Professional and Linguistic Assessments Board (PLAB) Practice Exam

What is the first-line treatment for status epilepticus?

1. Lorazepam followed by phenytoin

2. Phenytoin followed by lorazepam

3. Diazepam followed by levetiracetam

4. Carbamazepine followed by sodium valproate

The correct answer is: Lorazepam followed by phenytoin

The first-line treatment for status epilepticus encompasses the use of benzodiazepines, with lorazepam being the preferred choice due to its effectiveness and favorable pharmacokinetics. Lorazepam acts rapidly to terminate seizures, which is crucial in the management of status epilepticus, a medical emergency characterized by prolonged or repetitive seizures without recovery of consciousness. After administering lorazepam, it is standard practice to follow up with an anti-epileptic medication such as phenytoin to prevent the recurrence of seizures. Phenytoin provides a longer-lasting control of seizure activity and helps stabilize the patient over time. In contrast, the other options mention alternative medications or sequences that are not aligned with current emergency protocols. For instance, phenytoin is not typically given as an initial treatment due to its slower onset of action compared to lorazepam. Additionally, combining diazepam with levetiracetam or using carbamazepine and sodium valproate as initial treatments does not conform to established treatment guidelines for status epilepticus, as they are not prioritized in acute settings. Understanding this protocol is crucial for healthcare providers, as timely intervention can significantly influence patient outcomes in cases of status epilepticus.