1. Question 6
2 year old with seizures

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

3. 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

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

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

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

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

8. 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

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

10. 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

11. 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)

12. 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

13. 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