Neuro/somatic symptom/sleepwake Flashcards
What is the most effective treatment for primary enuresis?
enuresis alarm
What is the level of control and motivation in these 3 disorders? (conscious vs unconscious)
1. Somatic symptom disorders
2. Factitious disorders
3. Malingering
- Somatic symptom disorders: unconscious control, unconscious motivation
- Factitious disorders: conscious control, unconscious motivation
- Malingering: conscious control, conscious motivation
Compare children’s sleep to adults.
__ REM (more/less)
__ REM (earlier/later)
__ REM (more frequent, less frequent)
__ total hrs of sleep
More REM
Earlier REM
More frequent REM
More total hrs of sleep
Which nucleus of the hypothalamus regulars sleep?
Suprachiasmatic nucleus
Which part of sleep do you see the following activity on EEG?
A) alpha activity, vertex waves
C) K complexes w/sleep spindles or bundles
D) high amplitude delta (slow) waves
E) saw tooth waves
A) N1 sleep & when awake with eyes closed, drowsy twilight sleep
C) N2 sleep (light NREM sleep)
D) N3 sleep (deep, slow wave NREM sleep)
E) REM sleep
What is the progression of sleep cycle over 90 mins?
N1 –> N2 –> N3 –> N2 —> REM
Multiple sleep latency test is useful to assess for what dx?
Narcolepsy
Are Zolpidem and Zaleplon for sleep initiation or sleep maintenance?
sleep initiation
Is Suvorexant for sleep initiation or sleep maintenance?
sleep maintenance
What hormone secreted by pineal gland regulates circadian rhythm?
Melatonin
Psychostimulants such as Dextroamphetamine, Methylphenidate, Modafinil, Armodafinil and Selegiline are used to tx what sleep disorder?
hypersomnolence disorder and narcolepsy in daytime
Low hypocretin-1 (aka orexin) in the CSF is found in what sleep disorder?
Narcolepsy
REM latency < 15mins, mean sleep latency <8mins and 2 or more sleep onset REM periods found on nocturnal sleep polysomnography is aligned with what sleep d/o?
narcolepsy
Which sleep medication is contraindicated in narcolepsy b/c it is a orexin receptor antagonist?
Suvorexant
Narcolepsy has ___ % monozygotic twin concordance?
30%
What hypnotic can you give in the nighttime for tx of narcolepsy?
sodium oxybate: CNS depressant that increases N3 sleep
Sodium oxybate activates what receptor?
GABA-B receptor
For what category of sleep disorders are Modafinil and armodafinil helpful with? (3 disorders)
promoting daytime wakefulness
Narcolepsy
OSA
Shift work sleep disorder
What is the pharmacologic tx for delayed sleep phase tx?
Melatonin
Sleep phase chronotherapy is indicated for what sleep disorder?
Delayed sleep phase
What are the 2 Non-REM sleep arousal disorder specifiers in which no imagery is recalled and amnesia largely present?
- sleep-walking type
- sleep terror type
What stage does sleep walking occur in and does it begin before or after puberty?
N3
begings before puberty
Nightmare disorder occurs during which part of sleep. Patients have memory of these dreams and are easily awakened.
REM SLEEP
Image rehearsal therapy is beneficial effects for what sleep issue?
Nightmares
develop an alternative script to the nightmare
What is the first line pharmacologic agent for tx of RLS?
dopamine agonists:
Ropinirole, Pramipexole, Rotigotine
Most common pediatric chronic illness.
Asthma
Infants younger than _____ months, require virologic assays that directly detect HIV due to presence of maternal HIV antibody.
18 months
What is a common side effect of phenobarbital seen in kids?
Kids become hyperactive after
Jerky mgmt of upper body followed by seizure, normal IQ
Juvenile myoclonic epilepsy
Child presents with restlessness, irritability, stiffness, seizures, peripheral neuropathy starting at 6 months of age due to issues with myelin production. What AR disorder are we concerned this child has?
Krabbe’s disease
Deficiency of galactocerebrosidase
Children with metachromatic leukodystrophy, whcih is due to demyelination of white matter/central and peripheral NS due to deficiency in arylsulfatase A typically come to psychiatry for what presentation?
Psychosis
Huntington’s disease affects what part of brain?
Basal ganglia
What is tx for WIlson’s dx?
Penicillamine (chelating agent)
what is difference between NF1 & NF2 (presentation and genes)
NF1 has cutaneous lesions, nerve lesions, neurofibromas & schwannomas, lisch nodules (pigmented iris harmartomas) and MR
NF2 has been/l vestibular (nerve 8) schwannomas
Hypo-pigmented spots (ash leaf spots), seizures, aggression and AD inheritance is likely what dx?
Tuberous sclerosis
Facial port-wine in trigeminal nerve, glaucoma, seizures, MR is likely what d/o?
Sturge-Weber syndrome
Problems with coordination starting around age 4, child can’t break focus unless they move their head, have a red eye and highly sensitive to UV light along with cognitive deterioration is indicative of what d/o?
Ataxia-telangectasia
Cerebellar degenerative disease
what is treatment for Guillain-Barré syndrome?
Plasmapheresis or IVIG
How is Duchenne muscular dystrophy inherited?
X-linked recessive
which muscular dystrophy presents as progressive, symmetrical muscle weakness affecting hips/pelvic/thighs and shoulders and may see enlarged calves due to absence of dystrophin starting around 2-6y/o?
Duchenne muscular dystrophy
In a pt with Huntington’s dx which brain region on MRI is most likely to show b/l atrophy?
Head of the caudate nucleus
_______ syndrome presents as beginning in childhood or adolescence and is characterized by periods of hypersomnolence and altered behaviors during wakefulness.
Kleine-Levin syndrome
This disorder typically occurs in healthy children who begin to lose expressive and receptive language skills most commonly between the ages of 4 and 7 years, although children at both younger and older ages may manifest initial symptoms. Concurrent with the development of aphasia, paroxysmal epileptiform EEG changes and, in many cases, seizures occur.
Landau-kleffner syndrome (aka acquired epileptic aphasia)
What is the most common type of childhood brain cancer? Of note, in boys>girls and arises in posterior fossa w/complication of hydrocephalus.
Medullosblatomas
Do males or females have more cases of juvenile myasthenia gravis?
females (2-6x more)
