Family Medicine Board Review EXAM 2024 QUESTIONS & ANSWERS 100% VERIFIED

Family Medicine Board Review EXAM 2024 QUESTIONS & ANSWERS 100% VERIFIED Sample Question & Answer: 24-year old female presents to your office with a 3-month history of difficulty sleeping. She says that she struggles to fall asleep and wakes up multiple times at night at least three times a week. She tries to go to bed at 10:00 p.m. and wakes up at 6:30 a.m. to start her day. She lies awake for an hour in bed before falling asleep and spends up to 2 hours awake in the middle of the night trying to fall back asleep. Lately she has been feeling fatigued and having difficulty concentrating at work. You conduct a full history and physical examination and tell her to return in 2 weeks with a sleep diary. At this follow-up visit you see from her diary that she is sleeping an average of 5½ hours per night. Which one of the following would be the most appropriate recommendation? A) Set her alarm for 5:30 a.m. B) Add a mid-afternoon nap C) Move her bedtime to 9:00 p.m. D) Move her bedtime to 12:30 a.m. E) Stay up for an h - Answer - ANSWER: D This patient presents with symptoms of chronic insomnia. Cognitive-behavioral therapy for insomnia (CBT-I) and brief behavioral therapy for insomnia (BBT-I) are effective nonpharmacologic treatments for chronic insomnia. Modified CBT-I and BBT-I can be administered by a primary care physician. The basic principles include stimulus control (sleep hygiene) and sleep restriction. Reducing time in bed increases sleep efficiency. In this case, 6 hours of time in bed would improve the patient's sleep efficiency and a bedtime of 12:30 a.m. would accomplish this goal. Generally, reduced time in bed is accomplished by postponing bedtime rather than getting up earlier. Naps generally do not improve sleep efficiency. While getting out of bed is recommended after being in bed for 30 minutes without falling asleep, or being awake for 30 minutes after being asleep, staying up for a prescribed period of time is not recommended.