Welcome to your Neurophysiology Name Email 1. [Which antidromic median sensory configuration would result in an initial positivity?] Recording from digit 3 with the reference electrode over digit 5 Recording from digit 3 with the reference electrode over digit 3 Recording from digit 5 with the reference electrode over digit 3 Any of the above configurations would result in an initial positivity if the stimulating anode and cathode were reversed with stimulation at the wrist None . 2. [Which of the following statements best describes the utility of somatosensory evoked potentials (SSEPs) in the evaluation of peripheral nervous system disorders?] Intact N9 and absence of subsequent potentials suggest brachial plexus trunk lesion Absent popliteal fossa potential but intact lumbar potential (LP) is characteristically seen in Guillain–Barré syndrome SSEPs obtained by dermatomal stimulation are useful in the evaluation of radiculopathy SSEPs are always normal in Friedreich’s ataxia despite abnormal nerve conduction studies None . 3. [A 20-year-old woman is admitted with progressive ascending weakness and sensory symptoms suggestive of Guillain–Barré syndrome (GBS). During the electrodiagnostic study, the technologist performs sural sensory response, which was normal. Before peroneal or tibial studies can be done, the patient requests that further studies be stopped as she cannot tolerate the testing. Based on the normal sural response, what would be the best conclusion or recommendation?] The patient does not have GBS GBS cannot be ruled out because normal sural sensory response is not uncommon in GBS Because sural sensory response is normal, the patient does not have any type of neuropathy Repeat the study after the patient is sedated under anesthesia None . 4. [A 65-year-old man was referred for neuromuscular evaluation of head drop. Over the last 6 months, he noticed increasing weakness in his neck muscles and difficulty keeping his head up. On examination, he has severe neck extensor weakness (2/5) but strength in all other muscle groups is normal. Which of the following conditions is most likely?] Motor neuron disease presenting with head drop Myasthenia gravis Pompe disease Isolated neck extensor myopathy None . 5. [All of the following responses can be seen during intermittent photic stimulation (IPS) except] Photosensitive response Photomyogenic response (PMR) Photoparoxysmal response (PPR) Photoelectric response None . 6. [An EEG from a 15-year-old male with focal cortical dysplasia in the right posterior quadrant, admitted for video-EEG monitoring, is shown below (filter: 1–70 Hz). The waveforms highlighted in the box are most consistent with (fig)] Posterior slow waves of youth Positive occipital sharp transients of sleep (POSTS) Lambda waves Periodic lateralized epileptiform discharges (PLEDs) None Comment . 7. [A 40-year-old man presents with a history of 2 generalized convulsions over a period of 3 days after sustaining a closed head injury. Since then, he has remained seizure free for 2 years on phenytoin monotherapy, and wants to discontinue the medication. His neurologic examination is normal. An appropriate recommendation would be to] Obtain a routine EEG prior to stopping phenytoin Stop phenytoin in the epilepsy-monitoring unit and obtain video-EEG monitoring for 1 week Taper off phenytoin without obtaining an EEG Change phenytoin to levetiracetam since it is better tolerated None . 8. [Which of the following referential montages is least likely to be helpful to evaluate changes in the temporal region?] Cz Ipsilateral ear Contralateral ear Average None . 9. [Which of the following is true regarding the nomenclature of EEG activity?] Sigma rhythm refers to 15–20 Hz activity Rho waves refer to positive occipital sharp transients of sleep (POSTS) Phi rhythm refers to temporal rhythmic delta activity in children Ripples refers to 50–80 Hz activity None . 10. [A very well-built 40-year-old guitar player presents with muscle stiffness that he has had most of his life and also weakness in cold weather. On examination, he does not have any limb weakness. A routine EMG revealed repetitive discharges that wax and wane in frequency and amplitude. What does this patient most likely have?] Periodic paralysis Myotonic dystrophy type I Myotonic dystrophy type II Myotonia congenita None . 