Test on family for Matas, form 5

Create multiple choice questions using the following information: In November, Mrs. Baker has Holling read The Tempest. Despite his preconceptions, Holling is captivated by all the "good stuff" in the play, especially the cussing, which he decides to learn by heart. He figures that Mrs. Baker could not have read the play herself; if she had, she certainly would not have let him have it. Holling is amazed when he discovers that his teacher not only has read the play, but she knows the bad parts as well. Mrs. Baker gives Holling a one-hundred-and-fifty question test on The Tempest, and assigns him to read the play again, telling him "there is a lot more to (it) than a list of colorful curses." The deadline set by Holling's classmates for him to bring them cream puffs arrives, but although Holling's father's company has won the Baker's Sporting Emporium contract, he refuses to extend an advance on his son's allowance. Desperate, Holling goes to Goldman's Best Bakery, offering to work for the money he lacks to buy the cream puffs. Coincidentally, Mr. Goldman, who is active in Long Island's Shakespeare Company, needs a boy to perform in their upcoming Extravaganza, and because of his work with Mrs. Baker, Holling fits the bill. Mr. Goldman gives Holling the required number of cream puffs in exchange, but sadly, while the students are at recess, Caliban and Sycorax, the escaped rats who inhabit the classroom walls and ceiling, come out and decimate the treats. Somehow, the disaster is blamed on Holling; he must clean up the mess, and his classmates decree that he still owes them cream puffs. The next Wednesday, Holling brings five cream puffs to school, which is all he can afford. In addition to facing his classmates' ire, he has to deal with the fact that, in the Shakespeare Company Holiday Extravaganza, he must play the part of Ariel, who is a fairy, and wear yellow tights with white feathers on an unmentionable part of his anatomy; "not a good thing for a boy from Camillo Junior High." To Holling's surprise, just when things are at their darkest, Mrs. Baker comes through for him, bringing cream puffs for the students on his behalf. That afternoon, Mrs. Baker and Holling discuss The Tempest, and whether or not Caliban, the "monster," deserves a happy ending. Holling argues that, as the antagonist, he does not, but Mrs. Baker muses whether Shakespeare might have shown, even in a monster, the capacity of humankind to use defeat to grow. Mrs. Bigio stumbles into the classroom at this point, emitting sounds of indescribable sadness; she has just learned that her husband has been killed in a futile reconnaissance mission in Vietnam. Two nights after his funeral, the Catholic Relief Agency, which houses Vietnamese refugees, including Holling's classmate Mai Thi, is the target of a hate crime. Holling reflects that Shakespeare, with his happy endings for nearly everyone in The Tempest, is wrong. He says, "sometimes, there isn't a Prospero to make everything fine...and...the quality of mercy is strained." In December, Camillo Junior High is awash in "signs of the season." Mrs. Baker, however, does not share the holiday spirit, but Holling is too absorbed with his problems with the Shakespeare Holiday Extravaganza to wonder why. As always, Holling seeks help from his family, but to no avail; his mother comments insipidly that his embarrassing costume is cute, his father tells him to wear it to please Mr. Goldman, who might one day need an architect, and his sister warns him that if news of his role gets to the high school, no one better find out they are related. The only thing that prevents December from being a total disaster is Mrs. Baker's announcement that Mickey Mantle will be signing autographs at the Baker Sporting Emporium. Unfortunately, Mrs. Baker also tells the class about Holling and the Shakespeare Extravaganza, and encourages the students to attend both events. Holling's classmates are intensely curious about his role as Ariel, whom he euphemistically describes as "a warrior." Mr. Goldman tells Mrs. Baker that Holling needs "some practice on interpretation", and she practices with him, playing the part of Prospero. Mrs. Baker is a terrific reader, and when she and Holling rehearse the part where Prospero releases Ariel from bondage, Holling is inspired, realizing what it means to be