A 26-year-old librarian presents with chronic daytime somnolence, which has frequently caused him to fall asleep at work. He does not smoke but drinks

Subject
Medicine
System
Public Health & Preventive Medicine

Kathryn

Member
Jul 29, 2020
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Singapore
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A 26-year-old librarian presents with chronic daytime somnolence, which has frequently caused him to fall asleep at work. He does not smoke but drinks 1 to 2 glasses of wine daily. He says he frequently awakens at night but denies any visual or auditory hallucinations on falling asleep. His height is 186 cm (73 in), and his weight is 60% greater than expected. Chest examination reveals no specific findings other than distant breath sounds. Arterial blood gas analysis during normal ventilation shows:
Pao2 82mm Hg
Paco2 55mm Hg
After the patient voluntarily hyperventilates for 1 minute, blood gas analysis returns within normal limits. Which of the following will have the greatest benefit on this patient’s symptoms?

(A) Benzodiazepines at bedtime
(B) Daily acetazolamide
(C) Morning administration of dextroamphetamine
(D) Supplemental oxygen at night
(E) Weight loss
 
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