Sleep-Related Movement Disorders Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Sleep-Related Movement Disorders. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Sleep-Related Movement Disorders Indian Medical PG Question 1: A 50-year-old woman with schizophrenia who has been taking an antipsychotic drug for the past three years has begun to exhibit involuntary chewing and lip-smacking movements. Which is the most likely possibility?
- A. Akathisia
- B. Neuroleptic Malignant Syndrome
- C. Restless Legs Syndrome
- D. Tardive Dyskinesia (Correct Answer)
Sleep-Related Movement Disorders Explanation: ***Tardive Dyskinesia***
- This condition is characterized by **involuntary, repetitive movements**, often involving the face (e.g., **chewing, lip-smacking, grimacing**) and extremities, that develop after prolonged use of antipsychotic medications.
- The delayed onset (after three years of antipsychotic use) and the specific nature of the movements are highly suggestive of **tardive dyskinesia**.
*Akathisia*
- Akathisia presents as a feeling of **inner restlessness** and an inability to sit still, leading to constant pacing or fidgeting.
- While it is a common side effect of antipsychotics, the cardinal symptoms are motor restlessness rather than involuntary movements like chewing and lip-smacking.
*Neuroleptic Malignant Syndrome*
- This is a rare, life-threatening reaction to antipsychotics characterized by **fever, severe muscle rigidity, altered mental status, and autonomic dysfunction**.
- The patient's symptoms of involuntary chewing and lip-smacking do not align with the acute and severe presentation of NMS.
*Restless Legs Syndrome*
- RLS involves an **uncontrollable urge to move the legs**, typically worse at night and relieved by movement, often accompanied by unpleasant sensations.
- The patient's symptoms are in the face (chewing, lip-smacking) and not described as an urge to move the legs or worse at night.
Sleep-Related Movement Disorders Indian Medical PG Question 2: Which condition is associated with periodic discharges on EEG at 4-second intervals?
- A. SSPE (Correct Answer)
- B. Absence Seizure
- C. REM sleep disorder
- D. Focal epilepsy
Sleep-Related Movement Disorders Explanation: ***SSPE***
- **Subacute sclerosing panencephalitis (SSPE)** is a rare, fatal, progressive brain disorder characterized by inflammation and degeneration of the brain.
- The distinctive EEG pattern consists of **periodic high-amplitude, slow-wave complexes** that recur every 4-15 seconds, often every 4-8 seconds, making 4-second intervals a key indicator.
*Absence Seizure*
- Absence seizures typically manifest as **brief staring spells** with impaired consciousness, lasting only a few seconds.
- The EEG in absence seizures shows characteristic **generalized 3-Hz spike-and-wave discharges**, not 4-second interval periodic discharges.
*REM sleep disorder*
- **REM sleep behavior disorder** involves the acting out of vivid dreams due to the absence of normal muscle atonia during REM sleep [1].
- EEG in REM sleep behavior disorder shows normal sleep architecture but may include evidence of **muscle activity (EMG)** during REM sleep, not periodic discharges [1].
*Focal epilepsy*
- **Focal epilepsy** originates in a specific area of the brain, causing seizures with symptoms dependent on the affected region [2].
- EEG findings in focal epilepsy typically show **interictal spikes or sharp waves** localized to the region of seizure onset, which are distinct from generalized periodic discharges [2].
Sleep-Related Movement Disorders Indian Medical PG Question 3: A 32-year-old patient with Restless leg syndrome comes to the OPD. What is the most appropriate first line treatment?
- A. Iron Supplementation
- B. Gabapentin (Correct Answer)
- C. Pramipexole
- D. Vitamin B12
Sleep-Related Movement Disorders Explanation: ***Gabapentin***
- **Gabapentin** and other alpha-2-delta ligands (e.g., pregabalin) are considered **first-line agents** for moderate to severe Restless Legs Syndrome (RLS), particularly when symptoms are bothersome and daily.
- They work by modulating **calcium channels** and are effective in reducing RLS symptoms with a generally favorable side effect profile.
*Iron Supplementation*
- **Iron supplementation** is appropriate as first-line treatment only if **serum ferritin levels** are below 75 mcg/L, indicating iron deficiency.
- While RLS is associated with **iron deficiency**, it's not the universal first-line treatment without biochemical confirmation [1].
*Pramipexole*
- **Dopamine agonists** like pramipexole are effective for RLS but are generally **second-line treatments** due to concerns about augmentation (worsening of RLS symptoms) and impulse control disorders.
- Augmentation is a significant side effect where symptoms worsen paradoxically with continued use, particularly with higher doses.
*Vitamin B12*
- **Vitamin B12 deficiency** can cause neurological symptoms, but it is **not a primary cause or treatment** for Restless Legs Syndrome.
- Supplementation with **Vitamin B12** would only be considered if a confirmed deficiency exists, which is not stated as a contributing factor in this patient.
Sleep-Related Movement Disorders Indian Medical PG Question 4: During polysomnography, which stage of sleep is represented by the marked areas when observing the following wave patterns?
