A 75-Year-Old Man Comes to the Office Due to Difficulty

question 64

Multiple Choice

A 75-year-old man comes to the office due to difficulty sleeping for the past several months.  The patient says, "I think I would be fine if I could just get some sleep."  He describes taking at least 45 minutes to an hour to fall asleep at night.  He also awakens 2-3 times in the middle of the night and has difficulty falling back asleep, often staying up for an hour or more at a time.  He wakes up naturally at his usual time of 6:30 AM but then feels tired throughout the day.  The patient lives in a retirement community.  His wife died last year and he lives alone.  He misses his wife but has no other psychosocial stressors and enjoys playing golf and socializing with a group of friends.  He does not feel anxious or depressed and is not sure what keeps him awake or why he is waking up so often.  His medical history is significant for aortic stenosis, well-controlled hypertension, osteoporosis, benign prostatic hyperplasia, and constipation.  His current medications include terazosin, alendronate, and over-the-counter fiber supplements and multivitamins.  The patient does not smoke or use illicit drugs.  He drinks alcohol rarely on social occasions.  Physical examination is noncontributory.  Which of the following is the most appropriate management of this patient's condition?

• A)Prescribe diphenhydramine at bedtime
• B)Prescribe lorazepam at bedtime
• C)Prescribe temazepam at bedtime
• D)Prescribe zolpidem at bedtime
• E)Recommend cognitive-behavioral therapy

Understand the role of mutual agreement in modifying, discharging, or terminating contracts.

Comprehend the legal effects of conditions connected to contracts.

Know the legal remedies available for non-performance and breach of contract.

Understand the principles governing the termination of contractual duties by agreement or performance.

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Definitions:

Enhancers

Genetic elements that increase the transcription of specific genes, playing a key role in regulating gene expression.

DNA Sequences

The precise order of nucleotides (adenine, thymine, cytosine, and guanine) within a portion of a DNA molecule, determining genetic information.

Promoters

DNA sequences located upstream of a gene that initiate transcription by binding RNA polymerase and other necessary transcription factors.

Silencers

DNA sequences that can bind regulatory proteins to inhibit the expression of a gene, thus playing a crucial role in gene regulation.