Seizure Disorders USMLE Step 1 Practice Question
A 42-year-old man with a history of acute ischemic stroke 6 months ago presents to the emergency department following a seizure witnessed by his wife. She reports he suddenly lost consciousness and then displayed bilateral symmetric tonic-clonic movements of all extremities lasting approximately 4 minutes. After the movements stopped, he was unresponsive and confused for 10 minutes before gradually regaining alertness. Vital signs on arrival: BP 158/92 mmHg, HR 115/min, RR 8/min, temperature 37.2°C, SpO2 92% on room air. Physical examination reveals no fever, no neck stiffness, and no acute focal neurologic deficits. Prior brain MRI showed a cortical infarction in the left motor cortex. Laboratory studies show normal serum glucose, normal electrolytes, and negative urine drug screen. Which of the following best describes this seizure event?
Answer choices
- APrimary generalized tonic-clonic seizure with unknown etiology
- BStatus epilepticus requiring immediate intubation and ICU admission
- CProvoked seizure secondary to acute metabolic derangement
- DSecondary generalized seizure arising from a focal cortical lesionCorrect answer
- EAbsence seizure with secondary generalized features
- FNon-convulsive seizure mimicking convulsive activity
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