skip to main content

Pediatric obstructive sleep apnea — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardPediatricsPediatric obstructive sleep apneaUSMLE Step 3

An obese 10-year-old remains sleepy and hypertensive 10 weeks after adenotonsillectomy. Repeat polysomnography shows persistent obstructive sleep apnea with an apnea-hypopnea index of 14/hour. Examination shows no recurrent adenotonsillar tissue. What is the best next treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Refer for CPAP management while continuing structured weight treatment

The best answer is “Refer for CPAP management while continuing structured weight treatment”. AAP guidance recommends objective reevaluation in high-risk children and CPAP when symptoms or polysomnographic obstruction persist after adenotonsillectomy. Obesity treatment remains important but is slow and unreliable as the sole immediate therapy. Oxygen can improve saturation without relieving obstruction or hypercapnia, and sedatives may worsen airway collapse.

Reference: AAP Clinical Practice Guideline: Childhood Obstructive Sleep Apnea: https://publications.aap.org/pediatrics/article/130/3/576/30284/Diagnosis-and-Management-of-Childhood-Obstructive