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Neuro 11 Neoplasms

Neoplasms and Sleep

QuestionAnswer
How do the features of acute dystonia differ from tardive dyskinesia? Acute dystonia is acute in onset (few hrs) and involves sustained contraction of neck and limbs. Tardive dyskinesia takes months to years to develop and is characteriszed by repetitive facial/oral movement.
Which medication is used more than any other in the tx of Parkinson pts? Levidopa + carbidopa
What is the max amt of time a TIA may last? 24h
What kind of tumor is the MC brain tumor? Mets
Adult brain tumors are most often supratentorial or infratentorial? Supratentorial (adults are taller than kids so their tumors are on top; kids are infratentorial)
What is the next step once a brain tumor has been ID'd on CT or MRI of the head? Full body CT scan and bone scan to ID primary tumor (remember MC brain tumor is mets!)
What are the important characteristics of neurofibromatosis type 1 (name 4)? 1. Cafe au lait spots 2. Neurofibromas 3. Lisch nodules 4. Axillary and inguinal freckling
Name two characteristic sleep changes in depressed pts. 1. Decreased slow wave sleep 2. Increased time in REM (decreased REM latency, increased REM time)
Name two characteristic sleep changes in elderly pts. 1. Less slow wave sleep 2. Less REM sleep (increased REM latency, decreased time in REM)
When a pt appears to wake up after a nightmare or night terror, in which type of dream is the pt actually not awake? Night terrors (person only looks awake but is actually still sleeping)
When do nightmares occur? After scary movies. Ok, fine, during REM sleep. :)
When do night terrors occur? During non-REM sleep
Obese pt complaining of chronic fatigue. On labs, has polycythemia and elevated RBC ct. What should you consider in your diagnosis? Pickwickian syndrome (obesity hypoventilation syndrome: hypersomnolence, dyspnea, hypoxemia)
What is required to make the diagnosis of narcolepsy? 1. Cataplexy 2. Rule out other causes of excessive daytime sleepiness 3. Multiple sleep latency test (when given 4-5 opportunities to nap every 2 hours, narcolep pts fall asleep in <8min)
What is the first line pharm tx for narcolepsy? Modafenil (stimulant)
Name 3 drugs that can be used to treat narcoleptic cataplexy? Venlafaxine (SNRI), fluoxetine (SSRI), or atomoxetine
Name that insomnia treatment!: non-addictive, OTC, vivid dreams, safe for <3mos Melatonin
Name that insomnia treatment!: commonly used by pts first line; assoc'd with poor sleep quality, not for long-term use, anticholinergic SE (avoid in elderly) Antihistamines (deiphenhydramine, tylenol PM, doxylamine)
Name that insomnia treatment!: antidepressant that increases sleep latency; small risk of priapism (suuuuuurrrrrreeeee) Trazodone
Name that insomnia treatment!: antidepressant with small risk of arrhythmias (get EKG prior to use), anticholinergic SE (avoid in elderly) TCAs (amitriptyline, doxepin)
Which has more anticholinergic SE: amitriptyline or nortriptyline? Amitriptyline
Name that insomnia treatment!: addictive; short-term only (<35d) Long acting benzos (temazepam, lorazepam, clonazepam, diazepam, chlordiazepoxide)
Name that insomnia treatment!: acts at the benzo receptor, short-term use only (<35d), rebound insomnia when discontinued Zolpidem (Ambien), Zaleplon (Sonata)
Name that insomnia treatment!: hypnotic sleep aid approved for long-term use Eszopiclone (Lunesta)
Name that insomnia treatment!: non-addictive b/c it works at melatonin receptors instead of GABA/benzo receptors; must be avoided if hepatic insufficiency; long-term studies are lacking Ramelteon (Rozerem)
The sensation of unpleasant parasthesias that compels the pt to have voluntary, spontaneous lower limb movements Restless leg syndrom
Pt presents complaining of the sensation fo spiders or ants crawling on his feet and inside his calf muscles. Which drugs can be used to treat of his condition? 1. Dopa agonists: pramipexole or ropinirole or carbidopa/levodopa 2. Iron supplementation 3. Clonazepam 4. Gabapentin 5. Opioids (last line) *Can also recommend avoidance of caffeine)
What is the mechanism of action of the preferred medication in the tx of restless leg syndrome? Dopamine agonists (pramipexole or ropinirole or carbidopa/levodopa)
What EEG waveform is seen in stage 1 sleep? theta waves
What EEG waveform is seen in stage 2 sleep? sleep spindles and k-complexes
What EEG waveform is seen in stage 3 sleep? delta waves
What EEG waveform is seen in REM sleep? beta waves
Benzodiazepines increase which stage of sleep at the expense of what other stages of sleep? Increase stage 2 but decrease stage 3 and REM.
What are the 3 MC primary brain tumors in adults? 1. Glioblastoma multiforme 2. Meningioma 3. Schwannoma
What are the 3 MC primary brain tumors in children? 1. Astrocytoma 2. Medulloblastoma 3. Epyndymoma
What is the 2nd MCC of mass lesion in HIV pts? What CSF finding is diagnostic? Primary CNS lymphoma. EBV-DNA in CSF is pretty much diagnostic.
Bilateral schwannomas are a/w which disorder? Neurofibromatosis type II (2 earrings)
Created by: sarah3148
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