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Neuro pt. 2 Flashcards

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1
Q

What is a vegetative state?

A

like a coma, but with return of some circadian rhythm that causes periods of eye opening, roving eye movements, autonomic changes typically seen with sleep/wake cycling, etc but with no evidence of awareness of self or the environment

often occurs after a coma within 10-30 days

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2
Q

What neurons promote non-REM sleep? How do they do it?

A

neurons of the venterolateral preoptic nucleus (VLPO)

they release GABA and galanin at their sites of projection to inhibit wake-producing cholinergic and aminergic regions

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3
Q

What sleep stage is associated with alpha waves?

A

not sleep - relaxed wakefullness

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4
Q

What are the possible causes of nutritional deficiencies?

A

alcoholism

poor intake (GI disorders, hyperemesis gravidarum, post-bariatric surgery, anorexia)

malabsorption (gastric or intestinal resection, autoimmune disease)

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5
Q

What is “locked in” syndrome?

A

A syndrome caused by injury to the pons that impairs facial movements, eye movements, and interrupts the corticospinal tract (causing quadriplegia)

patients are conscious but unable to effectuate muscle movements

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6
Q

What are the causes of niacin deficiency?

A

malnourished alcoholics

seen in populations that eat maize rather than enriched wheat (which has added niacin)

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7
Q

What treatments for MS are used during pregnancy?

A

usually none (not needed because of reduced flairs during pregnancy)

if necessary, glatimer acetate canbe used

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8
Q

What is an advanced sleep-wake phase disorder?

A

a disorder that causes patients to exhibit a stable sleep-wake cycle that is several hours earlier than the conventional time

going to bed early, waking up early

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9
Q

What parasomnias are associated with non-REM sleep?

A

disorders of arousal

confusional arousals, sleep terrors, sleep-related eating disorder, sleep walking

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10
Q

What types of contraceptives are most effective for women with neurological conditions generally?

A

IUDs, implants, and depo-provera are generally most effective

some medications can interfere with combined oral contraceptives

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11
Q

Where is norepinephrine produced?

A

Locus coeruleus

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12
Q

What is the relationship between attention and arousal?

A

There isn’t any direct relationship - you can have high attentionand low arousal or low attention and high arousal

both will fluctuate throughout the day

both are needed to complete a cognitive task

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13
Q

What muscle tone is associated with non-REM sleep? REM sleep?

A

non-REM sleep: reduced

REM sleep: absent/atonic (but cansee phasic muscle twitches)

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14
Q

When is seizure frequency lowest in all forms of catamenial epilepsy?

A

between days 4 to 10-14 of the menstrual cycle

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15
Q

What symptoms besides the diagnostic criteria can be associated with delirium?

A

speech impairment

illusions or hallucinations

emotional dysregulation

sleep-wake cycle impairment

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16
Q

What are the main symptoms of folate deficiency?

A

peripheral neuropathy

in pregnancy: linked to neural tube defects

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17
Q

What is the normal function of vitamin B6?

A

involved in ATP production, glucose synthesis, neurotransmitter synthesis, and conversion of homocysteine to cystathionine

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18
Q

What is the cause of narcolepsy?

A

loss of hypocretin/orexin-containing neurons

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19
Q

What is a jet-lag disorder?

A

a disorder caused by a temporary mismatch between the timing of the sleep and wake cycle and the external environment (secondary to travel over at least two time zones)

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20
Q

What NT is produced in the locus coeruleus?

A

Norepinephrine

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21
Q

What is the relationship between pregnancy and MS attacks? Post-partum?

A

pregnancy: significantly decreased, especially during the third trimester
* hypothesized to be due to a hormonally mediated switch in immune profile from Th1 to Th2*

post-partum: significantly increased risk of flairs

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22
Q

What is akinetic mutism?

