American Board of Internal Medicine (ABIM) Certification Practice Exam

What diagnostic method is used to detect nonconvulsive seizures in patients with altered mental status?

1. CT scan

2. MRI

3. Continuous electroencephalographic monitoring

4. Blood tests

The correct answer is: Continuous electroencephalographic monitoring

Continuous electroencephalographic monitoring is the most effective diagnostic method for detecting nonconvulsive seizures in patients with altered mental status. This technique involves the continuous recording of electrical activity in the brain, which allows for the identification of subtle seizure activity that may not manifest with typical clinical signs. In cases where a patient presents with altered mental status, the underlying cause can range from metabolic disturbances to structural brain abnormalities. Traditional imaging techniques like CT scans and MRIs are crucial for diagnosing many neurological conditions but can miss nonconvulsive seizures, as these seizures do not produce obvious anatomical changes in brain structure. Blood tests may be helpful for identifying metabolic causes of altered mental status but are not specific for diagnosing seizure activity. Therefore, continuous EEG monitoring stands out as it can reveal electrical patterns associated with seizures, leading to appropriate treatment and management of the condition. This makes it invaluable in making a diagnosis in complex clinical scenarios where the patient’s presentation may not clearly indicate active seizures.