Sleep-Wake Disorders — MCQs
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A 7-year-old girl is reported by the parents as waking up in the night screaming, and she sits up in bed frightened. She does not respond to questions and after 2 or 3 minutes she goes back to sleep. She has no memory of these events the following morning. Which of the following is the most likely diagnosis?
Narcolepsy is characterized by all of the following except -
Sleep drunkenness is otherwise called as:
Hallucinations which occur at the start of sleep are:
Kleine-Levin syndrome, which of the following is NOT true?
What is the primary characteristic of narcolepsy?
Not seen in Narcolepsy:
Somnambulism is mostly seen in which age group?
The definition of premature ejaculation, according to DSM-5 is ejaculation occurring in less than-
Which of the following is not the right advice, with respect to sleep hygiene?
Sleep-Wake Disorders Indian Medical PG Practice Questions and MCQs
Question 41: A 7-year-old girl is reported by the parents as waking up in the night screaming, and she sits up in bed frightened. She does not respond to questions and after 2 or 3 minutes she goes back to sleep. She has no memory of these events the following morning. Which of the following is the most likely diagnosis?
- A. Nightmare
- B. Sleep terrors (Correct Answer)
- C. Narcolepsy
- D. Nocturnal seizures
Explanation: ***Sleep terrors*** - **Sleep terrors** are characterized by abrupt awakenings, intense fear and screaming, autonomic arousal, and unresponsiveness, typically occurring during **NREM sleep** in the first third of the night. - The child will have **no memory** of the event the next morning, which is a key diagnostic feature, and they often return to sleep quickly afterward. *Nightmare* - **Nightmares** occur during **REM sleep**, usually in the latter half of the night, and the individual can often recall vivid and frightening details upon waking. - Unlike sleep terrors, individuals experiencing nightmares are typically **responsive to comfort** and fully alert after waking. *Narcolepsy* - **Narcolepsy** is a chronic neurological condition characterized by overwhelming daytime sleepiness and irresistible urges to sleep, often accompanied by **cataplexy**. - It does not involve nocturnal screaming episodes or unresponsiveness followed by a quick return to sleep with no memory. *Nocturnal seizures* - **Nocturnal seizures** can cause nocturnal awakenings with confusion or unusual behaviors, but they often involve **stereotyped movements**, sometimes with motor manifestations or post-ictal confusion that lasts longer than a few minutes. - While there might be no memory of the event, the screaming and frightened demeanor without typical seizure activity make sleep terrors a more likely diagnosis.
Question 42: Narcolepsy is characterized by all of the following except -
- A. Sleep paralysis
- B. Snoring (Correct Answer)
- C. Hallucination
- D. Cataplexy
Explanation: ***Snoring*** - **Snoring** is a common symptom of **obstructive sleep apnea**, not a characteristic feature of narcolepsy. - While individuals with narcolepsy can snore, it is not a diagnostic criterion or a primary symptom differentiating it from other sleep disorders. *Sleep paralysis* - **Sleep paralysis**, the inability to move or speak while waking up or falling asleep, is a common symptom in narcolepsy. - It often occurs during the transitions between sleep and wakefulness, a manifestation of REM sleep intrusion into wakefulness. *Hallucination* - **Hypnagogic (at sleep onset) and hypnopompic (at sleep offset) hallucinations** are vivid, dream-like experiences that occur when falling asleep or waking up. - These can be frightening and are another sign of involuntary intrusion of REM sleep phenomena into wakefulness. *Cataplexy* - **Cataplexy** is the sudden, brief loss of voluntary muscle tone, often triggered by strong emotions like laughter or anger. - It is a highly specific symptom of narcolepsy, particularly in type 1, due to a deficiency in **hypocretin** (orexin) in the brain.
Question 43: Sleep drunkenness is otherwise called as:
- A. Confusional arousal (Correct Answer)
- B. Somnambulism
- C. Hypnotism
- D. Automatism
Explanation: ***Confusional arousal*** - This term directly describes a state of **disorientation** and impaired mental and motor activity upon waking from sleep, which is the definition of **sleep drunkenness**. - It is classified as an **NREM parasomnia**, occurring during stages N2 or N3 of sleep. *Somnambulism* - Also known as **sleepwalking**, this parasomnia involves complex motor behaviors performed during sleep, but the individual is typically not conscious or lucid during the episode. - While both are NREM parasomnias, **sleepwalking** involves more purposeful movement rather than just confusion and disorientation upon waking. *Hypnotism* - This refers to a **trance-like state** induced by another person or by self-suggestion, where the individual is highly responsive to suggestion. - It is an **induced state of consciousness**, completely different from a spontaneous sleep-wake transition disorder. *Automatism* - This is a broad term for actions performed **unconsciously** or involuntarily. It can occur in various medical conditions, including seizures or certain psychiatric disorders. - While sleep drunkenness involves automatic behaviors, **automatism** itself isn't a specific synonym, but rather a characteristic that can be observed within a confusional arousal episode.
