American Board of Internal Medicine (ABIM) Certification Practice Exam

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Which pharmacologic treatment is used for fatigue associated with multiple sclerosis?

Tricyclic antidepressants
Modafinil
Gabapentin
Oxybutynin

The correct answer is: Modafinil

Modafinil is a medication that is often used to treat excessive daytime sleepiness and fatigue in conditions like narcolepsy, but it also has been studied and found effective for fatigue related to multiple sclerosis (MS). Fatigue is a common and disabling symptom for many individuals with MS, impacting quality of life and daily functioning. Modafinil works as a wakefulness-promoting agent and is considered to have a better side effect profile compared to traditional stimulants. It helps enhance alertness and reduce the perception of fatigue without the sedative effects associated with some other treatments. The use of modafinil in MS-related fatigue is supported by clinical studies showing improvements in both subjective and objective measures of fatigue in patients with MS. Other pharmacologic options for treating fatigue in MS, while potentially helpful, do not directly target the specific mechanisms contributing to MS-related fatigue or lack the same level of evidence supporting their use in this context.