application in different contexts. Law students often need to differentiate between nuanced legal principles, which can be difficult for those without experience in the field.Moreover, law exams
tend to be long and require detailed written responses. These exams test the
Week 4 midterm NR547 study guide MUST KNOW
Complete Guide with Questions and Verified Answers
100% Correct
1. General Exam / Strategy Pearls
• They like clinical vignettes + screening tools + time frames.
• She explicitly said there were 4–5 sexual dysfunction questions on her midterm even
though she didn’t think it’d be tested → pay attention to sexual dysfunction.
• Rating scales most likely tested:
o GAD-7 – know that 18 = severe anxiety and general scoring ranges.
o PHQ-9 – used when insomnia might be due to depression.
o HAM-D / HAM-A also fair game.
and practical application. Depending on the subject area, these exams can vary significantly in format. Common types of business exams and Writing Skills: Business exams
2. Sleep-Wake Disorders – Must-Know
Insomnia
• DSM criteria for Insomnia:
o Difficulty initiating or maintaining sleep or early morning awakening.
o Occurs ≥ 3 nights/week for ≥ 3 months.
o Causes clinically significant distress/impairment.
• First step when picture is unclear or stress-related: sleep diary/log.
• If you suspect depression → PHQ-9 first, not sleep diary.
Narcolepsy
• Key association: Hypocretin/orexin deficiency.
• Diagnostics you should remember:
o CSF hypocretin analysis.
o Polysomnography (PSG) + Multiple Sleep Latency Test (MSLT).
• Can be associated with cataplexy: bilateral loss of muscle tone triggered by
laughter/excitement.
Obstructive Sleep Apnea (OSA)
• Risk factors:
o Obesity, age 40–60, family history.
• Classic vignette:
o Loud snoring, daytime sleepiness, fatigue, waking up gasping/choking,
morning headaches, decreased libido, waking drenched in sweat.
• Obese middle-aged adult with these symptoms → think airway obstruction (OSA) as
the cause of mood/energy changes, not depression first.
Circadian Rhythm Sleep-Wake Disorder
, • Due to disruption of endogenous 24-hour cycle.
• High-yield risk groups:
o Night-shift workers, blind individuals, those with medical illnesses.
• Vignette: new ICU nurse working 3×12-hour night shifts, sleepy while driving →
circadian rhythm sleep-wake disorder. and practical application. Depending on the subject area, these exams can vary
significantly in format. Common types of business exams and Writing Skills: Business exams
application in different contexts. Law students often need to differentiate between nuanced legal principles, which can be difficult for those without experience in the field.Moreover,
law exams tend to be long and require detailed written responses. These exams test the
Parasomnias & REM Behavior Disorder
• Night terrors:
o Occur in deep sleep (stages 3–4), usually in children.
• Nightmare disorder:
o Vivid dreams related to threats to safety/survival.
• REM Sleep Behavior Disorder:
o Often a precursor to Parkinson disease or Lewy body dementia → big exam
pearl.
High-Yield Sleep Scales Mentioned
Know what you’d use them for, not every item:
• Insomnia Severity Index – severity of insomnia.
• STOP-BANG – screening for OSA.
• Restless Legs Syndrome Scale – severity of RLS.
• Morningness–Eveningness Questionnaire – circadian preference, used in shift-
work/circadian rhythm questions.
• DBAS (Dysfunctional Beliefs and Attitudes about Sleep) – cognitive distortions about
sleep.
3. Sleep Treatment – What They Really Test
Nonpharmacologic
• First-line for insomnia: CBT-I (cognitive behavioral therapy for insomnia).
• Sleep hygiene is a core part: consistent schedule, no naps, avoid exercise within 4 hours
of bedtime, dark/cool/quiet room, no screens, no heavy meals late.
OTC Sleep Aids
• Diphenhydramine (Benadryl):
o FDA-approved for short-term insomnia.
o Reduces sleep latency and increases total sleep time.
o Anticholinergic effects + next-day sedation, especially in older adults.
