United States Medical Licensing Step 3: USMLE-STEP-3

Correct Answer: C Section: (none)

Explanation:

Falling on outstretched arms is one of the most common injuries among school-aged children. This can result in a buckle, or torus, fracture of the distal radius and/or ulna. This is a common accidental mechanism and should not, by itself, raise suspicions for an inflicted injury. AP and lateral x-rays of the wrist and elbow would be diagnostic of this type of injury. Nursemaid's elbows occur from a pulling or twisting mechanism to the upper extremity and are not the result of falls. An MRI of this injury would be overkill.

Correct Answer: A Section: (none)

Explanation:

This patient suffers from ADHD as evidenced by numerous inattentive and hyperactive/ impulsive

symptoms and signs. Autistic disorder is a pervasive developmental disorder (PDD) consisting of

impairments in social interaction and communication, in addition to stereotyped behaviors. Conduct

disorder is a disruptive behavior disorder characterized by aggression and violation of the rights of others.

While oppositional defiant disorder is also a disruptive behavior disorder, it is not as severe as conduct

disorder, occurring at an earlier age and demonstrating a pattern of negativistic and defiant behaviors.

OCD is an anxiety disorder not uncommonly seen in children, diagnosed by the presence of recurrent,

distressing obsessions and/or compulsions.

Stimulants are the first-line treatment for ADHD. However, there are many misconceptions regarding their

use, which may necessitate the use of more detailed psychoeducation.

It was previously believed that stimulants exert their clinical effect through sedation, but this is no longer

considered to be true. Stimulants not only improve behavior, but there is evidence that they actually

"normalize" school performance as well. The use of drug holidays, such as weekends and during the

summer, is recommended in order to make up for any growth suppression.

Correct Answer: B Section: (none)

Explanation: Explanations: This patient presents with a major depressive episode. He is appropriately begun on an antidepressant, namely mirtazepine. With all antidepressants, the first symptoms to improve over days to weeks will be the neurovegetative symptoms such as insomnia, anergia, appetite, and concentration. Unfortunately, the depressed mood and hopelessness are often the last symptoms of depression to remit. Like many other psychiatric as well as medical illnesses, MDD tends to be a recurrent illness. While individual episodes are very treatable, there is a high risk of recurrence without continued treatment. After having a single episode of depression, studies indicate approximately 5085% of individuals will develop subsequent episodes of major depression.