A

an extreme form of abulia (apathetic state with cognitive and behavioral slowing), typically caused by bilateral basal-medial frontal lobe injuries, often also involving the hypothalamus

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23
Q

What respiratory and heart rate is associated with non-REM sleep? REM sleep?

A

non-REM sleep: regular

REM sleep: irregular

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24
Q

What is the treatment for thiamine/B1 deficiency?

A

medical emergency

high doses of thiamine (must be given before glucose if giving glucose)

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25
Q

What specific cognitive testing tool should be used to evaluate for delirium?

A

Confusion Assessment Method (CAM or CAM-ICU)

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26
Q

What is the relationship between seizure freqency and pregnancy?

A

variable - best predicted by seizure frequency one year prior to surgery

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27
Q

What are possible causes of bilateral thalamic dysfunction?

A

rare strokes, rare viral infections

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28
Q

What is the primary treatment for delirium?

A

Identify and treat underlying cause

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29
Q

What factors in the brain promote wakefullness?

A

ascending aminergic (histamine, dopamine, serotonin, norepinephrine) and cholinergic (acetylcholine) projections

hypocretin/orexin system

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30
Q

What MS drug is the worst for pregnancy?

A

teriflunomide

it can get into sperm too and also stays in the body for up to 2 years

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31
Q

What is the function of PER and CRY proteins in the circadian system?

A

They dimerize and get phosphorylated to create a negative feedback loop to inhibit expression of clock and BMAL1 genes

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32
Q

What is a parasomnia?

A

unpleasant or undesirable behavioral or experiential phenomena that occurs predominantly or exclusively during the sleep period

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33
Q

What types of cells provide light information to the primary circadian pacemaker?

A

melanopsin containing retinal ganglion cells via the retinohypothalamic tract

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34
Q

What changes in migraine frequency typically occur during pregnancy?

A

reduced frequency (estrogen levels are high and maintained)

post-partum period has higher frequency as estrogen levels rapidly decline

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35
Q

When are neurons in the pedunculopontine tegmental nucleus (PPT) and laterodorsal tegmental nucleus (LDT) of the pons and basal forebrain most active?

A

during wake and REM sleep

these neurons produce acetylcholine

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36
Q

Which of the following migraine medications should be avoided in women of childbearing age due to significant risk of teratogenesis?

a) magnesium
b) propranolol
c) sumatriptan
d) valproic acid

A

d) valproic acid

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37
Q

What sleep stage is associated with sleep spindles and K-complexes?

A

stage N2 of non-REM sleep

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38
Q

What are the symptoms of B12/cobalamin deficiency?

A

affects spinal cord, brain, peripheral nerve, and optic nerve

classic syndrome: subacute combined degeneration of the lateral corticospinal tracts and dorsal columns (sensory and motor defects)

can also affect cognitive function

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39
Q

What pharmalogical interventions are available for delirium?

A

antipsychotics (best quality evidence): haloperidol (big risk of long QT)

alpha-2 agonists (emerging contender)

benzodiazepine (only if delirium is due to alcohol or benzo withdrawal)

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40
Q

What is the relationship between menopause and migraine frequency?

A

migraines decrease during menopause

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41
Q

What is stupor?

A

a state between alert and coma where a patient can respond purposefully, but requires constant stimulation to engage

vague term

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42
Q

What is a coma?

A

a state of unresponsiveness where the patient cannot be stimulated to respond purposefully - there is no evidence of awareness of self or the environment, no eye opening, no evidence of circadian rhythm

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43
Q

Where is hypocretin made?

A

made by neurons of the lateral hypothalamus

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44
Q

How is B12/cobalamin absorbed?

A

it is found in meat, fish, dairy

released from food into the stomach

B12 binds to intrinsic factor in the intestine, which allows it to absorb in the ilium

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45
Q

What are the general sex differences in migraines?

A

much more common in women than in men (43% vs 18% lifetime risk)

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46
Q

Where is acetylcholine produced?

A

nucleus basalis of meynert

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47
Q

What is a minimally conscious state?

