A 54-year-old woman with a previously well-controlled seizure disorder was brought to the hospital because of recurrent, generalized tonic-clonic seizures. The patient was intubated and mechanically ventilated. She was treated with intravenous diazepam and fosphenytoin but continued to exhibit intermittent seizures and did not regain consciousness between them. A diagnosis of refractory status epilepticus was made. A large dose of which of the following drugs would be appropriate to add to the patient's therapy at this time?

Correct Answer: C

Rationale: The correct answer is C: Valproic acid. Valproic acid is a broad-spectrum antiepileptic drug effective in treating refractory status epilepticus. It acts on multiple mechanisms, making it suitable for cases not responding to first-line treatments. Diazepam (A) is already being used, and adding more might not be effective. Ethosuximide (B) is indicated for absence seizures, not generalized tonic-clonic seizures. Carbamazepine (D) is ineffective in treating status epilepticus.

Correct Answer: B

Rationale: The correct answer is B: Lamotrigine. Lamotrigine is commonly prescribed for epilepsy, which can present with symptoms like jaundice. As a 12-year-old girl with extensive jaundice, the most likely underlying condition is epilepsy, making lamotrigine the appropriate choice. Gabapentin (A) is not typically used for jaundice or epilepsy in children. Phenobarbital (C) is an older antiepileptic drug with more side effects than lamotrigine, making it less likely for a pediatric patient. Diazepam (D) is a benzodiazepine used for anxiety and seizures but is not the first-line treatment for epilepsy in children.

Correct Answer: D

Rationale: Step 1: Identify the patient has poorly controlled simple partial seizures. Step 2: Valproic acid is partially effective. Step 3: Consider alternative options for drug-resistant partial seizures. Step 4: Perampanel is an FDA-approved treatment for partial-onset seizures in patients aged 12 and older. Step 5: Perampanel works by blocking glutamate receptors, reducing neuronal excitability. Therefore, it is the most appropriate choice for this patient. Other choices are not specifically indicated for partial seizures or have different mechanisms of action.

Correct Answer: B

Rationale: Correct Answer: B (Carbidopa) Rationale: 1. Carbidopa is a dopa decarboxylase inhibitor commonly used with levodopa to treat Parkinson's disease. 2. Haloperidol, an antipsychotic, can worsen Parkinson's symptoms like cogwheel rigidity. 3. Combining haloperidol with carbidopa can lead to a drug interaction and exacerbate Parkinson's symptoms. 4. Amantadine, pramipexole, and benztropine are commonly used to manage Parkinson's symptoms and would not be contraindicated. Summary: A: Amantadine - Not contraindicated, can be used to manage Parkinson's symptoms. C: Pramipexole - Not contraindicated, can be used to manage Parkinson's symptoms. D: Benztropine - Not contraindicated, can be used to manage Parkinson's symptoms.

Correct Answer: C

Rationale: Step-by-step rationale for why choice C, Mesolimbic pathway, is correct: 1. The mesolimbic pathway is involved in the reward and pleasure system. 2. Dysfunction in this pathway can lead to psychotic symptoms like hallucinations. 3. Antipsychotic medications target this pathway to reduce psychotic symptoms. 4. The patient's symptoms of hearing voices suggest dysfunction in the mesolimbic pathway. Summary of why other choices are incorrect: A. Frontal cortex: Primarily involved in executive functions, not directly related to psychotic symptoms like hallucinations. B. Vestibular nuclei: Responsible for balance and spatial orientation, not related to psychotic symptoms. D. Striatum: Involved in motor control and procedural learning, not directly linked to hallucinations or psychotic symptoms.