RPSGT ACTUAL EXAM WELL ELABORATED

RPSGT ACTUAL EXAM WELL ELABORATED

QUESTIONS AND DETAILED ANSWERS

UPDATE ALREADY GRADED A+

How is sleep latency different in those that do not generate alpha rhythm? - ANSWER ✔it is shorter than normal What are the scoring criteria for stage R sleep? - ANSWER ✔a) low amplitude, mixed frequency EEG;

• low chin EMG tone; c) rapid eye movements

What are the rules for stage N1 in patients that do not generate alpha? - ANSWER ✔4-7 Hz activity with slowing background frequencies by at least 1 Hz from Wake, vertex sharp waves and slow eye movements What kind of eye movements are typical in N3 sleep? - ANSWER ✔eye movements are not typically seen during stage N3 sleep What are some characteristics of stage R sleep? - ANSWER ✔rapid eye movements, low chin EMG tone; sawtooth waves in 2-6 Hz over central head regions, often preceding a burst of rapid eye movements; transient muscle activity What is the rule that defines the continuation of stage N2 sleep? - ANSWER ✔Continue to score epochs with low amplitude, mixed frequency EEG activity without K complexes or sleep spindles as stage N2 if they are preceded by a) K complexes unassociated with arousals or b) sleep spindles What criteria define the end of a period of stage N2 sleep? - ANSWER ✔End stage N2 sleep when 1 of the following occur: a) transition to stage W; b) an arousal changes it to stage N1 until a K complex unassociated with an arousal or a sleep spindle occurs; c) a major body movement followed by slow eye movements and low amplitude mixed frequency EEG without nonarousal associated K complexes or sleep spindles; d) transition to stage N3; e) transition to stage R. 1 / 4

What is the rule that defines the continuation of a period of stage R sleep? - ANSWER ✔Continue to score stage R sleep, even in the absence of rapid eye movements, for epochs following 1 or more epochs of stage R if the EEG continues to show low amplitude mixed frequency activity without K complexes or sleep spindles and the chin EMG tone remains low.What are the rules defining the end of stage R sleep? - ANSWER ✔a) there is a transition to stage W or N3; b) an increase in chin EMG tone above the level of stage R is seen and criteria for N1 are met; c) an arousal occurs followed by low amplitude, mixed frequency EEG and slow eye movements, which would be scored as N1; d) a major body movement followed by slow eye movements and low amplitude mixed frequency EEG without non-arousal associated K complexes or sleep spindles; e) one or more non- arousal associated K complexes or sleep spindles are present in the first half of the epoch in the absence of rapid eye movements, even if chin stays low.What are the rules for scoring epochs with major body movement? - ANSWER ✔a) if alpha rhythm is present for part of the epoch, score as W; b) if no alpha is discernible, but an epoch scorable as stage W either precedes or follows the epoch with a major body movement, score as W; c) otherwise, score the epoch as the same stage that follows it.What is the rule for scoring arousals? - ANSWER ✔Score arousal during sleep stages N1, N2, N3 or R if there is an abrupt shift of EEG frequency including alpha, theta and/or frequencies > 16 Hz (but not spindles) that lasts at least 3 seconds, with at least 10 seconds of stable sleep preceding the change.Scoring of arousal during REM requires a concurrent increase in submental EMG lasting at least 1 second.What are the scoring rules for sinus tachycardia during sleep? - ANSWER ✔A sustained sinus heart rate of greater than 90 beats per minute for adults.What are the scoring rules for bradycardia during sleep? - ANSWER ✔A sustained heart rate of less than 4 beats per minute for ages 6 through adult.What are the scoring rules for asystole? - ANSWER ✔Cardiac pauses greater than 3 seconds for ages 6 through adult. 2 / 4

What are the scoring rules for wide complex tachycardia? - ANSWER ✔A rhythm lasting a minimum of

• consecutive beats at a rate greater than 100 per minute with QRS duration of greater than or equal to

120 msec.What are the scoring rules for narrow complex tachycardia? - ANSWER ✔A rhythm lasting a minimum of 3 consecutive beats at a rate of greater than 100 per minute with a QRS of less than 120 msec.What are the scoring rules for atrial fibrillation? - ANSWER ✔An irregularly irregular ventricular rhythm associated with replacement of consistent P waves by rapid oscillations that vary in size, shape and timing.Define sleep onset. - ANSWER ✔The start of the first epoch scored as any stage other than W. This is calculated from lights out to the first epoch of sleep.What are the characteristics of N1? - ANSWER ✔5% of total sleep time; EEG: LVMF theta 4-7 Hz; vertex sharp waves may be seen in C3 & C4 in the latter parts of the stage; EOG: slow rolling eye movements; and EMG is variable, but often lower than W.What is a vertex sharp wave? - ANSWER ✔A sharp negative deflection followed by a positive deflection lasting < or = 0.5 seconds with an amplitude as high as 200uV. Observed in C3/C4.What are the characteristics of N2? - ANSWER ✔50% of total sleep time; EEG: consists of theta waves interspersed with K-complexes in F3/F4 and sleep spindles in C3/C4; EOG: similar to EEG; EMG variable amplitude, but usually lower than wake.When do you start scoring N2? - ANSWER ✔If one or both of the following occur during the first half of that epoch or the last half of the previous epoch: a)one or more K-complexes unassociated with arousals and or b)one or more trains of sleep spindles.What is a K-complex? - ANSWER ✔A well delineated negative sharp wave followed by a positive component lasting at least 0.5 sec in duration.What is a sleep spindle? - ANSWER ✔Trains of EEG activity in the 11-16Hz range. 3 / 4

What is the rule for an arousal to be associated with a K-complex? - ANSWER ✔It must occur within 1 second after the termination of the K-complex.What are the criteria for ending N2? - ANSWER ✔Transition to W, N1, N3 or R; an arousal to N1; a major body movement followed by slow eye movements and LVMF EEG w/o N2 criteri.What are the characteristics of N3? - ANSWER ✔20-25% of total sleep time; EEG of 0.5-2Hz, best seen in C3/C4; 20% of epoch amplitudes >75uV; EMG is variable, but often lower than N2 and sometimes as low as R; 20-25% of total sleep time.Describe sawtooth waves. - ANSWER ✔Sharply contoured EEG activity of 2-6Hz, best observed in C3/C4 during R; they often precede a burst of REMs.How is an epoch with a major body movement scored? - ANSWER ✔If alpha rhythm is present for any part of the epoch, score as W. If there is no alpha, but an epoch before or after is scored as W, then score as W. Otherwise, score the epoch as the same stage as the epoch that follows it.What is the healthy sleep duration for infants (4-12 months)? - ANSWER✔✔12-16 hours What is the diagnostic criteria for alternating leg muscle activation? - ANSWER✔✔>= 4 EMG bursts, 0.5-3 Hz in frequency alternating between legs with usual duration of .1-.5s What is the diagnostic criteria for bruxism? - ANSWER✔✔- either brief (Rhythmic masticatory muscle activity) or sustained elevations in chin EMG at least 2x amplitude of background EMG

• 0.25-2s in duration and if at least 3 elevations occur in regular sequence
• sustained elevations in EMG are scored as bruxism if duration is >2s
• a period of stable background chin EMG must occur before a new episode can be scored
• can be scored reliably if at least 2 audible tooth grinding episodes are heard in the absence of epilepsy

What is the diagnostic criteria for rhythmic movement disorder? - ANSWER✔✔- 0.5-2 Hz

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