A 7-year-old child is brought by his mother for a school physical. His growth parameters show his height to be fiftieth percentile and his weight to be significantly higher than ninety-fifth percentile. His mother complains that he always seems sleepy during the day and that he has started complaining of headaches. His second-grade teacher has commented that he has difficulty staying awake in class. His mother complains that he wakes up the whole house with his snoring at night. Which of the following is the most appropriate next step in evaluating and managing this condition?
a. Try steroids to decrease tonsillar and adenoid hypertrophy
b. Refer to an otolaryngologist for tonsillectomy and adenoidectomy
c. Arrange for continuous positive airway pressure (CPAP) at home
d. Arrange for home oxygen therapy for use at night
e. Arrange for polysomnography
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is e; Arrange for polysomnography.
A nasopharyngeal airway, the use of nasal CPAP, and tonsillectomy and adenoidectomy can be effective treatments for obstructive sleep apnea (OSA). However, the diagnosis of OSA should first be made by polysomnography (sleep study) to exclude other causes of snoring. Administering oxygen may decrease the respiratory drive in severe OSA, and thus should be used only with caution. Untreated OSA can lead to cor pulmonale, as well as growth and developmental abnormalities.