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MC > Sleep DO > Flashcards

Sleep DO Flashcards

1
Q

Normal sleep: in a fit young person the ideal is
7.5–8 hours; latency_______minutes; wakefulness
within sleep usually_______ of time

A

<30

<5%

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2
Q

People with _______ usually present with the TATT
syndrome—‘tired all the time’. These patients are
often unaware of waking or becoming aroused
during the night

A

OSA

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3
Q

The majority of cases of excessive somnolence are

caused by ____ and _____

A

OSA and narcolepsy

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4
Q

untreated moderate to severe OSA has an_______ 5-year mortality and a ____ 8-year mortality, mainly from cardiovascular and motor vehicle accident related deaths

A

11–13%

37%

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5
Q

______is defined as the inability to initiate or

maintain sleep.

A

Insomnia

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6
Q

Pharma Tx of insomnia

It is advisable to avoid hypnotic agents as firstline
treatment. If any form of continuous agent is
necessary it is best to limit it to _____

A

2 weeks

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7
Q

Tricyclic antidepressants with sedative effects
(e.g. ________) are often used as hypnotics
but should generally be avoided in the absence
of depressive disorders

A

amitriptyline

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8
Q

The term ‘________ is used to describe cyclical brief
interruptions of ventilation, each cycle lasting 15–90
seconds and resulting in hypoxaemia, hypercapnia
and respiratory acidosis, terminating in an arousal
from sleep (often not recognised by the patient).

A

sleep apnoea’

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9
Q

Sleep apnoea is broadly classified into ___ and ____

A

obstructive

and central types

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10
Q

________ refers to the
presence of apnoeas and hypopnoeas during sleep
together with daytime dysfunction, predominantly
excessive daytime sleepiness. The effects include
snoring

A

Obstructive sleep apnoea (OSA)

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11
Q

Predisposing factors to OSA

A

• diminished airway size (e.g. macroglossia obesity,
tonsillar-adenoidal hypertrophy)
• upper airway muscle hypotonia (e.g. alcohol hypnotics, neurological disorders
• nasal obstruction

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12
Q

Effects of sleep apnea syndromes

A

• excessive daytime sleepiness and tiredness
• nocturnal problems (e.g. loud snoring, thrashing,
‘seizures’, choking, pain reactions)
• morning headache
• subtle neuropsychiatric disturbance—learning
difficulties, loss of concentration, personality
change, depression
• sexual dysfunction
• occupational and driving problems

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13
Q 
\_\_\_\_\_\_ is currently the most effective treatment
for OSA (consider it for CSA).
A

CPAP

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14
Q

MOA of CPAP

A

Provides an air splint to the upper airway and

prevents pharyngeal collapse

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15
Q

In children, OSA is usually due to t____ and _____ and is relieved by surgery

A

onsillar and/

or adenoid hypertrophy

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16
Q

There are no reliable drug treatment options for
OSA.

Consider:
1
2

A

• amitriptyline 25–100 mg (o) nocte, in severe
cases during REM sleep and intolerance of CPAP
• trial of corticosteroid sprays in children with
mild OSA

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17
Q

______ is a specific, permanent neurological
disorder that is characterised by brief spells of
irresistible sleep during daytime hours in inappropriate
circumstances, even during activity and usually
at times when the average person simply feels sleepy

A

Narcolepsy

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18
Q

Tetrad of Sx of Narcolepsy

• __________: sudden brief sleep
attacks (15–20 minutes).
• _________: a sudden decrease or loss of muscle
tone in the lower limbs that may cause the
person to slump to the floor, unable to move.
These attacks are usually triggered by sudden
surprise or emotional upset.
• _________: a frightening feeling of inability to
move while drowsy (between sleep and waking).
• _________

A

Daytime hypersomnolence

Cataplexy

Sleep paralysis

Hypnagogic (terrifying) hallucinations on falling asleep or waking up (hypnopompic hallucination).