A

A state of severly impaired consciousness with minimal but definite behavioral evidence of self or environmental awareness

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48
Q

What are the three recognized subtypes of delirium?

A

hyperactive (picking at clothes, climbing out of bed, combative)

hypoactive (lethargy, stupor, falling asleep, may mimic depression)

mixed (alternating motoric presentations)

mixed is most common

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49
Q

What neurons control REM sleep?

A

cholinergic neurons of the pedunculopontine (PPT) and laterodorsal tegmental (LDT) nuclei

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50
Q

What is arousal?

A

the level of conscious brain activity

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51
Q

What are the types of central sleep apnea?

A

primary, central sleep apnea with cheyne stokes respiration, central sleep apnea due to high altitude periodic breathing, central sleep apnea due to medication/substance

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52
Q

What are the treatments for a non-24 hours sleep-wake phase disorder?

A

daily timed doses of melatonin before bedtime (including a synthetic melatonin agonist tasimelteon)

if not blind: stronger entraining (bright light after awakening, melatonin before bedtime, regular schedule of exercise and meals)

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53
Q

What is shift work disorder?

A

a disorder characterized by complaints of either insomnia or excessive sleepiness resulting from having to work during usual sleep periods

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54
Q

What two stimuli reset the circadian clock?

A

light and melatonin

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55
Q

What is a delayed sleep-wake phase disorder?

A

a disorder where patients have a stable sleep-wake cycle that is delayed (avg. 3 hours) compared to the general population

go to bed late, wake up late

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56
Q

What is the physiology of REM sleep?

A

cholinergic REM-on neurons activate the thalamocortical system leading to a low-voltage fast EEG that resembles waking-state EEG

they also produce atonia through descending projections that reduce motor tone

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57
Q

What conditions are associated with an irregular sleep-wake rhythm disorder?

A

children with developmental delays

elderly institutionalized individuals (without clear daily structure and possible with SCN degeneration)

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58
Q

What is brain death?

A

irreversible loss of all functions of the brain (including cerebrum, cerebellum, and respiratory function)

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59
Q

What is the mallampati score?

A

A score of how much can be seen of the back of the throat when a patient’s mouth is open and tongue is out, used to evaluate for obstructive sleep apnea

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60
Q

What is the hypothesized cause of catamenial (hormonally sensitivite) epilepsy?

A

seizures evoked during periods of increased vulnerability where there is an increased estrogen to progesterone ratio

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61
Q

What is encephalopathy?

A

any brain dysfunction, generally applied to acute global brain dysfunction

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62
Q

What types of neurological drugs can interfere with combined oral contraceptives?

A

enzyme-inducing medications that interfere with hepatic metabolism of COCs

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63
Q

What patients are predisposed to a non-24 hour sleep-wake phase disorder?

A

blind people (especially if lacking the photic input to the SCN through melanopsin retinal ganglion cells)

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64
Q

What are the imaging signs associated with thiamine/B1 deficiency?

A

mammillary body T1 hyperintensity (pathognomonic, but not always present)

medial thalami T2/FLAIR hyperintensity (characteristic, seen in majority of cases)

periaqueductal gray matter T2/FLAIR hyperintensity

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65
Q

What are the effects of B6/pyridoxine deficiency?

A

sensory > motor polyneuropathy with paresthesia, pain, weakness, and hyporeflexia

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66
Q

What migraine treatments should be avoided during all parts of pregnancy?

A

opiates - not effective

ergots - increased miscarriage rate

barbituates - fetal malformations and cognitive deficits

valproic acid and topiramate - class D for pregnancy

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67
Q

What three patterns of brain injury can lead to impairment of arousal?

A
  • injury to ascending reticular activating system of midbrain
  • injury to both thalami, which interrupts the transmission of signals from the ascending reticular activating system to the cerebral cortex
  • widespread dysfunction of both cerebral hemispheres
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68
Q

Howare circadian rhythm sleep-wake disorders clinically evaluated?

