Usmle Step 1 MCQ’s # 26

Title: Usmle Step 1 MCQ’s # 26
Subject: Behavioral Science

Q NO 26: A 41-year-old married woman of Asian decent becomes pregnant with her first child. During the course of routine prenatal care, the women undergoes a series of tests checking on her health and the health of the fetus. The results of the tests suggest the woman is in good health, but strongly indicate that her child will be born with Down syndrome. When informed of this result the woman becomes visibly upset and begins to cry. “How could this happen to me?” she says, “God must be punishing me!” At this point the physician’s best reply would be which of the following?

A. “I don’t think God has anything to do with this. This sort of thing just happens some of the time.”
B. “I know it is hard to heard this kind of news, but let me assure you that you are still young enough to have other children.”
C. “Let’s take a moment to reflect and pray together for guidance.”
D. “Sometimes God works in mysterious ways that we can not understand. We just have to try to keep our faith.”
E. “Take some deep breaths and try to relax. When you collect yourself, we can talk about how you want to proceed.”
F. “Tell me a bit more about why you think God is punishing you.”
G. “The chances for Down syndrome are simply higher when a woman your age becomes pregnant. That’s why we run these tests.”
H. “The real issue before us is, how do you want to proceed? Do you want to carry the child to term or explore other options?”


Explanation:
The correct answer is F. The core issue here is that the physician needs more information. In particular, he needs to find out about the patient’s beliefs about how the world works and why things happen. Simply imposing his own beliefs, rational or scientific as they may be, does not allow an understanding of how the patient perceives the world. Understanding how the patient sees the world is essential for conveying to her the reasons for Down syndrome, and helping her make a thoughtful decision as to what to do next.
This response may state the physician’s views, which may be contradictory to those of the patient. The problem to be solved here is not how to convince the patient to see things as the physician does (choice A), but for the physician to understand how the patient sees the world.
This response seeks to empathize, and reassure the patient. In doing so, however, it makes an unwarranted assumption that the reason for the woman’s distress is a fear of not being able to have more children (choice B). Whether this is the woman’s chief concern or not is unknown. Ask how the patient sees the world first before trying to make the patient feel better about that world.
Whereas facilitating the tree expression of a patient’s religious beliefs (choice C) is always a good idea, the physician does not yet know what this patient’s beliefs are. The physician is inappropriately directing a course of action, rather than first eliciting from the patient what she would consider appropriate.
This response uses Catholic theology to try to provide comfort to the patient (choice D). If the patient shares this belief system, it may well be effective. If the patient has different beliefs, it will be well shy of the mark and may even cause confusion rather than comfort. Ask before assuming.
This response uses behavior techniques to try to calm the patient (choice E) . While a positive end in its own right, this approach does not help the physician understand how to interact with the patient when she is calm. In addition, this type of suggestion, without context, may convey the impression that the physician simply wants the patient to be calm, but not that he wants to understand the reasons for her distress.
This response risks being perceived as blaming the patient (she is too old), and it does nothing to gain an understanding of how the patient sees the world (choice C)
This response ignores the patient’s distress and the religious issues raised (choice H) Yes, some decisions need to be made, but the physician needs to find out about the patient’s beliefs to have the ability to frame the various options.

Source: http://www.usmleworldwide.com/blog/?p=289

Usmle Step 1 MCQ's # 25

Title: Usmle Step 1 MCQ's # 25
Subject: Behavioral Science 

Q NO 25: A 16-year-old girl is brought to emergency room by her parents for severe right toot pain. The patient states that the pain started 1 day prior to presentation. She cannot recall any recent trauma, and denies any past medical or surgical problem. She is active and walks at least 1 hour daily in the nearby forest. She goes to high school and is doing very well. She gets along well with her parents except that they insist she should eat more as her weight has dropped from 130 to 105 pounds over the past year. Which of the following is the most likely diagnosis?