Question 44: Hallucinations which occur at the start of sleep are:
- A. Hypnopompic hallucinations
- B. Non-specific hallucination
- C. Hypnagogic hallucinations (Correct Answer)
- D. Jactatio nocturna capitis
Explanation: ***Hypnagogic hallucinations*** - These are **vivid, dream-like experiences** that occur as a person is falling asleep (the ingress of sleep). - They are common in the general population, often benign, and can involve visual, auditory, or tactile sensations. *Hypnopompic hallucinations* - These hallucinations occur when a person is **waking up from sleep** (the egress of sleep). - They are similar in nature to hypnagogic hallucinations but are experienced upon awakening. *Non-specific hallucination* - This term is too broad and does not specify the **timing** or **context** of the hallucination. - Medical terminology generally uses more precise terms to describe different types of hallucinations based on their characteristics and temporal relationship to sleep or wakefulness. *Jactatio nocturna capitis* - This refers to **rhythmic head or body rocking** during sleep or sleep onset. - It is a type of parasomnia, not a hallucination, and is related to repetitive motor movements.
Question 45: Kleine-Levin syndrome, which of the following is NOT true?
- A. Also called sleeping beauty syndrome
- B. Spontaneous resolution
- C. Hyposexuality (Correct Answer)
- D. Hypersomnia
Explanation: ***Hyposexuality*** - Patients with Kleine-Levin syndrome typically experience **hypersexuality**, not hyposexuality, during their episodes. - This symptom, along with **compulsive eating** (megaphagia), distinguishes the syndrome. *Also called sleeping beauty syndrome* - This is a well-known alternative name for **Kleine-Levin syndrome**, reflecting the prominent symptom of episodic hypersomnia. - The duration of these sleep episodes can be prolonged, leading to patients sleeping for **days or weeks** at a time. *Spontaneous resolution* - Kleine-Levin syndrome often resolves spontaneously, usually within **8-12 years** from its onset. - The frequency and severity of episodes tend to decrease over time until they cease altogether. *Hypersomnia* - **Recurrent episodes of hypersomnia** are a hallmark symptom of Kleine-Levin syndrome, where individuals sleep for excessively long periods. - This severe sleepiness is often accompanied by cognitive and behavioral changes when awake, such as **confusion, irritability**, and **megaphagia**.
Question 46: What is the primary characteristic of narcolepsy?
- A. Sleep terrors
- B. Sleep walking
- C. Excessive daytime sleepiness (Correct Answer)
- D. Sleeptalking
Explanation: **Excessive daytime sleepiness** - **Excessive daytime sleepiness (EDS)** is the hallmark symptom of narcolepsy, often manifesting as an irresistible urge to sleep, even after adequate nighttime sleep. - This **sleepiness** can lead to sudden sleep attacks during inappropriate times, impacting daily activities and safety. - EDS is present in virtually all cases of narcolepsy and is the **primary diagnostic criterion**. *Sleep terrors* - **Sleep terrors** are a parasomnia characterized by sudden awakening in a state of fear and confusion, often accompanied by screaming or thrashing, and are distinct from narcolepsy. - They typically occur during **non-rapid eye movement (NREM) sleep** and the individual usually has no memory of the event. *Sleep walking* - **Sleepwalking** (somnambulism) is another parasomnia where individuals perform complex behaviors while asleep, such as walking or talking, without conscious awareness. - It occurs during **deep NREM sleep** and is not a primary characteristic of narcolepsy. *Sleeptalking* - **Sleeptalking** (somniloquy) involves speaking while asleep and is a common, generally benign parasomnia that can occur during any sleep stage. - While it can be a symptom of various sleep disorders, it is not the defining feature of narcolepsy.
Question 47: Not seen in Narcolepsy:
- A. Sleep attack
- B. Cataplexy
- C. Catalepsy (Correct Answer)
- D. Sleep paralysis
Explanation: ***Catalepsy*** - **Catalepsy** is a trancelike state with **muscle rigidity** and **waxy flexibility**, often seen in conditions like **catatonic schizophrenia** or **epilepsy**. - It is **NOT a feature of narcolepsy** and is distinct from cataplexy, which involves sudden muscle weakness (not sustained rigidity). *Sleep attack* - **Sleep attacks ARE seen in narcolepsy** - they are a primary symptom characterized by **sudden, irresistible bouts of sleepiness** during waking hours. - These attacks can occur without warning and are a defining feature of the disorder. *Cataplexy* - **Cataplexy IS seen in narcolepsy** - it is a hallmark symptom of **narcolepsy type 1**, involving sudden, **brief episodes of muscle weakness** triggered by strong emotions like laughter or anger. - Despite muscle weakness, the individual remains conscious throughout the episode. *Sleep paralysis* - **Sleep paralysis IS seen in narcolepsy** - characterized by a **temporary inability to move or speak** when waking up or falling asleep. - This occurs due to a dissociation of REM sleep features into wakefulness.
