Question 6 2 year old with seizures

Case: 2 year old Second seizure Now resolved GCS 6 36.6 HR 146 cap refill < 2 sec RR 12 sats 90%

Correct answers include: A) List four (4) risk factors that increase the recurrence rate of a further febrile convulsion: Correct answers include: Age (the younger at first febrile convulsion, the worse, 1 year old 50% recurrence, 2 year old 30%) Immediate family with history feb convulsion or epilepsy First seizure complex febrile one Soon after fever onset Triggered by a relatively low temperature fever Frequent fevers

Not: Hypoglycaemia CNS infection Etc  these are by definition NOT febrile convulsions

B) List 3 immediate bedside procedures you would perform on this patient

B) List 3 immediate bedside procedures you would perform on this patient

B) List 3 immediate bedside procedures you (actually) would perform on this patient

Correct answers: Not a procedure: Not immediate: Aiway maenouvres and oxygen VBG/IVC BSL Not a procedure: Recovery position “oxygen” only, without mention of managing airway or specifics – not enough for a fellowship level exam Not immediate: Urine culture

Not convinced: Contraindicated: Intubate LP – obtunded child, decreased conscious state, recurrent recent seizures

C) Give the name and IV dose of one medication to immediately terminate the seizure Sensible choice, correct dose (mg/kg) Need to know, fair question Midazolam 0.15mg/kg on RCH/APLS. Not sure why so many people picking 0.10mg/kg? Give the name and IV dose of one medication to prevent further seizures Avoid brand names Know dose

Systems/groups looks better. E.g. D) Give 3 causes for the seizure that should be considered apart from a febrile convulsion This is an easy question Medical student could answer this Hence – use it to show off knowledge Systems/groups looks better. E.g. Metabolic (hypoglycaemia, hyponatraemia), Trauma (extradural, subdural, including NAI), Infective (bacterial meningitis, herpes encephalitis)

Overall Part A was a bit of a tricky question, not something we think about on day to day basis, but still reasonable for this exam The rest is bread and butter ED, fair question, expect high accuracy Pass mark 8/12

Pass mark 51%, but many only 1 mark off Score Frequency 1, 2, 3, 4 5 2 6 7 15 8 11 9 3 10 12