboratory reference interval is 2.0-15.0 mg/L. Blood pressure and neurologic examination are normal. How should these findings influence treatment?
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Correct answer: B - Increase lamotrigine with clinical follow-up and trough monitoring toward her effective baseline.
Question 5
During one hour of continuous EEG in an obtunded adult, six separate right temporal electrographic seizures occur. Each has definite evolution in frequency and spatial distribution, lasts three minutes, and is followed by return to the preceding EEG background. No time-locked clinical change is detected, and no seizure lasts ten continuous minutes. Applying the ACNS 2021 terminology, how should the hourly seizure burden be classified?
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Correct answer: C - Electrographic status epilepticus, because seizures occupy 30% of the recorded hour
Question 6
A 32-year-old continues to have two or three disabling focal seizures per month after separate adequate, tolerated trials of lamotrigine and levetiracetam. Adherence is confirmed, and video-EEG has documented the habitual seizures with a consistent left temporal onset. Expert review of an epilepsy-protocol MRI identifies no lesion. He asks whether a normal MRI means that surgery can never be considered. Which plan is appropriate at this point?
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Correct answer: B - Initiate comprehensive presurgical evaluation despite the nonlesional MRI.
Domain 2: Genetic and developmental disorders (3-5%)
Question 7
A 6-year-old has seizures beginning in infancy, developmental slowing, and dystonic episodes after prolonged exercise or missed meals. MRI is normal. Lumbar puncture after a supervised four-hour fast shows CSF glucose of 30 mg/dL, with a blood glucose of 90 mg/dL drawn immediately before the procedure. CSF cell count, protein, and lactate are normal. Which intervention most directly addresses the metabolic defect suggested by this combination?
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Correct answer: D - Ketogenic dietary therapy to provide an alternative cerebral energy substrate
Domain 3: Vascular neurology (1-2%)
Question 8
Headache, visual blurring, and a tonic-clonic seizure develop in a renal transplant recipient whose blood pressure is 218/124 mmHg. MRI shows bilateral parieto-occipital subcortical FLAIR hyperintensity with increased apparent diffusion coefficient values; the abnormalities do not follow an arterial territory. Which tissue process best explains the dominant MRI abnormality?
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Correct answer: A - Blood-brain barrier leakage with extracellular fluid accumulation
Domain 9: Questions not associated with a specific neurologic disorder (6-10%)
Question 9
An EEG referred for a second opinion was reported as showing left temporal sharp waves. Review reveals arciform 8- to 10-Hz temporal trains during drowsiness. Occasional isolated waves have the same shape as the waves within the trains, with no aftergoing slow wave or disruption of the background. The activity does not evolve. The most appropriate name for this finding is:
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Correct answer: A - Wicket rhythms
Question 10
Phenytoin monitoring in a patient with chronic kidney disease and albumin of 2.0 g/dL yields a total trough concentration of 8.0 micrograms/mL (reference 10-20) and a directly measured free concentration of 2.8 micrograms/mL (reference 1-2). The patient has new gaze-evoked nystagmus and gait ataxia, without recent seizures. What is the most defensible interpretation?
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Correct answer: A - The free level supports toxicity despite the low total concentration.