Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency Medicine > Pediatric Seizures > Flashcards

Pediatric Seizures Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

Are seizures common or uncommon in children?

A

Common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What percentage of children will have a sz prior to 16 y/o?

A

4-6%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common (~50%) cause of first time sz in children?

A

Fever (febrile sz)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the 2nd most common (~35%) cause of first time seizure in children?

A

Idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

(Generalized/Partial) sz involve (the entire brain/one hemisphere of the brain)? (answer both)

A

Gen: entire
Partial: one hemisphere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Is a tonic-clonic sz a generalized or partial sz?

A

generalized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Is an absence sz generalized or partial?

A

generalized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is a simple sz generalized or partial?

A

partial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is an atonic sz generalized or partial?

A

generalized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Is a myoclonic sz generalized or partial?

A

generalized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why do you want to position a pt on their side if they are having a sz?

A

To avoid aspiration of drool or vomit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are medication options for patients having a sz lasting >3 min?

A

Lorazepam IV or IM, Diazepam IV or PR, Midazolam IV IM or intranasal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

After assessing the ABCs on a pt having a sz, what 5 things should you do/check?

A

Place O2, measure O2 Sat, Monitor CV, obtain IV access, measure a bedside glucose (Accucheck)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

From what three time periods do you want to obtain a history on a pt who has had a sz?

A

Pre sz, sz itself, post-sz (post ictal time)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In what direction do eyes tend to deviate during a tonic clonic sz?

A

upwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Can abx be a precipitating cause of sz? Other medications?

A

Yes and yes–always ask about recent abx, adult Rx/toxic ingestions i.e. ethylene glycol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some factors that may predispose a child to sz?

A

Hx of hydrocephalus, hardware in the brain, prior meningitis, head trauma, immunosuppressed predisposition to CNS infection, hypercoagulable states i.e. Sickle cell dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why should formula mix not be diluted?

A

This can lead to very low sodium levels which can precipitate a sz in a young child

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When taking the temperature on a child following a sz, where is the best location?

A

Rectal temp is best

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some signs of increased ICP in a young child?

A

bulging fontanelles, papilledema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What condition may predispose children to sz and presents with skin lesions like Ashleaf spots, shagreen patch, and café au lait?

A

Tuberous sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

A febrile sz is a seizure associated with a fever ___ F (most have temp ___ F) in children ___ y/o

A

> 100.4 F; >102 F; <6 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Can a child w/ temp of 101.5F be diagnosed with febrile sz if they have a history of prior afebrile seizures?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

T/F A child w/ a temperature of 101F can be diagnosed with febrile sz when they have an acute metabolic abnormality

A

false, they cannot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

If a patient has a temp of 102F and has no meningeal signs and no signs of CNS infection, can they be dx’d with a febrile sz?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the typical age range of children diagnosed with febrile sz?

A

6 mo-6 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

During what age range is there a peak of febrile sz dx?

A

12-18 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

On what day of illness does a febrile sz usually occur?

A

The first day (Day 1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

T/F Febrile sz can only occur with viral infections

A

F, they can occur with bacterial and viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which two viruses are the culprit of a majority of febrile sz?

A

HHV-6, influenza

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

After what vaccinations are children at an increased risk of having a febrile sz?

A

DTP and MMR (up to 14 days following vaccination!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Are febrile sz familial?

A

Yes, 10-20% of parents/siblings also have febrile sz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Simple febrile seizures last ____ (usually ____), they are (Partial/Generalized), (with/without) focal features, and (do/do not) recur within 24 hrs.

A

<15 min; 2-3 min; generaliZed; without, do not

34
Q

Complex febrile seizures last ____, (with/without) focal features, and (do/do not) recur within 24 hrs.

A

> 15min; with; do

35
Q

What is Todd’s paralysis?

A

postictal paralysis

36
Q

When evaluating a patient following their first simple febrile sz, what labs or imaging are NOT necessary?

