A 24-Year-Old Man Comes to the Physician Due to Excessive

A 24-year-old man comes to the physician due to excessive daytime sleepiness.  The patient is a college student whose symptoms started around age 12, when he began needing more sleep than his peers to feel refreshed.  Two years later, he started having daily episodes of sudden weakness, consistently triggered by laughter or crying, in which his head would nod or his knees would buckle for about 30 seconds.  The patient also describes times when he was unable to move for several minutes after awakening from sleep.  He mentions nightly dreams that seem very real, often featuring activities that he had been engaged in during the preceding day.  If measured, which of the following compounds is most likely to be abnormal in this patient's cerebrospinal fluid?

A) 5-hydroxyindoleacetic acid
B) 14-3-3 protein
C) Homovanillic acid
D) Hypocretin-1
E) Melatonin

Correct Answer:

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