A. Conversion disorder
B. Depression with somatic manifestation
C. Injured medial ankle tendon
D. Metatarsal stress fracture
E. Tick bite 

Explanation: 
The correct answer is D. The patient is not eating well, as mentioned by her parents, and her weight loss (over 15% of baseline) as well as her school performance anil activity level, is consistent with anorexia nervosa. Metatarsal stress fracture is a complication of rigorous prolonged walking or running in this population. While she is malnourished and underweight, she has poor insight and continues to decrease her input and increase her output with prolonged physical activity. The fracture is a complication of increased output beyond the patient’s physical limitation.
Conversion disorder (choice A) is manifested by chronic neurologic pain or deficit without any objective organic cause. This patient’s chief complaint is acute pain without any sign of another neurologic deficit.
Diffuse muscle and joint aches in conjunction with lack of energy and reduced physical activity, is characteristic of depression (choice B). This patient’s pain is localized and she is very active.
Ruptured or injured tendon of the ankle is a common injury, but the patient does not recall any recent injury and localization of the pain is not consistent with medial ankle injury (choice C). 
The girl’s daily walking in the nearby forest raises suspicion for tick bite (choice E) and Lyme disease with secondary joint pain. Arthritis associated with Lyme disease is generally centered around joints, and does not present as acutely as in this patient.

Usmle Step 1 MCQ's # 24

Title: Usmle Step 1 MCQ's # 24
Subject: Behavioral Science

Q NO 24: A 70-year-old woman with a history of diabetes and alcoholism is sent to the emergency department by her chronic care facility. Stewards at her home report she has had “mental status changes.” These changes have evolved acutely but fluctuate widely. On mental status examination, the woman has deficiencies of recent memory, and a diminished level of awareness. During the inter view, her speech becomes nonsensical and she begins to describe visual hallucinations. Physical examination reveals fever and tachycardia. Which of the following best characterizes this patient’s condition?

A. Amnesia
B. Delirium
C. Dementia
D. Normal aging
E. Psychosis secondary to schizophrenia

Explanation:
The correct answer is B. Delirium is characterized by acute onset of mental status changes that wax and wane. It may present as impaired awareness easy distraction, confusion, and disturbances of perception such as illusions misinterpretations, and visual hallucinations. Recent memory is usually impaired, and speech may be rambling, perseverating, nonsensical pressured or incoherent. Patients may also be agitated or obtunded. The degree of awareness of their condition may fluctuate with time. Physical examination or laboratory studies usually reveal some organic cause for the delirium. Common causes of delirium include intoxication occult infection, head trauma seizure, mania, thyrotoxicosis, renal failure, hepatic failure, neoplasm, stroke, and shock.
Amnesia (choice A) may be due to head trauma, Korsakoff syndrome, transient global amnesia, or various other cerebral events. Head trauma produces retrograde as well as anterograde amnesia while post concussive syndrome is associated with mental dullness, poor memory, depressed mood, and headaches. This patient’s fever, isolated memory deficits, and lack of causal pathology makes the diagnosis of amnesia unlikely.
Dementia (choice C) in contrast to delirium, is a chronically progressive condition that produces a steady and lasting decline in short- and long-term memory. It is associated with a decline in social and occupational functioning. The patient’s sensorium remains intact in dementia. This patient has no long-term memory deficits and the course of the disease is fluctuating and acute. In addition, the patient has sensory disturbances (visual hallucinations). Thus, the diagnosis of dementia is incorrect.
Normal aging (choice D) does not produce the profound memory deficits and sensory deficits outlined here. Characterizing the patient’s constellation of symptoms as normal aging is incorrect.
Psychosis secondary to schizophrenia (choice E) does not characterize this patient’s findings. The altered sensorium of delirium tends to affect the visual modalities while the psychosis of schizophrenia typically affects the auditory’ system (auditory’ hallucinations).

Usmle Step 1 MCQ's # 23

Title: Usmle Step 1 MCQ's # 23
Subject: Behavioral Science

Q NO 24: A 35-year-old homeless and unemployed man comes into the emergency department, stating he needs to be in the hospital. He is very vague and makes poor eye contact. He reports being “suicidal, homicidal, and paranoid.” When the psychiatrist insists on more details about the symptoms, he gets irritable and threatens that if he leaves the hospital and kills somebody, the doctor will be blamed. He admits to using marijuana, crack, and cocaine occasionally, but not recently. His physical examination is unremarkable. During his interview, his associations are tight, and there is no evidence of psychotic symptoms. A urine drug screen is negative. Which of the following conditions should probably be ruled out first?