A

Labs, EEG, and Neuroimaging are not necessary nor beneficial. If anything, assess for cause of fever (i.e. UTI = UA, cough w/ fever = CXR, etc)

37
Q

If the patient is back to baseline and neurologically intact, should you perform an LP?

A

No need

38
Q

In a pt with febrile sz, who is < 12 months, should an LP be considered?

A

Yes, Strongly considered!

39
Q

In a pt with febrile sz, who is 12-18 months, should an LP be considered?

A

Yes, considered

40
Q

In a pt with febrile sz, who has prior abx tx, should an LP be considered?

A

Yes, strongly considered

41
Q

Why are S. pneumoniae and H. Influenza less likely causes of bacterial meningitis these days?

A

People have been vaccinated now

42
Q

Does meningitis manifest with sz other than a febrile sz, or can it manifest as a febrile sz alone?

A

According to the retrospective study by Green et al
no pts had meningitis manifesting solely as a simple febrile seizure
Those that had bacterial meningitis presented with prolonged focal seizure, multiple seizures, generalized petechia, and nuchal rigidity

43
Q

What is the utility of LP for simple febrile szs in children 6-18 months who have received appropriate immunizations and have not been pre tx’d with abx?

A

Not very useful as the percentage of children in this age group with ABM is extremely low and in several studies none of the CSF cx grew a bacterial pathogen

44
Q

What are some features of a child that increase the risk of acute bacterial meningitis?

A

Illness > 3 days; first rapid rise in temperature
Physician visit within last 48 hrs
Current antibiotics for extracranial infection
Immunocompromised
Unvaccinated child
Multiple seizures/back-to-back sz
Prolonged post-ictal phase

45
Q

What would some PE findings be that would be concerning for ABM?

A 
Focal neurological deficits
Altered motor tone
Nuchal rigidity
Poor perfusion
Generalized petechiae
46
Q

What is the incidence of acute bacterial meningitis in children with SE and fever? Would LP be indicated?

A

~ 12%; Yes–once sz stops, ABCs have been assessed, and pt is stable

47
Q

What percentage of pts will experience recurrent febrile seizure? What are some factors that increase recurrence risk?

A 
33%
Young age onset (< 1 year)
FHx of febrile sz
Baseline developmental delay
Complex febrile sz
48
Q

What percentage of pts will develop epilepsy after having a first time febrile sz?

A

2%

49
Q

T/F Reduction in temperature w/ acetaminophen or ibuprofen reduces the risk of subsequent febrile seizures?

A

False

50
Q

T/F Neither continuous or intermittent anticonvulsant therapy is recommended for children w/ simple febrile szs

A

True; can use rectal diazepam prn

51
Q

While a pt is having a sz, should the caregiver or individual present, place something in the pts mouth to prevent them from biting their tongue?

A

NO, do not do this, pt can choke

52
Q

T/F Chin lift and jaw thrust are important components of maintaining a pts airway during a sz

A

T

53
Q

While most pts who have had a first time febrile sz can be discharged home, what are some indications for admission of these pts?

A

Prolonged postictal phase
Complex febrile seizure
Age < 6 months
Social concerns (Inability of caretakers to provide appropriate observation, Prolonged distance to medical care)

54
Q

What is absence epilepsy?

A

Absent staring with/without eyelid flutter

55
Q

In pts w/ Juvenile myoclonic epilepsy, when are myoclonic jerks greater in incidence?

A

the morning

56
Q

When is the onset of Juvenile Myoclonic Epilepsy? (general)

A

adolescence

57
Q

What is a precipitating factor of Juvenile Myoclonic Epilepsy? (provide example)

A

Precipitated by stressors (lack of sleep etc)

58
Q

What types of sz might a pt with Juvenile Myoclonic Epilepsy experience?

A

May have tonic-clonic and absence seizures as well

59
Q

In a pt with Benign Epilepsy of Childhood with Centrotemporal Spikes (BECTS/Rolandic), what are some signs/sx they may present with?

