Quiz 07/29/2022 (2)

A 67-year-old male with a gait disorder is having a polysomnogram due to aggressive leg movements during sleep. During the study, an abnormality is noted during sleep. The EMG and chin leads show excessive muscle artifact during sleep, while at the same time the EEG shows quick deflections in the lateral leads, indicating rapid alternating eye movements. He is given a diagnosis and started on medication. Which of the following is the most appropriate treatment for this sleep issue?

A 20-year-old female presents with complaints of 2 years of excessive daytime sleepiness and brain fog during the day. She reports sleeping is unrefreshing. In the morning she has difficulty waking up and feels an uncontrollable desire to go back to sleep. She denies difficulty staying asleep during the night and denies episodes of suddenly collapsing in stressful situations. She had a polysomnogram where she slept for 12 hours, had 4 apneic episodes per hour, had REM sleep onset latency of 7 minutes, and did not have sleep-onset REM periods (SOREMPs). Which of the following is her diagnosis?

A 15-year-old male comes to the clinic with his parents as they complain he has periods of the year where he will sleep up to 20 hours a day for multiple days in a row, as well as uninhibited eating and inappropriate sexual behavior. These episodes last for up to around 2 weeks at most, and then he is behaviorally back to normal in between episodes. Which is the most likely diagnosis?

Narcolepsy is associated with which of the following HLA alleles?

A 56-year-old woman with a history of right temporal epilepsy with no other comorbidities had an ambulatory 24-hour EEG performed. What is the state of the patient in this segment of the recording?

Sleep spindles are first seen at what gestational age (GA)?

Where is the anatomic origin of the normal EEG sleep structure seen in the 3rd second of this recording?

Which of the following does this EEG tracing reveal?

Patients with narcolepsy and cataplexy have a deficiency in which of the following neuropeptides?

A 33-year-old woman has recently given birth to a healthy 3-month-old boy. She has been complaining of poor sleep for the past year, mainly from an uncontrollable urge to move her legs that is only relieved by moving them. This is present during the day to a small degree but is much worse at night and during periods of rest. What would be the best test to order for her?

An overweight 54-year-old male presents to the neurology clinic with excessive daytime sleepiness. His wife states that the patient snores excessively during sleep. Which of the following is the most appropriate diagnostic test?

Which of the following regions of the brain, when active, promotes the switch from drowsiness to non-REM sleep?

A 53-year-old man has had increasing difficulty falling and staying asleep over the past 3 months. This is accompanied by hallucinations, delirium, and general clumsiness. He was an orphan as a child and does not know his family’s medical history. If a sleep study is performed, during which stage of sleep would you most likely expect to find an absence of normal sleep architecture?

A 43-year-old man with obesity and hypertension presents with complaints of excessive daytime sleepiness, gasping awakenings, and witnessed periods of not breathing during sleep. A polysomnogram is performed and confirms the presence of sleep-disordered breathing. What feature would point to a central rather than obstructive cause?

A 62-year-old man complains of 5 years of vivid dreams. At times this involves punching and kicking, which has hurt his wife. He undergoes a polysomnogram and there is no sleep-disordered breathing and the EEG is normal. What would be the best first-line medication to treat this behavior?

A 70-year-old male presents to your clinic with the chief complaint of leg discomfort. He states that he has difficulty sleeping at night due to these symptoms. Movement of his limbs gives transient relief. Serum ferritin levels were within normal limits. Which of the following therapeutic options is the most appropriate treatment for his disorder?

A 5-year-old girl is brought in by her parents because of 1 month of episodes of screaming at night. She has no recollection of these events in the mornings and she is developmentally appropriate and healthy otherwise. What is the best treatment?

Which of the following medications is associated with sudden irresistible attacks of sleep?

A healthy 24-year-old female was admitted to the epilepsy monitoring unit for spell classification. What state is the patient during this segment of recording?

A morbidly obese patient with a past medical history of brainstem stroke and excessive daytime sleepiness undergoes polysomnography. Polysomnographic testing revealed an average of 8-10 apnea/hypopneas per hour during sleep. During prolonged periods of apnea, there were no out-of-phase movements on plethysmography. Which of the following is the most likely diagnosis?