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Focal seizure with impaired awareness — USMLE Step 2 CK MCQ

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HardInternal MedicineFocal seizure with impaired awarenessUSMLE Step 2 CK

A 54-year-old woman has a first unprovoked episode of lip smacking, impaired awareness, and postictal confusion. Glucose, sodium, toxicology, and examination are normal afterward. Noncontrast head CT shows no acute lesion. Which outpatient diagnostic evaluation best defines recurrence risk and identifies a focal structural cause?

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Correct answer: A — Electroencephalography and epilepsy-protocol brain MRI

The best answer is “Electroencephalography and epilepsy-protocol brain MRI”. A focal unprovoked seizure requires EEG to identify epileptiform activity and epilepsy-protocol MRI to detect a structural focus that routine CT can miss. Both findings inform recurrence risk and the decision to begin antiseizure treatment after a first event. Normal metabolic testing and recovery do not eliminate etiologic evaluation.

Reference: AAN Guideline: First Unprovoked Seizure in Adults: https://pubmed.ncbi.nlm.nih.gov/25901057/