A

sleep logs

actigraphy (fancy fit bit, measures daily activity/light exposure/peripheral temperature)

measuring melatonin through blood, saliva, or urine

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69
Q

What delirium subtype is associated with COVID-19?

A

hyperactive delirium

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70
Q

What are the treatments for catamenial epilepsy?

A

anti-epileptics, surgery if intractable

other treatments may help: depo-provera to suppress the menstrual period, chemical menopause induction with GnRH

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71
Q

What medications are associated with delirium?

A

anticholinergics, benzodiazepines, opioids, corticosteroids

also polypharmacy (> 3 meds) in general

72
Q

What NT is produced in the nucleus basalis of meynert?

A

acetylcholine

73
Q

What is the sex differencein epilepsy prevalence?

A

There isn’t one - men and women have similar prevalence

74
Q

How is restless leg syndrome treated?

A

iron supplements, dopamine agonists, pregabalin/gabapentin

75
Q

What is the relationship between progesteroneand neurotransmitters?

A

increases synthesis of inhibitory neurotransmitter GABA

binds to GABA receptors and potentiate their inhibitory effects (raising seizure threshold)

76
Q

Where is serotonin produced?

A

raphe nuclei

77
Q

What are the sex differences in diagnosis of multiple sclerosis?

A

Women predominant (3x as likely)

78
Q

What key factor might explain the sex differences in migraine prevalence?

A

abrupt withdrawal of estrogen (as occurs during the menstrual cycle) may trigger migraines in women and explain the increased prevalence

79
Q

What conditions are associated with REM behavior disorder?

A

parkinson’s disease, multi-system atrophy, lewy body dementia

80
Q

How is REM sleep triggered?

A

normally aminergic neurons tonically inhibit REM-on neurons

periodically at night, aminergic neurons fall silent and release inhibiton of REM-on neurons

81
Q

What conditions are mimics of B12/cobalamine deficiency?

A

copper deficiency

zinc toxicity

nitrous oxide exposure

multiple sclerosis

cervical spondylosis

82
Q

What are the possible causes of bihemispheric brain dysfunction?

A

anoxic brain injuries, intoxications, generalized convulsive or nonconvulsive seizures

83
Q

What is attention?

A

maintaining cognitive focus on a single task or behavior

84
Q

What is the relationship between peri-menopause and seizure frequency? Menopause?

A

peri-menopause: increased seizures (fluctuations in hormone levels)

menopause: decreasedseizures

85
Q

What is the treatment for pellagra?

A

high dose niacin replacement

86
Q

What are the imaging findings of B12/cobalamin deficiency?

A

cervical spine MRI can show myelopathy with demyelination in lateral corticospinal tracts and dorsal columns

87
Q

How can delirium be differentiated from dementia?

A

dementia has a slower and more insidious onset usually and does not fluctuate throughout the day (whereas delirium has relatively rapid onset and does fluctuate)

88
Q

What is the relationship between estradiol and neurotransmitters?

A

increases transmission of and sensitivity to the excitatory neurotransmitter glutamate

decreases synthesis of the inhibitory neurotransmitter GABA

89
Q

What are the treatment strategies for shift work disorder?

A

goal = adjust the circadian clock so that the individual can be most alert during their work shift and most sleepy when they are off work (and also balance being awake during the days on off-days)

uses light therapy, sunglasses during the day

90
Q

What is the genetic basis for delayed sleep-wake phase disorder?

A

unclear, but may be correlated to changes in the Period gene or cryptochrome 1 gene

91
Q

What is the difference between obstructive and central sleep apnea?

A

obstructive: respiratory effort is present
central: respiratory effort is absent

92
Q

What parasomnias are associated with REM sleep?

A

dream enactment behavior with diminished atonia

93
Q

What MS drugs can reduce efficacy of hormonal contraception?