free "to create his own happy ending." On the night of the performance, Mrs. Baker, Mrs. Bigio, Danny Hupfer and his parents, Meryl Lee, and Mai Thi are in the audience to support Holling, unlike his own parents, who do not want to miss the Bing Crosby Christmas Special on television. Holling executes his part with such passion that his classmates are moved to tears, and do not even notice what he is wearing. When the show is over, Holling, finding the dressing room locked, rushes outside, still in costume, where his father is supposed to be waiting to take him to Baker's Sporting Emporium to see Mickey Mantle. Typically, his father is not there, and Holling, frantic, flags down a bus and begs the driver to take him to the Emporium. The driver takes pity on him and complies, getting him to the Emporium just in time, but when Holling approaches Mickey Mantle for an autograph, the famous player looks derisively at his costume and snaps rudely, "I don't sign baseballs for kids in yellow tights." Danny Hupfer witnesses this snub, and loyally returns his own autographed baseball to Mickey Mantle, saying, "I guess I don't need this after all." Holling and Danny leave together in silence, smarting because "when gods die, they die hard." During the days remaining until holiday break, Mrs. Bigio is especially cantankerous; her cafeteria cooking is unappetizing at best, and her comments to the students are impatient and unkind. Holling, remembering Mrs. Bigio's sadness when she received the news of her husband's death, does not complain, but he is bewildered at the sheer desolation he witnesses when Mrs. Bigio bitterly tells Mai Thi that she "shouldn't even be here...a queen in a refugee home while American boys are sitting in swamps on Christmas Day." After school on the last day before break, Mrs. Baker gives Holling, Danny Hupfer, and Doug Swieteck each a new baseball and mitt, and sends them to the gym, where, to their delight, they meet Joe Pepitone and Horace Clark in their Yankee uniforms, and receive tickets to Opening Day at the Stadium. Mrs. Baker's family knows what happened with Mickey Mantle, and wants to make it up to the boys. The next day, President Johnson declares a Christmas ceasefire in Vietnam, and the holiday season begins in earnest.

Seder, beytza, kiddush, karpas, matzot, maror, zeroah, Exodus, haroset, haggadah, Symbolic Explanations: haroset - the reminder of spring karpas - the mortar the slaves used to build structures salt water - sacrifice of the Passover lamb maror - the bitterness of slavery zeroah - the tears shed over the years of slavery Complete the Sentences: Instead of sitting at the table to dine as we do today, Jesus and his disciples would recline while eating, identifying them as free men, not slaves. As the Seder Meal begins, the “mother” of the family blesses the kiddush, just as the altar server does before Mass actually begins. Similarities Between Seder and Mass: a) Both involve specific prayers and rituals. b) Both commemorate historical events. c) Both have symbolic foods and elements. Special Numbers and Remembrance: Four is a special number throughout the seder. There are 4 cups of wine and 4 questions. Elijah is remembered in two ways during the seder: by opening the door for him and having a special cup of wine for him. Purpose of Celebrating Seder: Jewish people celebrate a seder each year at Passover to remember and retell the story of the Israelites' liberation from slavery in Egypt. Learning about the Seder: We, as Catholics, learn about the seder to understand the connections between the Passover meal and the Last Supper. Personal Reflection: One thing I learned from this unit that was not asked on this test is the significance of the various symbolic foods in the Seder Meal and their meanings. Similarities between Passover and Easter Celebrations: Both Passover and Easter celebrate important religious events, focus on themes of renewal and rebirth, and involve special meals with symbolic foods. Differences between Passover and Easter Celebrations: Passover is a Jewish holiday commemorating the Exodus from Egypt, while Easter is a Christian holiday celebrating the resurrection of Jesus Christ. Passover is based on the Jewish lunar calendar, while Easter is based on the Gregorian calendar. The rituals and practices associated with each holiday also differ significantly.

