New Quiz 10 Dec Welcome to your Neurophysiology Name Email 1. [Ictal patterns at the onset of generalized tonic–clonic seizures include all of the following except] Voltage attenuation Paroxysmal beta activity Generalized polyspike-wave discharges Rhythmic 3 Hz sinusoidal activity None . 2. [What would be the clinical significance of the following EEG pattern (filter: 1–70 Hz) ifseen in other distributions? (fig)] If occipital, is highly associated with absence epilepsy If temporal, is highly associated with nonspecific dysfunction If central, is considered a normal sleep variant If generalized, is associated with poor prognosis None Comment . 3. [What is the anterior slow activity seen in the following EEG (filter 0.1–70 Hz)? (fig)] Lateral eye movements Sweat artifact 60 Hz artifact Frontal intermittent rhythmic delta activity (FIRDA) None Comment . 4. [In evaluating a spinal cord lesion with somatosensory evoked potential (SSEP)] SSEP has no prognostic value regarding sensory recovery compared to clinical examination after acute spinal cord injury SSEP has no value in evaluation of cervical intramedullary tumors since SSEP abnormalities are always accompanied by clinical symptoms Prolonged central conduction time (CCT) with normal potentials suggests extramedullary tumor rather than an intramedullary tumor Cervical syrinx is most commonly associated with absence of N13, P14, and N20 potentials None . 5. [Intraoperative compromise to which of the following blood vessels is likely to be detected by monitoring somatosensory evoked potentials (SSEPs) during surgery?] Posterior inferior cerebellar artery Anterior spinal artery Posterior spinal artery Medial lenticulostriate artery None . 6. [What does “paradoxical alpha rhythm” refer to?] Presence of posterior alpha frequencies when the eyes are closed Appearance of posterior alpha frequencies when the eyes are open during drowsiness Presence of alpha frequencies anteriorly rather than posteriorly Appearance of alpha activity during slow wave sleep None . 7. [A 30-second epoch of a polysomnogram (PSG) from a 30-year-old woman with insomnia is shown below. This is most consistent with (fig)] Normal wake epoch Normal N2 epoch Hypopnea Periodic limb movement disorder (PLMD) None Comment . 8. [A 47-year-old female has a history of chronic alcohol abuse and seizures. She was noncompliant with her antiepileptic drugs (AEDs) and had a seizure resulting in a right parietal scalp contusion. She subsequently had another generalized convulsion a few hours later. What is seen on her EEG (filter 1–70 Hz) below? (fig)] Sweat artifact Eye movement artifact Ventilator artifact Cable artifact None Comment . 9. [All of the following statements describe the process of transition of quiet sleep (QS) into NREM sleep except] High-voltage slow (HVS) pattern develops into a more generalized, posterior dominant delta activity Intermittent, isolated, monophasic occipital slow waves can be seen Cone waves appear during infancy and persist through mid-childhood Vertex waves are well developed at 3 months of age None . 10. [Which of the following statements is true regarding brainstem auditory evoked potential (BAEP) in acoustic neuromas?] Wave I is absent Wave V latency is normal Waves I–V interpeak latency (IPL) is prolonged Normal waveforms have no relevance to postoperative hearing function None . 11. [A polysomnogram (PSG) is being scored. The technologist labeled an epoch as Stage N2 when he noticed a K-complex. During the next 2-minute period, there are no spindles or K-complexes, but the EEG background consists of low-voltage mixed-frequencies. At the end of the 2 minutes, there is an arousal; after the arousal, the background continues to show low-voltage mixed-frequencies.] 2 3 4 5 None . 12. [A 45-year-old man with suspected myasthenia gravis had a 3-Hz repetitive stimulation (slow repetitive stimulation) of the left ulnar nerve with abductor digiti minimi (ADM) recording, which was normal. The next most appropriate step for evaluation of neuromuscular junction dysfunction would include] Use a higher rate of stimulation such as 20 or 50 Hz Make sure the limb is not cold, and warm the limb by 3–4°C if needed Administer pyridostigmine and repeat the test Use a higher amplifier gain during the study None . 13. [A 55-year-old man presents with severe fatigue and weakness for over 4 months and recent onset of dry mouth. He does not report any obvious diplopia. He is a chronic smoker. On examination, he has mild facial weakness, ptosis, mild to moderate weakness of neck flexion, and proximal limb weakness. Deep tendon reflexes are absent. Sensory examination is normal. Routine nerve conduction study and needle EMG study in the above patient is expected to reveal which of the following?] Absent sensory responses Decreased conduction velocity Decreased motor amplitudes Positive sharp waves and fibrillation potentials None . 