exam 3 questions

Question 1

Which of the following is most likely to promote sleep under normal physiological condiitons
a) cold-sensitive neurons
b) rhinovirus
c) cortisol
d) IL-10
e) TNF-alpha

Answer 1

e) TNF-alpha - proinflammatory - promotes NREM

• IL-10 is antiinflammatory – decrease NREM sleep

Question 2

If you were a physician at the Mayo Clinic performing an elective surgery on a patient from a royal family from the Middle East who just flew in the day before, during what time of day might you want to conduct the surgery to reduce the time of recovery?
a) Biological night of patient
b) Biological day of patient
c) At the end of the workday in the early evening, local time
d) In the second half of the workday in the late afternoon, local time

Answer 2

b) Biological day of patient - wounds and surgeries heal quicker in the biological day because the immune system is more active and efficient at killing off potential pathogens

Question 2

Viral infection has been shown to alter which stage in mice and humans?
a) N2
b) REM
c) Passive Sleep
d) N1
e) N3
f) Active Sleep

Answer 2

e) N3 - an immune response to a pathogen mediated by proinflammatories occurs during N3/SWS. One study concluded viral infection reduced REM in mice, but that’s not true in both mice and humans

Question 3

You are a physician. Whom of your patients is most likely to present with nocturnal enuresis and require some type of treatment?
a) 4 year-old boy
b) 10 year-old girl
c) 10 year-old boy
d) 4 year-old girl

Answer 3

c) 10 year-old boy - males are more likely to have nocturnal enuresis than females, and it’s developmental, so there’s no need for treatment until about 10 yrs old or so

Question 4

NREM parasomnias such as sleepwalking primarily result from REM phenomena bleeding into NREM sleep
a) True
b) False

Answer 4

b) false – result from NREM bleeding into wakefulness a bit, although not full wakefulness, because sleepwalking is still considered sleepb.

Question 5

A common diagnostic test used in the diagnosis of hypersomnia is

a) blood test for inflammatory markers
b) MLST
c) KSS
d) blood test for orexin levels

Answer 5

b) MLST – can tell how sleepy someone is

Question 6

Which of the following is an effective treatment strategy to increase sleep duration in patients with insomnia?
a) Consistent bedtime and sleeping in as long as possible in the morning
b) Sleep restriction therapy
c) Intermittent total sleep deprivation therapy
d) Relaxation therapy

Answer 6

b) Sleep restriction therapy - make those who can’t seem to sleep so sleepy that they eventually fall aslee

Question 7

Patients with shift work disorder present with worse insomnia and waking sleepiness than shift workers without shift work disorder, but the incidence of medical problems is the same between the patients and non-patients
a) False
b) True

Answer 7

a) false

Question 8

A shift working nurse who rotates between day and night shifts was exposed to COVID-19 when he was not wearing personal protective equipment. When are they most likely to be at higher risk of having a higher virus load?
a) Night
b) Day
c) All shifts are likely to result in the same viral loadc.

Answer 8

a) Night - the immune system isn’t as strong at this time

Question 9

Since narcolepsy is considered an autoimmune disease, the frontline treatments used to treat narcolepsy include treatments also used for treatment of multiple sclerosis (e.g. interferons and glatiramer acetate), which are designed to shift the immune balance toward an anti-inflammatory response
a) True
b) False

Answer 9

b) false

Question 10

Craniofacial abnormalities are a mechanism that, most likely, underlies which of the following disorders?
a) Bruxism
b) Narcolepsy
c) Obstructive sleep apnea
d) Night eating disorder
e) Incoherent sleep talking

Answer 10

c) obstructive sleep apnea

Question 11

A flat line on the nasal pressure trace with evidence of abdominal and thoracic effort on traces of a polysomnogram most represents which of the following sleep disorders?
a) Hypopnea
b) Obstructive sleep apnea
c) Chronic obstructive pulmonary disease
d) High-altitude pulmonary edema
e) Central sleep apnea

Answer 11

e) Obstructive sleep apnea - no breathing but still respiratory effort

*if central sleep apnea there would be no effort to breathe and a clear breath

Question 12

Who is at greatest risk for sleep apnea?
a) A 25-year-old male lineman in the National Football League
b) A female in her 40s
c) A male going through puberty
d) A female striker in the National Women’s Soccer League

Answer 12

a) A 25-year-old male lineman in the National Football League - linemen tend to have large necks

Question 13

A woman who sleepwalks with a prupose may have the following sleep disorder

a) sleep-related eating disorder
b) reverse sleep paralysis disorder
c) shift-work sleep disorder
d) night-eating disorder
e) narcolepsy

Answer 13

a) sleep related eating disorder

*not night-eating disorder b/c w/ a purpose but doesnt occur during sleep, like sleepwalking does. occurs during wakefulness

