Mehl. bullet: sleep disorders Flashcards
M. Mechanism of narcolepsy?
deficiency of orexin (hypocretin).
M. Diagnosis of narcolepsy?
polysomnography.
M. What is cataplexy?
Loss of muscle tone usually in response to emotional stimulus (e.g., laughter), seen in narcolepsy.
M. cataplexy seen in what?
seen in narcolepsy.
M. Polysomnography findings in narcolepsy? REM and sleep latency?
REM latency: decreased
sleep latency: decreased
M. 16M + BMI 31 + snores loudly + morning headaches + 3-5 beats of jerk nystagmus with lateral gaze; Dx?
sleep-related hypoventilation”; nystagmus is weird finding, but it’s on the Psych NBME; morning headaches are common in sleep-related hypoventilation; can do polysomnography to diagnose.
M. 42F + 3-month Hx of insomnia + discomfort while lying in bed; next best step in management?
check serum iron and ferritin levels; student says wtf? –> restless leg syndrome is most often caused by iron deficiency.
M. 42F + 3-month Hx of insomnia + discomfort while lying in bed + serum iron and ferritin are normal; next best step in management?
D2 agonist – i.e., pramipexole or ropinirole, etc.
M. Patient with restless leg syndrome is at increased risk for what disease later in life?
answer on USMLE = Parkinson disease (if D2 agonist can Tx, then lack of dopamine transmission may be etiology in some patients).
M. 35F + family member Dx with breast cancer + says she can’t sleep; Q asks which med to give?
clonazepam -> benzo OK for acute Tx of insomnia; never prescribe chronically.
answer on Psych NBME
M. 35M + recently divorced + stressed + insomnia; which med to give?
answers are SSRI, antipsychotic, and zolpidem;
correct answer = zolpidem -> non-benzo zolpidem may be used short-term for insomnia. Take home point is be aware both benzo + non-benzo can be used acutely for insomnia.
M. 59M + wife says he has bizarre behavior at night where he jumps out of bed and runs back and forth across the room punching the air + says he does not recall such behavior but remembers bad dreams; Dx?
answer = REM sleep behavior disorder -> incomplete or absent REM muscle atonia; tends to occur in older adult men; if recurrent, may indicate onset of neurodegenerative disorder like Parkinson disease.
M. 8M + gets out of bed at night and tries to leave the house; when his mom tries to stop him, he violently tries to pull away from her; once he got out of the house and woke up outside while in the middle of an episode; he has no recollection of the episodes; Dx?
sleep terror disorder; tends to occur in pre-adolescent boys.
