May 2003
American College of Emergency Physicians Section of Pediatric Emergency Medicine

Ghazala Q. Sharieff, MD, FACEP
Associate Clinical Professor
Department of Emergency Medicine
Children's Hospital and Health Center
University of California, San Diago
Director of Pediatric Emergency Medicine
Palomar-Pomerado Hospitals
San Diego, CA

1. A 2-1/2 year old child has a 5 minute generalized tonic-clonic seizure with a fever of 102. Examination reveals a right otitis media, no nuchal rigidity and normal mental status one hour after the event. Neurodevelopmental status is normal. Family history is positive for maternal febrile seizures. This is the child's first seizure. Which of the following statements are true?

   1. Phenobarbital should be initiated.
   2. A lumbar puncture should be performed
   3. An EEG should be performed in one week
   4. The risk of recurrence of a febrile seizure in this child is approximately 30%.
      
      

2. What is the fastest rate that phenytoin can be administered intravenously in a child?

   1. 1mg/kg/min
   2. 50mg/min
   3. 3mg/kg/min
   4. 2mg/kg/min
      
      

3. All of the following statements are true Except:

   1. Fosphenytoin can be given at an IV rate of 3mg/min.
   2. Felbamate has been associated with aplastic anemia and liver toxicity.
   3. Lamotrigine can lead to rash development, however there is no report of serious skin disease.
   4. Fosphenytoin cannot be given IM due to severe pain at the injection site.
      
      

4. Simple febrile seizures are defined as all of the following Except:

   1. Generalized seizure lasting < 15 minutes
   2. Only two seizures in a 24 hour period
   3. No evidence of CNS infection
   4. Age range 6 months to 5 years.
      
      

5. Which of the following is not a risk factor for febrile seizure recurrence?

   1. Age less than 24 months of age with onset of first febrile seizure
   2. Age less than 12 months of age with onset of first febrile seizure
   3. Temperature less than 40C with febrile seizure
   4. Family history of febrile seizures
      
      

6. List the pediatric doses of the following medications:

   1. Lorazepam____________mg/kg
   2. Diazepam: rectal_______mg/kg, IV____________mg/kg
   3. Loading dose of phenobarbital_________________mg/kg
   4. Loading dose of phenytoin____________________mg/kg
   5. Loading dose of fosphenytoin: IV/IM________________mg PE (phenytoin equivalents)/kg
   6. Midazolam: rectal________mg/kg: IV________mg/kg: IM__________mg/kg
      
      

7. A 3-month old female presents with a generalized seizure which has been present for 25 minutes. The seizure is refractory to rectal valium given by the paramedics and Ativan in the ED. Her temperature is 36.5C. There is no sign of trauma. Mother reports that she just started the baby on formula this week. All of the following are true except:

   1. The mother should be questioned regarding exact formula preparation
   2. Hyponatremia may be corrected by using 4-5cc/kg of 3% saline
   3. Patients with hyponatremic seizures tend to have higher temperatures than infants with seizures due to other causes
   4. Patients with hyponatremic seizures typically have prolonged seizures
      
      

8. The risk of development of epilepsy in the general populations is approximately 1% by age 7 years. In children with simple febrile seizures, the incidence of epilepsy is:

   1. No different that the rate in the general population
   2. Only slightly higher than the rate in the general population
   3. 30-50 times that of the general population
   4. 10 times that of the general population
      
      

9. The latest ACEP article on febrile seizures recommends the following in regards to lumbar puncture for patients with febrile seizures:

   1. All patients less than 12 months of age should undergo lumbar puncture
   2. All patients less than 18 months of age should undergo a lumbar puncture
   3. A lumbar puncture can be deferred in patients less than 18 months of age with a simple febrile seizure if the patient is well-appearing
   4. A CT scan should be performed prior to performing a lumbar puncture
      
      

10. Which of the following causes of gastroenteritis have been associated with seizures?

    1. Salmonella
    2. Shigella
    3. Campylobacter
    4. Rotavirus
       
       

11. Which of the following is the most common cause of seizures in children?

    1. Fever
    2. Head injury
    3. Metabolic disturbances
    4. Hypoxia
    5. Ischemia
       
       

12. Which of the following is the drug of choice for neonatal seizures?

    1. Phenytoin
    2. Fosphenytoin
    3. Valproic acid
    4. Phenobarbital

Copyright 2004 American College of Emergency Physicians. Pediatric Emergency Medicine Section quizzes may be reproduced for educational purposes only. To obtain permission to reprint for any other purpose, please submit your written request to: Deputy Executive Director, American College of Emergency Physicians, PO Box 619911, Dallas, TX 75261.

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