Question 14

Jet lag is caused solely by a misalignment between the SCN clock and the light-dark cycle in the new time-zone
a) False
b) True

Answer 14

a) False - jet lag is a combination of internal desynchrony (all peripheral clocks are desynchronized)

Question 15

If a woman has untreated insomnia as a young adult, which medical problem is she at greater risk for developing two decades in the future?
a) depression
b) morbid obesity
c) sleep talking
d) REM behavior disorder

Answer 15

a) depression

Question 16

Constant positive air pressure has been shown to impact which health biomarker(s)?
a) orexin levels
b) CRP
c) IL-6
d) LDL

Answer 16

b) CRP, c) IL-6

Question 17

How does sleep-loss influence the acquired immune response
a) No impact of sleep loss on the acquired immune response
b) Sleep-loss increases inflammatory cytokines, and thus, increases antibody levels
c) Sleep-loss after vaccination reduces antibody levels
d) Sleep-loss prior to vaccination reduces antibody levels

Answer 17

c and d

Question 18

A person presents to the clinic with a complaint of involuntary sleep attacks. What symptoms would you ask to help distinguish between a probable diagnosis of obstructive sleep apnea versus narcolepsy?
a) ESS > 10
b) MSLT < 8 mins
c) Hypnagogic hallucinations
d) Sleep onset REM

Answer 18

wrong a) ESS > 10 - a person with OSA would have this also
wrong b) MSLT < 8 mins - a person with OSA would have this also
c) Hypnagogic hallucinations - hallmark of narcolepsy; hallucinating because not enough sleep
d) Sleep onset REM - goes right into deep-sleep REM because cannot stay awake

Question 19

What is the most common treatment option for narcolepsy
a) Modanifil
b) orexin antagonist
c) CPAP
d) Power naps

Answer 19

a) Modanifil- promotes wakefulness, helps with narcolepsy, which is the inability to stay awake

Question 20

You are going to take a trip to Stockholm but do not want to deal with jet lag during your trip. What can you do to reduce the number of days to adapt prior to your travel
a) Go to bed and wake up later by 1 hr per day and evening light exposure
b) Go to bed and wake up earlier by 1 hr per day and evening light exposure
c) Go to bed and wake up later by 1 hr per day and morning light exposure
d) Go to bed and wake up earlier by 1 hr per day and morning light exposure

Answer 20

d) Go to bed and wake up earlier by 1 hr per day and morning light exposure – morning light exposure because phase advance, and going to bed and waking up earlier by 1 hr per day

Question 21

The common _ genetic variant rs10830963 is associated with an increased risk of Type 2 Diabetes (T2D)
a) Hctr2 (hypocretin receptor 2)
b) Beta-2 (adrenergic receptor)
c) MTNR1B (melatonin receptor)
d) 5-HT2 (serotonin receptor

Answer 21

c) MTNR1B (melatonin receptor)

Question 22

This type of temperature sensitive neuron will promote sleep
a) hot
b) cold
c) warm
d) cool

Answer 22

c) warm - cozy

Question 23

Change in Autonomic Nervous System (ANS) activity during sleep in the early morning hours prior to habitual awakening may contribute to nocturnal asthma by which mechanism?
a) Increase in growth hormone levels
b) NREM atonia
c) Increase responsiveness to hypercapnia
d) Dip in catecholamines

Answer 23

d) Dip in catecholamines - dip in E/NE may cause bronchoconstriction (E/NE are major bronchodilators), which can lead to asthma

Question 24

Due to loss of descending drive, central chemoreception to extracellular carbon dioxide is lost during ___.
a) REM
b) SWS
c) Exercise during the biological night
d) Never

Answer 24

a) REM - during REM, you lose the ability to thermoregulate and metabolically regulate, so carbon dioxide detection abilities are lost

Question 25

A young adult with a delayed circadian phase maintains advanced bed and wake times due to works scheduel responsibilities. She is most likely to present with which of the following sleep problems:
a) delayed
b) sleep onset insomnia
c) early morning awakening
d) sleep maintence insomnia

Answer 25

b) sleep onset insomnia – because they’re going to bed before their DLMO, since they maintain advance bedtimes. They go to bed before they’re physiologically tired and ready to go to bed, so when they try to sleep (sleep onset), they can’t, and the result is insomnia (can’t sleep)

Question 26

If you were to awaken two hours earlier than typical, the following would likely happen…
a) an acute increase in growth hormone levels
b) an acute increase in melatonin in response to the transition from dark to light
c) a reduction in glucose levels
d) a reduction in insulin sensititivity

Answer 26

d) a reduction in insulin sensitivity

Question 27

Individuals are most vulnerable to experiencing presyncope symptoms during
a) sleep
b) biological night
c) biological day