• Valerian root:
o May reduce time to fall asleep.
o Use with caution: potentiates other sedatives (alcohol, benzos, narcotics, other
sleep meds).
, Melatonin & Melatonin Agonists
• Melatonin:
o Helps with sleep onset, not maintenance.
o Typically taken 1–2 hours before bed.
• Ramelteon (Rozerem):
o Prescription melatonin agonist.
o Good for sleep onset, low adverse-effect profile. application in different contexts. Law students often need to
differentiate between nuanced legal principles, which can be difficult for those without experience in the field.Moreover, law exams tend to be long and require
detailed written responses. These exams test the, these exams can vary significantly in format. Common types of business exams and Writing Skills: Business
exams
Orexin Receptor Antagonists (DORAs)
• Orexin = promotes wakefulness/alertness.
• DORAs block orexin → promote sleep.
• Know these pairs:
o Suvorexant (Belsomra) – improves sleep maintenance, mild AEs, dose ↓ with
CYP3A4 inhibitors.
o Lemborexant (Dayvigo) – for insomnia in adults, main AE: daytime
somnolence, avoid with strong/moderate CYP3A inhibitors/inducers.
Sedating Antidepressants
Useful if insomnia + depression/anxiety:
• Trazodone, Mirtazapine, Amitriptyline.
• Common AEs:
o Sedation, anticholinergic effects, weight gain, daytime sleepiness, dizziness,
dry mouth.
• Use caution in:
o Hepatic impairment, cardiac disease, hypertension, older adults.
Z-Drugs (Z-Hypnotics)
• Zolpidem, Zaleplon, Eszopiclone:
o Bind benzodiazepine site on GABA receptors.
o First-line pharmacologic agents for insomnia.
o Useful for sleep onset and/or maintenance depending on formulation (e.g.,
zolpidem CR).
• Must monitor for:
o Abuse, dependence, suicidal ideation.
Benzodiazepines
• Not first-line for insomnia.
• Use only when first-line treatments fail, and even then short-term and with caution
due to dependence/misuse risks.
tend to be long and require detailed written responses. These exams test the
Week 4 midterm NR547 study guide MUST KNOW
Complete Guide with Questions and Verified Answers
100% Correct
1. General Exam / Strategy Pearls
• They like clinical vignettes + screening tools + time frames.
• She explicitly said there were 4–5 sexual dysfunction questions on her midterm even
though she didn’t think it’d be tested → pay attention to sexual dysfunction.
• Rating scales most likely tested:
o GAD-7 – know that 18 = severe anxiety and general scoring ranges.
o PHQ-9 – used when insomnia might be due to depression.
o HAM-D / HAM-A also fair game.
and practical application. Depending on the subject area, these exams can vary significantly in format. Common types of business exams and Writing Skills: Business exams
2. Sleep-Wake Disorders – Must-Know
Insomnia
• DSM criteria for Insomnia:
o Difficulty initiating or maintaining sleep or early morning awakening.
o Occurs ≥ 3 nights/week for ≥ 3 months.
o Causes clinically significant distress/impairment.
• First step when picture is unclear or stress-related: sleep diary/log.
• If you suspect depression → PHQ-9 first, not sleep diary.
Narcolepsy
• Key association: Hypocretin/orexin deficiency.
• Diagnostics you should remember:
o CSF hypocretin analysis.
o Polysomnography (PSG) + Multiple Sleep Latency Test (MSLT).
• Can be associated with cataplexy: bilateral loss of muscle tone triggered by
laughter/excitement.
Obstructive Sleep Apnea (OSA)
• Risk factors:
o Obesity, age 40–60, family history.
• Classic vignette:
o Loud snoring, daytime sleepiness, fatigue, waking up gasping/choking,
morning headaches, decreased libido, waking drenched in sweat.
• Obese middle-aged adult with these symptoms → think airway obstruction (OSA) as
the cause of mood/energy changes, not depression first.
