Sleep Medicine Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Sleep Medicine. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Sleep Medicine Indian Medical PG Question 1: Which of the following is false about narcolepsy?
- A. Sudden loss of muscle tone (cataplexy)
- B. Cataplexy is a common symptom
- C. Typically occurs only during nighttime sleep (Correct Answer)
- D. Typical onset in the second decade of life
Sleep Medicine Explanation: ***Typically occurs only during nighttime sleep***
- Narcolepsy is characterized by **excessive daytime sleepiness** and sudden, uncontrollable urges to sleep during the day, not exclusively nighttime sleep.
- Patients with narcolepsy often experience disrupted nocturnal sleep, including **frequent awakenings** and vivid dreams.
*Sudden loss of muscle tone (cataplexy)*
- This statement accurately describes **cataplexy**, a hallmark symptom of narcolepsy, which is a sudden, brief loss of **muscle tone** triggered by strong emotions.
- Cataplexy is a key diagnostic feature, though not all individuals with narcolepsy experience it.
*Cataplexy is a common symptom*
- **Cataplexy is indeed common** in narcolepsy, particularly in Narcolepsy Type 1, where it is caused by a deficiency in **hypocretin (orexin)**.
- It is a defining characteristic for diagnosing narcolepsy with cataplexy.
*Typical onset in the second decade of life*
- The onset of narcolepsy symptoms, including excessive daytime sleepiness and cataplexy, often occurs during **adolescence or early adulthood**, typically between the ages of 10 and 25.
- This timing can significantly impact education and social development.
Sleep Medicine Indian Medical PG Question 2: A 40-year-old man presents with daytime sleepiness and impaired concentration and memory. On examination his BMI is 41 kg/m2, BP is 160/100 mm Hg. His awake ABG analysis is given: PaO2=66 mm Hg, PaCO2=50 mm Hg, HCO3=28 mEq/L. What is the most likely diagnosis?
- A. Obstructive sleep apnea (Correct Answer)
- B. Narcolepsy
- C. Obesity hypoventilation syndrome
- D. Central sleep apnea
Sleep Medicine Explanation: ***Obstructive Sleep Apnea (Correct Answer)***
- Classic triad: **morbid obesity (BMI 41 kg/m²)**, **excessive daytime somnolence**, and **systemic hypertension (160/100 mmHg)** — hallmarks of OSA
- **ABG findings** (PaO2=66 mmHg, PaCO2=50 mmHg, HCO3=28 mEq/L) indicate **chronic nocturnal hypoxemia and hypercapnia** with compensatory **metabolic alkalosis** from repeated apneic episodes
- **Cognitive impairment** (impaired concentration and memory) results from **sleep fragmentation** and intermittent nocturnal hypoxia
- Obesity promotes **pharyngeal fat deposition** → upper airway narrowing and collapse during sleep → recurrent obstructive events
*Narcolepsy*
- Causes excessive daytime sleepiness but is **not associated with obesity, hypertension, or ABG abnormalities**
- Hallmarks include **cataplexy**, sleep paralysis, and hypnagogic/hypnopompic hallucinations — none present here
- Caused by **orexin (hypocretin) deficiency**; associated with **HLA-DQB1*06:02**; ABG is normal
*Obesity Hypoventilation Syndrome (OHS / Pickwickian Syndrome)*
- Defined as **awake PaCO2 >45 mmHg + BMI >30 kg/m²** with exclusion of other causes of hypoventilation
- OHS frequently coexists as an **overlap with and consequence of severe OSA** rather than being the primary diagnosis
- In this setting, **OSA is the most prevalent and primary diagnosis**; OHS is specifically considered when awake hypoventilation persists despite adequate OSA treatment
*Central Sleep Apnea*
- Results from **failure of central respiratory drive** (brainstem), not upper airway obstruction
- Associated with **congestive heart failure, opioid use, high-altitude exposure, or neurological disease** — none present here
- Not characteristically associated with morbid obesity; clinical and ABG picture here favors an **obstructive** rather than central pattern
Sleep Medicine Indian Medical PG Question 3: A 32-year-old man comes to the physician complaining of excessive sleepiness for the past several months. He reports falling asleep while dealing with customers and had a near accident when he fell asleep while driving. The patient reports that he occasionally hears voices while falling asleep and finds himself "temporarily frozen" and unable to move upon awakening. Which of the following is the most appropriate treatment for this patient?
- A. Melatonin
- B. Modafinil (Correct Answer)
- C. Clonazepam
- D. Continuous positive airway pressure
Sleep Medicine Explanation: ***Modafinil***
- The patient's symptoms of **excessive daytime sleepiness** (EDS), **hypnagogic hallucinations** (hearing voices while falling asleep), and **sleep paralysis** are classic signs of **narcolepsy**.