A

modafinil and armodafinil

patients can still use IUDs

94
Q

What neurotransmitters are associated with the ascending reticular activating system?

A

norepinephrine and acetylcholine - they maintain and increase arousal

95
Q

Where is melatonin produced?

A

pineal gland

96
Q

What is the pathophysiology of insomnia?

A

a precipitating event/stressory in association with moderators leads to abnormalities in neurobiological processes

this leads to a viscious cycle of neurophysiologic hyperarousal and psychological/behavioral changes

97
Q

What lab findings are associated with B12/cobalamin?

A

low serum B12

high homocysteine

high methylmalonic acid

98
Q

What condition typically causes B6/pyridoxine deficiency?

A

seen in patients treated with isoniazid

99
Q

What NT is produced in the pineal gland?

A

melatonin

100
Q

What are the characteristic findings of REM sleep?

A

rapid eye movements behind closed eyes

active EEG

muscle atonia

101
Q

What is the normal function of niacin/B2?

A

it is a precursor to NAD and is important for energy metabolism and ATP production

102
Q

Where is the primary circadian pacemaker located?

A

suprachiasmatic nucleus within the hypothalamus

103
Q

What is the genetic basis for advanced sleep-wake phase disorder?

A

strong hereditary component associated with mutation in teh casein kinases or the phosphorylation sites for these kinases on the Period gene (results in faster cycling through the feedback loop)

104
Q

How are hormonally sensitive migraines treated?

A

Usually just like non-hormonally sensitive ones at first (abortive therapy like triptans)

prophylactic medications can be added around the time of menstruation

if resistant to treatment, COCs without the placebo week can be effective (but does have some risks)

105
Q

What are the causes of B12 deficiency?

A

poor nutrition

malabsorption: absence of intrinsic factor, atrophic gastritis, gastric/ileal resection, celiac sprue, medications

106
Q

What are the metabolic roles of B12/cobalamin?

A

co-factor for conversion of homocystein to methionine conversion (affects DNA synthesis)

disruption in even chain fatty acid synthesis, leading to impaired myelin integrity

107
Q

What are the criteria for delirium?

A

disturbance in attention and awareness that develops over a short period of time and represents a change from baseline; can also be associated with additional disturbances in cognition

there also must be direct evidence of a potential cause of the delirium

108
Q

What factors predispose patients to delirium?

A

age, cognitive impairments, visual impairments

others with less evidence: illness severity, comorbidity, infections, fractures, vascular surgery, bladder catheters

109
Q

What is the classical presentation of thiamine/B1 deficiency?

A

Wernicke-Korsakoff syndrome with peripheral neuropathy

OR

beriberi syndrome

110
Q

What is the difference between focal and global neurologic dysfunction?

A

Focal = can be traced back to a localized lesion/problem in the nervous system

global = broader problem, usually relating to neurotransmitter dysregulation or inappropriate neural connections

111
Q

What is quiescence?

A

A brain state characterized by overall severely suppressed activity, diminished feeding drive, and loss of circadian rhythms in response to severe body stress

112
Q

What treatment should be taken alongside of antiepileptics for women of childbearing age?

A

folic acid - decreases rates of neural tube defects

113
Q

Where is dopamine produced?

A

substantia nigra

114
Q

What is the ascending reticular activating system?

A

An anatomic system for regulating arousal that functions as the core pacemaker of brain activity

It is a small collection of neurons that starts in the midbrain and projects up to synapses in the thalamus on the interlaminar nuclei and then goes from the thalamus to the cortex

115
Q

What are the treatments for sleep apnea?

A

positional therapy

oral appliance (if mild)

surgery

CPAP/ventilation

hypoglossal or phrenic nerve stimulator

116
Q

What are precipitating factors for delirium?

A

I WATCH DEATH

Infections

Withdrawal

Acute metabolic processes

Trauma

CNS pathology

Hypoxia/hypercarbia

Deficiencies

Endocrine

Acute vascular

Toxins

Heavy metal

117
Q

What sleep stage is associated with delta waves?