EOG (Electrooculography)
EEG (Electroencephalography)
EMG (Electromyography)
- A. REM sleep
- B. NREM I sleep (Correct Answer)
- C. NREM II sleep
- D. NREM III sleep
Sleep-Related Movement Disorders Explanation: ***NREM I sleep***
- This stage is characterized by a transition from wakefulness to sleep, identifiable by the appearance of **slow eye movements** in the EOG and a reduction in EEG frequency with the presence of **theta waves**.
- The EMG shows a decrease in muscle tone but without the complete atonia seen in REM sleep.
*REM sleep*
- **Rapid eye movements** are characteristic in the EOG, and the EEG shows **low-amplitude, mixed-frequency waves** similar to wakefulness.
- The EMG would display profound muscle atonia, which is not evident in the provided tracing.
*NREM II sleep*
- This stage is marked by the presence of **sleep spindles** and **K-complexes** in the EEG, which are absent in the marked area.
- Eye movements are generally absent, and muscle activity continues to be low.
*NREM III sleep*
- This is the deepest stage of sleep, characterized by **high-amplitude, slow-delta waves** (20-50% of the epoch) in the EEG.
- Eye movements are typically absent, and muscle tone is very low but not completely absent.
Sleep-Related Movement Disorders Indian Medical PG Question 5: A 60-year-old man with Parkinson’s disease presents with visual hallucinations and cognitive decline over the past year. He is on levodopa. What is the most likely diagnosis?
- A. Frontotemporal dementia
- B. Alzheimer's disease
- C. Lewy body dementia
- D. Parkinson’s disease dementia (Correct Answer)
Sleep-Related Movement Disorders Explanation: No changes were made to the text as none of the provided references met the relevance criteria (score >= 7) for characterizing the differential diagnosis between Parkinson’s disease dementia and Lewy body dementia, specifically the 'one-year rule' or the pathological progression from established Parkinson's disease motor signs to cognitive decline.
Sleep-Related Movement Disorders Indian Medical PG Question 6: A 55-year-old woman presents with widespread pain, fatigue, and sleep disturbances. Physical examination reveals multiple tender points. What is the most likely diagnosis?
- A. Rheumatoid arthritis
- B. Systemic lupus erythematosus
- C. Fibromyalgia (Correct Answer)
- D. Osteoarthritis
Sleep-Related Movement Disorders Explanation: ***Fibromyalgia***
- The classic presentation of **widespread pain**, **fatigue**, **sleep disturbances**, and **multiple tender points** is characteristic of fibromyalgia [1].
- Diagnosis is primarily clinical, based on these symptoms and the exclusion of other conditions [1].
*Rheumatoid arthritis*
- Characterized by **inflammatory arthritis** affecting primarily small joints, with swelling, morning stiffness, and systemic symptoms, but not widespread tender points as the primary feature [2].
- Laboratory tests often show elevated **ESR/CRP**, positive **rheumatoid factor (RF)**, and **anti-CCP antibodies**.
*Systemic lupus erythematosus*
- A multisystem autoimmune disease with varied manifestations, including rash, arthritis, serositis, and renal involvement, but not typically widespread tender points as the predominant symptom.
- Associated with positive **antinuclear antibodies (ANA)**, DNA antibodies, and other autoantibodies.
*Osteoarthritis*
- A degenerative joint disease often affecting weight-bearing joints, characterized by **joint pain** that worsens with activity and improves with rest, typically without significant systemic symptoms or widespread tender points [2].
- Physical exam may reveal **crepitus** and limited range of motion, and X-rays show joint space narrowing and osteophytes.
Sleep-Related Movement Disorders Indian Medical PG Question 7: In narcolepsy, the polysomnographic recording typically shows which of the following patterns?
- A. REM intrusion during inappropriate periods (Correct Answer)
- B. An absence of REM sleep in midcycle
- C. Extreme muscular relaxation
- D. Spike-and-wave EEG recording
Sleep-Related Movement Disorders Explanation: ***REM intrusion during inappropriate periods***
- In narcolepsy, the hallmark polysomnographic finding is **sleep-onset REM periods (SOREMPs)** - the occurrence of REM sleep within 15 minutes of sleep onset.
- The **Multiple Sleep Latency Test (MSLT)** in narcolepsy typically shows **≥2 SOREMPs** along with a mean sleep latency of ≤8 minutes.
- Clinically, this **REM sleep intrusion** manifests as **sudden, irresistible sleep attacks** during the day, **cataplexy** (sudden muscle weakness triggered by strong emotions), **sleep paralysis**, and **hypnagogic/hypnopompic hallucinations**.
- These represent features of REM sleep (muscle atonia, dreams) occurring at inappropriate times.
*An absence of REM sleep in midcycle*
- This statement is incorrect as narcolepsy is characterized by an **abnormal presence and early onset of REM sleep**, not its absence.
- Individuals with narcolepsy enter REM sleep much faster than normal (often within minutes rather than the typical 90 minutes).