A. Delusional disorder
B. Factitious disorder
C. Malingering
D. Schizophrenia
E. Substance-induced mood disorder

Explanation:
The correct answer is C. Malingering is diagnosed when there is a voluntary production of physical or psychological symptoms to accomplish a specific goal. Patients are usually vague or have poorly localized complaints. They are easily irritated if a doctor is skeptical of the history
Delusional disorder (choice A) is characterized by one fixed and unshakable delusion. The delusion is non-bizarre and has to be present at least a month. A part from the impact of the delusion, the functioning is not markedly impaired in other areas of life.
Factitious disorder (choice B) is diagnosed when there is a deliberate production of symptoms to attain the sick role and meet unconscious needs. It can be present with physical or psychological symptoms and is associated with early parental abuse or rejection.
Schizophrenia (choice D) is defined by the presence of active symptoms of delusions, hallucinations, and disorganized speech or behavior in the past month. The continuous signs must be present longer than 6 months and cause significant impairment in social or occupational functioning.
Substance-induced mood disorder (choice E) refers to the mood induced shortly after the use of substances. Depending on the type of substance, the mood can be depressed or elated.

Usmle Step 1 MCQ's # 22

Title: Usmle Step 1 MCQ's # 22
Subject: Behavioral Science

Q NO 22: A 45-year-old man has been having problems staying asleep for the past year. He typically goes to bed alter watching the news at 11:30 PM and has no trouble tailing asleep, however, he keeps awakening and always feels tired all day while at work. His primary physician refers him to the university’ sleep center where an overnight polysomnogram is performed. During the study, he is found to have decreased stage 1 sleep, and decreased delta and REM sleep. He has frequent awakenings associated with gasping breaths, oxygen desaturations (monitored by pulse oximetry), and bradycardia. The best initial medical therapy for this problem would be which of the following?

A. Behavioral therapy
B. Imipramine
C. Tonsillectomy and adenoidectomy
D. Triazolam
E. Weight loss and use of continuous positive airway pressure (CPAP)

Explanation:
The correct answer is E. This is a classic description of a person with obstructive sleep apnea (OSA) syndrome. The patient is typically a middle-age, obese male who snores loudly during sleep. The problem stems from obstruction from tissues of the nasopharynx and hypopharynx. The obstruction results in significant periods of apnea associated with arterial hypoxemia and bradycardia. The patient may develop both system and pulmonary hypertension and is at a high risk of sudden death during sleep due to severe hypoxemia and arrhythmias. Often the patient will have a long apneic period followed by gasping respirations and awakening. This cycle repeats over the course of the night and therefore, the patient actually gets little sleep resulting in daytime somnolence. On a polysomnogram (multichannel recording of sleep), one sees a decrease in stage 1 sleep. This is the first stage on non-REM (NREM) sleep. Most adults spend most of the sleep cycle in stage 2 NREM sleep. Stage 3 and 4 NREM sleep is deep sleep and together constitutes delta sleep. The time in REM sleep gets longer as the night progresses and therefore occurs mostly during the last halt of the night. In OSAI we also see a decrease in delta sleep and REM sleep is also decreased. The initial medical treatment for OSA is weight loss with a trial of nasal prong or face mask continuous positive airway pressure (CPAP). Many are noncompliant with this therapy because the presence of the CPAP is felt to be uncomfortable and prevents the patient from falling asleep. Ultimately, one of several surgical procedures involving the removal of tissue from the naso- and hypopharynx may be performed.

Usmle Step 1 MCQ's # 21

Title: Usmle Step 1 MCQ's # 21
Subject: Behavioral Science

Q NO 21: A 15-year-old boy dies in an automobile accident. Following the boy’s death, his 12-year-old brother starts wearing the older boy’s leather jacket all of the time, no matter how warm the weather. This would be most likely to be an example of which of the following defense mechanisms?

A. Denial
B. Identification
C. Rationalization
D. Reaction formation
E. Sublimation

Explanation:
The correct answer is B. This is identification, which is the unconscious adoption of the characteristics or activities of not her person. It often is i mechanism for reducing the pain of separation or loss. Another example would be widow who takes over her husband’s voluntary work alter he dies.
Denial (choice A) is when a person behaves as it he does not know something he might reasonably be expected to know.
Rationalization (choice C) is the offering of a false but acceptable explanation for behavior.
Reaction formation (choice D) is the adoption of behavior opposite to that of one’s true feelings.
Sublimation (choice E) is the diversion of unacceptable impulses into acceptable outlets.

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Usmle Step 1 MCQ's # 20

Title: Usmle Step 1 MCQ's # 20
Subject: Behavioral Science

Q NO 20: A 36-year-old married woman complains to her physician that she is having trouble sleeping. A detailed history shows that her insomnia is sporadic and seems to be connected to cyclical stressors related to her working environment. The physician prescribes alprazolam to be taken “as needed.” The next day, the physician receives a distressed call from the patient. With anger in her voice, she tells the physician that the “pharmacist said that taking this medication might cancel out the effects of my birth control pills.” At this point the physician’s next response should be which of the following?

