Order Sleep Medicine Discussion Solutions

Order Sleep Medicine Discussion Solutions
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Order Sleep Medicine Discussion Solutions
QUESTIONS
1. What percentage of Americans suffer from insomnia (both acute and
chronic)?
A. 10%
B. 40%
C. 90%
D. 1%
E. None of the above
2. A 75-year-old man complains of difficulty falling asleep for the past 2 years.
He was started on zolpidem by his primary care physician at that time and
has been taking it since then. He states he is not sure if it is still helping
and feels fatigued during the day. He goes to bed at the same time every
night and lies in bed for hours thinking about things, watching the clock.
The patient states he sleeps better at his sister’s house. He denies any depression but does feel some anxiety about going to bed. He does watch TV
in bed. About 2 years ago, he mentioned he had a significant amount of
stress when his wife was sick, but she is much better now. What is the most
likely diagnosis?
A. Sleep apnea
B. Circadian rhythm disorder
C. Idiopathic insomnia
D. Depression
E. Psychophysiologic insomnia
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CTSleep Medicine
CHAPTER
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Order Sleep Medicine Discussion Solutions
3. A 22-year-old man comes to the office complaining of difficulty sleeping
and daytime tiredness, which started right after college. His usual bedtime is 10:00 PM, but he cannot fall asleep until 1:00 or 2:00 AM, and then
he wakes up for work around 6:00 AM. The patient states that on the
weekends, he can stay in bed until 11:00 AM or noon, and he goes to bed
around 2:00 AM. He does feel better on the weekends. He does not snore,
is not obese, and had no problems as a child. The patient also denies any
recent stressors. What is the best treatment for him?
A. Light therapy
B. Sedative hypnotic
C. Antidepressant
D. Stop working
E. None of the above
4. Which of the following disorders is most commonly associated with
chronic insomnia?
A. Restless legs syndrome (RLS)
B. Sleep apnea
C. Narcolepsy
D. Depression
E. Obsessive compulsive disorder
5. A 35-year-old female presents to a sleep specialist for difficulty falling
asleep and staying asleep over the course of 1 year. The patient also complains of daytime fatigue. She has been diagnosed with attention-deficit
hyperactivity disorder (ADHD) in the past but has never been treated.
The patient is diagnosed with primary insomnia. What is the best treatment for her?
A. Stimulant
B. Short-acting sedative hypnotic
C. Cognitive behavioral therapy
D. Antidepressant
E. None of the above
6. Which of the following is not a behavioral therapy for insomnia?
A. Relaxation therapy
B. Stimulus control
C. Biofeedback
D. Sleep restriction therapy
E. All of the above
46 Section I • Neurology
7. Of all the treatments for insomnia, sedative hypnotics are commonly
used. What length of time is generally recommended for this family of
drugs?
A. Six months
B. Less than 1 month
C. At least 1 year
D. Nine months
8. A 67-year-old man presents with complaints of “acting out his dreams.”
He states they are very violent, and his wife has been injured on multiple
occasions. He usually recalls the exact dream when his wife wakes him.
There are no focal deficits on neurologic examination. He does have an
uncle diagnosed with Parkinson’s disease. What is the most likely location of this problem?
A. Cortex
B. Basal ganglia
C. Pons
D. Thalamus
E. None of the above
9. In the above patient, what is the best line of treatment?
A. Clonazepam
B. Selective serotonin reuptake inhibitors (SSRIs)
C. Gabapentin
D. Carbidopa/levodopa
E. There is no treatment.
10. What neurodegenerative disorder may rapid eye movement (REM) behavior disorder be associated with or be the prodrome of?
A. Alzheimer’s disease
B. Huntington’s chorea
C. Mitochondrial myopathy
D. Parkinson’s disease
E. All of the above
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