Emergency medicine: status epilepticus: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Emergency medicine: status epilepticus

Sample item

A 25-year-old man has had a generalised tonic-clonic seizure for 8 minutes and is still convulsing in the emergency department. Intravenous access has just been obtained. What is the first-line drug?

AIntravenous thiopentoneBOral carbamazepineCIntravenous phenytoin loading as the first drugDIntravenous lorazepam

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Intravenous lorazepam

A seizure lasting more than 5 minutes is status epilepticus and should be treated immediately. A benzodiazepine such as intravenous lorazepam (0.1 mg/kg, up to 4 mg) is first-line, and intramuscular midazolam is equally effective when there is no IV access. If seizures continue, a second-line agent such as levetiracetam, valproate or phenytoin is given, and refractory cases need anaesthesia.

Option by option

A. Intravenous thiopentone
Thiopentone is for refractory status in intensive care with ventilation.
B. Oral carbamazepine
Oral drugs cannot be given to a convulsing patient and are too slow.
C. Intravenous phenytoin loading as the first drug
Phenytoin is a second-line agent with slow loading and cardiac risk, not the first drug.
D. Intravenous lorazepam (correct)
Correct. Benzodiazepines act rapidly on GABA-A receptors to terminate seizures.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Intravenous lorazepam. A seizure lasting more than 5 minutes is status epilepticus and should be treated immediately.

Why is "Intravenous thiopentone" not the answer?

Thiopentone is for refractory status in intensive care with ventilation.

Why is "Oral carbamazepine" not the answer?

Oral drugs cannot be given to a convulsing patient and are too slow.

Why is "Intravenous phenytoin loading as the first drug" not the answer?

Phenytoin is a second-line agent with slow loading and cardiac risk, not the first drug.

What concept does this question test?

It tests Emergency medicine: status epilepticus in General Medicine. A benzodiazepine such as intravenous lorazepam (0.1 mg/kg, up to 4 mg) is first-line, and intramuscular midazolam is equally effective when there is no IV access. If seizures continue, a second-line agent such as levetiracetam, valproate or phenytoin is given, and refractory cases need anaesthesia.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Emergency medicine: status epilepticus?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.