NEWEST FAMILY MEDICINE – SLEEP
MEDICINE CERTIFICATED EXAM FOR THE
AMERICAN BOARD OF FAMILY MEDICINE
(ABMS) | Q&A WITH RATIONALES
1. A 52-year-old obese male with hypertension
reports excessive daytime sleepiness, loud snoring,
and witnessed apneas. His Epworth Sleepiness Scale
score is 16/24. What is the most appropriate next
step?
A) Home sleep apnea test (HSAT)
B) In-lab polysomnography (PSG)
C) Trial of positional therapy
D) Mandibular advancement device
Correct answer: A
Rationale: High pretest probability of obstructive
sleep apnea (OSA) with moderate to severe
symptoms. HSAT is appropriate for uncomplicated
patients without significant cardiopulmonary disease
or other sleep disorders.
,2. A 45-year-old female reports falling asleep
suddenly during work meetings, while driving, and
during meals. She also reports cataplexy (knee
buckling with laughter). What is the most appropriate
diagnostic test?
A) Home sleep apnea test
B) In-lab polysomnography followed by multiple sleep
latency test (MSLT)
C) Actigraphy for 14 days
D) Maintenance of wakefulness test
Correct answer: B
Rationale: Suspected narcolepsy type 1 (cataplexy +
hypersomnolence) requires overnight PSG to rule out
other causes, then MSLT to demonstrate mean sleep
latency ≤8 minutes and ≥2 sleep-onset REM periods.
3. A 68-year-old male with Parkinson's disease
reports acting out violent dreams, kicking his wife,
and falling out of bed. What is the most likely
diagnosis?
A) REM sleep behavior disorder (RBD)
B) Night terrors
C) Sleepwalking
D) Nocturnal seizures
,Correct answer: A
Rationale: RBD presents with dream-enactment
behaviors during REM sleep (loss of atonia). It is
strongly associated with synucleinopathies
(Parkinson's, dementia with Lewy bodies, multiple
system atrophy).
4. A 30-year-old female reports severe restless legs
syndrome (RLS) symptoms occurring every night.
Her ferritin is 25 ng/mL. She has no
contraindications. What is first-line treatment?
A) Pramipexole 0.125 mg daily
B) Gabapentin 300 mg at bedtime
C) Oral iron supplementation
D) Ropinirole 0.25 mg daily
Correct answer: C
Rationale: For RLS with ferritin <50-75 ng/mL, oral
iron supplementation is first-line to correct
deficiency. Dopamine agonists (pramipexole,
ropinirole) are second-line due to augmentation risk.
5. A 55-year-old male with OSA on CPAP reports
using his machine for 6 hours per night but still has
an apnea-hypopnea index (AHI) of 25 on the device
, download. Mask leak is minimal. What is the most
appropriate next step?
A) Increase CPAP pressure
B) Switch to auto-adjusting CPAP (APAP)
C) Switch to bilevel positive airway pressure (BiPAP)
D) Refer for surgical evaluation
Correct answer: A
Rationale: Residual AHI >5 on CPAP despite good
adherence indicates insufficient pressure. Increase
CPAP pressure. APAP may help but increasing fixed
pressure is first step.
6. A 42-year-old female with chronic insomnia reports
difficulty falling asleep, waking multiple times, and
daytime fatigue. She has tried sleep hygiene and
over-the-counter diphenhydramine for 3 months.
What is first-line FDA-approved pharmacotherapy?
A) Zolpidem 5 mg at bedtime
B) Trazodone 50 mg at bedtime
C) Doxepin 3 mg at bedtime
D) Diphenhydramine 50 mg continued
Correct answer: C
MEDICINE CERTIFICATED EXAM FOR THE
AMERICAN BOARD OF FAMILY MEDICINE
(ABMS) | Q&A WITH RATIONALES
1. A 52-year-old obese male with hypertension
reports excessive daytime sleepiness, loud snoring,
and witnessed apneas. His Epworth Sleepiness Scale
score is 16/24. What is the most appropriate next
step?
A) Home sleep apnea test (HSAT)
B) In-lab polysomnography (PSG)
C) Trial of positional therapy
D) Mandibular advancement device
Correct answer: A
Rationale: High pretest probability of obstructive
sleep apnea (OSA) with moderate to severe
symptoms. HSAT is appropriate for uncomplicated
patients without significant cardiopulmonary disease
or other sleep disorders.
,2. A 45-year-old female reports falling asleep
suddenly during work meetings, while driving, and
during meals. She also reports cataplexy (knee
buckling with laughter). What is the most appropriate
diagnostic test?
A) Home sleep apnea test
B) In-lab polysomnography followed by multiple sleep
latency test (MSLT)
C) Actigraphy for 14 days
D) Maintenance of wakefulness test
Correct answer: B
Rationale: Suspected narcolepsy type 1 (cataplexy +
hypersomnolence) requires overnight PSG to rule out
other causes, then MSLT to demonstrate mean sleep
latency ≤8 minutes and ≥2 sleep-onset REM periods.
3. A 68-year-old male with Parkinson's disease
reports acting out violent dreams, kicking his wife,
and falling out of bed. What is the most likely
diagnosis?
A) REM sleep behavior disorder (RBD)
B) Night terrors
C) Sleepwalking
D) Nocturnal seizures
,Correct answer: A
Rationale: RBD presents with dream-enactment
behaviors during REM sleep (loss of atonia). It is
strongly associated with synucleinopathies
(Parkinson's, dementia with Lewy bodies, multiple
system atrophy).
4. A 30-year-old female reports severe restless legs
syndrome (RLS) symptoms occurring every night.
Her ferritin is 25 ng/mL. She has no
contraindications. What is first-line treatment?
A) Pramipexole 0.125 mg daily
B) Gabapentin 300 mg at bedtime
C) Oral iron supplementation
D) Ropinirole 0.25 mg daily
Correct answer: C
Rationale: For RLS with ferritin <50-75 ng/mL, oral
iron supplementation is first-line to correct
deficiency. Dopamine agonists (pramipexole,
ropinirole) are second-line due to augmentation risk.
5. A 55-year-old male with OSA on CPAP reports
using his machine for 6 hours per night but still has
an apnea-hypopnea index (AHI) of 25 on the device
, download. Mask leak is minimal. What is the most
appropriate next step?
A) Increase CPAP pressure
B) Switch to auto-adjusting CPAP (APAP)
C) Switch to bilevel positive airway pressure (BiPAP)
D) Refer for surgical evaluation
Correct answer: A
Rationale: Residual AHI >5 on CPAP despite good
adherence indicates insufficient pressure. Increase
CPAP pressure. APAP may help but increasing fixed
pressure is first step.
6. A 42-year-old female with chronic insomnia reports
difficulty falling asleep, waking multiple times, and
daytime fatigue. She has tried sleep hygiene and
over-the-counter diphenhydramine for 3 months.
What is first-line FDA-approved pharmacotherapy?
A) Zolpidem 5 mg at bedtime
B) Trazodone 50 mg at bedtime
C) Doxepin 3 mg at bedtime
D) Diphenhydramine 50 mg continued
Correct answer: C