- **Modafinil** is a **non-amphetamine stimulant** that promotes wakefulness and is a first-line treatment for narcolepsy, improving alertness and reducing EDS.
*Melatonin*
- **Melatonin** is a hormone involved in regulating the **sleep-wake cycle** and is primarily used for **insomnia**, **jet lag**, or **circadian rhythm disorders**.
- It is not effective for treating the hallmark symptoms of narcolepsy, such as cataplexy or excessive daytime sleepiness.
*Clonazepam*
- **Clonazepam** is a **benzodiazepine** that acts as a central nervous system depressant, primarily used for **anxiety disorders**, seizures, and some sleep disorders like **REM sleep behavior disorder**.
- While it can help with some parasomnias, it would worsen daytime sleepiness in a patient with narcolepsy and is not a primary treatment for its core symptoms.
*Continuous positive airway pressure*
- **Continuous positive airway pressure (CPAP)** is the standard treatment for **obstructive sleep apnea (OSA)**, a condition characterized by recurrent upper airway collapse during sleep.
- Although OSA can cause excessive daytime sleepiness, the patient's additional symptoms of hypnagogic hallucinations and sleep paralysis are not typical of OSA, making narcolepsy and its specific treatments more appropriate.
Sleep Medicine Indian Medical PG Question 4: A 42-year-old female executive is referred to the sleep clinic with jaw pain. She complains that after she arrives home at night around 10 pm she frequently drinks 3-4 gin and tonics to help quiet her mind.’ She wakes up the next morning around 3am to read the international stock market news, at which point she states her teeth ache an unbearable amount. A study is performed on the patient and it is noted that she grinds her teeth and mutters during roughly half of her sleep.
Which of the following would you expect to see on her EEG and at which stage of sleep would you expect her jaw pain to be caused?
- A. Alpha waves, N2
- B. Beta waves, N3
- C. Delta waves, N3
- D. Sleep spindles, N2 (Correct Answer)
Sleep Medicine Explanation: ***Sleep spindles, N2***
- The patient's presentation of teeth grinding (**bruxism**) and muttering during sleep, along with jaw pain, is characteristic of **parasomnias**, which often occur during **stage N2 sleep**.
- **Sleep spindles** and **K-complexes** are defining EEG features of **N2 sleep**, indicating that the sleep study would likely show these patterns.
*Alpha waves, N2*
- **Alpha waves** are characteristic of a **relaxed, awake state** or the early stages of falling asleep (N1), not N2 sleep.
- While the patient has jaw pain, its cause is linked to sleep behaviors occurring in more advanced sleep stages than N1.
*Beta waves, N3*
- **Beta waves** are typically seen during **active wakefulness** and **REM sleep**, not deep N3 sleep.
- **N3 sleep** (slow-wave sleep) is characterized by **delta waves**, not beta waves.
*Delta waves, N3*
- Although **delta waves** are indeed characteristic of **N3 sleep** (deep sleep), the patient's symptoms of teeth grinding and muttering are more commonly associated with **N2 sleep** or arousal disorders, not typically the deepest stage of sleep.
- Bruxism and muttering are generally not prominent features of undisturbed N3 sleep.
Sleep Medicine Indian Medical PG Question 5: The sleep apnea syndrome is defined as -
- A. Apnea-Hypopnea Index (AHI) ≥ 5/hour (Correct Answer)
- B. Apnea-Hypopnea Index (AHI) ≥ 10/hour
- C. Apnea-Hypopnea Index (AHI) ≥ 30/hour
- D. Apnea-Hypopnea Index (AHI) ≥ 15/hour
Sleep Medicine Explanation: ***Apnea-Hypopnea Index (AHI) ≥ 5/hour***
- The definition of **sleep apnea syndrome** generally requires an **AHI of 5 or more events per hour**, often accompanied by symptoms like excessive daytime sleepiness or cardiovascular complications [1].
- This threshold identifies individuals with clinically significant sleep-disordered breathing that warrants further evaluation and potential treatment [1].
*Apnea-Hypopnea Index (AHI) ≥ 10/hour*
- While an AHI of 10/hour indicates sleep apnea, it is a higher severity criterion and does not represent the **minimum threshold** for defining the syndrome [1].
- Patients with an AHI between 5 and 10 also have sleep apnea and can experience significant symptoms.
*Apnea-Hypopnea Index (AHI) ≥ 30/hour*
- An AHI of 30/hour or more signifies **severe sleep apnea**, which requires aggressive management.
- This is far above the **general diagnostic threshold** for sleep apnea syndrome.
*Apnea-Hypopnea Index (AHI) ≥ 15/hour*
- An AHI of 15/hour is typically classified as **moderate sleep apnea**.
- This value is higher than the **lowest AHI threshold** used to define the presence of sleep apnea syndrome.
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