*Extreme muscular relaxation*
- While **cataplexy** (present in Type 1 narcolepsy) involves sudden loss of muscle tone due to REM-related atonia during wakefulness, this is a clinical symptom rather than a continuous polysomnographic finding.
- Polysomnography focuses on **sleep architecture** and the timing of **REM sleep onset**, not general muscle relaxation patterns.
*Spike-and-wave EEG recording*
- **Spike-and-wave patterns** on EEG are characteristic of **absence seizures** (a form of epilepsy), not narcolepsy.
- Narcolepsy is a primary **sleep disorder** with distinct polysomnographic features related to **REM sleep dysregulation**, not epileptiform activity.
Sleep-Related Movement Disorders Indian Medical PG Question 8: Muller's manoeuvre is used to
- A. To remove foreign body from ear
- B. To find degree of obstruction in sleep disordered breathing (Correct Answer)
- C. To remove laryngeal foreign body
- D. To find out opening of mouth
Sleep-Related Movement Disorders Explanation: ***To find degree of obstruction in sleep disordered breathing***
- **Muller's manoeuvre** is a diagnostic technique where the patient attempts to inspire forcefully against a **closed mouth and nostrils** while an endoscope observes the upper airway.
- This maneuver helps to simulate the negative intraluminal pressure that occurs during sleep, making it useful in identifying the **site and severity of airway obstruction** in patients with sleep-disordered breathing.
*To remove foreign body from ear*
- Removing foreign bodies from the ear typically involves **irrigation**, specialized instruments (e.g., alligator forceps), or suction, not a breathing maneuver.
- This option is unrelated to the physiological assessment of airway obstruction.
*To remove laryngeal foreign body*
- The primary methods for removing laryngeal foreign bodies are the **Heimlich maneuver** (abdominal thrusts) or direct laryngoscopy and removal.
- Muller's manoeuvre is a diagnostic procedure, not a therapeutic one for foreign body extraction.
*To find out opening of mouth*
- Measuring the **opening of the mouth** is typically done with a ruler or specific instruments to assess jaw mobility (e.g., for temporomandibular joint disorders or trismus).
- This is a simple measurement and does not involve the complex physiological assessment of the upper airway that Muller's manoeuvre provides.
Sleep-Related Movement Disorders Indian Medical PG Question 9: A 55-year-old man presents with a tremor that occurs when his hands are at rest. He has a slow, shuffling gait and difficulty initiating movement. His symptoms improve with levodopa. What is the most likely diagnosis?
- A. Parkinson’s disease (Correct Answer)
- B. Huntington’s disease
- C. Essential tremor
- D. Multiple sclerosis
Sleep-Related Movement Disorders Explanation: ***Parkinson’s disease***
- The classic triad of symptoms—**resting tremor**, **bradykinesia** (difficulty initiating movement, shuffling gait), and **rigidity**—is highly characteristic of Parkinson's disease [1, 5].
- Significant improvement with **levodopa** is a hallmark of dopaminergic responsiveness seen in Parkinson's disease.
*Huntington’s disease*
- Characterized by **chorea** (involuntary, jerky movements), cognitive decline, and psychiatric symptoms, which are not described in this patient.
- The onset is typically earlier, and the tremor is not primarily a resting tremor.
*Essential tremor*
- Primarily an **action tremor** [1] that occurs during voluntary movement, unlike the resting tremor described in the patient.
- While it can be debilitating, it typically does not present with **bradykinesia** or **shuffling gait**.
*Multiple sclerosis*
- A demyelinating disease presenting with a wide range of neurological symptoms depending on lesion location, such as sensory disturbances, weakness, visual problems, and **ataxia**.
- While tremors can occur (often intention tremors), the clinical presentation of a **resting tremor**, **shuffling gait**, and **bradykinesia** is not typical of MS.
Sleep-Related Movement Disorders Indian Medical PG Question 10: All of the following decrease in iron deficiency anemia except:
- A. Serum iron
- B. Ferritin
- C. TIBC (Correct Answer)
- D. Transferrin saturation
Sleep-Related Movement Disorders Explanation: ***TIBC***
- In **iron deficiency anemia**, the body attempts to maximize iron absorption and transport, leading to an **increase** in **Total Iron Binding Capacity (TIBC)** [1].
- TIBC reflects the amount of **transferrin** available to bind iron; more transferrin is produced when iron stores are low [1].
*Serum iron*
- **Serum iron** measures the iron circulating in the blood bound to transferrin.
- In **iron deficiency anemia**, the overall amount of circulating iron is **decreased** due to insufficient iron stores [1].
*Ferritin*
- **Ferritin** is a storage protein for iron, reflecting the body's iron stores [2].
- In **iron deficiency anemia**, iron stores are depleted, resulting in a **decreased** serum ferritin level [1].
*Transferrin saturation*
- **Transferrin saturation** is the percentage of transferrin binding sites occupied by iron.
- In **iron deficiency anemia**, with low serum iron and increased TIBC, the percentage of binding sites occupied by iron is **lowered** [1].
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