Welcome to your Neurophysiology Name Email 1. [All of the following statements regarding continuous video-EEG monitoring (cEEG) in the ICU are true except] Monitoring can help characterize jerking events in terms of ictal and nonictal There is no added benefit of cEEG monitoring if no seizures were identified in the first 24 hours of monitoring in any critically ill patient It can help in prognostication after subarachnoid hemorrhage (SAH) A patient with a witnessed generalized tonic–clonic seizure, felt to be due to hypoglycemia, is back to his baseline mental state (Glasgow Coma Scale (GCS) 15) and does not need cEEG None . 2. [Around 37–40 weeks conceptional age, all of the following features regarding wakefulness are true except] Wakefulness is characterized by 1–2 Hz activity in the occipital region Wakefulness may resemble sleep-onset REM Wakefulness may be characterized by some rhythmic theta waves Wakefulness may resemble active sleep (AS) None . 3. [Nerve conduction and EMG studies are appropriate initial diagnostic procedures in all of the following conditions except] A 5-year-old boy with high creatine phosphokinase (CPK), enlarged calf muscles, and positive Gower’s sign A 12-year-old boy with fatigue, weakness, and ptosis A 15-year-old girl with slowly progressive distal weakness, atrophy, and sensory loss 22-year-old man with subacute onset of lower extremity numbness and weakness None . 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. [Absence seizures can be potentiated by all of the following except] Hyperglycemia Hyperventilation (HV) Intermittent photic stimulation (IPS) NREM sleep None . 6. [A 64-year-old man with a history of hypertension, seizures, dementia, and resection of a brain tumor 35 years ago was admitted for bizarre behavior noted at the nursing home. His wife stated that his last seizure, described as a staring spell, was 7 years ago. His MRI brain showed a left posterior–temporal lobe meningioma along with evidence of a prior right temporal lobe resection. Twelve hours into the monitoring session (filter 1–70 Hz), a dramatic decrease in EEG amplitude was seen as shown below. What is the most likely cause of the change? (fig)] Cessation of a generalized seizure discharge Suctioning the patient Cerebral hypoperfusion Starting propofol infusion without a bolus None Comment . 7. [All of the following statements regarding the utility of somatosensory evoked potentials (SSEPs) during intraoperative monitoring (IOM) are true except] SSEPs are useful for monitoring during surgical lesioning of dorsal roots and dorsal root entry zone Postoperative SSEP amplitude reduction correlates with relief of pain and spasticity In addition to median and tibial nerves, pudendal nerve monitoring is important Monitoring of SSEPs does not have clinical utility in monitoring dorsal rhizotomy since the changes are inconsistent None . 8. [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 . 9. [A 19-year-old man presents with difficulty walking for a few years and frequent falls.His peroneal nerve conduction study is shown below. Which of the following tests ismost likely to be diagnostic in this patient? (fig)] Mitofusin (MFN) mutation Peripheral myelin protein (PMP) mutation analysis Very long-chain fatty acids Spinal fluid analysis None Comment . 10. [While performing a blink reflex study with right trigeminal stimulation, ipsilateral R1, ipsilateral R2, and contralateral R2 responses were absent. A focal lesion in which of the following locations could lead to these findings?] Right facial nerve or nucleus Right trigeminal nerve or nucleus Right oculomotor nerve or nucleus Right abducens nerve or nucleus None . 11. [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 . 12. [Which of the following patterns has been associated with chronic fatigue/pain conditions?] Alpha intrusion Alpha–beta sleep Monomorphic spindle-like activity Absence of REM sleep None . 13. [Which of the following is NOT usually considered to have a bipolar montage configuration?] Longitudinal Transverse Hatband Laplacian None . 14. [The interface between the EEG electrode and the electrolyte paste can be considered as] An electrical double layer that presents capacitance impeding current flow Potentially unstable with new electrodes causing “pop” artifacts A source of half-cell potential that remains stable despite movement of the electrode Highly polarized when a silver–silver chloride interface is used None . 