Seizures Flashcards
A 7-year-old girl has been noticed to have episodes of losing concentration and staring blankly. She suddenly stops what she is doing and then 5 – 10 seconds later resumes her previous activity and is back to normal. These episodes are occurring 10 or more times per day. Her teachers have commented that her school performance has deteriorated. Examination findings are normal. What is the MOST likely diagnosis for this girl’s events?
Question 1Select one:
a.
Myoclonic seizure
b.
Vasovagal episode
c.
Typical absence seizure
d.
Focal impaired awareness seizure
Typical absence seizure
An 18 month old girl is brought to ED by her mother. She had been to see the GP the previous day with a fever and a viral ear infection. Today she bumped heads with her older sister while playing. She went very pale, fell to the floor and was not breathing. She became stiff for a few seconds and then had a few irregular body jerks. After the jerks stopped she became floppy and was sleepy and not herself for 10 min.
She is now normal to examine. What is the most likely diagnosis?
Question 2Select one:
a.
Reflex anoxic seizure
b.
Simple febrile seizure
c.
Focal impaired awareness seizure
d.
Symptomatic epileptic seizure
Reflex anoxic seizure
Mark is a 4-year-old boy who has a 6-minute generalised tonic clonic seizure during a febrile illness. He has never had a seizure before. His father is on antiepileptic drugs for epilepsy which he has had since childhood. Mark has normal development and is neurologically normal on examination after the seizure. He is now playing happily on the observation unit. WHICH ONE of the following is THE BEST ADVICE to give Mark’s parents about the future risk of epilepsy?
Question 3Select one:
a.
A febrile convulsion itself decreases the risk of epilepsy
b.
A febrile seizure >5 minutes carries a 50% risk of epilepsy
c.
The family history of epilepsy increases the risk of epilepsy
d.
Mark needs an EEG in order to predict his risk of epilepsy
The family history of epilepsy increases the risk of epilepsy
A nine-month-old boy, Jason, is admitted having had two 20-minute generalized tonic-clonic seizures. For 24 hours prior to this he had been anorexic, irritable and feverish. Examination reveals a drowsy, sick looking child who dislikes being handled but has no neck stiffness. His temperature is 40°C, he has a heart rate of 140/minute and he has decreased capillary return. The only focus of infection you can find is a red throat. There is no rash.
What is your working diagnosis?
Question 4Select one:
a.
Potential intracranial infection with seizure
b.
Complex febrile seizure due to pharyngitis
c.
Simple febrile seizure due to pharyngitis
d.
Epilepsy presenting during febrile illness
Potential intracranial infection with seizure
A nine-month-old boy, Jason, is admitted having had a 20-minute generalized tonic-clonic seizure. For 24 hours prior to this he had been anorexic, irritable and feverish. Examination reveals a drowsy, sick looking child who dislikes being handled but has no neck stiffness. His temperature is 40°C and he has a pharyngitis but otherwise no focus for infection on examination. There is no rash. Which of the following is the MOST APPROPRIATE immediate investigation and management for Jason?
Question 5Select one:
a.
Urea, electrolytes, calcium, rectal diazepam, and IV penicillin
b.
Urgent EEG, intravenous phenobarbitone, and midazolam
c.
Sepsis screen including lumbar puncture, and IV ceftriaxone
d.
Tepid sponging, paracetamol and high dose oral penicillin
Sepsis screen including lumbar puncture, and IV ceftriaxone
A nine-month-old boy, Mitchell, is admitted having had 2 brief (1 minute) generalized tonic-clonic seizures within 12 hours associated with a fever . By the next day you are able to diagnose a febrile seizure with a viral illness. Mitchell’s past history reveals that he has been well up till now, but his development is mildly delayed. His father had epilepsy as an adolescent. From this history, what is the approximate likelihood that Mitchell either has or will develop epilepsy by 7 years of age?
Question 6Select one:
a.
90%
b.
0.5%
c.
10%
d.
1%
10%
A child of 9 months has a 20-minute left sided epileptic seizure. He had been irritable, drowsy and sick-looking and has feeding poorly for the previous 12 hours. You find he has a temperature of 39.5oC. He has no focal findings of infection and no meningism. WHICH ONE of the following investigations do you need to perform before you can establish that he has had a benign febrile seizure?
Question 7Select one:
a.
Electroencephalogram
b.
Bladder stab urine
c.
Lumbar puncture
d.
Full blood count
Lumbar puncture
A 15-month boy has had four episodes characterised by crying, holding his breath, looking blue followed by stiffening and falling to the ground. On one occasion he was unconscious and had a few jerks of both arms and legs. Each had been following a temper tantrum. Each lasted less than a minute and he was fully recovered within a few minutes. WHICH ONE of the following is the BEST MANAGEMENT for him at this point?
Question 8Select one:
a.
Make a diagnosis of breath-holding attacks and reassure family.
b.
Organise an outpatient EEG to guide anticonvulsant therapy
c.
Organise brain CT or MRI under general anaesthetic
d.
Commence anticonvulsants: no investigations necessary
Make a diagnosis of breath-holding attacks and reassure family
An 18 month old girl. Tracy, is admitted to hospital with her second febrile seizure – she had had a febrile seizure at 10 months of age. On this occasion the onset was of clonic jerking of her left arm and progressed to a bilateral clonic seizure lasting 5 minutes . Tracy’s father has had epilepsy since 8 years of age. Tracy’s mother had febrile seizures when she was a toddler. Tracy is not yet walking, and is able to say Mama and Dada but has no other words as yet.
Based on the above information WHICH ONE of the following gives the MOST LIKELY figure for Tracy’s risk of growing out of her febrile convulsions WITHOUT developing epilepsy by 7 years of age?
Question 9Select one:
a.
99%
b.
40%
c.
90%
d.
10%
90%