A

Somatosensory changes (numbness/tingling), speech arrest, facial twitching, drooling

60
Q

In a pt with Benign Epilepsy of Childhood with Centrotemporal Spikes (BECTS/Rolandic), will the pt have this condition for life?

A

A lot of children will outgrow these szs

61
Q

What medications are recommended for tx of Benign Epilepsy of Childhood with Centrotemporal Spikes (BECTS/Rolandic)?

A

Neurologists will often not recommend medications etc for tx

However: Can use same AEDs used to treat partial seizures, and they are often responsive to carbamazepine

62
Q

In a pt with Benign Epilepsy of Childhood with Centrotemporal Spikes (BECTS/Rolandic), when might they experience sz? What type of sz will they have?

A

May have tonic clonic seizures at night, often during sleep

63
Q

What are infantile spasms? Are they more or less concerning than other sz types?

A

Sudden flexion, extension or mixed movements of trunk and proximal muscles
More concerning and tx’d w/ greater urgency

64
Q

What is the typical age of onset for Lennox Gastaut Syndrome? What types of sz will these pts have?

A

3-5 years

Mixed sz types

65
Q

T/F Pts w/ Lennox Gastaut Syndrome can be expected to function at a normal cognitive level as other children their age

A

False, most children have severe developmental delay

66
Q

As part of the evaluation of epilepsy syndrome, providers (will/will not) need to order a(n) (urgent/non-urgent) EEG and MRI, with exception to what condition?

A

Will; non-urgent (outpatient); infantile spasms (Need urgent EEG, MRI, and metabolic evaluation with neurology consultation)

67
Q

Mortality with infantile spasms is as high as ___-___% and only ___-___% of children with infantile spasms have normal intelligence.

A

15-20%; 5-10%

68
Q

In pts with infantile spasms, there is a high association with what other medical condition?

A

Tuberous sclerosis

69
Q

In a pt with epilepsy syndrome who is experiencing absence sz, what are the pharmaceutical treatments of choice?

A

Ethosuximide, valproic acid, lamotrigine, levetiracetam

70
Q

In a pt with Juvenile Myoclonic Epilepsy, what are the pharmaceutical treatments of choice?

A

Valproic acid, topiramate, levetiracetam

71
Q

In a pt with Infantile Spasms, what are the pharmaceutical treatments of choice?

A

ACTH (Adrenocorticotropic hormone), steroids, zonisamide, topiramate, vitamin B-6

72
Q

In pts with seizures w/o epilepsy syndrome, lab evaluation should be based on individual clinical circumstances (H&P) and may include…

A

Electrolytes (glucose, Ca, Mg, Phos)
Ammonia, Lactic Acid (if metabolic syndrome suspected)
Drug Screen (possible toxin exposure)
LP + Antibiotics

73
Q

An emergent ___ should be ordered if the pt shows focal neuro signs, or signs of intracranial mass effect such as AMS, papilledema, bulging fontanelle. Otherwise, a ___ is generally not indicated in pts w/ sz w/o epilepsy syndrome.

A

CT

74
Q

A(n) ___ is superior to CT in detecting epileptogenic foci

A

MRI

75
Q

EEG helps determine ___, ___, and ___. An EEG (does not need to be/should be) performed after all first nonfebrile, unprovoked seizures.

A

sz type, presence of an epilepsy syndrome, risk for recurrence
Should be

76
Q

A majority of children w/ first unprovoked seizure (will/will not) have many recurrences

A

will not

only ~10% will go on to have many seizures

77
Q

Treatment with AED after a first seizure as opposed to after a second seizure (has/has not) been shown to improve prognosis for long-term seizure remission

A

Has not

78
Q

Do you or do you not admit patients with infantile spasms?

A

ALWAYS ADMIT

79
Q

What is the most common cause of neonatal sz?

A

Hypoxic Ischemic Encephalopathy

80
Q

What is the common first-line treatment of neonatal sz?

A

Phenobarbital

Emergency Medicine (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions