New Quiz 03 Jan Welcome to your Neurophysiology Name Email 1. [A 24-year-old administrator with hypothyroidism has noticed numbness in her hands. She frequently wakes up at night with tingling in her fingers and hands. Her primary care physician diagnosed her with carpal tunnel syndrome (CTS) and referred her for electrodiagnostic studies. Her median and ulnar motor studies were normal. Her median and ulnar antidromic sensory studies with recording from 2nd and 5th digits were normal. Which of the following is the best step to find evidence of CTS in this patient?] Perform median and ulnar mixed palmar studies Measure median and ulnar digit 4 sensory latencies Median nerve study with inching across the wrist Any of the above None . 2. [Which of the following statements best characterizes the psychomotor variant?] It is abnormal in adults, being associated with temporal lobe seizures It is typically seen in slow wave sleep It tends to evolve into alpha or beta frequencies It is comprised of 5–7 Hz sharply contoured rhythmic bursts None . 3. [A neuromuscular fellow notices the findings shown below while performing an EMG ofa weak muscle. What is the source of the waveforms shown? (fig)] Anterior horn cells Muscle fibers Motor nerve axons Ephaptic transmission in muscle fibers None Comment . 4. [A 35-year-old man noticed weakness in his right hand for the last few months and thenrecently developed painless left leg weakness. He denies any pain in his limbs or sensory loss. His median motor study is shown below. Based on this nerve conduction study finding, what is the most likely diagnosis? (fig)] Carpal tunnel syndrome (CTS) Multifocal motor neuropathy Lower trunk brachial plexopathy Hirayama’s monomelic amyotrophy None Comment . 5. [Characteristic features of REM sleep include all of the following except] Low-voltage mixed-frequency EEG background Trains of sharply contoured, 2–6 Hz waves in the central region Occasional nonarousal associated K-complexes Short irregular bursts of EMG activity on chin EMG None . 6. [Which of the following differences between Landau–Kleffner syndrome (LKS) and continuous spike waves of sleep (CSWS) is true?] The discharges in LKS are more bitemporal and/or biparietal vs more diffuse in CSWS There is language regression in CSWS vs a global behavioral regression in LKS Epileptiform activity in LKS gets activated in REM sleep vs in NREM sleep in CSWS Carbamazepine may help in CSWS vs steroids in LKS None . 7. [In a spherical head model, magnetoencephalography (MEG) detects all of the following signals except] Those tangential to the cortical surface Those perpendicular to the cortical surface Those tilted 10–20 degrees from radial orientation to the cortical surface Those within the cortical fissures None . 8. [Which of the following statements best describes the evolution of sleep spindles in infants and children?] They first appear by age 6 months They exhibit centro-parietal predominance rather than midline predominance throughout infancy They reach a frequency of 14 Hz by 12 months Faster spindle activity with paroxysmal traits is considered normal in infants None . 9. [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.Lower limb nerve conduction studies revealed absent motor and sensory responses.What does the upper limb study shown below reveal? (fig )] Demyelinating neuropathy with profoundly diminished conduction velocity and a partial conduction block Demyelinating neuropathy with abnormal temporal dispersion Demyelinating neuropathy with profoundly diminished conduction velocity Axonal neuropathy None Comment . 10. [All of the following are features of a normal EEG in a 1-year-old child except] 6 Hz posterior dominant rhythm (PDR) Hypnagogic hypersynchrony Sleep spindles with vertex predominance Discernible photic driving response None . 11. [Intermittent rhythmic delta activity (IRDA) is] Usually diffuse but predominant in the frontal region in children Activated by hyperventilation (HV) Activated by sleep Not reactive to eye opening None . 12. [Indications for intraoperative monitoring (IOM) of brainstem auditory evoked potentials (BAEPs) include all of the following except] Resection of acoustic neuroma Resection of cerebellopontine angle (CPA) meningioma Resection of superior temporal gyrus glioma Microvascular decompression for trigeminal neuralgia None . 13. [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 . 14. [A 25-year-old man was involved in a motor vehicle accident 3 weeks ago. He suffered a crush injury to his forearm and was noted to have diffuse weakness in his hand. A few days after recovery from extensive surgery to his forearm, he continued to have weakness. An EMG of a distal weak muscle might reveal which of the following patterns? Choices Spontaneous activity Motor unit Motor unit Recruitment pattern duration amplitude ] None . 15. [A 65-year-old female presented to a neurologist for possible seizure workup. Her husband bmentioned that while she is sleeping, she kicks him, appears restless, and talks in her sleep. If he wakes her up, she is noted to be confused but able to recount her event as a dream that corresponds to the observed behavior. What is the most likely diagnosis?] Restless legs syndrome (RLS) REM behavior disorder Periodic limb movement disorder (PLMD) Frontal lobe seizure None . 16. [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 . 17. [Ciganek rhythm is characterized by all of the following except] Presence in the bitemporal region Presence during both wakefulness and drowsiness Activation by mental task Notched morphology None . 18. [The conduction velocity of an action potential is least likely to be affected by which of the following?] Axon diameter Axon temperature Distance between nodes of Ranvier Number of surrounding axons None . 19. [Which thalamic nucleus helps in synchronization of EEG?] Reticular nucleus Anterior nucleus Pulvinar nucleus Medial geniculate nucleus None . 20. [A 60-year-old man developed Bell’s palsy. He was treated with oral corticosteroids andantiviral agents but continued to have facial weakness. He was seen by an ear–nose–throat physician for possible surgical intervention for the facial weakness, and facial electrodiagnostic studies were requested. EMG from the frontalis muscle during maximum activation is shown below. What does it reveal? (fig)] Early recruitment Severely reduced recruitment Normal recruitment for frontalis muscle Synkinesis None Comment . 21. [All of the following periodic patterns are highly pathognomonic of an underlying neurological disorder except] Periodic generalized sharp waves occurring at 1 Hz frequency and accompanied by occasional myoclonic jerks Periodic generalized sharp waves occurring every 10–15 seconds and accompanied by occasional myoclonic jerks Bitemporal independent periodic lateralized sharp waves at 1–1.5 Hz frequency Left parieto-central periodic lateralized epileptiform discharges (PLEDs) at 1 Hz frequency None . 22. [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 . 23. [All of the following conditions can cause symmetric bilateral prolongation of P100 latency except] Leber’s hereditary optic neuropathy Adrenoleukodystrophy Pseudotumor cerebri Freidreich’s ataxia None . 24. [Which of the following findings would most likely be seen in Rasmussen syndrome?] Burst suppression Generalized periodic discharges (GPDs) Electrographic status epilepticus Diffuse low voltage None . 25. [The commonly evaluated interpeak latencies (IPLs) of brainstem auditory evoked potentials (BAEPs) include all of the following except] I – III III–V V–VII I–V None .
