Grandma: I'm afraid that we can't find the new playground. Timmy: Don't worry, Grandma! We can use the map on your phone. Grandma: What does the map say? Timmy: It says we have to walk straight down this road to the hospital. Grandma: Is it next to the hospital? Timmy: No, we have to turn right at the hospital and walk to the library. Timmy: We turn left at the library and walk to the park. The playground is in the middle of the park. Grandma: Very good, Timmy!

Write simple RCQ for A1 kids using: Good morning, Grandma! Good morning, Timmy. How are you? I'm great. I just had a dream about a dragon. Was it a good dream? Yes! The dragon was very friendly. He let me ride on his back. We flew up in the sky together. Where did you go? We went to an island in the ocean. There were many palm trees there. We drank coconut juice. Wow, that sounds great! Yes, it was great. The dragon could also breathe fire. Hе made a fire for us at night.

Title: The Adventures of Max and the Magical Computer (Shortened Version) Once upon a time, in a small town called Techville, there lived a curious fourth-grader named Max. One day, while exploring his grandma’s attic, he found an old, dusty computer. As he cleaned it, the screen lit up, and a cheerful voice said, “Hello, Max! I’m Compy, your magical computer. Let’s learn about operating systems, files, and folders!” Max was thrilled. “A talking computer? Let’s go!” Chapter 1: The World of Windows Compy explained, “I run on Windows, the brain of the computer. It uses a Graphical User Interface (GUI), so you can interact with me using icons, menus, and buttons. Let’s start by changing my desktop background—the image on the screen.” Max chose a spaceship picture. “Cool! Can I add a screen saver too?” “Of course!” said Compy. “It’s an image that appears when I’m inactive. Try this swirling galaxy!” Max set the screen saver and giggled as it appeared. “This is fun!” Chapter 2: Organizing with Folders and Files Compy’s screen filled with random icons. “Oh no! My files are a mess. Can you help?” “Sure! What are files and folders?” asked Max. “A file is information, like a picture or document. Files have names, like ‘Homework.docx.’ The part after the dot, like .docx, is the file extension. It tells you the file type,” Compy explained. Max pointed to “Game.exe.” “So, this is a program file?” “Yes!” said Compy. “To organize, we use folders—like drawers for files. You can even put folders inside folders!” Max created a “School” folder, added his homework files, and made a “Projects” folder inside it. “Now everything’s neat!” Chapter 3: The File Explorer Adventure Compy’s screen flickered. “Some files are missing. Let’s use Windows Explorer to find them. It’s like a map for files and folders.” Max opened Windows Explorer and saw a tree-like list of folders. “This is like a tree with branches!” “Exactly!” said Compy. “Search for the missing files and move them to the right folders.” Max found the files in “Downloads” and moved them. “I feel like a computer detective!” Chapter 4: The Final Challenge Compy’s screen turned into a game board. “Time for a quiz! What’s the purpose of an operating system? How do you change the desktop background? What’s the difference between a file and a folder?” Max answered all the questions correctly, and fireworks lit up the screen. “Congratulations, Max! You’re a computer whiz!” The End Max smiled. “Thanks, Compy! I can’t wait to teach my friends!” Compy replied, “Remember, Max, learning is an adventure. Keep exploring!” As Max turned off the computer, he knew his journey into technology had just begun.

A trip to Rio Julia and her family traveled from New York to visit Rio de Janeiro in Brazil. Julia's cousin Gabriela lived there. They all went to the opening night of the Olympics. The stadium was very crowded. It made Julia nervous. Everyone screamed and cheered. Their seats were far away. Julia could barely see. The music was loud. It made her head hurt. Julia had been happy to visit Rio. Now she just wanted to go home. Gabriela woke Julia up the next morning. "There's another Olympic event today!" she said. Julia did not want to go, but she smiled and got ready. The families walked through shady streets. Gabriela's street ended at a beach. Julia stopped and stared. Tall buildings stood along the beach. Olympic racing boats floated on the water. There was a big mountain behind them. "That's Sugarloaf Mountain," Gabriela said. It was beautiful. The next day, Julia ran to Gabriela's room. "We're going up Sugarloaf Mountain!" she said. They rode a cable car. It hung high above the city. Julia stared out the window. White buildings stood above the green jungle. They went to a big market. Julia tasted a mango. It was not like the mangoes at home. It was juicy and sweet! They went to an Olympic swimming race. Gabriela's brother, Chaz, cheered, "Go Brazil!" "Brazil is not even in this event!" Gabriela said. "Oh." Chaz said. He smiled at Julia. "Go Americа!" It was Julia's last day in Rio. They went to Grandma and Grandpa's. Julia remembered the house. She had visited when she was five. Grandpa had taught her to dance. It felt like home. Grandma made a spicy bean stew. After lunch, they went to an Olympic football game. "The crowd is very noisy," Julia said. "I'm scared." "Don't worry," Grandpa said. "Football fans are one big family." At the stadium, the crowd seemed even louder. Julia held Grandpa's hand. Brazil got the ball. Everyone cheered. Julia got caught up in the game. She cheered, too. Then, Brazil scored a goal. The crowd cheered. Grandpa lifted Julia in the air. They sang a song with the crowd to celebrate.

