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A 26 yr old man comes to the physician because 6 months Hx of losing conciousness when he laughs.He sleeps 12 to 14 hrs every night ,has vivid dreams and nightmares, and feels tired during the day.He was recently involved in a motor vehicle collision.Findings on physical exam are unremarkable.Which of the following is most likely Dx?
A-Absence seizures
B-Complex partial seizures
C-Major depressive disorder
D-Malingering
E-Narcolepsy
F-post traumatic stress
G-Sleep apnea
H-Sleep terror

MY ANSWER IS NARCOLEPSY....

LOSS OF CONSCIOUSNESS=SLEEP PARALYSIS + CATAPLEXY
EPISODES TRIGGERED BY LAUGHTER AND OTHER EMOTIONAL STATES....
NORMAL SLEEP AT NIGHT
FEEL TIRED DURING DAY
HYPOGOGIC AND POMPIC HALLUCINATIONS=OUT OF BODY EXPERIENCE


ALL CLASSIC SIGNS....WHY IN EXPLANATION,ITS MALINGERING???

I tought so,but Sarim and Yabearuh both beleive that it is Malingering...
we should ask someone who did it online...TY

Hmm, guess they are both wrong then....Its not malingering in anyway.

could you please write the NBME #,Block#,Q#...

nbme 5 block 1 q10

my be Narcolapsy bcoz hints are falling asleep in days and recent accident.

The answer here is E- Narcolepsy..... I think the hint here is that the loss of consciousness is preceded by extreme laughter. Its def not malingering

Yeaaa..............

Patient in real practice would give a history like that...Instead of saying...i doze off...he'll say i pass out or i go unconscious....

It doesn't mean he's malingering...

and yes,laughter is a big hint.