Create me a multiple choice type of test with 4 options on this topic for college level: SEXUAL ORIENTATION • According to the Psychological Association of the Philippines, typically at ages 6 or 8, we experience or develop attraction to other people. By adolescence, we really know who we are attracted to and would experiment through dating and relationships. Everyone’s sexuality is different and deeply personal. Our capacity for emotional and sexual attraction is diverse and complex. FOUR CATEGORIES OF SEXUAL ORIENTATION 1. HETEROSEXUALITY • The attraction to individuals of the opposite sex. 2. HOMOSEXUALITY • The attraction between people who are the same sex. 3. BISEXUALITY • The attraction to individuals of either sex. 4. ASEXUALITY • A term used to describe someone who does not experience sexual attraction toward individuals of any gender. GENDER • Gender refers to the characteristics of women, men, girls and boys that are socially constructed. This includes norms, behaviors and roles associated with being a woman, man, girl or boy, as well as relationships with each other. As a social construct, gender varies from society to society and can change over time. • There are many ways through which gender is manifested. As soon as a new baby arrives in the family, adults surrounding the baby manifests their social interpretation of the baby’s sex by the color assigned to the baby. Example: common for the families to buy blue apparels and toys when the baby is a male, as blue is associated with boyhood. • Conversely, female babies are often assigned to color pink, would buy toys and clothes that are color pink which is associated to a girlhood. Remarkably, the moment a baby is born, the name, toys, and apparels are picked by parents and relatives based on their interpretation of the baby’s sex. • Throughout childhood and adolescence, this assignment becomes more complex as the expectations go beyond the kind of clothes worn, but also in terms of how the person must or must not behave.

Create me a multiple choice test questions with 4 options on the following topic:Consumer Education for Different Audience 1. Children and Youth: - Focus: Building foundational knowledge about basic consumer concepts, making safe choices, understanding money and value, and recognizing scams and unsafe situations. 2. Teens and Young Adults: - Focus: Building financial literacy, responsible debt management, understanding contracts and agreements, responsible technology use, online safety, and consumer rights. 3. Working Adults and Families: - Focus: Managing budgets, making informed purchasing decisions, understanding credit and debt, finding consumer protection resources, and navigating complex financial products (mortgages, insurance, investments). 4. Seniors: - Focus: Protecting themselves from scams and fraud, understanding common consumer issues like telemarketing, identity theft, and online scams, managing medications and healthcare costs, and accessing community resources. 5. Special Populations: - Focus: Adapting consumer education programs to the specific needs of people with disabilities, immigrants, refugees, and other marginalized communities. 6. Business and Industry:- Focus: Understanding ethical marketing practices, complying with consumer protection laws, and providing clear and accurate information to consumers. 7. Policymakers and Regulators: - Focus: Understanding consumer needs, developing effective consumer protection laws, enforcing regulations, and ensuring a fair and competitive marketplace. Adapting consumer education programs for children, teens, and seniors requires tailoring content and delivery methods to their unique needs and learning styles. Children (Ages 5-12): - Understanding the concept of money: Teaching children about saving, spending, and the value of money. - Developing basic budgeting skills: Helping children learn to make choices about how to spend their allowance or pocket money. EFFECTIVE STRATEGIES •Focus on basic concepts: Introduce core concepts like saving, spending, and budgeting in a fun and engaging way. Use simple language and relatable examples. •Real-life scenarios: Use age-appropriate scenarios to illustrate financial concepts, like buying toys or snacks. •Parental involvement: Encourage parent participation and provide resources to help them reinforce lessons at home. Teens (Ages 13-18): - Building budgeting and financial planning skills: Teaching teens how to manage their money, set financial goals, and plan for the future. - Navigating the digital marketplace: Equipping teens with the knowledge and skills to make safe and informed online purchases, understand digital marketing, and protect themselves from scams. EFFECTIVE STRATEGIES • Practical skills: Focus on skills relevant to teens, like managing money for social activities, saving for college, and understanding credit cards. • Digital literacy: Address the growing influence of online shopping, social media advertising, and financial scams. • Real-world applications: Connect financial concepts to real-life decisions teens make, like choosing a part-time job or making purchases online. Seniors (Ages 65+) - Managing retirement savings and healthcare costs: Providing information and resources on retirement planning, Medicare and Medicaid, and other healthcare options. - Navigating the digital world: Offering technology training and resources to help seniors access online services and information safely and securely. EFFECTIVE STRATEGIES • Addressing specific concerns: Focus on topics relevant to senior citizens, like retirement planning, managing healthcare expenses, and avoiding scams. • Clear and concise communication: Use simple language and visual aids to ensure easy understanding. • Social interaction: Create opportunities for seniors to share experiences and learn from each other. Teaching Financial