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First unprovoked seizure — MCCQE Part 1 MCQ

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ModerateSeizuresFirst unprovoked seizureMCCQE Part 1

A 31-year-old man has a witnessed generalised tonic-clonic seizure lasting 90 seconds, recovers, has normal capillary glucose and no fever or trauma. Which of the following is the most appropriate next step?

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

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Correct answer: C — Arrange evaluation for first seizure including ECG, labs and neuroimaging where indicated, and advise no driving pending assessment

Arrange evaluation for first seizure including ECG, labs and neuroimaging where indicated, and advise no driving pending assessment is the single best answer because the age, timing, examination findings and investigations in the vignette fit First unprovoked seizure better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Canadian League Against Epilepsy guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: Canadian League Against Epilepsy guidance