Question of the Week # 26

A 4-year-old boy has just had his second generalized tonic-clonic seizure in a 4 month period. You have recommended starting an anticonvulsant. The parents have concerns about the recommended medication and would prefer to wait and see if their son has more seizures. Your most-appropriate next step would be:

A) Comply with parents wishes
B) Start anticonvulsants
C) refer to ethics committee
D) seek legal advise from hospital attorney
E) Seek court support to start the patient on medications

Copy Rights: USMLEGalaxy, LLC

16 Responses

  1. a

  2. a

  3. A

  4. a

  5. A

  6. a

  7. A

  8. aaaaaaaaa

  9. i think we should go for a court because it is a matter of his development. what if a next seizure is status epilepticus.

  10. B
    You being a doctor understands the need to start anticonvulsants therapy. So you should try to convince parents or start therapy.

  11. i think b

  12. ‘Parents can not withhold limb or life saving treatment’. This child is at risk of sudden death (SUDEP-sudden death in epilepsy). This risk is higher with GTC seizures( more than one episode) and in younger age. Usually seizures are low mortality risk but GTC have higher mortality. Incidence of SUDEP is 24 times more than general population.
    GTC seizures (more than one) especially in younger age, in mental retarded and/or polytherapy are life threatening. This child can die in his next GTC episode if GTC seizures are not controlled with anticonvulsants.
    This child needs anticonvulsants and the parents can not withhold this treatment because the child’s life is at stake!
    Unless Dr Archer kindly specify what would be the best answer for Step 3 exam purpose, I would choose option B. Option B would be my choice my exam and in real life setting.

    • This is NOT an Emergency Question. You are recommending to start anti convulsive medication to the parents child –but they do not accept your recommendations at this time and which to wait to see if he gets better with time as the child grows up —Best next step is documentation of the conversation and recommendation and follow up in consecutive consultation and physical exam –“anti convulsive are not life saving medications they are preventive medications only”

  13. USMLEGALAXY – please provide answers to posted questions. thanks.

  14. In case anyone was wondering, I found this from the Archer ethics lecture.
    30. Case Study
    1) ] A 4-year-old boy has just had his second generalized tonic-clonic seizure in a 4 month period. You have recommended starting an anticonvulsant. The parents have concerns about the recommended medication and would prefer to wait and see if their son has more seizures. Your next step would be: A) Comply with parents wishes B) Start anticonvulsants C) refer to ethics committee D) seek legal advise from hospital attorney E) Seek court support to start the patient on medications
    Ans. A ( Not life threatening)

  15. b

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