sleep

Question 1

5 y/o with screaming/crying for no reason about 1 hour after falling asleep. Sits up in bed with eyes open, trembling, sweating, mother cannot gain his attention for 5 minutes. No new stressors. Boy has no memory of the event. PE normal. Dx? (4x)

Answer 1

SLEEP TERROR

Question 2

Paralysis when awakening, lasts several minutes. Can see/hear but cannot move during episodes. Disappears spontaneously or when called by his wife. No hallucinations, nightmares, daytime sleepiness or h/o falls. Neuro exam normal (4x)

Answer 2

SLEEP PARALYSIS

Question 3

REM sleep is first evident at which stage of development? (x3)

Answer 3

IN UTERO

Question 4

What sleep stage is the most important in restoring the altered functions that result from prolonged sleep deprivation? (3x)

Answer 4

STAGE 4, NON-RAPID EYE MOVEMENT

Question 5

Insomnia secondary to depression will more consistently affect REM sleep in which of the following ways? (3x)

Answer 5

REDUCED LATENCY TO REM SLEEP

Question 6

Which of the following is a characteristics change on polysomnogram associated with major depression? (x3)

Answer 6

SHORT REM LATENCY

Question 7

A pt presents with a hx of irresistible episodic sleepiness that is accompanied by a vivid, dreamlike state at the onset of an episode. Which of the following additional sleep symptoms are likely to be present? (x2)

Answer 7

SLEEP PARALYSIS

Question 8

8 y/o with persistent delayed sleep onset despite good sleep hygiene, given no indication of broader psychopathology, which med has best evidence to treat this problem and restore normal circadian rhythm? (2x)

Answer 8

MELATONIN

Question 9

REM sleep behavior disorder is commonly associated with abnormal inclusions containing which of the following proteins? (2x)

Answer 9

SYNUCLEIN

Question 10

Medical student asks for something to help w/o attention and alertness. Taking a 2-week board review course and struggles to keep up w/ the pace. Sleeping 4hrs/night. Usually sleeps 8hr/night. Dx? (2x)

Answer 10

DYSSOMNIA NOS

Question 11

Age-related sleep pattern change (2x)

Answer 11

GREATER WAKEFULNESS INTERMIXED WITH SLEEP

Question 12

What aspect of sleep is increased in older adults? (2x)

Answer 12

DURATION OF AWAKENINGS

Question 13

What medication is best for decreasing nightmares in PTSD pts? (2x)

Answer 13

PRAZOSIN

Question 14

Pt reports insomnia, frequent nighttime awakenings, and excessive daytime sleepiness. Sleep study reveals brief lower external jerks with brief repeated arousals. Pt is unaware of these movements. Which dx is most consistent with pt presentation? (2x)

Answer 14

PERIODIC LIMB MOVEMENT DISORDER

Question 15

HPA axis cortisol production is less active in?

Answer 15

SLEEP ONSET

Question 16

Neuropeptides decreased in hypothalamus in narcolepsy

Answer 16

OREXIN A

Question 17

In Narcolepsy weakness in the arms and legs with laughter would respond to which med

Answer 17

VENLAFAXINE

Question 18

What finding on a multiple sleep latency test (MSLT) confirms the diagnosis of narcolepsy?

Answer 18

DECREASED REM LATENCY

Question 19

Physiologic changes during REM sleep

Answer 19

INCREASED HEART RATE, INCREASED EYE MOVEMENTS, DECREASED MUSCLE TONE

Question 20

Brief episodes of sudden loss of muscle tone, with intense emotion are characteristic of:

Answer 20

NARCOLEPSY

Question 21

65 y/o M trouble falling asleep 2/2 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 short while but is ultimately irresistible. Most likely Dx is:

Answer 21

RESTLESS LEG SYNDROME

Question 22

Most common symptom in narcoleptics:

Answer 22

SLEEP ATTACKS

Question 23

A patient with day time sleepiness, frequent naps. Sleep studies shows that pt enters REM within 5 minutes and wakes frequently at night. Which treatment is appropriate?

Answer 23

MODAFINIL GIVEN DOSE IN THE MORNING

Question 24

Changes w/ sleep associated with aging:

Answer 24

DELTA WAVE AMPLITUDE DECREASES AND PROPORTIONALLY LESS TIME IS SPENT IN STAGE 3 AND 4

Question 25

High voltage delta activity with slow eye-rolling on polysomnogram characterizes which stage of sleep?

Answer 25

N3

Question 26

What is the first step to manage restless leg syndrome?

Answer 26

CHECK FOR IRON DEFICIENCY

Question 27

Pts over 65 y/o who experience chronic insomnia are most likely to have what comorbid psych conditions

Answer 27

ALCOHOL ABUSE

Question 28

EEG findings in Stage II (N2) sleep

Answer 28

K-COMPLEXES AND SLEEP SPINDLES

Question 29

65yo p/w pillow-punching (x several months) in his sleep with sudden awakening from dreams involving pursuit by assailants. Dx?

Answer 29

REM BEHAVIOR DISORDER

Question 30

The evidence suggests that after completing treatment for insomnia, long term outcomes are better among patients with which medication/therapy?

Answer 30

CBT

Question 31

EEG biofeedback more effective than progressive muscle relaxation in treating?

Answer 31

INSOMNIA

Question 32

17 yo with increased sleep duration to 18 hours, lethargy and cognitive slowing. Sleep EEG is normal.

