Behavioral Science & Ethics USMLE Step 1 Practice Question
A 57-year-old man presents with his wife for evaluation of progressive daytime somnolence. He reports falling asleep during meetings at work and while driving to his office. His wife notes loud snoring throughout the night and witnessed episodes of gasping and breath-holding followed by arousal. He wakes most mornings with a throbbing headache and feels unrefreshed despite 8 hours in bed. He denies current medications and has no significant past medical history. Vital signs: BP 168/92 mmHg, HR 88/min, RR 16/min. BMI is 36 kg/m2. Physical examination reveals a soft palate at the midline, normal nasal septum, and no pharyngeal erythema or exudate. Which of the following is the most appropriate next diagnostic step?
Answer choices
- APolysomnographyCorrect answer
- BBegin continuous positive airway pressure (CPAP) therapy empirically
- CStart antihypertensive therapy and schedule follow-up sleep study in 3 months
- DInitional weight loss program with sleep hygiene counseling; reassess in 8 weeks
- EPerform nasopharyngoscopy to evaluate for structural obstruction
- FInitiate methylphenidate to address daytime sleepiness while awaiting sleep study
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