Seizures Practice Questions

30 multiple-choice questions on Seizures for paramedic and EMT students, from Chapter 19 (Neurologic Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. A woman who is 12 weeks pregnant and has known epilepsy has been seizing for 6 minutes. Her BP is 128/80 mm Hg. What is the most appropriate treatment?

   1. A. Magnesium sulfate for eclampsia
   2. B. No drugs, to protect the fetus
   3. C. A benzodiazepine per protocol
   4. D. Her usual oral antiseizure drug
   Show answer

   Answer: C. A benzodiazepine per protocol

   A seizure lasting 5 minutes or more is status epilepticus, and a benzodiazepine is first-line therapy in pregnancy too. Uncontrolled seizures and hypoxia are far more dangerous to the fetus than the drug. Eclampsia occurs after 20 weeks of pregnancy and usually with high BP, so magnesium is not first-line here. Withholding treatment is unsafe, and oral drugs cannot be given to a seizing patient.

2. At the start of a seizure, a patient's head and eyes turn forcefully to the left before the whole body begins to jerk. Where did the seizure most likely begin?

   1. A. The left cerebral hemisphere
   2. B. The right cerebellar hemisphere
   3. C. The spinal cord
   4. D. The right cerebral hemisphere
   Show answer

   Answer: D. The right cerebral hemisphere

   A forced (versive) turn of the head and eyes at the start of a seizure usually points away from the side where the seizure began, so a turn to the left suggests a right hemisphere focus. This is useful information to report because it helps localize a possible structural lesion. The cerebellum and spinal cord do not generate this type of seizure.

3. After her 2-year-old's brief febrile seizure, a mother asks whether giving fever medicine on a schedule would have prevented it. Which reply is most accurate?

   1. A. Yes, if given on a strict schedule
   2. B. Yes, if paired with a cool sponge bath
   3. C. Yes, if aspirin had been used instead
   4. D. Fever medicine does not prevent them
   Show answer

   Answer: D. Fever medicine does not prevent them

   Studies show that acetaminophen or ibuprofen can make a child more comfortable but does not prevent febrile seizures or their recurrence. Cool baths do not prevent them either and can cause shivering. Aspirin should not be given to children with viral illnesses because of the risk of Reye syndrome. Parents can be reassured that the seizure was not caused by their failure to treat the fever.

4. A 40-year-old taking phenytoin for seizures has had a week of staggering, slurred speech and sideways jerking of the eyes since his dose was increased. His glucose is normal. What is the most likely cause?

   1. A. An absence seizure
   2. B. Phenytoin toxicity
   3. C. Alcohol withdrawal
   4. D. Positional vertigo
   Show answer

   Answer: B. Phenytoin toxicity

   Phenytoin toxicity typically causes nystagmus first, then ataxia, slurred speech and drowsiness, and it often follows a dose increase or a drug interaction. Absence seizures are brief staring spells in children, alcohol withdrawal causes tremor and tachycardia, and positional vertigo causes brief spinning with head movement but not slurred speech.

5. Which phase of a generalized tonic-clonic seizure involves sustained muscle rigidity?

   1. A. Clonic phase
   2. B. Postictal phase
   3. C. Tonic phase
   4. D. Aura phase
   Show answer

   Answer: C. Tonic phase

   The tonic phase is sustained contraction, often with apnea. The clonic phase follows with rhythmic jerking, then the postictal phase of confusion and fatigue.

6. A patient tells you she smelled burning rubber just before her seizure. This sensation is best described as a(n):

   1. A. Syncopal prodrome
   2. B. Aura
   3. C. Drug hallucination
   4. D. Postictal state
   Show answer

   Answer: B. Aura

   An aura is actually a focal seizure the patient remembers, and it often precedes a generalized seizure. Odd smells suggest a temporal lobe focus.

7. A 7-year-old has brief staring spells for a few seconds with no falling and no postictal confusion. This most likely describes:

   1. A. Absence seizures
   2. B. Febrile seizures
   3. C. Tonic-clonic seizures
   4. D. Psychogenic seizures
   Show answer

   Answer: A. Absence seizures

   Absence seizures cause brief lapses in awareness, usually in children, with immediate return to normal activity and no postictal period.

8. A patient has rhythmic jerking of the right hand but remains awake and talks to you throughout. This is a:

   1. A. Absence seizure
   2. B. Generalized seizure
   3. C. Febrile seizure
   4. D. Focal aware seizure
   Show answer

   Answer: D. Focal aware seizure

   Focal aware seizures (formerly simple partial) involve one area of the brain without loss of awareness. They can spread and become generalized.

