Seizure Disorders USMLE Step 1 Practice Question
A 24-year-old woman with no prior medical history presents to the emergency department after a witnessed generalized tonic-clonic seizure lasting approximately 90 seconds. She is now in the postictal period with mild confusion and drowsiness. Vital signs are: BP 138/88 mmHg, HR 108 bpm, RR 20/min, temperature 37.1°C, SpO2 99% on room air. Physical examination reveals no focal neurologic deficits, and there is no evidence of head trauma. Laboratory studies show serum glucose 98 mg/dL, serum sodium 138 mEq/L, and normal renal function. Urine drug screen is negative. Non-contrast head CT is unremarkable with no acute intracranial abnormality. Electroencephalography demonstrates generalized 3-Hz spike-and-wave discharges. What is the most appropriate next step in management of this patient?
Answer choices
- AObtain brain MRI with contrast prior to any pharmacologic intervention
- BInitiate valproic acid as first-line antiepileptic therapy
- CInitiate levetiracetam monotherapy and schedule outpatient EEGCorrect answer
- DPrescribe phenytoin with a loading dose followed by maintenance therapy
- EAdminister lorazepam intravenously and admit for 24-hour observation without antiepileptic drugs
- FPerform lumbar puncture to exclude infectious etiologies before starting treatment
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