Sleep-Wake Disorders Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Sleep-Wake Disorders. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Sleep-Wake Disorders 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-Wake Disorders 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-Wake Disorders Indian Medical PG Question 2: 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-Wake Disorders 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-Wake Disorders Indian Medical PG Question 3: 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
Sleep-Wake Disorders 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.
Sleep-Wake Disorders Indian Medical PG Question 4: A child presents with complaints of bed wetting. What is the first line of treatment?
- A. Bed alarm technique (Correct Answer)
- B. Motivational therapy
- C. Oxybutynin
- D. Desmopressin
Sleep-Wake Disorders Explanation: ***Bed alarm technique***
- The **bed alarm technique** is considered the most effective first-line treatment for **nocturnal enuresis** in children.
- It works through **classical conditioning**, training the child to wake up in response to bladder fullness.
*Motivational therapy*
- **Motivational therapy** can be a useful adjunct to other treatments, but it is not typically the sole **first-line therapy** due to varying effectiveness.
- It focuses on building the child's confidence and encouraging dryness but does not directly address the physiological aspects of bedwetting.
*Oxybutynin*
- **Oxybutynin** is an anticholinergic medication that can reduce bladder contractions and increase bladder capacity.
- It is usually reserved for cases where **bedwetting alarms** and **desmopressin** have been ineffective, or when there is an identifiable **overactive bladder component**.
*Desmopressin*
- **Desmopressin** is an antidiuretic hormone analogue that reduces urine production during the night.
- While effective, it is often considered a **second-line treatment** after behavioral interventions like the bed alarm, or when rapid but temporary improvement is desired.
Sleep-Wake Disorders Indian Medical PG Question 5: What is the primary characteristic feature of Klein-Levin syndrome?
- A. Insomnia
- B. Anxiety
- C. Depression
- D. Hypersomnia (Correct Answer)
Sleep-Wake Disorders Explanation: ***Hypersomnia***
- **Hypersomnia** is the cardinal and primary characteristic feature of Klein-Levin syndrome, characterized by recurrent episodes of excessive sleepiness lasting days to weeks.
- During these episodes, individuals may sleep for **16 to 20 hours a day** and are extremely difficult to awaken.
- Episodes are often accompanied by **cognitive disturbances** (confusion, derealization), **behavioral changes** (apathy, hyperphagia, hypersexuality), but **hypersomnia remains the defining feature**.
- Normal functioning returns between episodes.
*Insomnia*
- **Insomnia** (difficulty falling or staying asleep) is the opposite of the key symptom seen in Klein-Levin syndrome.
- Klein-Levin syndrome is a disorder of excessive sleep, not sleep deprivation.
*Anxiety*
- **Anxiety** may occur as a secondary feature or during the distress of episodes, but it is not the primary characteristic feature.
- The core pathology manifests as profound sleep disturbance, not an anxiety disorder.
*Depression*
- **Depression** is sometimes observed during or after episodes of Klein-Levin syndrome, but it is not the primary defining feature.
- The diagnostic hallmark is the **recurrent hypersomnia with associated cognitive and behavioral symptoms**, not mood disturbance.
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