tùy chọn được liệt kê, trong trường hợp này không có bằng chứng tồn tại để bổ sung của một loại thuốc thứ hai có thể có cạnh tranh cho protein ràng buộc (có thể dẫn đến sự gia tăng miễn phí, chứ không phải là tổng số, mức độ phenytoin) | 150 listed options in this case no evidence exists for addition of a second drug that could have competed for protein binding which can lead to an increase in free rather than total phenytoin levels induction of hepatic metabolism would lead to reduced rather than increased levels of a drug and there is no evidence to suggest impaired renal clearance as the cause of the increase in level in this patient. 13. A 28-year-old woman comes to the office for evaluation of intermittent episodes of a choking sensation associated with profuse salivation and repetitive swallowing. Her episodes last approximately 2 minutes occur several times per month and are often preceded by an unusual taste. There is no definite loss of consciousness. This patient s symptoms are most consistent with epilepsy arising from which of the following cortical regions A. Cingulate B. Insula C. Lateral temporal D. Mesial temporal E. Orbitofrontal Correct Answer The correct answer is B. Insular seizures have prominent oral symptoms including chewing salivation repetitive swallowing speech arrest and laryngeal symptoms such as choking or stridor. Autonomic epigastric emotional or gustatory as in this patient auras can occur. 14. An 8-year-old girl is brought to the office because of a 6-month history of episodes of brief head jerks. No associated loss of consciousness occurs and the episodes seem to worsen under periods of stress. She has no other significant past medical or family history. On examination the patient has occasional brief episodic jerking of the head to the left. She is able to briefly repress the movements after being asked to do so but this is followed by an increase in the frequency of the jerking movements. Neurologic examination is otherwise normal. Which of the following is the most appropriate next step in diagnosis A. Brain MRI B. EEG-video monitoring C. No further diagnostic testing is indicated D. Psychiatric evaluation E. Routine EEG Correct Answer The correct answer is C.