15. [The following EEG (filter 1–70 Hz; sensitivity 20 μV/mm; solid vertical lines are 1 secondapart) was obtained from a 19-month-old patient with Landau–Kleffner syndrome (LKS). This EEG is characterized by all of the following ways except (fig)] Association with auditory verbal agnosia Definite association with clinical seizures Clear activation with state change None of the above None Comment . 16. [Assume an EEG acquisition system that has a 10-bit analog-to-digital converter (ADC) with a voltage range of –2 mV to +2 mV. What will happen to the voltage resolution if the voltage range of the EEG system is reduced to the –1 mV to +1 mV range?] It will remain the same because the number of bins has not changed It will decrease by a factor of 2 It will increase by a factor of 2 It will increase by a factor of 4 None . 17. [A 53-year-old male with a history of drug and alcohol abuse presented to the emergency department (ED) with fluctuating mental status with hallucinations, bizarre behavior, and urinary incontinence. A routine EEG (filter 1−70 Hz) without video was obtained as shown below. What does his EEG show? (fig )] Mild cerebral dysfunction Nonconvulsive status epilepticus Temporal lobe epilepsy Psychogenic nonepileptic spell None Comment . 18. [Which of the following features is characteristic of syncope?] Myoclonus tends to be multifocal Tonic activity tends to be more pronounced in syncope than in prolonged cerebral hypoxia Prolonged syncope is associated with postictal confusion lasting more than a minute EEG becomes flat at the onset of unconsciousness None . 19. [One week after a pure neuropraxic injury in the forearm, a nerve conduction study will reveal all the following findings except] Decreased distal compound muscle action potential (CMAP) amplitude Decreased proximal CMAP amplitude Complete conduction block No motor unit activity on needle EMG None . 20. [The following figure shows myogenic motor evoked potentials (mMEPs) from a patientundergoing abdominal aortic aneurysm repair. The top, middle, and bottom panels represent recordings obtained from the left APB, left quadriceps, and left tibialis anterior, respectively. Within each panel, the traces from bottom to top represent 2 minutes before, 2 minutes after, 8 minutes after, and 22 minutes after aortic cross-clamping, respectively. Which of the following statements best describes the findings shown in the figure? (fig)] Both the upper and lower limbs are significantly affected by aortic cross-clamping The upper limb is spared and the flat potentials in the lower limb are artifacts Changes in lower limb potentials represent transient spinal cord ischemia corrected by an increase in mean arterial pressure Above mMEPs are uninterpretable without simultaneous somatosensory evoked potentials (SSEPs) None Comment . 21. [Which of the following features of wicket spikes differentiates them from epileptiform spikes?] Their occurrence in deeper stages of sleep Their occurrence in trains Their sharp monophasic morphology Their high amplitude of up to 200 μV None . 22. [The normal recruitment frequencies in a limb and cranial muscle are] Around 16 Hz for cranial muscle and 7–10 Hz for limb muscle Around 16 Hz for limb muscle and 7–10 Hz for cranial muscle Around 25 Hz for cranial muscle and 50 Hz for limb muscle Around 50 Hz for cranial muscle and 2 Hz for limb muscle None . 23. [During a routine 30-minute EEG, the technologist records video to show the occasional leg movements that the patient exhibited. The neurologist should code this as] A routine EEG A routine EEG plus modified video recording Video-EEG monitoring Video-EEG monitoring with a modifier for reduced service None . 24. [Many types of artifacts exist in the ICU setting of physiological and nonphysiological origin. Which of the following is NOT a typical description of the EEG pattern associated with the listed artifact?] Extracorporeal membrane oxygenation (ECMO) is associated with a 1–3 Hz square wave artifact Ventilators can cause artifact that varies widely in morphology, amplitude, and polarity, but can be associated with a faster frequency artifact due to charged water molecules in the ventilator tubing that can be improved by suctioning Mechanical chest percussion device can cause rhythmic 5–6 Hz activity in 1 electrode Cardiopulmonary resuscitation (CPR) can lead to high-amplitude, rhythmic 1–2 Hz activity that is due to movement artifact and is not cerebral activity None . 25. [Decreased activation on needle EMG can be seen in which of the following conditions?] Pain limiting the effort by the patient Upper motor neuron dysfunction or disease Testing of a very strong muscle All of the above None .
