Mehl. sleep disorders 03-14 (1)

Question 1

Narcolepsy. definition?

Answer 1

Chronic sleep disorder affecting the brain’s ability to regulate sleep-wake cycles normally.

Question 2

Chronic sleep disorder affecting the brain’s ability to regulate sleep-wake cycles normally.?

Answer 2

Narcolepsy.

Question 3

Narcolepsy. CP?

Answer 3

Characterized by excessive daytime sleepiness, sudden episodes of muscle weakness (cataplexy), sleep paralysis, and hallucinations. The latter tend to occur prior to sleep (hypnagogic) or upon waking up (hypnopompic).

Question 4

Narcolepsy. what neurotrasmitter responsible?

Answer 4

Thought to be due to deficiency of a neurotransmitter called orexin (aka hypocretin), which normally promotes wakefulness.

Question 5

Narcolepsy. Tx?

Answer 5

Treatment is modafinil (dopamine reuptake inhibitor + promotes release of orexin from hypothalamus).

Question 6

Sleep apnea. types? 2

Answer 6

Can be obstructive (i.e., usually from obesity) or central (i.e., brain- related).

Question 7

Sleep apnea. mechanism?

Answer 7

Chronic fatigue and poor oxygenation can lead to dysthymia / depression.

Question 8

Sleep apnea. The answer on NBME is “mood disorder due to a medical condition.”

Answer 8

.

Question 9

Sleep apnea. how to Dx?

Answer 9

Polysomnography (sleep study) is what USMLE wants to diagnose.

Question 10

Sleep apnea.
When obstructive sleep apnea progresses to the point that the patient is a chronic CO2 retainer with pulmonary hypertension and/or cor pulmonale, we call it obesity hypoventilation syndrome (Pickwickian syndrome). If you’re confused about the cardio, go to the HY Cardio PDF.

Answer 10

.

Question 11

Restless leg syndrome. definition?

Answer 11

Idiopathic, irresistible urge to move legs while in bed/sleeping.

Question 12

Restless leg syndrome. MCC?

Answer 12

Most common cause is iron deficiency anemia. First step is checking the patient’s serum iron and ferritin.

Question 13

Restless leg syndrome. if suspect, first thing to do?

Answer 13

Most common cause is iron deficiency anemia. First step is checking the patient’s serum iron and ferritin.

Question 14

Restless leg syndrome. if iron normal –> how to Tx?

Answer 14

If iron studies are normal, gabapentin and D2 agonists (ropinirole, pramipexole) can be used.

Question 15

Restless leg syndrome. incr risk for what disease?

Answer 15

USMLE wants you to know that patients with RLS have increased risk of developing Parkinson disease, which makes sense since D2 agonists help, indicating a potential problem with dopamine signaling or production in some patients.

Question 17

Peds. Circadian rhythm sleep-wake disorder. definition?

Answer 17

Misalignment between the individual’s sleep pattern and the societal norm or natural environment.

Question 18

Misalignment between the individual’s sleep pattern and the societal norm or natural environment.?

Answer 18

Peds. Circadian rhythm sleep-wake disorder.

Question 19

Peds. Circadian rhythm sleep-wake disorder.

Common types include delayed sleep phase disorder (going to bed / waking up later than desired), advanced sleep phase disorder (going to bed / waking up earlier than desired), and shift work disorder (struggle with sleep due to abnormal work hours).

Answer 19

.

Question 20

Peds. Somnambulism. definition?

Answer 20

Sleep walking.

Question 21

Peds. Somnambulism. occurs during what stage?

Answer 21

Occurs during Stage 3 (deep) sleep.

Question 22

Peds. Nightmare disorder. during what sleep phase?

Answer 22

Occurs during REM sleep.

Question 23

Peds. Nightmare disorder. Cp?

Answer 23

Dreams often involve threats to survival or self-esteem, leading to awakenings and distress.

Question 24

Dreams often involve threats to survival or self-esteem, leading to awakenings and distress.?

Answer 24

Peds. Nightmare disorder.

Question 25

Peds. Nightmare disorder. why episodes can be remembered?

Answer 25

Episodes can be remembered by the patient after awakening since they occur during REM sleep.

Question 26

Peds. Sleep terror disorder. mistaken for what? in what sex?

Answer 26

Often mistaken for nightmares; more common in male children and abates by pre-adolescence

Question 27

Peds. Sleep terror disorder. in what sleep stage?

Answer 27

Occur in Stage 3 (delta wave) sleep.

Question 28

Peds. Sleep terror disorder. CP?

Answer 28

Episodes where the patient somnambulates and can wake up at different location, often in a panic; can demonstrate violent behavior, such as pulling on the mother’s arm to go outside, followed by awakening from the episode with no memory of what happened.

Question 29

Peds. Sleep terror disorder. vs nightmare disorder.?

Answer 29

This is in contrast to nightmare disorder, where the patient remembers a dream + cannot somnambulate due to muscle paralysis during REM.

Question 30

Peds. Insomnia. definition?

Answer 30

Inability to obtain adequate sleep, either due to difficulty falling asleep, staying asleep, or waking up too early, leading to impaired daytime functioning.

Question 31

Inability to obtain adequate sleep, either due to difficulty falling asleep, staying asleep, or waking up too early, leading to impaired daytime functioning. Dx?

Answer 31

Peds. Insomnia.

Question 32

Peds. Insomnia. usme want what Tx?

Answer 32

USMLE wants benzo (usually clonazepam) for acute insomnia.

Question 33

Peds. Insomnia. terminal insomnia can occur in ....?

Answer 33

Terminal insomnia can occur in depression (waking up too early).