Welcome back to MedSmarter’s USMLE Style Question of the Week. Here’s the breakdown of another high-yield Neurology question for those preparing for your USMLE Step 1 or just to gain some knowledge. As always you want to begin by reading the last sentence of the vignette first to get an understanding of what the question is asking for.
Question Break Down of the Week:
A 17-year-old girl is brought to the pediatrician by her father because of excessive daytime sleepiness. He states that over the past 7 months, he has received numerous phone calls from the girl’s school informing him that his daughter sleeps throughout all of her afternoon classes and is often difficult to arouse at the end of class. The patient reports that occasionally when she wakes up in the morning she cannot move for extended periods. She says that sometimes when she laughs at jokes or becomes nervous before a test, she feels as if she cannot move her legs. She admits that she has even fallen to the floor because of leg weakness while laughing. Which of the following is the best choice for treating this patient?
A) Chloral hydrate
B) Prochlorperazine maleate
C) Zolpidem
D) Hydroxyzine
E) Modafinil
The correct answer choice is E. The patient is presenting with excessive daytime sleepiness, cataplexy, and sleep paralysis, which are classic symptoms of narcolepsy. Modafinil is a psychostimulant that helps to arouse the brain, making it an appropriate treatment for narcolepsy. Chloral hydrate, Prochlorperazine maleate, and Zolpidem are all hypnotics that are used to induce sleep, which is the opposite of what is needed to treat narcolepsy. Hydroxyzine is an antihistamine used to treat anxiety and itching and is not used to treat narcolepsy.
Did you think the answer was different?
Did you think that the correct answer choice was other than E? You can view this video for a deeper discussion of why A, B, C, and D are not the correct answer choices.
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