Seizure Disorders USMLE Step 1 Practice Question
A 16-year-old boy with a 3-year history of juvenile myoclonic epilepsy, currently controlled on monotherapy with valproic acid, presents to the emergency department after experiencing 3 generalized tonic-clonic seizures over a 4-hour period. He is alert and oriented between seizures with spontaneous respirations. Vital signs are: BP 128/82 mmHg, HR 102/min, RR 18/min, temperature 37.2°C, SpO2 98% on room air. Serum valproic acid concentration is 65 mcg/mL (therapeutic range 50-100 mcg/mL). The patient denies recent medication non-compliance, head trauma, or prodromal symptoms. Neurologic examination between seizures is non-focal. Which of the following is the most appropriate immediate management?
Answer choices
- AAdminister lorazepam 0.1 mg/kg IV and prepare for intubation and ICU admission
- BAdminister lorazepam 0.1 mg/kg IV and initiate phenytoin or fosphenytoin loadingCorrect answer
- CObtain non-contrast head CT and lumbar puncture to exclude structural and infectious etiologies
- DDiscontinue valproic acid immediately and initiate levetiracetam at a therapeutic dose
- EMonitor closely in the emergency department without additional medication pending repeat valproic acid level
- FAdminister lorazepam 0.1 mg/kg IV and increase the valproic acid dose by 50% at the next scheduled administration
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