Literacy in school and Communities In Schools: Curriculum Integration: Financial literacy concepts can be seamlessly integrated into existing subjects, making learning more relevant and engaging. - Math: Budgeting exercises, calculating interest rates, analyzing financial data, and understanding compound interest are all natural applications of math skills. - Social Studies: Exploring the history of money, financial institutions, economic systems, and the impact of financial decisions on society provide valuable context. - Economics: Discussions about supply and demand, inflation, investment, and the role of consumers in the economy enhance financial literacy. Dedicated Courses: Offering elective courses or workshops specifically focused on personal finance provides deeper dives into crucial topics. - Personal Finance: Cover budgeting, saving, investing, credit, debt management, and insurance. - Entrepreneurship: Introduce concepts like business planning, marketing, financial forecasting, and managing cash flow. In Communities: Community Centers and Libraries: Workshops, seminars, and classes tailored to adults and families provide accessible learning opportunities. - Financial Planning: Cover budgeting, retirement planning, debt management, and estate planning. - Homeownership: Provide guidance on buying, selling, and maintaining a home. - Consumer Protection: Educate individuals about their rights and how to avoid scams. Partnerships with Financial Institutions: Collaborations with banks, credit unions, and financial advisors offer valuable resources, workshops, and financial literacy programs. Consumer Education for Low-Income and Vulnerable Populations Low-income refers to individuals or households with limited financial resources, typically below a certain threshold. Low-income individuals may face challenges like: 1. Limited education and job opportunities 2. Poor living conditions and housing 3. Food insecurity and malnutrition Causes of low income: 1. Unemployment or underemployment 2. Low-paying jobs or minimum wage 3. Limited education or skills 4. Single parenthood or large family size Vulnerable population'' is a term that is used to describe a group of people who possess some sort of disadvantage. elderly people, people with low incomes, homeless people, people in prison, migrant workers, pregnant women, Family Consumer Education: Managing Household Finances and Resources Financial literacy is the ability to understand and manage personal finances effectively. 1. Debt Debt is money you spend that isn’t yours. If you borrow money from the bank, use a credit card, or take out a short-term loan, or a payday loan, you are accumulating debt. Good debt is considered money borrowed for things that are absolutely necessary for making a life e.g. a house and for advancing your money-making potential e.g. an education. Bad debt is considered borrowing money or using a credit card to pay for things you don’t need, such as expensive clothes, hi-tech electronics, eating out at restaurants, going on holidays, etc. 2. Saving Saving is an essential part of financial wellness, a secure present, and a happy future. 3. Budgeting Budgeting is the life skill of planning and managing your money. By understanding exactly where your money goes every month, you are empowered to create an actionable plan by which you can spend less, by curtailing those unnecessary expenses and saving more for the things you need and want. 4. Investing Investing is all about creating and growing the wealth you need to enjoy a financially secure and happy future. It’s about putting your money into something that will make you a profit over time, such as property, retirement funds, and unit trusts Integrating Consumer Education into the Home Economics Curriculum. Integrating consumer education into the home economics curriculum can provide students with essential skills for making informed choices about their personal finances, food, clothing, and overall well-being. Here are some strategies and ideas for effectively incorporating consumer education: Financial Literacy Budgeting: Teach students how to create and manage a personal budget, including setting financial goals, tracking expenses, and understanding savings. Saving and Investment: Cover the basics of saving, including different saving accounts, and introduce concepts related to investing. Food and Nutrition Food Label Literacy: Engage students in learning how to read and interpret food labels, including nutrition facts and ingredient lists. Grocery Shopping Skills: Teach students how to compare product costs, understand unit pricing, and make healthy, budget-friendly choices while shopping. Clothing and Textile Education Consumer Choices in Clothing:Discuss factors influencing clothing purchases, such as quality, price, and sustainability. Fashion and Trends: Analyze the impact of marketing and advertising on consumer behavior regarding clothing. Sustainable Purchasing Eco-Friendly Choices: Raise awareness about environmentally friendly products and the importance of sustainability in consumer choices. Project-Based Learning - Assign real-life projects where students must apply their knowledge, such as creating a meal plan within a budget, planning a shopping list based on nutrient needs, or evaluating the cost-effectiveness of different products. Technology Integration - Use technology to teach students about online shopping, price comparison websites, and apps that aid budgeting and financial planning. Collaborative Learning Opportunities - Organize team projects where students work together to solve consumer-related problems, emphasizing teamwork and communication skills. Assessment and Reflection - Incorporate assessments that allow students to reflect on what they have learned about consumer education and how they can apply these skills in their daily lives.