9. A patient picks at his clothes, smacks his lips, and does not respond for a minute, then is confused. This most likely describes a:

   1. A. Absence seizure in an adult
   2. B. Tonic phase of a generalized seizure
   3. C. Focal impaired awareness seizure
   4. D. Syncopal episode with convulsions
   Show answer

   Answer: C. Focal impaired awareness seizure

   Focal impaired awareness seizures (formerly complex partial) feature automatisms such as lip smacking or picking, followed by postictal confusion.

10. A family asks how to lower the risk of sudden unexpected death in epilepsy (SUDEP) for their adult son. Which factor carries the greatest risk?

    1. A. Frequent brief absence seizures
    2. B. Well-controlled focal seizures
    3. C. Frequent tonic-clonic seizures
    4. D. Taking two antiseizure drugs daily
    Show answer

    Answer: C. Frequent tonic-clonic seizures

    In the AAN/AES guideline, frequent generalized tonic-clonic seizures are the strongest risk factor for SUDEP, and seizure freedom, especially from these seizures, lowers the risk. Absence and well-controlled focal seizures carry much less risk. Taking more than one antiseizure drug is not itself the danger; poor seizure control is.

11. A 4-month-old with a fever of 39.2 °C (102.6 °F) has a 3-minute generalized seizure. How should this seizure be viewed?

    1. A. A simple febrile seizure needing reassurance
    2. B. A normal response to fever at this age
    3. C. Not typical; consider meningitis
    4. D. A sign of teething that needs no care
    Show answer

    Answer: C. Not typical; consider meningitis

    Febrile seizures typically occur between about 6 months and 5 years of age. A seizure with fever in a younger infant should raise concern for meningitis or another serious infection, so the infant needs full evaluation and transport. It should not be treated as a simple febrile seizure or a normal reaction to fever, and teething does not cause high fever or seizures.

12. A wife says her husband's generalized seizure began 4 minutes before you arrived. He is still seizing when you reach him. How should you proceed?

    1. A. Time 5 minutes from your arrival first
    2. B. Wait for the seizure to stop by itself
    3. C. Treat now; the timing starts at onset
    4. D. Give his oral medicine when it stops
    Show answer

    Answer: C. Treat now; the timing starts at onset

    Seizure duration is counted from when the seizure began, not from EMS arrival. This seizure has lasted about 4 minutes and is about to meet the 5-minute definition of status epilepticus, so prepare and give a benzodiazepine without delay. Restarting the clock on arrival, waiting for it to stop, or relying on oral medicine all allow status epilepticus to continue.

13. A college student with well-controlled epilepsy takes his medicine every day. He had a seizure after staying up all night studying for exams. Which trigger most likely lowered his seizure threshold?

    1. A. Steady light from a desk lamp
    2. B. Sitting for many hours
    3. C. A large late-night meal
    4. D. Sleep deprivation
    Show answer

    Answer: D. Sleep deprivation

    Sleep deprivation is one of the most common seizure triggers in people with epilepsy, along with missed doses, alcohol, illness and stress. Patients can reduce risk by keeping regular sleep. Steady lamp light does not provoke seizures the way flashing light can in photosensitive patients, and neither prolonged sitting nor a large meal is a recognized trigger. A low blood sugar can provoke a seizure, so the glucose should still be checked.

14. Ten minutes after a tonic-clonic seizure, a man is confused and keeps pushing your hands away. His glucose and SpO2 are normal. What is the best approach?

    1. A. Calm reassurance as he recovers
    2. B. Prone restraint until he settles
    3. C. IM haloperidol to sedate him
    4. D. Shouting commands to orient him
    Show answer

    Answer: A. Calm reassurance as he recovers

    Postictal confusion and resistance are common and usually fade as the brain recovers. Speak calmly, reduce stimulation, keep him safe and reassess often. Prone restraint can cause asphyxia, sedating drugs such as IM haloperidol can mask his recovery or a new problem and are not needed for brief postictal confusion, and shouting increases agitation.

15. A 6-month-old has clusters of sudden, brief jerks in which his trunk bends forward and his arms fling out, repeated many times soon after waking. What should you suspect?

    1. A. A normal startle (Moro) reflex
    2. B. Colic from trapped intestinal gas
    3. C. Infantile spasms (a seizure type)
    4. D. Reflux with arching after feeds
    Show answer

    Answer: C. Infantile spasms (a seizure type)

    Infantile spasms are a seizure type of infancy in which brief flexion or extension spasms occur in clusters, often on waking. They are easily mistaken for colic or a startle reflex, but early diagnosis and treatment matter for development, so the infant needs prompt evaluation. A Moro reflex is a single response to a sudden stimulus, colic causes crying spells, and reflux causes spitting up or arching after feeds, not repeated clustered jerks.

