To Maryam - sara84

[ArchivalUser]

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???

[ArchivalUser]

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

[ArchivalUser]

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

[ArchivalUser]

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

[ArchivalUser]

nbme 5 block 1 q10

[ArchivalUser]

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

[ArchivalUser]

http://www.usmleforum.com/showthread.php?tid=500486

[ArchivalUser]

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

[ArchivalUser]

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

[ArchivalUser]

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.