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MMLU / A 76-year-old man comes to the office because of early awakening at night. He…

Problem

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question

A 76-year-old man comes to the office because of early awakening at night. He has no difficulty falling asleep but routinely wakes up between 2:00 and 3:00 AM. The patient is a retired postal worker, and he has always been physically active. He has diabetes mellitus controlled by diet. The patient drinks one cup of coffee in the morning with breakfast and usually walks for exercise in the morning. Before retiring at night he has one alcoholic beverage. He has no history of depression, nightmares, or snoring and he takes no over-the-counter medications. His wife of 45 years is also in good health. Vital signs are temperature 37.1°C (98.8°F), pulse 96/min and regular, respirations 18/min, and blood pressure 135/90 mm Hg. Physical examination shows a well-nourished, well-developed man. He is not obese. Examination of the head and neck is normal; there are no bruits or jugular venous distention. Chest is clear, and heart is normal with S1 and S2. Abdomen is soft and nontender with active bowel sounds and no organomegaly. Rectal examination discloses no abnormalities. Which of the following is the most appropriate management of this patient's insomnia?

choices

  1. Advise the patient to discontinue his bedtime drink of alcohol
  2. Advise the patient to read and snack in bed to relax
  3. Prescribe a vigorous pre-bedtime exercise regimen
  4. Prescribe sertraline

subject

professional_medicine

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Source and history

task_id
821108f7-467c-5291-8509-717f405938be
task_key
all--test--821108f7-467c-5291-8509-717f405938be
task_revision_id
1
config / split
all / test

Official source

initial import