Paediatric emergencies: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Paediatric emergencies

Sample item

A 4-year-old has been having a generalised tonic-clonic seizure for more than five minutes and is still convulsing on arrival. Which drug class is first-line?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Benzodiazepine such as lorazepam or midazolam

A seizure lasting beyond five minutes is status epilepticus, and a rapid-acting benzodiazepine given by the intravenous, buccal, intranasal or intramuscular route is the first-line drug. Phenytoin and phenobarbitone are second-line if seizures continue, and airway, breathing and glucose are checked at the same time.

Option by option

  • A. Oral sodium valproate

    Oral valproate cannot be given reliably to a convulsing child and acts too slowly.

  • B. Intravenous phenobarbitone

    Phenobarbitone is a second-line agent with a risk of respiratory depression.

  • C. Intravenous phenytoin

    Phenytoin acts slowly and is used as a second-line agent if benzodiazepines fail.

  • D. Benzodiazepine such as lorazepam or midazolam (correct)

    Correct. Benzodiazepines stop seizures quickly and are the initial treatment.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is D, Benzodiazepine such as lorazepam or midazolam. A seizure lasting beyond five minutes is status epilepticus, and a rapid-acting benzodiazepine given by the intravenous, buccal, intranasal or intramuscular route is the first-line drug.

Why is "Oral sodium valproate" not the answer?

Oral valproate cannot be given reliably to a convulsing child and acts too slowly.

Why is "Intravenous phenobarbitone" not the answer?

Phenobarbitone is a second-line agent with a risk of respiratory depression.

Why is "Intravenous phenytoin" not the answer?

Phenytoin acts slowly and is used as a second-line agent if benzodiazepines fail.

What concept does this question test?

It tests Paediatric emergencies in Pediatrics. Phenytoin and phenobarbitone are second-line if seizures continue, and airway, breathing and glucose are checked at the same time.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric emergencies?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.