11-28-2010, 06:00 PM
A 4-year-old child is seen in the emergency department
after having a seizure at home. This is the first
time that this has happened. The mother says that
the child was sitting on the couch watching television
when she suddenly became limp, started drooling,
and having generalized tonic-clonic movements
of her arms and legs. The mother relates that the
child felt like she was “burning up” and that the
tonic-clonic activity stopped after a few minutes.
The mother says that the child is otherwise healthy,
does not take any medicines, and has never been
hospitalized. The child’s immunizations are up-todate,
and she has no known drug allergies. On
examination, the vital signs are temperature of
104°F, BP 97/49, HR 112, and RR 26. The child is sitting
on the examination table playing with stickers
and drawing. She has a mild amount of clear nasal
congestion but her examination is otherwise normal.
When asked, the child replies that she feels fine.
What is the most likely diagnosis?
(A) bacterial meningitis
(B) first seizure in an epilepsy syndrome
© viral encephalitis
(D) typical febrile seizure
(E) hypocalcemic tetany
Which test(s) should be performed while the
child is in the emergency department to evaluate
the cause of these seizures?
(A) electroencephalogram (EEG)
(B) no testing is needed
© noncontrast head CT
(D) lumbar puncture
(E) blood and urine cultures
after having a seizure at home. This is the first
time that this has happened. The mother says that
the child was sitting on the couch watching television
when she suddenly became limp, started drooling,
and having generalized tonic-clonic movements
of her arms and legs. The mother relates that the
child felt like she was “burning up” and that the
tonic-clonic activity stopped after a few minutes.
The mother says that the child is otherwise healthy,
does not take any medicines, and has never been
hospitalized. The child’s immunizations are up-todate,
and she has no known drug allergies. On
examination, the vital signs are temperature of
104°F, BP 97/49, HR 112, and RR 26. The child is sitting
on the examination table playing with stickers
and drawing. She has a mild amount of clear nasal
congestion but her examination is otherwise normal.
When asked, the child replies that she feels fine.
What is the most likely diagnosis?
(A) bacterial meningitis
(B) first seizure in an epilepsy syndrome
© viral encephalitis
(D) typical febrile seizure
(E) hypocalcemic tetany
Which test(s) should be performed while the
child is in the emergency department to evaluate
the cause of these seizures?
(A) electroencephalogram (EEG)
(B) no testing is needed
© noncontrast head CT
(D) lumbar puncture
(E) blood and urine cultures