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Adult ADHD — USMLE Step 3 MCQ

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HardPsychiatry (Outpatient Management)Adult ADHDUSMLE Step 3

A 27-year-old woman has irresistible daytime sleep episodes and emotion-triggered loss of muscle tone. She reports adequate sleep and has stopped REM-suppressing medication under supervision. What testing best confirms the suspected diagnosis?

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Correct answer: A — Use overnight polysomnography followed the next day by standardized MSLT

The best answer is “Use overnight polysomnography followed the next day by standardized MSLT”. Cataplexy suggests narcolepsy. Proper testing uses overnight polysomnography to exclude competing disorders and document adequate sleep, followed by MSLT under standardized conditions. Narcolepsy evaluation uses attended overnight polysomnography followed by a properly prepared MSLT.

Reference: AASM Recommended Protocols for MSLT/MWT: https://pmc.ncbi.nlm.nih.gov/articles/PMC8726366/