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19
Q

In Narcolepsy,

____________
are of proven effectiveness in increasing alertness

A

Central nervous system psychostimulants

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20
Q

Examples of Central nervous system psychostimulants for narcolepsy

A
  1. dexamphetamine 5–10 mg (o), half an hour
    before breakfast and lunchtime; up to 40 mg
    daily may be required in slowly increasing doses
  2. methylphenidate (Ritalin) 10–20 mg (o) half an
    hour before breakfast and lunchtime; up to 60
    mg daily may be required
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21
Q

Important to consider for Central nervous system psychostimulants for narcolepsy

A

Drug holidays from these drugs may be necessary

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22
Q

Tricyclic antidepressants are used to treat
______, ________, ______ (e.g. clomipramine 20–100 mg (o)
daily)

A

cataplexy, sleep paralysis and hypnagogic

hallucinations

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23
Q

This type of excessive daytime sleepiness (EDS) can
present similarly to narcolepsy without cataplexy.
The condition, which accounts for 5–10% of patients

A

Idiopathic hypersomnia

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24
Q

Difference between Idiopathic hypersomnia and narcolespy

A

They usually have non-refreshing deep nocturnal sleep but, unlike narcolepsy, naps are not refreshing.

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25
Q

Tx of idiopathic narcolepsy

A

Treatment is usually based on psychostimulant

therapy to improve EDS.

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26
Q

_________ is a sonorous sound with breathing during
sleep, caused by vibrations in the upper airways
from the nose to the back of the throat. It is caused
by partially obstructed breathing during sleep

A

Snoring

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27
Q

When does snoring need medical intervention?

A

Generally harmless, but if very severe, unusual or
associated with periods of no breathing (>10 s)
assessment is advisable

28
Q

Periodic limb movements (PLMs) and restless legs
syndrome are important causes of insomnia and
excessive ________

A

daytime sleepiness

29
Q

Periodic limb movements, which
are also referred to as nocturnal myoclonus or ‘leg
jerks’, tend to occur usually in the ________of the leg but can occur in the upper limbs

A

anterior tibialis

muscles

30
Q

Dx of PLM

A

The diagnosis is often made during sleep studies

31
Q

Mx of PLM

A

levodopa plus carbidopa (e.g. Sinemet 100/25,
2 tablets before bedtime)
or
clonazepam 1 mg (o) nocte increasing to 3 mg (o)
nocte
or
sodium valproate 100 mg (o) nocte

32
Q

_______ also known as Ekbom syndrome, is a rather
common movement disorder of the nervous system
where the legs feel as though they want to exercise or
move when the body is trying to rest

A

RLS,

33
Q

What are the sensations felt in RLS

A

Sensations that may be experienced include ‘twitching’, ‘prickling’ and ‘creeping’.

34
Q

Dx of RLS

A

The diagnosis is made from the history—there

are no special diagnostic tests.

35
Q

Cause of RLS

A

unclear

36
Q

Secondary causes of RLS

A 
• anaemia (common)
• iron deficiency (common)
• uraemia
• hypothyroidism
pregnancy (usually ceases within weeks of
delivery)
37
Q

What drugs cause RLS

A

antihistamines, anti-emetics, selective
antidepressants, lithium, selective major
tranquillisers and antihypertensives

38
Q

What to do if Fe deficiency is the cause of RLS

A

Iron studies should be performed and, if low, treat

with iron and vitamin C tablets

39
Q

T or F

getting out of bed and going for a
walk or run seem to help RLS.

A

F

getting out of bed and going for a
walk or run does not seem to help RLS.

40
Q

Good exercise of RLS

A

a popular treatment is gentle stretching
of the legs, particularly of the hamstring
and calf muscles, for at least 5 minutes before
retiring.

41
Q

Tx of mild RLS

A

clonazepam 0.5–1 mg (o) 1 hour before retiring
or
levodopa ( + benserazide or carbidopa) 100–200 mg (o) (especially if limb movements at sleep onset are infrequent

42
Q

Tx of severe RLS

A

pramipexole 0.125 mg (o) daily, increasing as
tolerated to 0.75 mg
or
ropinirole 0.5 mg (o) → 4 mg daily

43
Q

______ is the habit of grinding, clenching or tapping
teeth, which may occur while awake (especially in
children) or more commonly while asleep

A

Bruxism

44
Q

What is the result of Bruxism?

