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NBME 20 Answers

nbme20/Block 1/Question#6 (46.8 difficulty score)
A 16-year-old student has uncontrollable ...
Direct transition from wakefulness to REM sleep🔍

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submitted by drdoom(807),
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hsiT is na nsetinigert .eon I like to rmeeermb ti htsi wa:y ni ppolee iwth aorlc,eyspn all the ihtgr“ ”skind of peles rae pgenahnip at lal teh “ogrwn tes”mi of day. ugrDin the yad, hwne a roepw npa dulwo plcatyliy htrwo uyo emidmetliay otin RE,M this kdi is onyl ntergnie eStga 1 ro 2 eltt(hgis lepes = sgetihtls sisnoe ajr hmi cbak ot .ray)ltei At ,tihgn nhwe he ulhdso eupclleyaf frtdi tino aSgte 1, ,2 nad os n,o eh dstaien oplytmelec oknzs t.uo ssClaci l.sceypnaor

Fmor pDUtTeoa: cleysNao“pr nac be duclaotzeenipc sa a irsreddo fo weap-elkes nrctolo ni chihw estemlne fo eeslp rtinued ntio kanssuelfwe nad etsmenel fo nfeelssauwk iuedtnr into e.”pels

chextra  Isn't REM a rather light sleep stage? Brain waves during REM are very similar to awake states. I think you even wake up briefly in the middle of REM sleep. I don't think FA gave me a great understanding of narcolepsy, but I see it as going from awake to REM (light) for any kind of sleep, daytime or night time. +  
sammyj98  I'm definitely not ace on this subject, but I think the brain waves present in REM are similar to wakefulness because of the dreaming component. I think of it as though the brain has to go through a process of hypnotizing the body into a state of relaxation, and then properly paralyzing it, and then it can simulate wakefulness (dreaming) to go through with it's defragging of the hard drive. So REM is actually the deepest sleep because the body is fully paralyzed. Please someone correct me, this is probably an inacurrate perspective. +3  
pg32  FA says that narcolepsy has nocturnal AND NARCOLEPTIC sleep episodes that start with REM sleep... So is @drdoom correct? FA seems to disagree regarding the daytime sleep pattern. +3  

submitted by hayayah(1056),
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In ynelocasp,r hetre is a ercitd inanittrso mfro weknlfuasse to RME yBllasica tsidnae fo ggion tughroh the relay tgsaes nda gallayrud gafinll ntoi a depe plee,s ouy utjs ydnudsle og ofrm bneig kweaa to iegnb ni a pdee e.spel

kamilia20  FA2020 P497(Sleep physiology): Changes in narcolepsy: decrease REM latency. +1  
baja_blast  p. 485 for us plebs still using FA 2019 +  
randi  FA2019 p. 556 "nocturnal and narcoleptic sleep episodes that start with REM sleep (sleep paralysis)" +  

submitted by charcot_bouchard(388),
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polyNcsera has eon of het ogliflonw 3 caahrrretc - 1. ayxepa2Ct.l edc irnxeo ni s f.c3 RME eyanctl &t1l;5 inm

ist ssa ithw n(to dx gcpi/aginin(o iepatpcHryrom ohalicnlin.ta Selep arslyiasp

charcot_bouchard  oh dx criteria must also include excessive daytime slepeiness for 3 time per week over 3 month +