[t comes from the GREEK name "Epilepsia" which means "taking hold of or seizing". - It is a disorder characterized by: recurrent seizures. SEIZURES R ectment transient attacks of: R epresent: R esult from: ASSOCIATED WITH: somatic, psychic, or, autonomic clinical featmes. clinical features of abnormally hyperexcitable cortical neurons. paroxvsmal and excessive electrical neuronal discharges. EEG changes & may be disturbance of consciousness. same causes of convulsions 1. Idiopathic epile~ • It is the commonest cause. no cause can be detected ( 65 % ) • It may be associated with positive family history in some cases. • It starts in the l st & 2nd decades in the form of: -- Grand ma! epilepsy. Petit mal epilepsy. Myoclonic epilepsy. Atonic seizures. 2. Secondary epilepsy A. Local causes in the brain: l. Congenital: 2. Traumatic: cerebral palsy. a cause can be detected cerebral contusion or laceration. 3. Inflammatory: 4. Neoplastic: 5. Degenerative: 6. Vascular: encephalitis, brain tumours. mening1t1s, presenile dementia. brain abscess. stroke (especially hemon-hagic), hypertensive encephalopathy. B. General causes with secondary effects on the brain: I. Toxic: 2. Iatrogenic: 3. Metabolic: 4. Endocrinal: 5. Organ failure: 6. Heart disease: 7. Nutritional: - Alcohol, cocaine, lead. - Lidocaine, INH. - j glucose & ! glucose. - Hypoparathyroidism. - Hepatic failme. - Adam's Stoke's attacks. - Pellagra. - Botulism, tetanus. - Ambilhar, Amphetamine, Aminophylline. - j Ca & ! Ca. - Hype1thyroid crisis. - Renal failure. - Fallot's tetralogy. - j Na & ! Na. - Vitamin B6 deficiency. 8. Physical: 9. HYSTERICAL. - High fevers. - Heat stroke. 136 137 CLINICAL PICTURE 1. GENERALISED SEIZURES " Excessive electrical discharges from cortical neurons in BOTH hemispheres simultaneously " I. II. 1. Grand Mal Epile~: 1. Pre-ictal stage "attacks of tonic-clonic convulsions " (aura) It is a warning sign of a coming attack. It may be: • Somatic: • Psychic: • Autonomic: 2. Ictal stage Myoclonus, Hallucinations. Tachycardia, (seizure) Sudden loss of consciousness: Parasthesias. Sweating. for seconds to minutes. -- Tonic phase (few seconds) o The UL & LL: o o o o The HEAD: The JAWS: CYANOSIS: are extended. is retracted to one side & the eye balls rolled up. are firmly clenched, with biting of the TONGUE. due to impaired respiration. There may be incontinence of urine. Clonic phase (few minutes) o The UL & LL: o The HEAD: 3. Post-ictal stage - It may be: • Somatic: • Psychic: • Autonomic: Drug of choice: contract & relax repeatedly & rapidly. jerks forcibly. (sequelae) Todd's paralysis(< 24 hours, due to neuronal exhaustion). Confusion. Vomiting. Carbamazepine (Tegretol) or Phenytoin (Epanutin) Petit Mal Epilepsy: "attacks of loss of consciousness " " Absence " It starts in childhood & improves at puberty & usually disappears at the age of 20. 2. It is NOT PRECEEDED by aura & NOT FOLLOWED by sequelae. 3. It is usually PRECIPITATED by: hyperventilation 4. It is characterized by: or photic stimulation. sudden loss of consciousness of short duration (few seconds). 5. It may be associated with: • High frequency ( 50 attacks / day). • Falling to the ground without warning. • Jerky movements of the head & UL Drug of choice: (myoclonic petit mal). Valproate (Depakine) or Succinimide (Zarontin) 137 138 Ill. M oclonic Seizures: "attacks of involuntary clonic movements " - It is characterized by: sudden, jerky, shock-like INVOLUNTARY muscle contraction. • The jerks are bilateral contractions, mainly of the shoulders and arms. • However, some patients repmtjerking in the lower limbs, trunk, or head. - It may be of 2 types: - Occurs singly • Simple: • As a pait of: I Drug of choice: IV. Atonic seizures: (no loss of consciousness). - Grand mal epilepsy (aura). - Petit mal epilepsy. Valproate (Depakine) or Clonazepam (Rivotril) I - Transient attacks of brief loss of postural tone, often resulting in falls and injuries. 2. PARTIAL SEIZURES "Excessive electrical discharges from cmtical neurons in a ce1tain area in ONE hemisphere" A. Simple seizures: " No disturbance in consciousness " - The CP depends on the site of the hyperexcitable neurones in the cerebral cortex, whether in: "Motor area or Senso,y areas". 