Normal sleep physiology — MCQs

An otherwise healthy 43-year-old woman comes to the physician because of several episodes of involuntary movements of her head over the past few months. They are sometimes associated with neck pain and last minutes to hours. Neurologic examination shows no abnormalities. During examination of the neck, the patient's head turns horizontally to the left. She states this movement is involuntary, and that she is unable to unturn her head. After 5 minutes, her head re-straightens. Which of the following best describes this patient's disorder?

A 20-year-old college student presents to the emergency room complaining of insomnia for the past 48 hours. He explains that although his body feels tired, he is "full of energy and focus" after taking a certain drug an hour ago. He now wants to sleep because he is having hallucinations. His vital signs are T 100.0 F, HR 110 bpm, and BP of 150/120 mmHg. The patient states that he was recently diagnosed with "inattentiveness." Which of the following is the mechanism of action of the most likely drug causing the intoxication?

A 71-year-old woman comes to her doctor because she is having trouble staying awake in the evening. Over the past year, she has noticed that she gets tired unusually early in the evenings and has trouble staying awake through dinner. She also experiences increased daytime sleepiness, fatigue, and difficulty concentrating. She typically goes to bed around 9 PM and gets out of bed between 2 and 3 AM. She does not have any trouble falling asleep. She takes 30-minute to 1-hour daytime naps approximately 3 times per week. She has no history of severe illness and does not take any medication. Which of the following is the most likely diagnosis?

A 57-year-old man comes to the physician because of a 3-month history of fatigue, difficulty swallowing, and weight loss. He has smoked 1 pack of cigarettes daily for 30 years. He is 173 cm (5 ft 8 in) tall, and weighs 54 kg (120 lb); BMI is 18 kg/m2. Upper gastrointestinal endoscopy shows an exophytic tumor at the gastroesophageal junction. The patient is diagnosed with advanced esophageal adenocarcinoma. Palliative treatment is begun. Two months later, he complains of difficulty sleeping. His husband says that the patient does not get out of bed most days and has lost interest in seeing his friends. Mental status examination shows a blunted affect, slowed speech, and poor concentration. This patient is at increased risk of developing which of the following findings on polysomnography?

A 31-year-old man presents to his primary care physician endorsing three months of decreased sleep. He reports an inability to fall asleep; although once asleep, he generally sleeps through the night and wakes up at a desired time. He has instituted sleep hygiene measures, but this has not helped. He has not felt anxious or depressed and is otherwise healthy. You prescribe him a medication that has the potential side effect of priapism. From which of the following locations is the neurotransmitter affected by this medication released?

A 15-year-old boy is brought to the physician with excessive daytime sleepiness over the past year. His parents are concerned with his below-average school performance over the last 3 months. He goes to bed around midnight and wakes up at 7 am on school days, but sleeps in late on weekends. He exercises regularly after school. He usually has a light snack an hour before bed. He does not snore or have awakenings during sleep. He has no history of a serious illness and takes no medications. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. He does not smoke or drink alcohol. There is no history of a similar problem in the family. His vital signs are within normal limits. His BMI is 22 kg/m2. Physical examination shows no abnormal findings. Which of the following is the most appropriate recommendation at this time?

A 37-year-old male presents to general medical clinic reporting sleeping difficulties. He states that he has daytime sleepiness, having fallen asleep several times while driving his car recently. He sometimes experiences very vivid dreams just before awakening. You ask the patient's wife if she has witnessed any episodes where her husband lost all muscle tone and fell to the ground, and she confirms that he has not had this symptom. The patient notes that this condition runs in his family, and he desperately asks for treatment. You begin him on a first-line medication for this illness, which works by which mechanism of action?

An 8-year-old girl is brought to the physician by her parents for a 10-month history of disturbing dreams and daytime sleepiness. She has difficulty falling asleep and says she sometimes sees ghosts just before falling asleep at night. She has had a 7-kg (15-lb) weight gain during this period despite no changes in appetite. She is alert and oriented, and neurologic examination is unremarkable. During physical examination, she spontaneously collapses after the physician drops a heavy book, producing a loud noise. She remains conscious after the collapse. Polysomnography with electroencephalogram is most likely to show which of the following?

A 51-year-old man presents to his physician with decreased libido and inability to achieve an erection. He also reports poor sleep, loss of pleasure to do his job, and depressed mood. His symptoms started a year ago, soon after his wife got into the car accident. She survived and recovered with the minimal deficit, but the patient still feels guilty due to this case. The patient was diagnosed with diabetes 6 months ago, but he does not take any medications for it. He denies any other conditions. His weight is 105 kg (231.5 lb), his height is 172 cm (5 ft 7 in), and his waist circumference is 106 cm. The blood pressure is 150/90 mm Hg, and the heart rate is 73/min. The physical examination only shows increased adiposity. Which of the following tests is specifically intended to distinguish between the organic and psychogenic cause of the patient’s condition?

A 21-year-old man presents to the clinic complaining of feeling tired during the day. He is concerned as his grades in school have worsened and he does not want to lose his scholarship. Upon further questioning, the patient describes frequently experiencing a dreamlike state before falling asleep and after waking up. He also has frequent nighttime awakenings where he finds himself unable to move. He denies snoring. The patient does not drink alcohol or abuse any other drugs. The patient's BMI is 21 kg/m2, and his vital signs are all within normal limits. What is this patient's diagnosis?