skip to main content

Status epilepticus — USMLE Step 3 MCQ

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

HardEmergency MedicineStatus epilepticusUSMLE Step 3

A child remains convulsing after an appropriately dosed IV benzodiazepine was given for convulsive status epilepticus. Glucose is normal and airway support is in place. What is the next medication strategy?

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

Reveal the answer and explanation

Correct answer: D — Give a loading dose of levetiracetam, fosphenytoin or valproate

The best answer is “Give a loading dose of levetiracetam, fosphenytoin or valproate”. Convulsive status that persists after an appropriately dosed IV benzodiazepine needs prompt second-line antiseizure treatment while airway support continues. Observation and routine EEG delay seizure control. Aspirin has no role, and oral ethosuximide treats absence seizures rather than rapid termination of convulsive status.

Reference: American Epilepsy Society, Convulsive Status Epilepticus Guideline: https://www.aesnet.org/clinical-care/clinical-guidance/guidelines-for-therapy-of-status-epilepticus