1. A 2-year-old male presents with parents after a prolonged seizure of 5 minutes. The parents state that he has been lethargic over the past day with poor oral intake. Finger stick glucose is 452. The patient is poorly responsive and begins seizing again. The best initial therapy is:

A. Intravenous fluid bolus
B. Insulin drip
C. Glimepiride
D. Mannitol
E. Sodium bicarbonate

2. A 5-year-old male presents with parents complaining of a seizure after accidentally ingesting his grandmother’s glimepiride. He is no longer seizing. His glucose is 44 mg/dl. The patient does not have IV access. Best sequence of treatment is:

A. IM glucagon, IV dextrose, IV octreotide
B. IV dextrose, IV octreotide
C. Rectal valium, IV dextrose
D. Rectal valium, oral pyridoxine, IV hypertonic saline
E. Oral cefepime

3. Predictors of a surgical space occupying lesion include all of the following EXCEPT:

A. Headache of <6 months’ duration
B. Sleep related headache
C. Absence of visual symptoms
D. Absence of family history of migraine
E. No findings on neurologic examination

4. A 13-year-old female presents in status epilepticus. EMS administered two doses of IV lorazepam. According to her friends who arrived shortly after the patient, they bet the patient that she couldn’t drink 4 gallons of water in 30 minutes. Next most appropriate intervention is?

A. Phosphenytoin
B. Pyridoxine
C. Hypertonic saline
D. Propofol drip

5. A 2-year-old female with no past medical history presents to the emergency department with parents. Parents state the child had a fever of 101 degrees F and a cough. After examining the child, the nurse calls you back in the room, because the patient has begun seizing. The seizure was generalized. It lasted 20 minutes. What is the most appropriate management of this child?

A. Discharge. No further work up is needed.
B. Observe in the department for 6 hours, then discharge.
C. Admit for observation. No further work up is needed.
D. Perform further work up and admit for observation.

Answers: 1.D 2.A 3.E 4.C 5.D

References:

Haymond MW. Cerebral edema in children with diabetic ketoacidosis. UpToDate. Accessed: 3/4/18. https://www.uptodate.com/contents/cerebral-edema-in-children-with-diabetic-ketoacidosis

Tintinalli JE, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. Eighth edition. New York: McGraw-Hill Education, 2016.