Neuro/somatic symptom/sleepwake

Question 1

What is the most effective treatment for primary enuresis?

Answer 1

enuresis alarm

Question 2

What is the level of control and motivation in these 3 disorders? (conscious vs unconscious)
1. Somatic symptom disorders
2. Factitious disorders
3. Malingering

Answer 2

1. Somatic symptom disorders: unconscious control, unconscious motivation
2. Factitious disorders: conscious control, unconscious motivation
3. Malingering: conscious control, conscious motivation

Question 3

Compare children’s sleep to adults.
__ REM (more/less)
__ REM (earlier/later)
__ REM (more frequent, less frequent)
__ total hrs of sleep

Answer 3

More REM
Earlier REM
More frequent REM
More total hrs of sleep

Question 4

Which nucleus of the hypothalamus regulars sleep?

Answer 4

Suprachiasmatic nucleus

Question 5

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

Answer 5

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

Question 6

What is the progression of sleep cycle over 90 mins?

Answer 6

N1 –> N2 –> N3 –> N2 —> REM

Question 7

Multiple sleep latency test is useful to assess for what dx?

Answer 7

Narcolepsy

Question 8

Are Zolpidem and Zaleplon for sleep initiation or sleep maintenance?

Answer 8

sleep initiation

Question 9

Is Suvorexant for sleep initiation or sleep maintenance?

Answer 9

sleep maintenance

Question 10

What hormone secreted by pineal gland regulates circadian rhythm?

Answer 10

Melatonin

Question 11

Psychostimulants such as Dextroamphetamine, Methylphenidate, Modafinil, Armodafinil and Selegiline are used to tx what sleep disorder?

Answer 11

hypersomnolence disorder and narcolepsy in daytime

Question 12

Low hypocretin-1 (aka orexin) in the CSF is found in what sleep disorder?

Answer 12

Narcolepsy

Question 13

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?

Answer 13

narcolepsy

Question 14

Which sleep medication is contraindicated in narcolepsy b/c it is a orexin receptor antagonist?

Answer 14

Suvorexant

Question 15

Narcolepsy has ___ % monozygotic twin concordance?

Answer 15

30%

Question 16

What hypnotic can you give in the nighttime for tx of narcolepsy?

Answer 16

sodium oxybate: CNS depressant that increases N3 sleep

Question 17

Sodium oxybate activates what receptor?

Answer 17

GABA-B receptor

Question 18

For what category of sleep disorders are Modafinil and armodafinil helpful with? (3 disorders)

Answer 18

promoting daytime wakefulness

Narcolepsy
OSA
Shift work sleep disorder

Question 19

What is the pharmacologic tx for delayed sleep phase tx?

Answer 19

Melatonin

Question 20

Sleep phase chronotherapy is indicated for what sleep disorder?

Answer 20

Delayed sleep phase

Question 21

What are the 2 Non-REM sleep arousal disorder specifiers in which no imagery is recalled and amnesia largely present?

Answer 21

1. sleep-walking type
2. sleep terror type

Question 22

What stage does sleep walking occur in and does it begin before or after puberty?

Answer 22

N3
begings before puberty

Question 23

Nightmare disorder occurs during which part of sleep. Patients have memory of these dreams and are easily awakened.

Answer 23

REM SLEEP

Question 24

Image rehearsal therapy is beneficial effects for what sleep issue?

Answer 24

Nightmares

develop an alternative script to the nightmare

Question 25

What is the first line pharmacologic agent for tx of RLS?

Answer 25

dopamine agonists: Ropinirole, Pramipexole, Rotigotine

Question 26

Most common pediatric chronic illness.

Answer 26

Asthma

Question 27

Infants younger than _____ months, require virologic assays that directly detect HIV due to presence of maternal HIV antibody.

Answer 27

18 months

Question 28

What is a common side effect of phenobarbital seen in kids?

Answer 28

Kids become hyperactive after

Question 29

Jerky mgmt of upper body followed by seizure, normal IQ

Answer 29

Juvenile myoclonic epilepsy

Question 30

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?

Answer 30

Krabbe’s disease Deficiency of galactocerebrosidase

Question 31

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?

Answer 31

Psychosis

Question 32

Huntington’s disease affects what part of brain?

Answer 32

Basal ganglia

Question 33

What is tx for WIlson’s dx?

Answer 33

Penicillamine (chelating agent)

Question 34

what is difference between NF1 & NF2 (presentation and genes)

Answer 34

NF1 has cutaneous lesions, nerve lesions, neurofibromas & schwannomas, lisch nodules (pigmented iris harmartomas) and MR NF2 has been/l vestibular (nerve 8) schwannomas

Question 35

Hypo-pigmented spots (ash leaf spots), seizures, aggression and AD inheritance is likely what dx?

Answer 35

Tuberous sclerosis

Question 36

Facial port-wine in trigeminal nerve, glaucoma, seizures, MR is likely what d/o?

Answer 36

Sturge-Weber syndrome

Question 37

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?

Answer 37

Ataxia-telangectasia Cerebellar degenerative disease

Question 38

what is treatment for Guillain-Barré syndrome?

Answer 38

Plasmapheresis or IVIG

Question 39

How is Duchenne muscular dystrophy inherited?

Answer 39

X-linked recessive

Question 40

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?

Answer 40

Duchenne muscular dystrophy

Question 41

In a pt with Huntington’s dx which brain region on MRI is most likely to show b/l atrophy?

Answer 41

Head of the caudate nucleus

Question 42

_______ syndrome presents as beginning in childhood or adolescence and is characterized by periods of hypersomnolence and altered behaviors during wakefulness.

Answer 42

Kleine-Levin syndrome

Question 43

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.

Answer 43

Landau-kleffner syndrome (aka acquired epileptic aphasia)

Question 44

What is the most common type of childhood brain cancer? Of note, in boys>girls and arises in posterior fossa w/complication of hydrocephalus.

Answer 44

Medullosblatomas

Question 45

Do males or females have more cases of juvenile myasthenia gravis?

Answer 45

females (2-6x more)