A

It may result in headaches and TMJ dysfunction in the person during the day.

45
Q

_______ are defined as dysfunctional episodes
associated with sleep, sleep stages or partial arousal.
They are more common in children.

A

Parasomnias

46
Q

Drugs associated with nightmares/ dream anxiety

A

alcohol, barbiturates, drugs such as zolpidem, SSRIs, β -blockers, benzodiazepines

47
Q

Mx of dream anxiety

A

Psychological evaluation with cognitive behaviour
therapy (CBT) is appropriate. Medication that may
help includes phenytoin, clonazepam or diazepam

48
Q

A feature is complex and elaborate motor activity
associated with dreams. The behaviour may be
violent with profane verbalisation

A

REM sleep behaviour disorder

49
Q

Tx of REM sleep behaviour disorder

A

Diagnosis is by sleep studies and treatment is low-dose clonazepam

50
Q

This is a complex motor activity in which the person
performs some repetitive activity in bed or walks
around freely while still asleep. There is amnesia
for the event

A

Somnambulism (sleepwalking)

51
Q

In Somnambulism,

Benzodiazepines such as_______ may
be useful but withdrawal usually leads to rebound
problems.

A

diazepam

52
Q

Sleep disorders in children are very common in _______, _______, ______

A

late

infancy, toddlerhood and early preschool age groups

53
Q

Toddlers begin to have dreams coinciding with

_________in the second year of life

A

language development

54
Q

Why not use sedative meds for sleep disturbances in children?

A

Not recommended for children <2 years although the
judicious use of a sedative/hypnotic for a short
term may break the sleepless cycle

55
Q

What sedative hypnotic drug can be given to children?

A

Such drugs include promethazine 0.5 mg/kg (max. 10 mg) and trimeprazine (Vallergan) 1–2 mg/kg per dose (not for
infants under 6 months)

56
Q

These are not true sleep disorders or night-time

arousals. They occur in deep non-REM sleep

A

Parasomnias

57
Q

Desrcibe the event clusters happening in each age group

  • ________4–8 years
  • _______8–12 years
  • _______ 6–10 years
  • _______3–6 years
A

sleep terrors

sleep walking

sleep talking

nightmares

58
Q

A study of elderly patients with insomnia showed
that:

• 25% had insomnia either coexisting with or
related to other sleep disorders, such as sleep
apnoea or periodic limb movement disorder
• 10% had insomnia related to _______
• 13% had insomnia associated with an _____

A

medical or psychiatric conditions

inability to stop taking sedative–hypnotic agents

59
Q

There are three types of stratified squamous
epithelium in the oral mucosa:

1 ________—surface layer, cornified
(orthokeratinised), attached to underlying
periosteum (e.g. hard palate and gingivae)

2 ________—(e.g. lip and buccal mucosa, alveolar
mucosa, floor of mouth, soft palate and tongue—
lateral and undersurface)

3 ______—with taste buds and papillae e.g. on
dorsum of tongue

A

masticatory

lining

specialised

60
Q

_________ is an important cause of
many oral mucosal disorders, such as ulceration,
bleeding gums and hyperplasia

A

Dental trauma or neglect

61
Q

Non-healing oral ulcers warrant biopsy to exclude

______

A

squamous cell carcinoma (SCC

62
Q

________ persisting for 3 weeks
after injury, e.g. sharp tooth or denture, should
have an incisional biopsy

A

Erythroplasia or leucoplakia

63
Q

Any oral ulcer or soft-tissue lesion that persists
______ after the apparent cause has been
removed should be biopsied.

A

3 weeks

64
Q

Consider ________infection
with unusual faucial ulceration and petechial
haemorrhages of the soft palate.

A

Epstein–Barr virus (EBV)

65
Q

______ are usually 3–5 mm in diameter—

minor ones have an erythematous margin

A

Aphthous ulcers

66
Q

______, other than palatal and

mandibular tori, are often variations from normal

A

Intraoral bony exostoses

67
Q

Histology of oral ulceration

A

The histology of oral ulceration is usually non-specific,
with fibrin slough covering granulation tissue, and
the aetiology is varied

MC (90 decks)

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