Question 1

Q: A 36-year-old woman complains of difficulty falling asleep over the past 4 months. On detailed history taking, she says that she drinks her last cup of tea at 8:30 p.m. before retiring at 10:30 p.m. She then watches the time on her cell phone on and off for an hour before falling asleep. In the morning, she is tired and makes mistakes at work. Her husband has not noticed excessive snoring or abnormal breathing during sleep. Medical history is unremarkable. She has smoked 5–7 cigarettes daily for 7 years and denies excess alcohol consumption. Her physical examination is normal. Which of the following is the best initial step in the management of this patient’s condition?

Proper sleep hygiene. ***Proper sleep hygiene*** - The patient's history of difficulty falling asleep, using a cell phone before bed, and tea consumption close to bedtime points towards **poor sleep hygiene** as a primary contributor to her insomnia. - Addressing these behavioral factors first with **sleep hygiene education** is the most appropriate initial step before considering pharmacologic interventions. *Ropinirole* - **Ropinirole** is a dopamine agonist primarily used to treat **Parkinson's disease** and **restless legs syndrome**. - There are no indications in the patient's presentation, such as an irresistible urge to move the legs, that would suggest restless legs syndrome. *Continuous positive airway pressure* - **Continuous positive airway pressure (CPAP)** is the standard treatment for **obstructive sleep apnea (OSA)**. - The patient's husband has not noticed snoring or abnormal breathing during sleep, making OSA less likely as the primary cause of her insomnia. *Modafinil* - **Modafinil** is a wakefulness-promoting agent used to treat **narcolepsy** and other disorders characterized by excessive daytime sleepiness. - The patient's primary complaint is difficulty *falling asleep* (**insomnia**), not excessive daytime sleepiness, and there's no evidence of narcolepsy. *Paroxetine* - **Paroxetine** is a selective serotonin reuptake inhibitor (SSRI) used to treat **depression** and **anxiety disorders**, and sometimes insomnia associated with these conditions. - There is no mention of symptoms of depression or anxiety in the patient's history that would warrant immediate antidepressant use for her sleep difficulties.

Question

A 36-year-old woman complains of difficulty falling asleep over the past 4 months. On detailed history taking, she says that she drinks her last cup of tea at 8:30 p.m. before retiring at 10:30 p.m. She then watches the time on her cell phone on and off for an hour before falling asleep. In the morning, she is tired and makes mistakes at work. Her husband has not noticed excessive snoring or abnormal breathing during sleep. Medical history is unremarkable. She has smoked 5–7 cigarettes daily for 7 years and denies excess alcohol consumption. Her physical examination is normal. Which of the following is the best initial step in the management of this patient’s condition?

Accepted Answer

Proper sleep hygiene

Answer

Ropinirole

Answer

Continuous positive airway pressure

Answer

Modafinil

Answer

Paroxetine

Anxiety — MCQs

Anxiety — MCQs

On this page

Practice by Chapter

Want unlimited practice?