Status Epilepticus Management — MFDS Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

ModeratePharmacologyStatus Epilepticus ManagementMFDS Part 1

An adult patient in a primary care dental surgery develops a generalised convulsive seizure that continues for 5 minutes. No individualised emergency management plan is immediately available, intravenous access has not been established, and buccal midazolam is available. Which medicine and route constitute the preferred first-line drug treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Midazolam 10 mg buccally

The preferred treatment is **midazolam 10 mg administered buccally**. A convulsive seizure lasting 5 minutes meets the threshold for emergency treatment. In a community dental setting without intravenous access, NICE recommends an immediately administered benzodiazepine; buccal midazolam is preferred when available. Rectal diazepam is an alternative, particularly where its use is specified in an individualised plan or buccal midazolam is unavailable. Intravenous phenytoin is a second-line antiseizure medicine after two adequate benzodiazepine doses. Propofol and thiopental are anaesthetic agents reserved for refractory status epilepticus in a critical-care environment. If intravenous access and full resuscitation facilities were immediately available, NICE identifies intravenous lorazepam—not intravenous midazolam—as the first-choice intravenous treatment.

Reference: National Institute for Health and Care Excellence. Epilepsies in children, young people and adults (NG217), section 7.1: Initial treatment for generalised convulsive status epilepticus. Updated 2025. https://www.nice.org.uk/guidance/ng217/chapter/7-Treating-status-epilepticus-repeated-or-cluster-seizures-and-prolonged-seizures