A

stage N3 of non-REM sleep

118
Q

What is the function of hypocretin?

A

hypocretin-containing neurons innervate wake-promoting areas and project diffusely to the cortex (maintaining wakefullness)

119
Q

What is obtundation?

A

similar to stupor (state between alert and coma), but more mild reduction in level of arousal

a vague term

120
Q

What are the signs of Wernicke’s encephalopathy?

A

nystagmus and ophthalmoparesis

gait ataxia

global confusion, memory loss, apathy

121
Q

Which of the following antiepileptic drugs interferes with the efficacy of combined oral contraceptive pills?

a) gabapentin
b) levetiracetam
c) topiramate
d) valproic acid

A

c) topiramate

122
Q

What is insomnia? What are the two types?

A

difficulty initiating or maintaining sleep, resulting in significantdistressor impairment in work or social performance

two types: chronic (> 3 months), short-term (< 3 months)

123
Q

What is the treatment for beriberi syndrome?

A

thiamine replacement, symptomatic treatment

124
Q

What are supportive interventions for delirium?

A

address/prevent dehydration and malnutrition

proper lighting for sleep-wake cycle

orientation aids (clocks, family photos, etc)

avoid restraints

early ambulation and mobility

125
Q

What sleep stage is associated with theta waves?

A

stage N1 of non-REM sleep

126
Q

What are the symptoms of pellagra?

A

diarrhea, scaly dermatitis with hyperpigmentation, neuropsychiatric symptoms

  • dermatitis, diarrhea, dementia*
  • caused by niacin deficiency*
127
Q

What are the treatments for migraines during pregnancy?

A

first line - non-pharmacological or acetaminophen

second line - NSAIDs (NOT in third trimester), metoclopromide (anti-emetic)

third line - sumatriptan

prophylactics: metoprolol or propranolol can be used if absolutely needed

128
Q

What are the treatments for irregular sleep-wake rhythm disorder?

A

mixed modality therapy (bright light exposure, structured physical and social activities, structured bedtime routine)

129
Q

What is the treatment for jet-lag disorder?

A

follows principles of advanced or delayed sleep-wake phase disorder (depending on direction of travel) and involves light exposure and melatonin at specific times

130
Q

How are advanced sleep-wake phase disorders treated?

A

using light in the evening to delay the circadian clock

131
Q

What is the biggest risk associated with haloperidol? What should be done to mitigate the risk?

A

QT interval prolongation

ECG monitoring should be given if the patient is at risk of torsades (electrolyte changes, familial QTc, other meds that prolong QT)

132
Q

What types of neuropathy occur in beriberi syndrome?

A

demyelinating and axonal

affects large fibers (weakness, loss of proprioception) and small fibers (burning pain, allodynia)

133
Q

What are the three basic brain states associated with a normal circadian rhythm?

A

awake, non-REM sleep, and REM sleep

134
Q

What NT is produced in the substantia nigra?

A

dopamine

135
Q

What is the presentation of beriberi syndrome?

A

neurological and cardiac dysfunction

peripheral edema (web beriberi) or no peripheral edema (dry beriberi)

length dependent peripheral neuropathy (demyelinating and axonal; large fiber and small fiber)

136
Q

What is the normal function of thiamine/vitamin B1?

A

it is a cofactor for two reactions of the krebs cycle (and thus key for metabolism)

137
Q

What is the effect of light in the early biological evening on the circadian clock? Light in the morning?

A

evening: delays circadian clock (go to sleep later)
morning: advances circadian clock (wake up earlier)

138
Q

What two factors can delay the circadian clock?

A

light at night, melatonin in the morning

139
Q

A 22 year-old woman with migraine with aura asks you about birth control. Which of the following forms of contraception is appropriate for her?

a) combined oral contraceptive pills
b) birth control patch
c) vaginal ring
d) intrauterine device

A

d) intrauterine device

140
Q

What is an irregular sleep wake rhythm disorder?