A. “I’m sorry. This is my fault. The problem is not yew likely given the dose level I prescribed and your only occasional use, but I should have discussed this issue with you before.”
B. “It’s not the pharmacist’s job to be tinkering with your medications. I suggest you have the prescription filled somewhere else.”
C. “Its really such a small chance that it is not worth woring about.”
D, “Really, its nothing to worry about. I’ll call the pharmacist and work it out.”
E. “Really, there is no problem here .Pharmacists just like to show what they know.”
F. “The pharmacist is being overly cautious. As long as you take both medications as I prescribed them for you, you will have no problem.”
G. “Well, if you don’t like the drug I prescribed, what would you rather have?”
H. “You seem angry about this. Tell me more about what you are feeling right now.”

Explanation:
The correct answer is A. Always admit a mistake. In this case the physician erred in not discussing the interaction of the new prescription with other drugs the patient was taking. The right answer starts by admitting the mistake, moves on to provide the necessary information to the patient, and closes by admitting the mistake again. Physicians are only human. Mistakes do unfortunately happen. Within the context of a good relationship with the patient, most mistakes can be openly discussed and corrected. By this discussion, the physician-patient relationship is strengthened.
Choices B, E, and F are defensive. Worse, they do not even acknowledge the mistake, and miss the opportunity’ to educate the patient. Denigrating the pharmacist, who is correctly doing his job, seeks to hide the mistake rather than correcting it.
Choice C provides an explanation without admitting any mistake was made. If the physician wants honesty from the patient, he must provide it in turn. Admit the error and then correct it.
Choice D suggests both that there is no problem, and that the physician will talk with the pharmacist and solve it. It is deceitful. No mistake is admitted, and the chance to educate the patient is lost.
In choice G again, no mistake is admitted. FR at her than educating the patient the physician asks the patient to prescribe for herself. The physician is the one with the expertise, and must lay out options from which the patient can choose. Ideally this should have been done before the alprazolam was prescribed.
Discussing the patient’s feelings (choice H) is off the point, and avoids dealing with the mistake. The error not the patient’s feelings about it, should be the first focus of the discussion.

Usmle Step 1 MCQ's # 19

Title: Usmle Step 1 MCQ's # 19
Subject: Behavioral Science

Q NO 19: A 60-year-old male executive with a history of angina pectoris and depression had bypass surgery the previous day. His depression has responded well to selective serotonin reuptake inhibitors (SSRIs) and there is no history of psychosis in the past. He now presents with confusion, agitation, irritability, and tries to remove his IV lines. His level of consciousness fluctuates, and at times he forgets who he is. He is given a neuroleptic drug, and appears much improved. What is the most likely diagnosis?

A. Adjustment disorder
B. Delirium
C. Dementia
D. Exacerbation of depression with suicidal ideation and psychotic features
E. Schizophrenia

Explanation:
The correct answer is B. Delirium is a common complication of general anesthesia and surgery. It is manifested by acute changes in mental status with waxing and waning level of consciousness, agitation, irritability, and psychosis. Patients usually respond to low-dose neuroleptics to achieve sedation. The course is self-limited.
Any psychosocial or biological stressor can lead to adjustment disorder (choice A). This patient’s surgery will restrict his level of functioning, at least in the short term. This will be difficult for a high-functioning individual to accept. Adjustment disorder may present with depressive mood, anxiety, and irritability, but a fluctuating level of consciousness is not a feature of this disorder.
Dementia (choice C) can present with irritability, confusion, and agitation, but usually has an insidious course and affects mainly cognition. In contrast to delirium, it does not have a fluctuating course.
Severe depression can present with irritability, suicidal ideation, and psychotic features (choice D) . The patient has a history of depression that responded well to SSRIs and he has no prior history of psychosis. He was motivated to undergo cardiac surgery, so removing his IV lines is unlikely to be a manifestation of suicidal ideation.
Schizophrenia (choice E) presents with bizarre behavior, hallucinations, and delusions. It usually starts at a younger age than the acute symptoms in this patient, and is characterized by progressive deterioration in functioning. It is unlikely for a schizophrenic to achieve the functional level of an executive.