16. Biting of which part of the tongue is most suggestive of a generalized seizure?

    1. A. The very tip
    2. B. The underside
    3. C. The base only
    4. D. The lateral edge
    Show answer

    Answer: D. The lateral edge

    Lateral tongue biting is fairly specific for generalized tonic-clonic seizures, while tip biting can occur with syncope or falls.

17. A patient's seizure-like activity includes side-to-side head shaking, pelvic thrusting, and eyes squeezed shut. This is most consistent with:

    1. A. Generalized tonic-clonic seizure
    2. B. Absence seizure
    3. C. Psychogenic nonepileptic seizure
    4. D. Hypoglycemic seizure
    Show answer

    Answer: C. Psychogenic nonepileptic seizure

    These features are typical of psychogenic nonepileptic events. Still, treat the patient respectfully, protect from injury, and do not assume a diagnosis in the field.

18. During the stiff (tonic) phase of a seizure, the patient's lips turn blue. The seizure began 1 minute ago. What is the most appropriate action?

    1. A. Begin chest compressions now
    2. B. Give oxygen and time the seizure
    3. C. Force a bite block between the teeth
    4. D. Intubate during the seizure
    Show answer

    Answer: B. Give oxygen and time the seizure

    Breathing pauses and cyanosis are common during the tonic phase and usually resolve when the seizure ends. Give oxygen, protect the patient from injury, time the seizure and treat with a benzodiazepine if it reaches 5 minutes. The patient has a pulse, so compressions are not indicated. Forcing objects into the mouth can break teeth and cause injury, and intubation during an active convulsion is neither needed nor safe.

19. After 40 minutes of status epilepticus, an adult has a temperature of 40.1 °C (104.2 °F). No infection is evident. What is the most likely cause of the high temperature?

    1. A. Malignant hyperthermia from midazolam
    2. B. Neuroleptic malignant syndrome
    3. C. Heat from sustained muscle activity
    4. D. Thyroid storm
    Show answer

    Answer: C. Heat from sustained muscle activity

    Prolonged convulsions generate a large amount of heat from continuous muscle contraction, so status epilepticus often causes hyperthermia, which adds to brain injury. Stopping the seizure and cooling are key, though infection should still be considered. Midazolam does not trigger malignant hyperthermia, neuroleptic malignant syndrome follows antipsychotic use, and thyroid storm is a rare cause in a patient without thyroid disease.

20. You plan to give intranasal midazolam to a seizing child, but his nose is full of blood from a fall during the seizure. What is the main concern?

    1. A. It will burn the lining of the nose
    2. B. The drug may be poorly absorbed
    3. C. It will act faster than usual
    4. D. It needs to be diluted first
    Show answer

    Answer: B. The drug may be poorly absorbed

    Intranasal drugs are absorbed through the nasal lining, so blood or heavy secretions can wash the dose away or block absorption. Suction the nose first or choose another route, such as IM or IV, per protocol. Midazolam is not caustic to the nose, absorption will be slower rather than faster, and dilution would increase the volume and make absorption worse.

21. A 30-year-old with known epilepsy had one of his typical brief seizures at work. He is now fully alert and oriented, and he declines transport. What is the most appropriate action?

    1. A. Transport him against his wishes
    2. B. Confirm capacity and document refusal
    3. C. Give a benzodiazepine before you leave
    4. D. Have his coworker sign the refusal
    Show answer

    Answer: B. Confirm capacity and document refusal

    A person with known epilepsy who has a typical seizure and fully recovers may decline transport if he has decision-making capacity. Confirm that he is oriented and understands the risks, advise him not to drive or be alone, and document the refusal carefully. Transport against his will is not justified when he has capacity, a benzodiazepine is not needed after a seizure has ended, and a coworker cannot refuse on his behalf; he signs his own refusal.

22. A patient remains unresponsive 30 minutes after his tonic-clonic seizure stopped, with subtle eye twitching. You should suspect:

    1. A. A normal postictal period
    2. B. Nonconvulsive status
    3. C. Simple exhaustion
    4. D. Psychogenic unresponsiveness
    Show answer

    Answer: B. Nonconvulsive status

    Persistent altered mental status with subtle twitching may represent ongoing seizure activity without obvious convulsions, which requires treatment and EEG evaluation.

23. A 9-year-old with a seizure disorder wears a helmet because several times a day she suddenly goes limp and drops to the floor without warning, then gets right up. Which seizure type does this describe?

    1. A. Tonic seizures
    2. B. Absence seizures
    3. C. Atonic seizures
    4. D. Vasovagal syncope
    Show answer

    Answer: C. Atonic seizures

    Atonic ('drop') seizures cause a sudden loss of muscle tone lasting a second or two, so the child falls and often injures the head or face. A helmet is used to prevent injury. Tonic seizures cause sudden stiffening rather than going limp, absence seizures cause staring without a fall, and vasovagal syncope has a trigger and warning signs such as nausea and lightheadedness.

