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Short Answer Questions for ED Fellowship Study

Case: PNES and status epilepticus management

A 39-year-old woman has been brought into your tertiary ED with 2 x “seizure-like” episodes, each lasting approximately 1 minute. She has a GCS of 14, BP 140/85, HR 99, Sats 99%RA, BSL 5.0. You suspect that she may have had a psychogenic, non-epileptic seizure (PNES). Shortly after presentation, she develops another tonic-clonic seizure lasting for more than 5 minutes. You deem that she is in status epilepticus.

1. What are (6) features that may suggest that this is a PNES episode? 6 marks

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Shortly after presentation, she develops another tonic-clonic seizure lasting for more than 5 minutes. You deem that she is in status epilepticus.

2. Apart from benzodiazepines, list (3) anti-epileptic medications that you would consider, with dose, route and contraindications. 6 marks

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This case forms part of a collaborative marking project designed to support fellowship preparation. In the week leading up to each tutorial, you can contribute answers to any active case. If you contribute, your answers may be reviewed, marked, and used to refine the model answers during the weekly fellowship teaching sessions.

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