A state of continuous awareness of one’s self and environment.
Consciousness
A state in which the patient can be roused only by vigorous and repeated stimuli and in which arousal cannot be sustained without repeated stimulation.
Stupor
T/F: Upon being awakened from deep sleep, a normal person may be confused for a few moments.
True
T/F: Cerebral oxygen uptake does not decrease during sleep.
True
A syndrome of unconscious awakening lasting for 3 months after non traumatic and 12 months after traumatic injury
Persistent vegetative state
T/F: The occurrence of a well-developed Babinski sign is unusual although its presence does not exclude the diagnosis of brain death.
True
Electrocerebral silence is considered to be present if?
There is no electrical potential of more than 2mV during a 30-minute recording except for artefacts created by the ventilator, ECG and surrounding electrical device.
An acute drop in CBF to this level causes slowing of the EEG and syncope or impaired consciousness
25 ml/min/100g brain tissue
Body temperature which can induce coma through a nonspecific effect on the metabolic activity of neurons
above 41 degrees Celsius or below 30 degrees Celsius
Most common underlying biochemical derangement in recurring episodes of stupor
hepatic failure
T/F: During a focal seizure, the eyes turn or jerk toward the convulsing side.
True
Conditions which could give rise to Cheyne-Stokes Respiration
massive supratentorial lesions, bilateral deep-seated cerebral lesions and mild metabolic disturbances
T/F: In hypertensive encephalopathy, focal signs may be present.
True
The most common pathologic basis of vegetative state
Diffuse cerebral injury
Cerebral blood flow below the level causes electrocerebral silence, comma and cessation of most neuronal metabolic and synaptic functions
12-15 mL/min/100g
Site in the heart with most of the subendocardial mechanoreceptors that are responsible for the afferent impulses to the nucleus tractus solitarius
Inferoposterior wall of the left ventricle
tributary of the glossopharyngeal nerve which transmit sensory impulses from the carotid sinus
Nerve of hering
This type of syncope is the result of orthostatic loss of blood pressure
Orthostatic hypotension
Type of syncope which is the result of impaired baroreflex function which cannot compensate for pooling of blood in splanchnic vessels
Postprandial hypotension
T/F: Bedside testing of orthostatic blood pressure is best performed by having the patient stand quickly and taking readings immediately and again at 1 min and at 3 min.
True
T/F: Syncope does not occur as a manifestation of TIA
True
Seizures arising from this area prolong the QT interval and increase sympathetic tone thereby lowering the threshold for ventricular arrythmia
Left insula
Seizures arising from this area shorten the QT interval and increase parasympathetic tone thereby increasing the risk of vagally mediated syncope.
Right insula
This medication may be helpful in patients with parkinsonism and chronic orthostatic hypotension
Domperidone
T/F: Arousing a person during Stage N3 is more difficult than arousal from REM sleep.
True
Neurologic signs of sleep deprivation?
mild and inconstant nystagmus, impairment of saccadic eye movements, loss of accommodation, exophoric, slight tremor of hands, ptosis of the eyelids, expressionless face, thickness of speech and mispronunciation
T/F: Fatigue worsens restless leg syndrome and there is a tendency for it to be worse in warm weather.
True
Genetic finding in people with periodic leg movements of sleep
Nucleotide variant in short segment of chromosome 6p
T/F: Depressive illness produces early morning waking and inability to return to sleep
True
Nocturnal tingling and numbness of the fingers and palms caused by tight carpal ligament which may awaken patient at night
Acroparesthesia
T/F: The chronic insomniac who has no other symptoms should be discouraged from using sedative drugs
True
Where is the lesion of von economo encephalitis?
Anterior hypothalamus and basal frontal lobes
Where is the lesion of hypersomnia?
Hypothalamus and subthalamus
In what stage of sleep does night terrors occur?
Stage 3 or 4
term denoting the patient’s incapacity to think with customary speed, clarity and coherence.
Confusion
It is the concomitant reduction and prominent delay in producing movement, speech, ideation and emotional reaction.
Abulia
Refers to the constant restless movements and inability to sit still
Akathisia
T/F: The EEG in delirium may show symmetrical mild generalized slow activity in the range of 5-10 per second.
True
Most prominent early symptom of dementia
Gradual development of forgetfulness
T/F: Ribot’s law states that up to a certain point in the illness, memories of the distant past are relatively well retained at a time when more recently acquired information has been lost.
True
Refers to the mechanical disruption of the deep white matter
Axonal shearing
T/F: The association cortex that are not obviously committed to primary motor and sensory functions is generally a heterotypical cortex.
True
Where does the neural control of the circadian rhythms reside?
Suprachiasmatic nuclei of the ventral-anterior region of the hypothalamus
Sleep becomes consolidated into a single long nocturnal period by what age?
4th or 5th year
T/F: approximately 20-25% of total sleep time in young adults is spent in REM sleep, 3-5% in stage N1, 50-60% in stage N2 and 10-20% in stage N3 combined.
True
Most important stage in sleep in restoring the altered function that result from prolonged sleep deprivation.
N3
Approximately how many percent of dreaming occurs outside of REM periods?
20%
Signifies a chronic inability to sleep despite adequate opportunity to do so.
Insomnia
T/F: The diagnosis of periodic leg movements depend on finding them during polysomnographic recordings whereas restless leg syndrome is identified on clinical grounds.
True
T/F: Von Economo encephalitis was related to a predominance of lesions in the anterior hypothalamus and basal frontal lobes whereas hypersomnia was related to lesions in the dorsal hypothalamus and subthalamus.
True
Treatment for nocturnal frontal lobe epilepsy.
Carbamazepine
T/F: Frightening dreams or nightmares are far more frequent than night terrors and affect children and adults.
True
Somnambulism almost exclusively occur during this stage of sleep?
N3
In fully 90% of nsrcoleptics, the condition is established by what age?
25th
Risk of narcolepsy in a first-degree relative of an affected individual
1-2%
T/F: stress is often blamed in bruxism.
True
EEG in delirium
Symmetrical mild generalized slow activity in the range of 5-10 per second
Circadian pacemaker that regulates the sleep-wake cycle
Suprachiasmatic nucleus in the anterior hypothalamus
The most effective stimulus for the internal clock
Light
Usually the first symptom of narcolepsy
Excessive daytime sleepiness
Most specific symptom of narcolepsy
Cataplexy
First approved drug for treatment of cataplexy
Sodium oxybate
First line agents for restless leg syndrome
Dopaminergic agonists
Repetitive, stereotyped movement of extremities with extension of big toe, ankle dorsiflexion, flexion of knee and hip during sleep
Periodic limb disorder
T/F: Restless leg syndrome is a clinical diagnosis and polysomnography is generally unnecessary
True
Most common disorder associated with insomnia
Depression
Stage of sleep that does not change significantly as we age
REM stage
Most common traumatic brain injury
Subarachnoid hemorrhage