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Childhood obesity — USMLE Step 3 MCQ

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HardPediatrics (well-child, chronic management)Childhood obesityUSMLE Step 3

A 12-year-old boy has blood pressures at or above the 95th percentile at three separate clinic visits despite correct cuff size and repeat auscultatory measurement. He has obesity but no symptoms, and urinalysis, creatinine, and electrolytes are normal. Which test is most appropriate before committing him to long-term antihypertensive therapy?

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Correct answer: D — Confirm the blood-pressure phenotype with 24-hour ambulatory monitoring

The best answer is “Confirm the blood-pressure phenotype with 24-hour ambulatory monitoring”. Repeated office readings suggest hypertension but cannot distinguish sustained hypertension from white-coat elevation. Ambulatory monitoring confirms the phenotype, quantifies awake and sleep burden, and guides whether long-term therapy is warranted. Secondary evaluation is then tailored to age, severity, history, and examination; invasive vascular imaging is not the initial confirmatory test in an asymptomatic child.

Reference: AAP Clinical Practice Guideline: High Blood Pressure in Children: https://publications.aap.org/pediatrics/article/140/3/e20171904/38358/Clinical-Practice-Guideline-for-Screening-and