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Convulsive status epilepticus — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsConvulsive status epilepticusSCE Acute Medicine

A 63-year-old man presents with acute neurological symptoms. Relevant history includes vascular, infectious or neuromuscular risk factors. On assessment, neurological examination shows focal or global dysfunction. Investigations show generalised convulsion persists after pre-hospital benzodiazepine. What is the most appropriate next step in management?

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Correct answer: B — Give a second benzodiazepine dose and load intravenous levetiracetam if seizures continue

The key discriminator is that generalised convulsion persists after pre-hospital benzodiazepine, which makes Give a second benzodiazepine dose and load intravenous levetiracetam if seizures continue the single best answer. Start broad-spectrum intravenous antibiotics is less appropriate because it does not address the dominant acute risk in the vignette; Give targeted antidote or reversal therapy would fit a different presentation or later stage of care. Give analgesia and antiemetic therapy and Start anticoagulation after assessing bleeding risk are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE NG217; BNF