Status epilepticus, acute stroke management, and elevated intracranial pressure management scenarios tested on USMLE Step 2 CK.
35 cards · basic cards · AI-written, checked twice. Edit anything.
- Status epilepticus is defined as ____ or more of continuous seizure activity.
- 5 minutes
- What is the definition of status epilepticus based on recurrent seizures?
- Two or more seizures occurring without full recovery of consciousness between them
- What class of medication is first-line treatment for status epilepticus?
- Benzodiazepines
- What is the preferred first-line benzodiazepine and route when IV access is available for status epilepticus?
- IV lorazepam
- What is the preferred first-line benzodiazepine and route when IV access is not available for status epilepticus?
- Intramuscular midazolam
- Name second-line agents used if status epilepticus persists after benzodiazepines.
- Fosphenytoin, levetiracetam, or valproate
- Why is fosphenytoin often preferred over phenytoin for acute loading?
- It causes fewer infusion-site reactions and can be infused faster or given intramuscularly
- What cardiac precaution is needed when giving IV phenytoin or fosphenytoin?
- Continuous cardiac monitoring, since infusion can cause arrhythmia and hypotension
- After roughly how long does status epilepticus refractory to first- and second-line agents become 'refractory status epilepticus'?
- About 60 minutes
- What is the treatment approach for refractory status epilepticus that fails second-line agents?
- Intubation with continuous IV anesthetic infusion (e.g., propofol or midazolam) and continuous EEG monitoring
- Before giving antiepileptic drugs to an actively seizing patient, what bedside test should be checked immediately?
- Fingerstick glucose
- If a patient remains unresponsive after visible seizure activity has stopped, what should be done?
- Start continuous EEG monitoring to rule out nonconvulsive status epilepticus
- What is the maximum time window from symptom onset for giving IV alteplase in acute ischemic stroke?
- 4.5 hours
- What imaging study must be obtained before giving thrombolytics for a suspected acute stroke?
- Noncontrast head CT, to exclude hemorrhage
- What is an absolute contraindication to IV tPA related to bleeding?
- Active internal bleeding