PUID: 42 || PLAB 2 Mock 2 :: FeverishChild4: Febrile Convulsion

Practice a case with the AI patient 🤖

Summary:

This scenario involves a child presenting with a febrile seizure, often caused by an underlying infection such as otitis media. Candidates are expected to assess the seizure event, identify its cause, rule out red flags like meningitis, and provide reassurance and education to the parent.

Key Points:

Seizure Assessment

• Ask about before, during, and after the seizure:

  • Before: Fever, signs of infection (e.g. ear tugging)

  • During: Duration, consciousness, motor activity, incontinence

  • After: Recovery state, postictal confusion, neurological deficits

• Postictal or focal deficits may warrant neuroimaging (CT scan)

Infection Source

• Common cause: Otitis media

• Check for:

  • Ear discharge, redness, tenderness

  • Other sources: UTI (burning micturition), gastroenteritis (diarrhoea)

Temperature History

• Enquire about:

  • How fever was measured

  • Use of antipyretics (paracetamol, ibuprofen)

  • Effectiveness and frequency

Important Considerations:

• Clearly state the diagnosis using medical terminology (e.g., "febrile seizure"), followed by a simple explanation.

• Rule out meningitis: ask about neck stiffness, photophobia, rash.

• Recognise penicillin allergy and prescribe an alternative (e.g., clarithromycin).

Diagnostic Approach:

1. Clarify seizure history (before, during, after).

2. Identify signs of infection and check ear for otitis media.

3. Exclude red flags (e.g., meningitis).

4. Confirm diagnosis: Simple febrile seizure due to ear infection.

Management:

• No hospital admission if:

  • Seizure lasted <5 minutes

  • Child is fully recovered with no red flags

• Treat underlying infection:

  • If allergic to penicillin, consider clarithromycin

• Fever control:

  • Antipyretics: paracetamol (4–6 hourly), ibuprofen

  • Non-pharmacologic: tepid sponging

• Parent education:

  • Benign nature of febrile seizures

  • How to manage fever and seizures at home

• FIT safety measures:

  • Place child in left lateral (recovery) position

  • Remove harmful objects, avoid restraining, no objects in mouth

  • Call 999 if seizure lasts >5 minutes or child remains unwell

• Referral:

  • All first-time seizures: Refer to First FIT clinic

• Follow-up:

  • Arrange review in 3–5 days

  • Provide leaflets on febrile seizures and otitis media

Communication Skills:

• Use empathetic language, acknowledge parental anxiety

• Explain diagnosis and reassure about prognosis

• Use clear, lay terms after stating the diagnosis

• Ask about and address ICE (Ideas, Concerns, Expectations)

Ethical Considerations:

• Avoid giving misinformation; say "as per hospital protocol" if unsure

• Respect parental autonomy

• Maintain clarity and honesty in communication

Additional Resources:

• NICE Guidelines on Fever in Under 5s

• GMC’s “Good Medical Practice” on communication and prescribing

• BNF for children (BNFC) for antibiotic dosing and choice