24. Two days after thyroid surgery, a 48-year-old has tingling around her mouth and in her fingers, cramping of her hands, and then a generalized seizure. What is the most likely cause?

    1. A. Thyroid storm after the surgery
    2. B. Low calcium from parathyroid injury
    3. C. Low sodium from too much IV fluid
    4. D. A delayed reaction to the anesthesia
    Show answer

    Answer: B. Low calcium from parathyroid injury

    The parathyroid glands sit behind the thyroid and can be injured or removed during thyroid surgery, causing low calcium. Hypocalcemia makes nerves overexcitable, producing tingling around the mouth and fingers, hand spasms (tetany) and seizures, and it can prolong the QT interval. Thyroid storm causes fever and tachycardia, low sodium does not cause tetany, and anesthetic reactions occur during or soon after surgery.

25. A 40-year-old with no seizure history has a first-time seizure. Which consideration is most important?

    1. A. Assume it is idiopathic epilepsy
    2. B. Release if back to baseline
    3. C. Look for an underlying cause
    4. D. Give antiseizure drugs routinely
    Show answer

    Answer: C. Look for an underlying cause

    New-onset seizures in adults may be caused by stroke, tumor, infection, toxins, trauma, or metabolic problems, so they need full evaluation.

26. Why is IM diazepam a poor choice for stopping a seizure?

    1. A. Muscle breaks it down before use
    2. B. Absorption from muscle is erratic
    3. C. It acts too fast to control safely
    4. D. It cannot be given to children
    Show answer

    Answer: B. Absorption from muscle is erratic

    Diazepam is poorly and unpredictably absorbed from muscle, so an IM dose may not stop the seizure in time. When there is no IV, IM or intranasal midazolam is preferred, and diazepam is given IV or rectally. The problem is slow, unpredictable uptake rather than breakdown of the drug in the muscle, diazepam is widely used in children (rectal and IV forms are standard), and IM absorption makes it slower rather than too fast.

27. During an active tonic-clonic seizure, the most appropriate action is to:

    1. A. Place a bite block in the mouth
    2. B. Hold the arms to stop jerking
    3. C. Move him to the stretcher at once
    4. D. Protect the head from injury
    Show answer

    Answer: D. Protect the head from injury

    During a seizure, protect the head, move hazards away and time the event, then place the patient on his side once the jerking stops. A bite block can break teeth or block the airway, holding the limbs can cause fractures or dislocations, and moving a convulsing patient to the stretcher risks injury to him and the crew, so protect him where he lies until the jerking stops.

28. A child's parent gave her prescribed rectal diazepam 10 minutes ago, but the seizure continues. How should the home dose affect your treatment?

    1. A. Wait 30 more minutes for it to work
    2. B. Ignore it and start the full sequence
    3. C. Give two more doses back to back
    4. D. Count it as the first dose
    Show answer

    Answer: D. Count it as the first dose

    A rescue benzodiazepine given by family counts as the first dose. If the seizure continues, give the next dose per protocol while watching breathing closely, because repeated benzodiazepine doses add to respiratory depression. Waiting allows status epilepticus to continue, ignoring the home dose risks an overdose, and stacking several doses quickly increases the risk of apnea.

29. A driver had a seizure at the wheel and crashed into a pole at about 35 mph. He is now postictal. Besides seizure care, what is most important?

    1. A. Assess for crash injuries and the spine
    2. B. Give oral glucose while he is still drowsy
    3. C. Have him sign a refusal at the scene
    4. D. Treat him as if he were intoxicated
    Show answer

    Answer: A. Assess for crash injuries and the spine

    A seizure that causes a crash creates two problems: the medical cause and the trauma. Assess the mechanism, look for head, chest and spinal injuries, and apply spinal motion restriction as indicated, while still checking the glucose and managing the airway. Oral glucose is unsafe in a drowsy patient who may not swallow, a postictal patient cannot give an informed refusal, and assuming intoxication can lead to missed injuries.

30. After their 18-month-old's first simple febrile seizure, the parents ask whether this means she has epilepsy. Which answer is most accurate?

    1. A. It means she now has epilepsy
    2. B. She will need daily seizure medicine
    3. C. It proves she has brain damage
    4. D. Most children never develop epilepsy
    Show answer

    Answer: D. Most children never develop epilepsy

    Simple febrile seizures are common and usually harmless. The risk of later epilepsy is only slightly higher than in other children, and most children with febrile seizures never develop epilepsy. About a third have another febrile seizure, but daily antiseizure medicine is not recommended for simple febrile seizures, and they do not cause brain damage. The child should still be evaluated for the source of the fever.