14. [A 30-second epoch of polysomnogram (PSG) in a patient with a history of excessive daytime sleepiness is shown below. The most significant finding noted in the figure can be seen in all of the following conditions except (fig)] Postarousal Stroke Acetazolamide treatment High altitude None Comment . 15. [A 55-year-old man presents with severe fatigue and weakness for over 4 months and recent onset of dry mouth. He does not report any obvious diplopia. He is a chronic smoker. On examination, he has mild facial weakness, ptosis, mild to moderate weakness of neck flexion, and proximal limb weakness. Deep tendon reflexes are absent. Sensory examination is normal.Ulnar motor study done in this patient is shown below. Top trace is at baseline and thebottom trace is after 10 seconds of exercise. What does it reveal? (fig )] Normal test after 10 seconds of exercise Decreased motor amplitude on repeat stimulation, suggestive of postsynaptic neuromuscular junction (NMJ) disorder Increased motor amplitude on repeat stimulation, suggestive of presynaptic NMJ disorder Technically limited study None Comment . 16. [Ulnar motor study performed in a woman with chronic weakness and sensory loss isshown below. What is this study consistent with?(fig)] Chronic inflammatory demyelinating neuropathy Hereditary demyelinating neuropathy with partial conduction block Hereditary axonal neuropathy with partial conduction block Monomelic amyotrophy None Comment . 17. [What is the main difference between active sleep (AS) and quiet sleep (QS) around 37–40 weeks of conceptional age?] AS consists of low-voltage irregular (LVI) pattern while QS consists of a tracé alternant pattern AS consists of irregular theta and delta frequencies while QS consists of a tracé discontinu pattern AS consists of an LVI pattern while QS consists of a tracé discontinu pattern AS consists of a high-voltage slow (HVS) pattern while QS consists of a tracé alternant None . 18. [The evolution of a drowsy pattern on EEG consists of all of the following except] Appearance of hypnagogic hypersynchrony by age 3 months Disappearance of hypnagogic hypersynchrony by age 2 years Dropout of the posterior dominant rhythm (PDR) by age 3 years Mature pattern with alpha dropout and diffuse low-voltage with intermixed slow and fast activity by adolescence None . 19. [Brainstem auditory evoked potential (BAEP) findings in brain death may include all of the following except] Intact Wave I and absence of other waves Intact Wave II and absence of other waves Intact Waves I and II and absence of other waves Absence of all waveforms None . 20. [During a routine EEG, the technologist asks the patient to spell the word “gladiolus” (the first National Spelling Bee winning word in 1925). Which of the following EEG activities can be expected to appear or enhance?] Alpha rhythm Mu rhythm Theta rhythm Lambda waves None . 21. [A 30-second epoch of a polysomnogram (PSG) is shown below. What sleep stage is it?(fig)] Wake N1 N2 REM None Comment . 22. [Which of the following is true regarding somatosensory evoked potential (SSEP) changes during intraoperative operative monitoring (IOM)?] Transient or persistent changes in central conduction time (CCT) compared to baseline occur in a small number of patients Transient intraoperative SSEP changes can be associated with adverse postoperative clinical outcome in 25% of patients Transient intraoperative SSEP changes do not predict postoperative SSEP deterioration Persistence of SSEP changes at the end of surgery increases the risk of adverse postoperative clinical outcome None . 23. [A median motor nerve conduction study performed in a 15-year-old boy is shown below. This study is suggestive of which of the following? (fig 34)] Severe carpal tunnel syndrome Severe demyelinating neuropathy Severe axonal neuropathy with carpal tunnel syndrome Martin–Gruber anastomosis None . 24. [The following EEG (filter: 1–70 Hz; sensitivity: 10 μV/mm; solid vertical lines are 1 second apart) is most consistent with which of the following epilepsy syndromes? (f ig)] Autosomal dominant nocturnal frontal lobe epilepsy Mesial temporal sclerosis Benign Rolandic epilepsy (BRE) Cingulate epilepsy None Comment . 25. [A 20-year-old college student presents with difficulty walking for 5 years but recently developed an increased tendency to trip and fall along with mild weakness in her hands. She also reports mild numbness in her feet. She denies any pain. Her birth and initial development were normal, but as a child she did not perform well in sports. On examination, cranial nerves are normal. Proximal limb strength is normal. She has distal weakness with bilateral foot drop and moderate finger extension and abduction weakness. She also has high-arched feet and atrophy of foot intrinsic muscles. Deep tendon reflexes are absent and there is lengthdependent sensory loss. What is the next most appropriate test to perform in the above patient?] Peripheral myelin protein (PMP) deletion/duplication genetic test Mitofusin (MFN) mutation test Spinal fluid analysis and sural nerve biopsy Muscle biopsy None .
