Neurology Q 6

A 51-year-old woman is evaluated for a 1-year history of daily afternoon fatigue that necessitates frequent naps and impairs her concentration at the office, where she works as a lawyer. Lifestyle adjustments, such as improving sleep hygiene, getting regular exercise, yoga, and vitamin supplementation have not resolved this symptom. She has a 5-year history of multiple sclerosis. Medications are glatiramer acetate and a vitamin D supplement.

On physical examination, vital signs are normal. Depression screening is negative. The remainder of the physical examination is noncontributory.

Results of laboratory studies, including hemoglobin and serum thyroid-stimulating hormone levels, are unremarkable.

A 51-year-old woman is evaluated for a 1-year history of daily afternoon fatigue that necessitates frequent naps and impairs her concentration at the office, where she works as a lawyer. Lifestyle adjustments, such as improving sleep hygiene, getting regular exercise, yoga, and vitamin supplementation have not resolved this symptom. She has a 5-year history of multiple sclerosis. Medications are glatiramer acetate and a vitamin D supplement. On physical examination, vital signs are normal. Depression screening is negative. The remainder of the physical examination is noncontributory. Results of laboratory studies, including hemoglobin and serum thyroid-stimulating hormone levels, are unremarkable.

Which of the following is the most appropriate management?

A Baclofen

B Memantine

C Modafinil

D Substitution of an interferon beta for the glatiramer acetate

E Tetrahydrocannabinol-cannabidiol combination

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