Circadian Rhythm Sleep-Wake Disorder
, • Due to disruption of endogenous 24-hour cycle.
• High-yield risk groups:
o Night-shift workers, blind individuals, those with medical illnesses.
• Vignette: new ICU nurse working 3×12-hour night shifts, sleepy while driving →
circadian rhythm sleep-wake disorder. and practical application. Depending on the subject area, these exams can vary
significantly in format. Common types of business exams and Writing Skills: Business exams
application in different contexts. Law students often need to differentiate between nuanced legal principles, which can be difficult for those without experience in the field.Moreover,
law exams tend to be long and require detailed written responses. These exams test the
Parasomnias & REM Behavior Disorder
• Night terrors:
o Occur in deep sleep (stages 3–4), usually in children.
• Nightmare disorder:
o Vivid dreams related to threats to safety/survival.
• REM Sleep Behavior Disorder:
o Often a precursor to Parkinson disease or Lewy body dementia → big exam
pearl.
High-Yield Sleep Scales Mentioned
Know what you’d use them for, not every item:
• Insomnia Severity Index – severity of insomnia.
• STOP-BANG – screening for OSA.
• Restless Legs Syndrome Scale – severity of RLS.
• Morningness–Eveningness Questionnaire – circadian preference, used in shift-
work/circadian rhythm questions.
• DBAS (Dysfunctional Beliefs and Attitudes about Sleep) – cognitive distortions about
sleep.
3. Sleep Treatment – What They Really Test
Nonpharmacologic
• First-line for insomnia: CBT-I (cognitive behavioral therapy for insomnia).
• Sleep hygiene is a core part: consistent schedule, no naps, avoid exercise within 4 hours
of bedtime, dark/cool/quiet room, no screens, no heavy meals late.
OTC Sleep Aids
• Diphenhydramine (Benadryl):
o FDA-approved for short-term insomnia.
o Reduces sleep latency and increases total sleep time.
o Anticholinergic effects + next-day sedation, especially in older adults.
• Valerian root:
o May reduce time to fall asleep.
o Use with caution: potentiates other sedatives (alcohol, benzos, narcotics, other
sleep meds).
, Melatonin & Melatonin Agonists
• Melatonin:
o Helps with sleep onset, not maintenance.
o Typically taken 1–2 hours before bed.
• Ramelteon (Rozerem):
o Prescription melatonin agonist.
o Good for sleep onset, low adverse-effect profile. application in different contexts. Law students often need to
differentiate between nuanced legal principles, which can be difficult for those without experience in the field.Moreover, law exams tend to be long and require
detailed written responses. These exams test the, these exams can vary significantly in format. Common types of business exams and Writing Skills: Business
exams
Orexin Receptor Antagonists (DORAs)
• Orexin = promotes wakefulness/alertness.
• DORAs block orexin → promote sleep.
• Know these pairs:
o Suvorexant (Belsomra) – improves sleep maintenance, mild AEs, dose ↓ with
CYP3A4 inhibitors.
o Lemborexant (Dayvigo) – for insomnia in adults, main AE: daytime
somnolence, avoid with strong/moderate CYP3A inhibitors/inducers.
Sedating Antidepressants
Useful if insomnia + depression/anxiety:
• Trazodone, Mirtazapine, Amitriptyline.
• Common AEs:
o Sedation, anticholinergic effects, weight gain, daytime sleepiness, dizziness,
dry mouth.
• Use caution in:
o Hepatic impairment, cardiac disease, hypertension, older adults.
Z-Drugs (Z-Hypnotics)
• Zolpidem, Zaleplon, Eszopiclone:
o Bind benzodiazepine site on GABA receptors.
o First-line pharmacologic agents for insomnia.
o Useful for sleep onset and/or maintenance depending on formulation (e.g.,
zolpidem CR).
• Must monitor for:
o Abuse, dependence, suicidal ideation.
Benzodiazepines
• Not first-line for insomnia.
• Use only when first-line treatments fail, and even then short-term and with caution
due to dependence/misuse risks.
