February 2022

Question 1

1
You work as a general practitioner. A mother comes with her 2-year-old son. He is previously healthy
and has shown a completely normal psychomotor development. Three months ago, he had an attack
of generalized seizures lasting 4 minutes during high fever. He was admitted to the hospital, and they
were explained it was febrile seizures and “nothing to worry about”. Yesterday he again had an attack
of generalized seizures, this time lasting 2 minutes. Also, this time he had high fever, but recovered
well after the seizures and the parents didn’t seek medical attention. However, his mother is worried
her son have epilepsy, and needs medications.
What is the best advice and management in this case?
A Refer the child to the Pediatric outpatient clinic for an EEG examination, as he probably has
epilepsy triggered by fever
B Reassure the mother that no investigations are necessary, but start with levetiracetam to prevent
further seizure attacks
C Reassure the mother that he has had febrile seizure attacks, and that no further investigations are
necessary at this point
D Refer the child to the Pediatric department for an EEG and MRI as he has epilepsy and it is
indicated with further investigations

Answer 1

C
Reassure the mother that he has had febrile seizure attacks, no further investigations necessary
as he is otherwise healthy and shows normal development. It is not indicated to start any daily
treatment/antiepileptic drug as Levetiracetam (they should have Diazepam or Midazolam at
home) and not indicated to do an EEG or MRI. Learning outcome: K4

Question 2

2
A 31-year-old woman recently had an abnormal pap-smear (High grade squamous intraepithelial
lesion-HSIL) and a positive human papillomavirus (HPV)-test for other HPV-types than HPV 16 or 18.
She asks if you would recommend her to take the HPV-vaccine.
Would you recommend a 31-year-old woman with HSIL and an ongoing HPV-infection to take the
HPV-vaccine?
A Yes. HPV-vaccine can reduce the risk of recurrence after treatment of HSIL.
B No. HPV-vaccines are only recommended for men and women 9-26 years of age.
C No. HPV-vaccines are prophylactic and have no indication in women who are infected with HPV.
D Yes. HPV-vaccine is an alternative to surgery in women with low-grade dysplasia.

Answer 2

A
The human papillomavirus (HPV) vaccine plays an important role in preventing a series of
diseases caused by HPV. Studies with women up to 45 years of age shows good prophylactic
effect of HPV-vaccination. After treatment of HSIL/high-grade dysplasia about 10% will have
recurrence of HSIL and need more treatment. Studies shows 50-80% reduced risk of recurrence
of HSIL after treatment in women who have received the HPV-vaccine. HPV-vaccination also
reduce the risk of new infections and re-infection from partner.