Short Story: Making Good Choices Last month, I made an important decision. I asked my parents if I could get some **pocket money**. I wanted to learn how to make **independent choices** and use the money **to buy for myself**. They agreed to give me some on a **weekly basis**. I was very happy! One day, at school, we had a **final** exam. I was very **worried**. I tried to **concentrate**, but I **can hardly** sit still when I'm nervous. My best friend, Jake, is always **fun loving**, and he didn’t **stay for long** in the classroom after the test started. He wanted to **pass notes**, but I said no. I didn’t want to **get caught**. The teacher said, “**Turn over** your papers now.” I looked at the test and felt **scared**. “What if I **lose** all my marks?” I thought. “I will look **stupid**.” I tried to **look straight into my eyes** in the small mirror on my pencil case and said, “You can do this.” Then, I started to **find** some answers and felt a little better. After school, we walked on the **sidewalk** and saw a big **crowd** of students talking about the test. Jake laughed and said, “Let’s buy some ice cream with your **pocket money**!” But I said no. “I want to save it **to buy for myself** something special.” When I got home, I helped my mom **wash up** the dishes. She smiled and said, “You made good choices today.” That night, I dreamed I was a **slave** in a boring office, working all day. But when I woke up, I laughed. I wasn’t a **slave**. I was just a kid learning to make smart choices. I **decided** to study more and use my **pocket money** wisely. I wanted to be **independent**, make good choices, and maybe be the **first** in my family to buy something big with saved money.

Match the word to its synonym level B1 CEFR. Use the vocabulary exactly adverb precisely except that aside from exist verb to be real existing adjective real, current Example: Flying cars are not practical with existing technology. existence noun reality Example: The existence of black holes has been confirmed by indirect observation. extraordinary adjective unusual feature noun important part of something Example: The Ramon Crater is a unique feature of the Negev Desert. feedback noun reaction figure noun shape Example: I can’t tell if that figure in the shadows is a man or a woman. figure out verb understand Example: I just can’t figure out how the magician did that amazing trick. financial adjective related to money Example: Her family is having financial problems so they can’t travel overseas this year. finance verb pay for Example: If I can’t get a loan from the bank, I won’t be able to finance a new apartment. finance noun money Example: An expert in finance predicts a global recession. finding/findings noun discoveries; results of a study Example: According to the findings of the police investigation, this is the gun which fired the fatal bullet. flexibility noun willingness to change flexible adjective adjusts easily Example: I’d prefer to meet on Monday morning but I can be flexible depending upon your schedule. flood noun a lot of water flood verb to cover with too much water flu noun type of sickness focus on/upon verb pay attention to Example: You should focus on your schoolwork if you want to improve your grades. focus noun attention People with attention deficit disorder lose focus easily. frequency noun how often frequent adjective very often Example: Hanah is a frequent customer and everyone at the store knows her. fresh adjective new Example: We need some fresh ideas if we’re going to solve this problem. frighten verb scare from preposition position, starting point gain verb make an increase, profit, earn Example: I have nothing to gain by choosing sides so I shall remain neutral. gain noun profit, amount earned generate verb create, make Example: Chat GPT can generate text written in any style you choose. guidance noun help, advice hopeful adjective optimistic, having a positive outlook Example: The farmers are hopeful that we will have rain this winter. hopefully adjective with luck ideal adjective best, most preferable Example: Nuclear power may not be an ideal solution to global warming, but it’s certainly worth considering. illness noun sickness, disease illustrate verb draw pictures illustration noun picture, image Example: Children’s storybooks have colorful illustrations. image noun picture, especially on film or television Example: The mother of the pop singer cried when she first saw her daughter’s image on television. in preposition within, inside, into in terms of