Sleep

Question 1

5 y/o. Screaming, crying for no reason about 1 hr after falling asleep. Sits up in bed w/ eyes open, trembling, sweating. Mother cannot gain his attention for 5 mins. No new stressors. Pt has no memory of event. PE normal.
Dx?

Answer 1

Sleep terror

Question 2

Paralysis when awakening which lasts several mins. Can see/hear, but cannot move. Disappears spontaneously or when called by his wife.
No hallucinations, nightmares, daytime sleepiness, or history of falls.
Neuro exam normal

Answer 2

Sleep paralysis

Question 3

REM sleep is first evident during which stage of development?

Answer 3

In utero

Question 4

What sleep stage is most important in restoring the altered functions that result from prolong sleep deprivation?

Answer 4

Stage 4 - Non rapid eye mvmt

Question 5

Insomnia secondary to depression will more consistently affect REM sleep in which way?

Answer 5

Reduced latency to REM sleep

Question 6

Which is a characteristic change on polysomnogram associated w/ major depression?

Answer 6

Short REM latency

Question 7

Pt presents w/ history of irresistible, episodic sleepiness accompanied by a vivid, dreamlike state at the onset of an episode.
What additional sleep sx likely to be present?

Answer 7

Sleep paralysis

Question 8

8 y/o w/ persistent delayed sleep onset despite good sleep hygiene. No indication of broader psychopathology.
Which med has best evidence to tx this problem and restore normal circadian rhythm?

Answer 8

Melatonin

Question 9

REM sleep behavior d/o is commonly associated w/ abnormal inclusions containing what protein?

Answer 9

Synuclein

Question 10

Med student asks for something to help w/ attention and alertness. Taking a 2 wk board review course and struggles to keep up w/ pace.
Sleeping 4hrs/night, usually sleeps 8hrs/night.
Dx?

Answer 10

Dyssomnia NOS

Question 11

Age-related sleep pattern change

Answer 11

Greater wakefulness intermixed w/ sleep

Question 12

What aspect of sleep is increased in older adults

Answer 12

Duration of awakenings

Question 13

What med is best for decreasing nightmares in PTSD pts?

Answer 13

Prazosin

Question 14

HPA axis cortisol production is less active in?

Answer 14

Sleep onset

Question 15

What neuropeptide is decreased in the hypothalamus in narcolepsy?

Answer 15

Orexin A

Question 16

In narcolepsy, weakness in the arms and legs w/ laughter would respond to which med?

Answer 16

Venlafaxine

Question 17

Physiological changes during REM sleep

Answer 17

Increased HR, increased eye mvmts

Decreased muscle tone

Question 18

Brief episodes of sudden loss of muscle tone w/ intense emotions are characteristic of

Answer 18

Narcolepsy

Question 19

Most common symptoms in narcoleptics?

Answer 19

Sleep attacks

Question 20

65 y/o M w/ trouble falling asleep secondary to unpleasant aching and drawing sensations in calves and thighs. Also creeping and crawling sensations in legs. Urge to move legs can be suppressed voluntarily for a short while, but is ultimately irresistible.
Dx?

Answer 20

Restless legs syndrome

Question 21

Pt w/ day time sleepiness and frequent naps.
Sleep studies show pt enters REM sleep within 5 mins and wakes frequently at night.
Tx?

Answer 21

Modafinil giving dose in morning

Question 22

Sleep changes associated w/ aging

Answer 22

Delta wave amplitude decreases.

Proportionally less time spent in stages 3 and 4.