Answer 32

KLINE-LEVIN SYNDROME

Question 33

Pt p/w complaints of excessive daytime sleepiness, morning headaches, and excessive nighttime sweating. Symptoms are consistent with which sleep disorder?

Answer 33

OBSTRUCTIVE SLEEP APNEA

Question 34

Which of the following is characteristic of sleep in individuals over the age of 65, as compared to that of young adults?

Answer 34

INCREASED FRAGMENTATION

Question 35

Which medication is most effective in the treatment of cataplexy?

Answer 35

CLOMIPRAMINE (TCAs 2/2 TO INC NE)

Question 36

51y/o pt w/ dysthymic disorder has responded well to citalopram. However, the pt continues to complain of morning headaches, anxiety and daytime fatigue. The psychiatrist prescribes clonazepam and the pt immediately reports profound daytime sedation. The differential dx, in addition to a direct sedative effect of the drug, should include:

Answer 36

SLEEP APNEA

Question 37

Somnambulism during childhood is associated with which of the following stages of sleep measured by an EEG?

Answer 37

STAGE IV

Question 38

Night terrors typically appear when in life?

Answer 38

CHILDHOOD

Question 39

42 y/o anesthesiologist with repeated episodes of falling asleep in the OR, mild depression, irritability and mild cognitive troubles. UDS is negative. He gained substantial weight in 18 months, which he attributes to poor eating habits. Most likely Dx:

Answer 39

BREATHING-RELATED SLEEP D/O

Question 40

A characteristic of non-REM sleep?

Answer 40

DECREASED RECALL OF DREAM ACTIVITY

Question 41

Somnambulism during childhood is associated with which of the following stages of sleep measured by an EEG?

Answer 41

STAGE IV

Question 42

Night terrors typically appear when in life?

Answer 42

CHILDHOOD

Question 43

42 y/o anesthesiologist with repeated episodes of falling asleep in the OR, mild depression, irritability and mild cognitive troubles. UDS is negative. He gained substantial weight in 18 months, which he attributes to poor eating habits. Most likely Dx:

Answer 43

BREATHING-RELATED SLEEP D/O

Question 44

A characteristic of non-REM sleep?

Answer 44

DECREASED RECALL OF DREAM ACTIVITY

Question 45

According to DSM 5, Length of time of sleep difficulty for diagnosis of insomnia

Answer 45

3 MONTHS

Question 46

Most common explanation given by individuals >65 years for difficulty maintaining sleep?

Answer 46

NOCTURIA

Question 47

67 y/o with MDD doing well on SSRI but continues to have insomnia and sleepiness during day. Snores loudly, morning headaches, and night sweats. Dx?

Answer 47

BREATHING-RELATED SLEEP DISORDER

Question 48

Which of the following measures of rapid eye movement (REM) is typically reduced in MDD?

Answer 48

SLEEP ONSET TO REM ONSET

Question 49

MDD has what sleep abnormality?

Answer 49

SHORTENED REM LATENCY, DECREASED STAGE 4 SLEEP, INCREASED AWAKENINGS IN THE SECOND HALF OF THE NIGHT

Question 50

REM sleep behavior disorder associated with which pathology:

Answer 50

PARKINSON'S DISEASE

Question 51

Involuntary jerking of legs while falling asleep, not uncomfortable, stops with falling asleep

Answer 51

NORMAL PHENOMENON, NONPATHOLOGICAL

Question 52

Predominantly non-REM sleep problem:

Answer 52

ENURESIS

Question 53

Sinusoidal waves at 9-11 Hz on EEG is:

Answer 53

DEEP SLEEP

Question 54

Pt working overtime develops frightening nocturnal episodes characterized by semi- wakefulness and inability to move, accompanied by the sense that an intruder is present. The pt denies daytime sleep attacks or sudden loss of motor control. Best initial tx?

Answer 54

GETTING SUFFICIENT SLEEP

Question 55

A patient reports feeling "irritable" with inability to sleep more than an hour at night one week after receiving 80 mg prednisone daily for a poison ivy rash.

Answer 55

BEGIN TO GRADUALLY TAPER THE PATIENT OFF OF THE PREDNISONE

Question 56

Most effective treatment for REM sleep behavior disorders.

Answer 56

CLONAZEPAM

Question 57

Which of the following aspects of sleep is increased in older adults?

Answer 57

SUBJECTIVE QUALITY

Question 58

A 35 yo recurrent episodes of awakening during sleep waking up with a panicked scream and sweating, racing HR. can't remember, daytime drowsiness affecting functioning, EEG normal. What is the diagnosis?

Answer 58

SLEEP TERRORS

Question 59

Most effective treatment for OSA

Answer 59

POSITIVE PRESSURE THERAPY

Question 60

32 yo with episodes of severe sleepiness and falls asleep while driving, reporting episodes of paralysis and hallucinations while awakening. Symptoms are best explained by a deficiency of what?

Answer 60

OREXIN

Question 61

Which sleep disorder is associated w/ mild neurocognitive disorder w/ Lewy bodies?

Answer 61

REM SLEEP BEHAVIOR DISORDER

Question 62

Maximium sleepiness in humans occurs when melatonin reaches its highest point and when what reaches lowest point

Answer 62

BODY TEMPERATURE

Question 63

This is characteristic of sleep in individuals over the age of 65 compared to young adults

Answer 63

INCREASED SLEEP FRAGMENTATION