1. Motor fits: • Focal fits: • Motor jacksonian fits: 2. General Sensory fits: • Focal fits: • Sensory jacksonian fits: 3. Special Senso1y fits: • Visual hallucinations: • Auditory hallucinations: • Olfactory hallucinations: B. Complex seizures: - SITE: movement of part of a limb or the whole limb. movement of one side of the body (see before). parasthesia of part of a limb or the whole limb. parasthesia of one side of the body (see before). irritation of the visual sensory area. irritation of the auditory sensory area. initation of the uncus. " disturbance in consciousness " The hyperexcitable neurons are in the Temporal lobe "Temporal lobe epilepsy". - DURATION: The seizure lasts few seconds to few minutes. - The seizure starts with A ura, followed by A bsence, Automatism, Amnesia: 1. 2. 3. 4. A ura: A bsence: Automatism: A mnesia: Olfactory hallucinations, Deja-vu phenomenon, Sensation of fear. Absent patient with staring eyes (with no response to conversation). Involuntary Purposeless acts: motor ( eg, lip smacking, chewing) or verbal. No recalling of the seizure. 138 139 3. PARTIAL SEIZURES ~ GENERALISED SEIZURES " Partial seizures may spread to involve the whole brain .- secondarily generalised seizures " . HY-sterical epilepsY • Usually: • The cause: • Incidence: young neurotic Sj2 . psychological & there is no organic lesion. usually occurs in the presence of people. • It is associated with: • EEG: • It is not associated with: normal. • Missed ttt. • Menses. • Alkalosis. anxiety, palpitaion & hyperventilation. tongue biting or incontinence of urine. • Alcohol use & Drug abuse ( e.g. cocaine ). • S timulation by photons & Hyperventilation. • S leep deprivation & Stress & sudden withdrawal of antiepileptic drngs. INVESTIGATIONS 1. EEG: • It is the most specific test for epilepsy because it records the electrical activity of the brain. • It shows specific pattern: 2. LOCAL INVESTIGATIONS: "Epilepsy waves". "CT & MRI of the brain" • To identify or exclude a LOCAL CAUSE of seizures in the brain. 3. GENERAL INVESTIGATIONS: "Laboratory investigations" • To search for a GENERAL CAUSE of seizures, e.g. blood glucose. 139 140 TREATMENT A. General Measures: 1. 2. Moderation of the patient's physical activity. A void the precipitating factors ( Alcohol, hyperventilation, photic stimulation ...... ). 3. A ketogenic diet is encouraged because it will induce acidosis: - Acidosis is beneficial as it raises the threshold of stimulation of the brain cells. B. Specific Treatment: 2. 1. Treatment of the cause in secondary epilepsy. Anti-epileptic drugs: a) Always sta1t with one drug, then add another drug if there is no response. b) Always stop the drugs ONLY if: • The patient stays free of symptoms for at least 2 years. • The patient has a normal EEG. 3. Side effects of Anti-epileptic drugs: I . Skin rash. 2. 3. Bone marrow depression. Ataxia. Drug 1. Barbiturates (Pbenonobarbitone) 2. Hydantoin (Epanutin) 3. Carbamazepine 4. Clonazepam 5. Valproate 6. Succinamide ANTI-EPILEPTIC DRUGS NEW ANTI-EPILEPTIC DRUGS - These drugs are new dtugs that may be used in resistant seizures. 1. Lamotrigine: 200 - 400 mg/ day. 2. Felbamate: 3. Gabapentin: 400- 800 mg/ day. 600 - 1200 mg/ day. \ " General rules for use ": Dose 100-600 mg I day 100-600 mg / day 200-600 mg I day 2-6 mg I day 500-1500 mg I day 500-1000 mg / day Best indicated - Broad spectrum. - Not for petit mal. - Grand mal. - Motor Jacksonian fits. - Grand mal. - Motor Jacksonian fits. - Complex seizures. - Not for petit ma!. - Myoclonic. - Grand mat. - Broad spectrum. - Petit mat. 140 141 STATUS EPILEPTICUS DEFINITION - A medical emergency: 1. Repeated attacks of generalized convulsions, with lack of recove,y of consciousness, 2. Persistent attack of seizure lasting for at least 30 minutes. OR, - If the convulsions are not stopped rapidly, coma deepens & death may occur due to: heart failure or respiratory failure or brain damage or hyperpyrexia. - The most common causes are: sudden withdrawal of anti-epileptic drugs & stroke. TREATMENT A. General Measures: l. Take care of: " ABC " • Place the patient on the ground, to guard against falling from bed. • Mouth gag & 02 inhalation ( endo-tracheal intubation may be needed). • Record the vital signs regularly. 2. Take a sample of: - Venous blood: for the level of: - A.tierial blood: for the level of: 3. a nti-epileptic drugs, a lcohol. pH, p0 2, pC02, HC0 3. Give cerebral dehydrating measures: e.g. Frusemide, cone. Mannitol, Dexamethazone. B. Specific Treatment: - Phenytoin with diazepam (or clonazepam) immediately: 1. Phenytoin: 2. Diazepam: Clonazepam: seizures recur: 15 mg I Kg slow infusion. 5 mg slowly IV, to be repeated after 5 minutes if seizures recur: maximum dose: 20 mg. OR: 2 mg slowly IV, to be repeated after 5 minutes if maximum dose: 6 mg. - If seizures persist after 20 min. of Phenytoin & diazepam: 3. PHENOBARBITONE: - In resistant cases: 200 mg infusion. 4. GENERAL ANAESTHESIA: may be used.