A

A sleep-rhythm disorder characterized by disorganized patterns of sleep and wake, with at least three separate sleep periods scattered throughout a 24 hour period

141
Q

What epilepsy drug carries the greatest risk of teratogenesis?

A

valproic acid

congenital defects and decreased cognitive development

142
Q

What are signs of korsakoff’s psychosis?

A

anterograde and retrograde amnesia

difficulty retaining information

lack of insight

confabulation (making up stories/details in conversations)

143
Q

Which of the following are thought to be triggered by an abrupt drop in estrogen levels?

a) menstrually related migraines
b) MS flairs
c) peri-menstrual seizures (C1 pattern)
d) peri-ovulatory seizures (C2 pattern)

A

a) menstrually related migraines

144
Q

What is the treatment for delayed sleep-wake phase disorders?

A

uses a combination of melatonin and light to advance the clock

bright light exposure in the biological morning, low dose melatonin 5-7 hours before the habitual (late) bedtime

145
Q

What is the effect of taking lamotrigine and combined oral contraceptives?

A

lamotrigine reduces efficacy of COCs andCOCs induce metabolism of lamotrigine (reducing lamotrigine levels below therapeutic amounts)

146
Q

What sleep disorder is represented by A-D?

A

A: advanced sleep-wake phase disorder

B: delayed sleep-wake phase disorder

C: non-24 hour sleep-wake disorder

D: irregular sleep-wake rhythm

147
Q

What is delirium?

A

a state of fluctuating attention and cognitive clarity often accompanied by sensory misperceptions/hallucinations

can be due to generalized illness, age, chronic mild brain injury but not generally caused by acute brain injury

148
Q

What standard assessments should be included in a delirium workup?

A

vital signs

CBC, chem panel, magnesium and phosphorous, glucose, urinalysis, TSH, vitamin B12, folate

149
Q

How does REM sleep produce muscle atonia?

A

REM-on neurons project to the medial medulla and activate neurons that are inhibitory to motor neurons (via glycine NTs) leading to decreased muscle tone

these glycenergic neurons also project to the locus coeruleus and inhibit adrenergic neurons, further decreasing muscle tone

150
Q

During which of the following time periods is an MS flair least likely to occur?

a) first trimester
b) second trimester
c) third trimester
d) post-partum

A

c) third trimester

151
Q

What is the treatment for B12/cobalamin deficiency?

A

vitamin B12 supplementation for life

152
Q

What is the key EEG finding associated with delirium?

A

generalized slowing

  • includes prominent theta and delta slow wave activity even during wakefullness*
  • not a specific finding*
153
Q

What are the clinical features of narcolepsy?

A
  • excessive daytime sleepiness
  • frequent transitions between wakefullness and sleep (sleep attacks, fragmented nocturnal sleep)
  • REM-like phenomena during wakefulness (cataplexy - sudden hypotonia or atonia triggered by strong emotions; hypnagogic or hypnopompic hallucinations - vivid dreams that appearreal; sleep paralysis)
154
Q

What is abulia?

A

An apathetic state with cognitive and behavioral slowing, but with intact cognitive function caused by medial frontal lobe injuries

155
Q

What temperature control is associated with non-REM sleep? REM sleep?

A

non-REM sleep: homeothermic

REM sleep: poikilothermic (sweating and shivering seen)

156
Q

What are possible causes of midbrain injury?

A

transtentorial brain herniation, strokes, viral infections, tumors

157
Q

What is a non-24 hour sleep-wake phase disorder?

A

individuals who cannot get the necessary daily photic input to maintain their entrainment to a 24 hour schedule

sleep time and wake time delays slightly each day due to longer than 24 hour circadian clock

158
Q

What are some mimics of coma/reduced arousal?