11. [A 48-year-old male with a history of seizures has an EEG as shown below. During therecording, the patient is noted to be drowsy by the technologist. What is the best interpretation of his EEG (filter: 1–70 Hz)? (fig)] Psychomotor seizures Mild encephalopathy Temporal lobe seizures No known disease process None Comment . 12. [While performing needle EMG studies, which of the following measures can potentially cause serious injury to the examiner?] Unwrapping a covered needle Recapping the needle after studying the first muscle Attaching a sheathed needle to cable Performing laryngeal EMG None . 13. [Safety factor at the neuromuscular refers to the] Separation of acetylcholine into primary, secondary, and tertiary presynaptic quanta Amplitude of end-plate potential above the threshold value needed to generate muscle fiber action potential Amplitude of end-plate potential below the threshold value needed to generate muscle fiber action potential Minimum nerve action potential needed to open presynaptic calcium channels None . 14. [Which of the following factors increases the likelihood of neuropathy or myopathy related to colchicine toxicity?] Hepatic impairment Renal failure Cardiac failure When used for nongouty conditions None . 15. [Which of the following statements is not true about amyloid myopathy?] It is commonly seen in cases of secondary amyloidosis It may cause hypertrophy of muscles Peripheral neuropathy is seen in greater than 20% of cases It is commonly seen with primary or hereditary amyloidosis None . 16. [Prolongation of central conduction time (CCT; ie, N22–P37 interpeak latency [IPL]) after tibial nerve stimulation can be seen in all of the following conditions except] Barbiturate-induced anesthesia Brainstem multiple sclerosis Neuromyelitis optica Adrenomyeloneuropathy None . 17. [Subclinical rhythmic electrographic discharge in adults (SREDA) is typically seen during the following scenarios except] Resting state Drowsiness Photic stimulation Hyperventilation (HV) None . 18. [Which of the following statements is true regarding sphenoidal electrodes?] They are positioned medial to the foramen ovale They may pick up posterior–temporal potentials better than surface electrodes They are felt to pick up similar potentials as FT9 and FT10 They require placement under fluoroscopic guidance None . 19. [Which of the following statements is true about the alpha rhythm?] It reaches its mean adult frequency of 10 Hz around age 10 years Its frequency remains unchanged even in the elderly Its frequency has no relationship to eye closure or opening It has higher amplitude over the left hemisphere in right-handed subjects None . 20. [A 60-year-old man presents with chronic history of difficulty walking and tendency tofall. On examination, he has mild distal weakness in the lower limbs, severe sensory lossin the lower limbs, and severe sensory ataxia. A motor nerve conduction study obtainedfrom the right peroneal nerve with extensor digitorum brevis recording is shown below.Which of the following statements is true about this study? (fig)] It suggests acquired demyelinating polyneuropathy It suggests axonal polyneuropathy It is a normal peroneal motor study for age Because this is a motor study, it is not relevant to the severe sensory ataxia None Comment . 21. [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 . 22. [Which of the following is shown in the figure below? (fig)] Many positive sharp waves and occasional fibrillation potentials Many positive sharp waves and large-amplitude motor unit potentials Complex repetitive discharges Myokymia None Comment . 23. [Potential safety concerns with transcranial magnetic stimulation (TMS) can include all of the following except] Triggering of seizures Transient headache Hearing loss Malfunctioning of vagus nerve stimulator None . 24. [Bilateral absence of lumbar potentials (LPs) with normal P37 latencies after tibial nerve stimulation is seen in which of the following conditions?] Severe peripheral neuropathy Bilateral cauda equina syndrome Guillain–Barré syndrome Technical problem with stimulation or recording None . 25. [All of the following statements regarding the evolution of photic driving response are true except] The initial photic driving appears at 1 year of age Best driving response in preschool children occurs at lower flash frequencies (less than 8 Hz) Best driving response in older children occurs at medium flash frequencies (6–12 Hz) Best driving response in adolescents occurs at wider flash frequencies (6–20 Hz) None .