Write simple RCQ for ESL A1 kids: Who Likes Cake? On Saturdays, we go to Grandma's house. Today is Saturday. Grandma and I are making a cake. The cake is pink. We put white sugar on top, and four candles. Why? It's my little sister's fourth birthday!

A Choose the correct answer. 1 When his grandma died, he came ….. some of her money and property. A into C across B up D round 2 We should try to ….. the amount of rubbish in our area. A increase C provide B improve D reduce 3 I avoid driving to work because there are always ….. jams in the centre. A transport C power B traffic D station 4 By the end of the year, there will be more ….. farms in our city. A solar C floating B vertical D electric 5 Who is going to ….. our new piano? A deal C deliver B produce D construct 6 She doesn’t like being ….. in the house; she wants people around her. A healthy C lonely B crowded D alone 7 Why don’t you come ….. for dinner tonight? A up C over B into D back 8 Mr Jones has found the cure for a serious ….. . A disease C crime B pollution D poverty 9 Scientists are hopeful ….. the future of energy sources. A for C about B in D with 10 Do you think ….. tube trains will ever be used? A drone C charging B front D vacuum Grammar B Choose the correct answer. 1 I’ll still ….. two hours from now. A have gardened C garden B have gardening D be gardening 2 ….. you ….. your homework by 7 o’clock? A Will ... finish C Will … have finished B Will … be finishing D Won’t … finish 3 By 2100, experts ….. new energy sources. A will have discovered C will be discovering B will be discovered D will discover 4 The film will have started before we ….. there. A will have got C get B will get D will be getting 5 This time tomorrow, Sheila ….. a job interview. A will have C will be having B is having D will have had 6 David ..... back from work by dinner time. A will be coming C will have come B will come D won’t be coming 7 I can’t believe that in a few hours, we ….. our first live concert. A are performing C will have performed B will be performing D will perform 8 ….. next Friday, I will be flying to Glasgow. A This time C By B At D Until 9 Jake ….. by the end of September. A will retire C will have retired B is retiring D will be retiring 10 ….. the time Mum gets home, I will have tidied my room. A Before C Until B At D By Everyday English C Choose the correct answer. 1 A: How did you find that job? B: a I’ll be working in the local library. b I’ll be there from June 15th. c There was an advert online. 2 A: I can’t wait! B: a Sounds like fun. b I’ll work in my uncle’s restaurant. c I’ll stay there for two weeks. 3 A: Do you have any plans for the summer? B: a Really? b What about you? c Haven’t I told you? 4 A: What will your duties be? B: a I’ll be flying to London to see my uncle. b I’ll be helping customers. c I’ll have earned enough money to buy a new smartphone. 5 A: How long will you stay there? B: a Until the end of July. b Well, this time next week, I’ll be relaxing. c And what are your plans?

What day is today, Timmy? Is it Grandma’s birthday? No, it’s not. It’s Valentine’s Day. What do you do on Valentine’s Day? Valentine’s Day is for love. We give cards to our friends. Do you like Valentine’s Day? I like Valentine’s Day. Your Dad and I got married on Valentine's Day. Did Dad give you a card today? Yes, he gave me a card. It is shaped like a heart.

Tom: Hi, Mia! Do you like your local park? Mia: Yes, I do! It’s my favorite local place to play. Tom: Cool! How do you get to the station from your house? Mia: I walk to the bus station. It’s near my home. Tom: I like pizza the most. What food do you like the most? Mia: I like ice cream most of all! Tom: What kinds of things amuse you? Mia: Funny cartoons amuse me a lot. They always make me laugh! Tom: I expect it will be sunny tomorrow. What do you expect to do? Mia: I expect to go to the local market with my family. Tom: That sounds fun! I expect to visit my grandma near the train station. Mia: Let’s meet at the station next weekend! Tom: Yes! See you then!

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