Usmle Step 1 MCQ's # 18

Title: Usmle Step 1 MCQ's # 18
Subject: Behavioral Science

Q NO 18: A 25-year-old male presents to his family physician with the following statement “Doctor, I can’t urinate in public restrooms. I can if there is no one around, but if I go to the restroom in a movie, an airport, at the ball park or anywhere that someone else comes in, I can’t urinate. Even if I have already started, it just stops and I can’t get it going until the other person leaves. I am so embarrassed. What do they think of me if they see I can’t do what every other man can do?” Which of the following is the most likely diagnosis?

A. Anxiety disorder due to a general medical condition
B. Panic disorder
C. Social phobia
D. Specific phobia
E. Substance-induced anxiety disorder

Explanation:
The correct answer is C. In the condition described, a person is in a social situation and fears that he or she will not be able to perform in the same manner as most everyone else can. The two most common social phobias concern public speaking and restroom performance (sometimes called “shy bladder”.)
Anxiety disorder due to a general medical condition (choice A) is diagnosed when a medical condition precipitates anxiety, e.g., hypoglycemia.
Panic disorder (choice B) is characterized by sudden paroxysms of anxiety. It can strike unexpectedly in uncued situations so it would not occur only when others are present.
Specific phobias (choice D) are unreasonable tears of some identifiable thing, not situation (e.g., elevators).
Substance-induced anxiety disorder (choice E) is diagnosed when anxiety is precipitated by ingestion of a psychoactive substance e.g. hallucinogens.

Usmle Step 1 MCQ's # 17

Title: Usmle Step 1 MCQ's # 17
Subject: Behavioral Science

Q NO 17: A 1 6-year-old girl comes to see her physician for a standard physical examination prior to attending summer camp. The examination is unremarkable. The girl tails within the normal range for height and weight. The physician notes that she has had menses for the past4years.Asthe girl is getting dressed, the physician sits and completes the required forms for the camp. When handed the completed forms, the girl thanks the physician and says, “Just one more thing. Could you also give me a prescription for birth control pills? I’m going to camp with my boyfriend and want to be prepared. And please, please, don’t tell my parents!” The physician’s most appropriate reply would be which of the following?

A. “Before I write you that type of prescription, I’d like to examine your boyfriend first.”
B. “How long have you been having sexual relations with your boyfriend?”
C. “I can only give you a prescription like that if I have your parents’ permission. Let’s set up a time to talk with them.”
D. “I wish you would reconsider. Sex before marriage can be yew complicated.”
E. “I’ll be glad to give you the prescription, but I want you to discuss things with your parents first.”
F. “I’ll be happy to give you a prescription, but let’s talk about some important issues first.”
“I’ll make a decision about the prescription after I have a discussion with you and your boyfriend. When should we schedule that?”
‘H. “I’m pleased that you are responsible enough to be prepared. I’ll be happy to give you the prescription and see no reason to tell your parents.”

Explanation:
The correct answer is F. Core to this question is the contrast between what the laws allow and what the good practice of medicine demands. Simply doing what the law allows is not enough. The physician must act in such a way as to anticipate the needs of the patient even beyond the manifest presentation.
Under the partial emancipation rules any minor between the ages of 15 and 17 can make medical decisions for themselves in four areas without parental involvement or notification. The four areas are: STD treatment substance abuse treatment birth control and prenatal care. Under this rule, the law allows the physician to write this girl the prescription for birth control pills without parental notification. However, the best answer requires more from the physician. The girl is so certain to become sexually active that she asks for birth control pills. Surely she needs something more from the physician than just a prescription. She needs counseling, advice, and information about other birth control methods especially barrier methods. The prescription should not be given without the discussion of these issues first. Note that the physician’s job is not to lecture here, but to find out what the girl already knows and to give her what ever information she is lacking.
The girl is the patient. The boyfriend (choice A) is not. This is not a request that is usually made before giving a birth control prescription and it is inappropriate here.
This question (choice B) maybe asked in the course of a discussion, possibly to determine if the girl should be screened for any sexually transmitted diseases, but it is an inappropriate lead-off comment.
Choice C is not what the law says, and so the physician is lying. However, encouraging the girl to discuss these issues with her parents is a good idea.
This response sets a moralistic scolding tone (choice D) . It is not the physician’s job to tell the girl what her conduct should be. Rather the girl should be provided with information and a listening ear it she has any questions.
The parents (choice E) need not be involved. The idea behind partial emancipation is to encourage behavior important for public health. It every girl had to ask her parents, she might hesitate to do so, and the number of out-of-wedlock births would rise.
Encouraging the girl to discuss important issues with her boy friend is a good idea.Mandating that it must happen, and in the physician’s presence (choice G) is unduly intrusive.
Yes, you can write the prescription, but more is required than is in choice H . Discussion, counseling, advice, and information should also be dispensed.