regarding Example: That company makes a great product but they’re lacking in terms of customer service. in actual fact in truth Example: The mayor says the city is a safe place to live, but in actual fact the violent crime rate is very high. in connection with about Example: Police arrested four men in connection with the robbery. in that case if that is true Example: Billy Bob: “Traffic could be heavy tomorrow.” Peggy Sue: “In that case, we better leave early.” in the meantime while, during Example: The new computers won’t arrive until next week, but we can keep using the old ones in the meantime. initial adjective first Example: Her initial reaction to that song was negative, but over time she’s come to like it. initially adverb at first instruction noun teaching, order Example: Most new electronic devices come with a set of instructions. intelligence noun smartness Example: Since you have a degree from a good university, I assume you have sufficient intelligence to understand this problem. intelligent adjective smart Example: Joe isn’t very intelligent, but he is a kind person with a warm heart. interest noun attraction Example: Yossi has little interest in politics, whereas his wife goes to all the protests and demonstrations. interest verb to attract Example: Sports don’t really interest me, but my brother is a big basketball fan. introduce verb to show something new Example: Today in class I will introduce the basic concepts of literary analysis. invest verb to put money into something in order to earn money Example: Joe invested in cryptocurrency and lost a lot of money. investor noun one who puts money into something in order to earn money Example: Venture capitalists are investors who put money into risky start-up businesses. investment noun putting money into something in order to earn money Example: Buying real estate in Israel is a very safe investment because the value never goes down. investigate verb research, study Example: The police collected evidence to investigate the murder. investigation noun study Example: The police don’t have a suspect for the murder as the investigation isn’t finished yet. investigator noun detective Example: Detective Schmendrick is the lead investigator for the murder case. just about almost Example: I’m just about done here so I’ll be there shortly. keep on doing verb continue Example: You’re crazy if you keep on doing the same thing and expect different results. kind of type of Example: What kind of dog is that, a poodle? knowledge noun awareness Example: John failed the test due to lack of knowledge of the material. lack verb not having, missing Example: John failed the test due to lack of knowledge of the material. landscape noun the view of the land likely adjective, adverb probably Example: When we learn from our mistakes, we’re not likely to forget. limited adjective restricted Example: We should go to the store today because the sale is for a limited time only. limitation noun restriction little adjective small, not a lot Example: She always tells the truth. I have little reason to doubt her. look at verb see Example: People used to read newspapers on the train. Nowadays they just look at their phones. low adverb to a small amount or level Example: I have to charge my phone because the battery is running low. material noun documents, information Example: We have a lot of material to cover before the end of the semester. meaning noun significance mean verb to have significance or purpose means noun form of, by the use of Example: They communicate by means of radio. measure noun step Example: The teacher took measures to prevent cheating during the test mention verb to say, point out Example: The coach said the team played very well today but didn’t mention any player specifically. miss verb (1) fail to catch (2) wishing to see somebody Examples: (1) The football player kicked the ball but missed the goal. (2) Wow, it’s good to see you! I’ve missed you so much! misunderstand verb understand incorrectly Example: I’m afraid I misunderstood the instructions. Could you repeat them please? more or less approximately, somewhat, to a varying degree Example: This is more or less a religious neighborhood, though there are a few secular families. must modal verb have to naturally adverb as expected, normally nature noun (1) open air (2) character Examples: (1) We like to go hiking in nature reserves. (2) Pit bulls are aggressive by nature.

[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.

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