Answer 27

b) biological night

Question 28

Recent research has shown that weekend recovery sleep is an effective strategy when someone gets too little sleep during the school week (e.g. it helps with glucose regulation during the next week compared to when no weekend recovery sleep was obtained)
a) True
b) False

Answer 28

b) false

Question 29

Leptin levels are _ during circadian misalignment, which could _ food intake
a) Lower; decrease
b) Higher; increase
c) Lower; increase
d) higher;decrease

Answer 29

c) Lower; increase - people are often hungry when their circadian clock is misaligned, so leptin (secreted when full) would be lower, increasing food intake

Question 30

Insufficient sleep increases the risk of cardiovascular disease by which of the following?
a) Increased melatonin levels
b) Reduced CRP levels
c) Reduced reactive oxygen species
d) Impaired nitric-oxide-mediated endothelium-dependent vasodilation .

Answer 30

d) Impaired nitric-oxide-mediated endothelium-dependent vasodilation - impaired vasodilation could mean increased vasoconstriction and higher blood pressure, thereby leading to the potential risk for cardiovascular diseased.

Question 31

Which of the following have been shown to decrease blood pressure?
a) TNF-alpha agonist
b) Daily administration of exogenous melatonin
c) Sleep extension in people with short sleep schedules
d) An increased AHI in sleep apnea patients

Answer 31

a) TNF-alpha agonist - promoting inflammation will increase blood pressure
**correct b) Daily administration of exogenous melatonin - melatonin promotes sleep and decreases blood pressure **
c) Sleep extension in people with short sleep schedules - promoting more sleep will promote decreased blood pressure
d) An increased AHI in sleep apnea patients - an increase in the apnea/hypopnea index will increase blood pressure, since people can’t breathe, or breathe less

Question 32

The recommended position for sleeping infants to reduce the risk of SIDS is which of the following
a) stomach
b) back

Answer 32

b) back

Question 33

SIDS is thought to be associated with which of the following
a) alterations of noreipinephrine neurons
b) alteraterations of adenosine neurons
c) alteraterations of seratonin neurons
d) alteraterations of acetylcholine neurons

Answer 33

c) alteraterations of seratonin neurons - both start with the letter “S”

Question 34

Human typically go to sleep in the
a) rising limb of the blood pressure rhythm
b) Descending limb of the core temperature rhythm
c) Rising limb of the cortisol rhythm
d) Descending limb of the distal temperature rhythm

Answer 34

a) rising limb of the blood pressure rhythm - rising blood pressure would impair entry into sleep
correct b) Descending limb of the core temperature rhythm - core body temperature is decreasing and peripheral skin temperature is increasing, making sleep more comfortable
c) Rising limb of the cortisol rhythm - rising cortisol, a strongly circadian-regulated stress hormone, would inhibit entry into sleep
d) Descending limb of the distal temperature rhythm - descending distal temperature rhythm may indicate that the core is heating up, which would inhibit sleep

Question 35

Based on your knowledge of sleep and thermoregulatory physiology, cold hands and feet would do which of the following to sleep onset latency?

a) Reduce
b) Increase
c) No change

Answer 35

b) Increase - cold limbs would mean the peripheral skin temperature gradient is decreasing (i.e. getting colder) and the core temperature gradient is increasing (i.e. getting warmer), which would inhibit sleep and therefore increase the time it takes to fall asleep by increasing sleep latency

Question 36

The sleep disturbing effects of caffeins is (are) associated with which of the following?
a) Decreased core temperature
b) Increased core temperature
c) Narrower DPG (less negative)
d) Wider DPG (more negative)

Answer 36

a) Decreased core temperature - will help sleep
CORRECT b) Increased core temperature - will disturb sleep
c) Narrower DPG (less negative) - a narrower, less negative distal/proximal gradient is associated with sleep, not sleep disturbance
CORRECT d) Wider DPG (more negative) - you’ll always have a negative DPG. Your proximal is always higher than your distal, so, if you’re vasoconstricting, you’re going to have a greater distance between proximal and distal, so it’ll be more negative. A wider DPG is typically associated with arousal and wakefulness

Question 37

Sleep _ sympathtic tone (SNA or MSNA) and sympathetic tone is _ in REM Sleep.
a) increases;lowest
b) increases; highest
c) reduces; highest
d) reduces;lowest

Answer 37

c) reduces; highest – SNA amplitude increases during wakefulness and decreases during sleep, as the nerve activity is greater when someone is active and awake. Sympathetic tone is highest during REM because REM is a physiologically-active sleep state

Question 38

During REM sleep, metabolic responses to cold stresses are __ _.

a) stable
b) enhanced
c) surpressed
d) irregular

Answer 38

c) supressed - you lose the ability to have metabolic regulation in REM, and dont have a metabolic response