Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Excessive Daytime Sleepiness Exfoliative Dermatitis 561

tests

■Lab testing unremarkable

■Brain imaging normal

■Sleep lab studies helpful if sleep apnea or restless legs syndrome

suspected

differential diagnosis

■Sleep deprivation excluded by history

■Sleep apnea & narcolepsy diagnosed by history & sleep study

■Meds or drugs (esp benzodiazepines, antidepressants, narcotics,

antihistamines, some antihypertensives, anticonvulsants, alcohol)

excluded clinically

■Hypothyroidism, anemia, renal or hepatic failure, diabetes, pul-

monary insufficiency excluded clinically

■Periodic limb movements in sleep (assoc w/ restless legs syndrome)

excluded by history & sleep study

■Anxiety disorders & depression excluded clinically

management

■Depends on cause

specific therapy

■Narcolepsy: see “Narcolepsy” section

■Sleep apnea

➣Avoid alcohol & other CNS depressant drugs

➣CPAP-assisted ventilation at night

➣Uvulopalatopharyngoplasty

follow-up

■Depends on severity & cause

complications and prognosis

■Depend on cause

Exfoliative Dermatitis.................................

J. MARK JACKSON, MD

history & physical

■History – pruritic eruption, patient may consider contact as a possi-

bility