An 18-Year-Old Man Comes to the Physician for Daytime Sleepiness

question 812

Multiple Choice

An 18-year-old man comes to the physician for daytime sleepiness lasting several months.  The patient recently started college, has difficulty staying awake during classes, and often falls asleep suddenly even though he "gets a good night's sleep."  He typically goes to bed at 2 am and sleeps until at least 9 am, usually later.  The patient's sleep pattern at night is fragmented.  He wakes frequently but is usually able to go back to sleep within a few minutes.  He does not snore or wake up gasping.  The patient feels like "someone is in the room with me when I'm just falling asleep and I sometimes hear my name being called."  His past medical history is otherwise insignificant.  The patient does not use tobacco or alcohol.  Blood pressure is 120/70 mm Hg and heart rate is 70/min.  His body mass index is 23 kg/m².  Which of the following is the best initial therapy for this patient?

• A)Lumbar puncture
• B)Melatonin
• C)Modafinil
• D)Quetiapine
• E)Valproic acid

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Definitions:

Portfolio

A collection of investments held by an individual or institution, which may include stocks, bonds, real estate, and other financial assets.

Indifference Curves

Graphical representations in economics showing different bundles of goods between which a consumer is indifferent, reflecting preferences of equal utility.

Budget Line

A graphical representation of all possible combinations of two goods that an individual can afford to purchase with a given budget, at given prices.

Risk Averse

Describes individuals or entities that prefer to avoid risk, often opting for safer investments even with potentially lower returns.