Insomnia/TIA, CVA, Parkinson's Overview

Question 1

what stages do elderly not spend as much time in later in life?

Answer 1

Stage 3 and 4

Question 2

Do elderly get the same amount of sleep?

Answer 2

Yes, but have decreased sleep efficiency (time in bed increases)

Question 3

Are insomnia or excessive daytime somnolence a normal part of aging?

Answer 3

No

Question 4

what should you ask patient/ sleep partner about?

Answer 4

Night time coughing
unusual movement
snoring
SOB when supine/ awakens patient from sleep

Question 5

will patients always know they are waking up?

Answer 5

No

Question 6

If patients report excessive daytime sleepiness what should you do?

Answer 6

Still evaluate and get a sleep study

may have sleep apnea, etc.

Question 7

2 main type of treatments for insomnia

Answer 7

Pharmocologic (best for primary)

Psychological

Question 8

if insomnia is due to acute distress what should you start with?

Answer 8

pharmacologic

Question 9

what can happen with benzos when they stop taking them?

Answer 9

rebound insomnia

Question 10

falls and fractures are less likely with what types of benzos

Answer 10

short acting

Question 11

episodes of either cessation or marked decreased airflow during sleep. Caused by upper airway obstruction or central (mor uncommon)

Answer 11

sleep apnea

Question 12

risk factors of OSA

Answer 12

Obesity
large neck circumference
structural factors related to nasal obstruction
male
postmenopausal state
smoke

Question 13

3 cardinal symptoms of OSA

Answer 13

snoring
sleepiness
noticed by bed partner

Question 14

Diagnosis for OSA

Answer 14

polysomnography

Question 15

should you treat a patient with OSA without symptoms?

Answer 15

Yes

Question 16

treatment for OSA

Answer 16

weight loss
discontinue sedative- hypnotics
avoidance of alcohol/ sedative use
non-supine sleeping position 
CPAP
Surgery

Question 17

itchy, scratchy, crawly sensation of legs so they can’t sleep

Answer 17

Restless leg syndrome

Question 18

fall asleep and then do the “river dance”, leg jerks around patients from sleep

Answer 18

PLMD

Question 19

tx for RLS

Answer 19

dopamine agonists (pramipexole, ropinirole)
levodopa/ carbidopa
anticonvulsants

Question 20

what are some types of embolisms

Answer 20

fats
amniotic fluid
air
valvular vegetation

Question 21

most common places for a clot to get stucks

Answer 21

carotid

posterior circulation

Question 22

contralateral hemiparesis/ leg, UI, confusion, poor judgement, mutism

Answer 22

ACA

Question 23

contralateral hemiparesis/ arm and face, aphasia/dominant hemisphere or apraxia

Answer 23

MCA

Question 24

monocular blindness (amaurosis)

Answer 24

ophthalmic (MCA branch)

Question 25

U/L or B/L CN deficits (Nystamgus, vertigo, dysarthria, diploplia) ataxia, limbs, sensroya nd motor deficits, altereted consciousness

Answer 25

vertebrobasilar

Question 26

motor hemiparesis, sensory hemianthestsia

Answer 26

lacunar infarcts

Question 27

aneurysm found, will often present later 30s early 40s, will often present in coma

Answer 27

Barry’s aneurysm

Question 28

most people with TIAs will have a stroke within what time?

Answer 28

6 month to a year

Question 29

presents with thunderclap HA w/ altered consciousness

Answer 29

SAH

Question 30

what is the pathophys condition with parkinson’s?

Answer 30

synucleinopathy