Usmle Step 1 MCQ's # 16

Title: Usmle Step 1 MCQ's # 16
Subject: Behavioral Science

Q NO 16: In a restaurant, a 3-year-old child screams shrilly as loudly as she can. The mother gives the child a piece of cookie each time she screams. Which of the following types of reinforcement does the mother receive when the child stops screaming?

A. Aversive
B. Fixed interval
C. Negative
D. Positive
E. Variable Ratio

Explanation:
The correct answer is C. When the child takes away the shrill screaming (which was aversive to the mother) it is reinforcing to the mother and guarantees that the mother will continue the behavior (giving a piece of cookie) which will guarantee that the child will continue to scream. Since the reinforcing event is the removal of an aversive stimulus this is called negative reinforcement.
Aversive reinforcement (choice A) involves doing something that the child would not like e.g. giving a spanking.
Fixed interval reinforcement (choice B) implies that a given amount of time goes by before reinforcement is available.
There is no positive reinforcement (choice D) for the mother because nothing that she wants is being given. What is reinforcing to her is the fact that something she does not want is being taken away.
A variable ratio (choice E) reinforcement schedule means that the child would only stop screaming sometimes when given a cookie (on a schedule that the mother could not predict).

Usmle Step 1 MCQ's # 15

Title: Usmle Step 1 MCQ's # 15
Subject: Behavioral Science

Q NO 15: A 22-year-old college student sometimes experiences a yew vivid and detailed hallucination of her room upon waking. She has learned to recognize the experience as a hallucination because often some details will be inappropriate, such as summer clothes on the chair when she knows it is December. This is an example of which of the following types of hallucination?

A. Hypnagogic hallucination
B. Hypnopompic hallucination
C. Second person auditory hallucination
D. Tactile hallucination
E. Third person auditory hallucination

Explanation:
The correct answer is B. This hallucination occurs on waking, making it a hypnopompic hallucination; hypnagogic hallucinations occur on going to sleep. These hallucinations are most often brief and simple, such as hearing a bell ring ora name called. However, they can be complex and of long duration, such as the one in the question stem. They can be accompanied by sleep paralysis (episodes of paralysis on awakening) and can be difficult to get out of , even when recognized. There is also a known cluster of cataplexy (episodic paralysis), sleep paralysis, hypnagogic/hypnopompic hallucinations, and narcolepsy (extreme drowsiness with repeated episodes of falling asleep).
Hypnagogic hallucinations (choice A) occur in going to sleep.
In second person auditory hallucinations (choice C) 1the person is directly addressed by a voice.
Tactile hallucinations (choice D) involve touch.
In third person auditory hallucinations (choice E) voices talk about the person.

Usmle Step 1 MCQ's # 14

Title: Usmle Step 1 MCQ's # 14
Subject: Behavioral Science

Q NO 14: A 78 year-old woman complains to her physician of not feeling rested after a night’s sleep. Physical examination and routine laboratory studies are unremarkable. The physician explains to her that the sleep patterns of normal elderly persons differ from those of younger individuals in which of the following ways?

A. Increased need for sleep

B. Increased REM sleep

C. More arousal and awakening at night

D. More total nighttime sleep

E. Significant sleep disturbances are more common

Explanation:

The correct answer is C. Sleep patterns differ from person to person, however some generalizations can be made regarding age and sleep. Elderly individuals have more awakening and arousal at night, they tend to awaken earlier, and have less total sleep. Multiple factors can contribute to sleep disturbances in the elderly, including primary sleep disorders sleep disorders secondary to other physical and psychiatric conditions, as well as medication-induced sleep problems.

With increased age, the needs for sleep decreases (compare with choice A). A newborn might sleep up to 22 hours daily, but an adult can generally feel rested with 6 to 8 hours of sleep.

The amount of time spent in REM sleep decreases with age (compare with choice B)’ starting at about age 50.

The elderly generally achieve less total nighttime sleep (compare with choice D).

Mild sleep disturbances (compare with choice E ) can be associated with normal aging, however any significant sleep disturbance that impairs daily activity or causes increased daily sleepiness requires further evaluation.