Question 48: Somnambulism is mostly seen in which age group?
- A. Adolescents
- B. All age groups
- C. Children (Correct Answer)
- D. Adults
Explanation: ***Correct Option: Children*** - Somnambulism (sleepwalking) is **most commonly seen in children**, with peak incidence between **4-12 years of age** - Approximately **15-40% of children** experience at least one episode of sleepwalking - Occurs during **slow-wave sleep (NREM stage 3)**, which is more prominent in childhood - Episodes typically **decrease and resolve by adolescence** as sleep architecture matures *Incorrect Option: Adolescents* - While sleepwalking can persist into adolescence, the **prevalence significantly decreases** during teenage years - Most children who sleepwalk stop by the time they reach adolescence *Incorrect Option: All age groups* - Though somnambulism can technically occur at any age, it is **NOT equally distributed** across age groups - The frequency is **significantly higher in children** compared to other age groups *Incorrect Option: Adults* - Adult-onset sleepwalking is **relatively rare (1-4% prevalence)** - When it occurs in adults, it may be associated with underlying conditions (medications, sleep deprivation, psychiatric disorders, or neurological conditions) - Childhood somnambulism has much higher prevalence rates
Question 49: The definition of premature ejaculation, according to DSM-5 is ejaculation occurring in less than-
- A. 5 min
- B. 3 min
- C. 2 min
- D. 1 min (Correct Answer)
Explanation: ***1 min*** - According to the **DSM-5 criteria**, premature ejaculation is defined as a persistent or recurrent pattern of ejaculation occurring within approximately **1 minute** of vaginal penetration. - This definition emphasizes an ejaculatory latency time that is unacceptably short for the individual, causing significant distress. *5 min* - This duration is **too long** to meet the DSM-5 criteria for premature ejaculation. - While an individual may feel unsatisfied, ejaculation occurring after 5 minutes of penetration would not typically be classified as premature based on diagnostic guidelines. *3 min* - This duration is **longer** than the 1-minute threshold established by the DSM-5 for premature ejaculation. - Although it might be considered rapid by some, it doesn't align with the specific diagnostic cutoff. *2 min* - This duration is also **longer** than the specified 1-minute cutoff for premature ejaculation in the DSM-5. - The diagnostic criteria are quite specific regarding the ejaculatory latency period for this condition.
Question 50: Which of the following is not the right advice, with respect to sleep hygiene?
- A. Wake up at the same time
- B. 30 mL and lesser amount of alcohol could be useful to induce sleep over long term (Correct Answer)
- C. Avoid daytime nap
- D. Use bed for sleep and sexual activity
Explanation: **30 mL and lesser amount of alcohol could be useful to induce sleep over long term** - While a small amount of alcohol might initially induce sleepiness due to its **sedative effects**, it actually **disrupts sleep quality** and architecture over the long term. - Regular alcohol consumption before bed can lead to **fragmented sleep**, reduced REM sleep, and exacerbation of sleep disorders. *Wake up at the same time* - Maintaining a **consistent wake-up time**, even on weekends, helps to regulate the body's natural **circadian rhythm**. - This consistency strengthens the sleep-wake cycle, making it easier to fall asleep and wake up naturally. *Avoid daytime nap* - For individuals with **insomnia** or those struggling to sleep at night, avoiding daytime naps helps consolidate sleep into the main nighttime period. - Napping can reduce **"sleep debt"**, making it harder to fall asleep at night. *Use bed for sleep and sexual activity* - This advice encourages **associating the bed primarily with sleep** (and sexual activity), strengthening the mental link between the bed and rest. - Avoiding other activities like working, eating, or watching TV in bed helps to prevent **conditioning the brain to be alert** in the sleep environment.
Practice by Chapter
Normal Sleep Physiology
Practice Questions
Insomnia Disorder
Practice Questions
Hypersomnolence Disorders
Practice Questions
Narcolepsy
Practice Questions
Breathing-Related Sleep Disorders
Practice Questions
Circadian Rhythm Sleep-Wake Disorders
Practice Questions
Parasomnias
Practice Questions
Sleep-Related Movement Disorders
Practice Questions
Sleep Disorders in Psychiatric Conditions
Practice Questions
Pharmacotherapy for Sleep Disorders
Practice Questions
Cognitive-Behavioral Therapy for Insomnia
Practice Questions
Sleep Hygiene and Other Non-pharmacological Approaches
Practice Questions
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