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Febrile seizure — USMLE Step 3 MCQ

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HardPediatrics (well-child, chronic management)Febrile seizureUSMLE Step 3

A patient receives observed intranasal esketamine. Blood pressure rises from 128/76 to 176/102 mm Hg at 40 minutes and remains 168/100 mm Hg without symptoms at the 2-hour mark. What is the best next step?

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Correct answer: B — Continue observation and obtain experienced blood-pressure management; discharge after pressure declines and the patient is stable

The best answer is “Continue observation and obtain experienced blood-pressure management; discharge after pressure declines and the patient is stable”. The 2-hour period is a minimum, not an automatic discharge trigger. Persistently high pressure warrants continued assessment and prompt experienced management; emergency transfer is required for symptoms of hypertensive crisis or encephalopathy, which are absent here. After esketamine, measure blood pressure at about 40 minutes and monitor for at least 2 hours. If pressure remains high, promptly seek help from a practitioner experienced in blood-pressure management; discharge follows clinical stability rather than elapsed time alone. The alternatives use a different threshold, timing, population, or intervention and therefore do not match the clinical facts presented.

Reference: FDA: SPRAVATO Prescribing Information: https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/211243s016lbl.pdf