A 30-year-old man is diagnosed with narcolepsy after multiple sleep latency testing (MSLT) reveals rapid sleep onset and early REM sleep. He experiences excessive daytime sleepiness, frequent episodes of cataplexy, and occasional sleep paralysis. Which of the following medications is the most appropriate first-line treatment for his condition?
A 25-year-old woman presents with a 2-year history of excessive daytime sleepiness. She states that she often dozes off at work and feels an overwhelming urge to sleep. She also describes vivid hallucinations when she is falling asleep and has had occasional episodes where she wakes up but is unable to move. She denies muscle weakness triggered by emotions. Polysomnography reveals a decreased sleep latency and rapid onset of REM sleep. What is the most appropriate next step in confirming the diagnosis?
A 25-year-old male presents to the neurology clinic reporting episodes of suddenly falling to the ground without losing consciousness, triggered by excitement or surprise, over the past year. He also admits to irresistible urges to nap during the day, even while driving, and recalls waking up unable to move for a few seconds several times in the past month. A sleep study is planned. Which diagnostic test is most appropriate to confirm the suspected diagnosis of narcolepsy in this patient?
A 19-year-old college student presents to the clinic with excessive daytime sleepiness that has been worsening over the past year. He reports falling asleep suddenly during lectures despite getting 7–8 hours of sleep at night. He also describes sudden episodes of muscle weakness triggered by laughter, lasting a few seconds. Additionally, he has experienced vivid, dream-like hallucinations when falling asleep and occasional episodes where he wakes up but cannot move. His neurological exam is unremarkable. Which of the following is the most likely cause of this patient’s condition?
A 22-year-old man presents to the sleep clinic with excessive daytime sleepiness. He reports frequently dozing off during lectures despite getting 7–8 hours of sleep at night. He also describes experiencing vivid dream-like hallucinations just before falling asleep and occasionally waking up unable to move for a few seconds. Upon further questioning, he recalls multiple episodes where he suddenly collapses to the ground after laughing but remains fully conscious during these episodes. Which of the following symptoms is most specific for narcolepsy?
A 19-year-old college student presents to the sleep clinic complaining of excessive daytime sleepiness for the past six months. She reports falling asleep during lectures and experiencing sudden muscle weakness when laughing, causing her to drop objects. She also mentions vivid dreams just as she falls asleep at night. Her sleep history reveals she sleeps 8 hours nightly but still feels unrefreshed. What is the most likely diagnosis based on this patient’s symptoms?
A 35-year-old pilot presents to her physician with complaints of difficulty falling asleep after long-haul flights. She reports frequent international travel and trouble adjusting to different time zones. She prefers to avoid prescription medications and asks if there is a natural supplement that could help regulate her sleep-wake cycle. The physician recommends an over-the-counter supplement that is naturally produced in the body and helps regulate circadian rhythms. Where in the body is this substance primarily produced?
A 65-year-old woman with a history of epilepsy has been taking carbamazepine for the past 6 months. She presents to the clinic with complaints of fatigue, nausea, and confusion. Laboratory tests reveal hyponatremia (serum sodium: 125 mEq/L), low plasma osmolality, and inappropriately elevated urine osmolality. Which of the following is the most likely cause of her symptoms?
A 10-year-old boy presents with frequent episodes of seeing bright, multicolored spots in his peripheral vision that last for about two minutes. These episodes are sometimes accompanied by brief eye deviation and headaches resembling migraines. Neurological examination and development are normal. What is the most likely diagnosis?
A 6-year-old girl with a history of frequent staring spells is brought to the emergency department after an episode of unresponsiveness. She is diagnosed with absence seizures, but her parents are hesitant about starting medication. They ask whether the seizures will resolve on their own. Which of the following is the most likely prognosis for this patient?
