LATEST SLEEP MEDICINE CERTIFICATION
EXAM OFFERED BY MULTIPLE ABMS BOARDS
— INTERNAL MEDICINE, PEDIATRICS,
PSYCHIATRY, NEUROLOGY, FAMILY
MEDICINE, OTOLARYNGOLOGY | COMPLETE
EXAM Q&A WITH RATIONALES
1. A 55-year-old male with a BMI of 34 kg/m² presents
with loud snoring, witnessed apneas, and excessive
daytime sleepiness (Epworth Sleepiness Scale [ESS]
score 16). Which is the most appropriate next step?
A) Home sleep apnea test (HSAT)
B) In-laboratory polysomnography (PSG)
C) Empiric trial of continuous positive airway
pressure (CPAP)
D) Multiple sleep latency test (MSLT)
Correct answer: A
Rationale: In patients with high pretest probability for
obstructive sleep apnea (OSA), HSAT is appropriate
for diagnosis.
2. A 45-year-old female with restless legs syndrome
(RLS) has a ferritin level of 25 ng/mL. Which is the
most appropriate next step?
,A) Oral iron supplementation (325 mg ferrous sulfate
with vitamin C)
B) Pramipexole
C) Gabapentin
D) Intravenous iron (ferric carboxymaltose)
Correct answer: A
Rationale: For RLS with ferritin <50-75 ng/mL, oral
iron is first-line. IV iron for severe cases or
malabsorption.
3. A 30-year-old male presents with recurrent
episodes of falling asleep at work, cataplexy
(triggered by laughter), sleep paralysis, and
hypnagogic hallucinations. Which is the most
appropriate next step?
A) Multiple sleep latency test (MSLT) preceded by
overnight PSG
B) HLA typing (DQ0602)
C) CSF hypocretin-1 level
D) Empiric modafinil trial
Correct answer: A
Rationale: Narcolepsy type 1 diagnosis requires
MSLT showing mean sleep latency <8 minutes and ≥2
sleep-onset REM periods (SOREMPs).
,4. A 62-year-old female with REM sleep behavior
disorder (RBD) has a normal neurologic exam. Which
is the most appropriate next step?
A) Neurologic referral for evaluation of
synucleinopathy (Parkinson's disease, multiple
system atrophy, dementia with Lewy bodies)
B) Polysomnography (PSG) to confirm RBD
C) Clonazepam 0.5 mg at bedtime
D) Melatonin 3 mg at bedtime
Correct answer: A
Rationale: RBD is a prodromal marker of
synucleinopathy; neurologic evaluation and
longitudinal follow-up are indicated.
5. A 25-year-old female with shift work disorder (night
shift nurse) reports difficulty staying awake during
shifts and insomnia during the day. Which is the most
appropriate pharmacologic intervention?
A) Modafinil 200 mg before night shift
B) Zolpidem 10 mg after night shift (for daytime sleep)
C) Caffeine 200 mg
D) Melatonin 5 mg before night shift
, Correct answer: A
Rationale: Modafinil is FDA-approved for shift work
disorder to improve wakefulness during night shifts.
6. A 70-year-old male with Alzheimer's dementia
presents with nighttime agitation, wandering, and
sundowning. Which is the most appropriate first-line
non-pharmacologic intervention?
A) Light therapy (morning bright light exposure)
B) Quetiapine 25 mg at bedtime
C) Melatonin 3 mg at bedtime
D) Physical restraints
Correct answer: A
Rationale: Light therapy (morning bright light) helps
regulate circadian rhythms in dementia; non-
pharmacologic measures are first-line.
7. A 52-year-old male with severe OSA (AHI 45) on
CPAP reports persistent daytime sleepiness (ESS 14)
after 6 months of good adherence (usage 7
hours/night, residual AHI 3). Which is the most
appropriate next step?
A) Add modafinil
B) Increase CPAP pressure
EXAM OFFERED BY MULTIPLE ABMS BOARDS
— INTERNAL MEDICINE, PEDIATRICS,
PSYCHIATRY, NEUROLOGY, FAMILY
MEDICINE, OTOLARYNGOLOGY | COMPLETE
EXAM Q&A WITH RATIONALES
1. A 55-year-old male with a BMI of 34 kg/m² presents
with loud snoring, witnessed apneas, and excessive
daytime sleepiness (Epworth Sleepiness Scale [ESS]
score 16). Which is the most appropriate next step?
A) Home sleep apnea test (HSAT)
B) In-laboratory polysomnography (PSG)
C) Empiric trial of continuous positive airway
pressure (CPAP)
D) Multiple sleep latency test (MSLT)
Correct answer: A
Rationale: In patients with high pretest probability for
obstructive sleep apnea (OSA), HSAT is appropriate
for diagnosis.
2. A 45-year-old female with restless legs syndrome
(RLS) has a ferritin level of 25 ng/mL. Which is the
most appropriate next step?
,A) Oral iron supplementation (325 mg ferrous sulfate
with vitamin C)
B) Pramipexole
C) Gabapentin
D) Intravenous iron (ferric carboxymaltose)
Correct answer: A
Rationale: For RLS with ferritin <50-75 ng/mL, oral
iron is first-line. IV iron for severe cases or
malabsorption.
3. A 30-year-old male presents with recurrent
episodes of falling asleep at work, cataplexy
(triggered by laughter), sleep paralysis, and
hypnagogic hallucinations. Which is the most
appropriate next step?
A) Multiple sleep latency test (MSLT) preceded by
overnight PSG
B) HLA typing (DQ0602)
C) CSF hypocretin-1 level
D) Empiric modafinil trial
Correct answer: A
Rationale: Narcolepsy type 1 diagnosis requires
MSLT showing mean sleep latency <8 minutes and ≥2
sleep-onset REM periods (SOREMPs).
,4. A 62-year-old female with REM sleep behavior
disorder (RBD) has a normal neurologic exam. Which
is the most appropriate next step?
A) Neurologic referral for evaluation of
synucleinopathy (Parkinson's disease, multiple
system atrophy, dementia with Lewy bodies)
B) Polysomnography (PSG) to confirm RBD
C) Clonazepam 0.5 mg at bedtime
D) Melatonin 3 mg at bedtime
Correct answer: A
Rationale: RBD is a prodromal marker of
synucleinopathy; neurologic evaluation and
longitudinal follow-up are indicated.
5. A 25-year-old female with shift work disorder (night
shift nurse) reports difficulty staying awake during
shifts and insomnia during the day. Which is the most
appropriate pharmacologic intervention?
A) Modafinil 200 mg before night shift
B) Zolpidem 10 mg after night shift (for daytime sleep)
C) Caffeine 200 mg
D) Melatonin 5 mg before night shift
, Correct answer: A
Rationale: Modafinil is FDA-approved for shift work
disorder to improve wakefulness during night shifts.
6. A 70-year-old male with Alzheimer's dementia
presents with nighttime agitation, wandering, and
sundowning. Which is the most appropriate first-line
non-pharmacologic intervention?
A) Light therapy (morning bright light exposure)
B) Quetiapine 25 mg at bedtime
C) Melatonin 3 mg at bedtime
D) Physical restraints
Correct answer: A
Rationale: Light therapy (morning bright light) helps
regulate circadian rhythms in dementia; non-
pharmacologic measures are first-line.
7. A 52-year-old male with severe OSA (AHI 45) on
CPAP reports persistent daytime sleepiness (ESS 14)
after 6 months of good adherence (usage 7
hours/night, residual AHI 3). Which is the most
appropriate next step?
A) Add modafinil
B) Increase CPAP pressure