A

locked in syndrome, paralytic medications, botulism, severe neuromuscular injury/disease, psychiatric conditions

159
Q

Which of the following are part of the core criteria for a diagnosis of delirium?

a) persisting deficits in working memory and planning
b) patients will be in a very restless state (hyperactive)
c) there are changes in either cognition or perception
d) the clinical course is typically sub-acute, presenting over several weeks
e) there is fragmentation of the sleep-wake cycle and EEG demonstrates generalized beta frequencies

A

c) there are changes in either cognition or perception

160
Q

What is the normal function of folate?

A

involved in production of adenine, guanine, and thymidine (and thus DNA synthesis overall)

161
Q

What difference in immune profiles between males and females may explain part of the sex difference in MS diagnosis?

A

men tend to have a Th2 dominant immune profile, whereas women tend to have a more Th1 dominant profile (potentially increasing susceptability)

162
Q

How is the “flip-flop” switch system of sleep/wake regulated?

A

GABA inhibits “wake” associated neurons

norepinephrine and serotonin inhibit “sleep” associated neurons

163
Q

What is the risk associated with taking COCs if you have migraines with aura?

A

Increased risk of ischemic stroke - especially for high dose COCs

especially not recommended for older patients, patients with underlying stroke risk factors, and smokers

164
Q

What is hypersomnia? What are the causes?

A

excessive daytime sleepiness

causes: inadequate sleep at night, poor quality sleep at night (due to underlying disorder), effect of medication or substance (alcohol, narcotics), or a primary disorder (narcolepsy or idiopathic hypersomnia)

165
Q

What are the two key clock proteins? What do they do?

A

CLOCK and BMAL1

the proteins dimerize and induce expression of the period and cryptochrome genes

166
Q

What NT is produced in the raphe nuclei?

A

serotonin

167
Q

What is the effect of melatonin in the early biological evening on the circadian clock? Melatonin in the morning?

A

evening: advances circadian clock (go to bed earlier)
morning: delays circadian clock (sleep later)

168
Q

What two factors can advance the circadian clock?

A

light in the biological morning, melatonin at night

169
Q

What are the treatments for insomnia?

A

cognitive behavioral therapy

pharamcological (GABA agonists, histamine antagonists, melatonin agonists, orexin/hypocretin antagonists)

EBB device (cools frontal lobe - unclear if effective)

170
Q

What are the causes of thiamine/vitamin B1 deficiency?

A

linked to alcoholism, but can be due to any nutrient deficient state (less common now because it is added to bread flour)

increased caloric intake will worsen the deficit because metabolism won’t be able to function properly

171
Q

What is the typical cause of folate deficiency?

A

seen most commonly in patients treated with methotrexate

172
Q

What are the basic criteria for brain death?

A
  • identified cause of potentially irreversible coma (ex. severe head injury, subarachnoid hemorrhage)
  • no purposeful responses to any stimuli, including noxious stimuli
  • no brainstem reflexes
  • no spontaneous respiratory movements
  • no factors to confound the examination (ex. paralytic medications, severe acidemia)
173
Q

Which of the following is part of a common work-up for an individual who might have delirium?

a) magnetic resonance imaging (MRI)
b) copper and arsenic screening
c) lumbar puncture (CSF analysis)
d) electroencephalography
e) chemistry-12 panel

A

e) chemistry-12 panel

the other tests may be indicated, but are not a routine part of the initial work-up

174
Q

What are menstrually related migraines? Pure menstrual migraines?

A

Defined as a migraine without aura that regularly occurs on days -2 to +3 of the menstrual cycle, but can also occur at other times

Pure menstrual migraine = only occurs between days -2 to +3 of the menstrual cycle

175
Q

What are the types of non-REM sleep?

A

N1: light sleep, easily aroused

N2: K-complexes, sleep spindles, and theta waves

N3: delta rhythm

176
Q

What risks are associated with shift work disorder?

A

increased risk of a number of diseases (including cancer and metabolic disorders)

Psych (6 decks)

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