Welcome to your Neurophysiology Name Email 1. [A 58-year-old woman has a history of staring spells since age 14 years. Her first generalized convulsion was at age 26 years, and she continues to have them intermittently. What is the most likely diagnosis based on the EEG (filter: 1–70 Hz) shown below? (fig )] Childhood absence epilepsy (CAE) Juvenile myoclonic epilepsy (JME) Symptomatic generalized epilepsy Partial epilepsy with secondary bilateral synchrony None Comment . 2. [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 . 3. [Routine nerve conduction and needle EMG studies are usually normal in which of the following conditions?] Lumbosacral radiculopathy Mild large-fiber neuropathy Small-fiber neuropathy Lambert–Eaton myasthenic syndrome (LEMS) None . 4. [The leakage current from a medical instrument should be] Less than 1 μA Less than 10 μA Less than 100 μA Less than 1 mA None . 5. [Pattern reversal visual evoked potential (PRVEP) is most suitable in the following patient type] Comatose patients Neonates Those with severe visual impairment Patients with suspected psychogenic blindness None . 6. [A 55-year-old woman presented with progressive weakness over 4 months. Initially, she noticed increasing difficulty with climbing steps and getting up from the floor. She recently noticed difficulty lifting her arms when reaching above her head or brushing her hair. She reports a mild dull ache in her muscles. She does not have any skin rash. On examination, she has moderate proximal weakness in the upper and lower limbs with preserved distal limb strength. Deep tendon reflexes and sensory examination were normal. Cranial nerve examination revealed mild facial weakness. The rest of the neurological examination is normal. The above clinical presentation best localizes to] Peripheral nerve Skeletal muscle Neuromuscular junction Spinal cord None . 7. [All of the following statements are true regarding the effect of age on visual evoked potential (VEP) except] P100 latencies reach adult values by age 1 year for larger check sizes P100 latencies reach adult values by age 1 year for smaller check sizes P100 latency may decrease during adolescence P100 latency increases after age 60 years None . 8. [The overall utility of MRI and evoked potentials (EP) in multiple sclerosis (MS) can be summarized by all of the following statements except] EP may be more efficient than MRI in detecting isolated optic neuritis EP is useful to confirm organic nature of subjective symptoms when MRI is normal MRI shows diagnostic lesions in more than 80% of patients with MS Multimodal EPs are abnormal in about 30% of presumptive MS patients with normal MRI None . 9. [The figure below shows a waveform obtained after a normal Valsalva testing in a patient. Which phase of Valsalva does the arrow point to? (fig)] Phase III Phase II Late Phase IV Phase II Early None Comment . 10. [All of the following statements are true about frontal arousal rhythm (FAR) except] It may be associated with cerebral dysfunction It consists of trains of delta waves It appears during sleep-to-wake transitions It is mainly seen in children None . 11. [Which of the following statements is true about visual evoked potential (VEP)?] It is a short-latency near-field potential Bifid P100 waveform may be corrected by stimulation of the inferior visual fields Visual acuity does not affect P100 latency P100 potential is best seen over the contralateral occipital region after hemifield stimulation None . 12. [A median motor study from a 40-year-old man with painless weakness is shown below.This is most consistent with which of the following conditions? (fig)] Amyotrophic lateral sclerosis Multifocal motor neuropathy Monomelic amyotrophy Spinobulbar muscular atrophy (SBMA) None Comment . 13. [The following waveforms show ulnar slow repetitive stimulation in a patient withsuspected myasthenia gravis at baseline and after 1 minute of exercise. What is theinterpretation? (fig)] Repair of decrement Both repair and facilitation Only facilitation This is a normal study None Comment . 14. [A 30-year-old is suspected to have brachial plexus injury after trauma. He has weakness and sensory loss in the hands. Routine nerve conduction studies revealed mildly decreased median and ulnar motor amplitudes. The resident doing the procedure is unsure if F-wave studies of the median and ulnar nerve would be helpful. What is the correct response?] Median and ulnar F-wave responses will not help with localization in this case F-wave responses should be done routinely but will not help in this case F-wave responses may help with localization in this case F-wave responses are not useful because the amplitudes were mildly decreased None . 15. [A 72-year-old male with congestive heart failure and excessive daytime sleepiness is being evaluated for sleep apnea. A 30-second epoch of his polysomnogram (PSG) is shown below. All of the following findings are noted except (fig)] Snoring Apnea Hypopnea Hypoxemia None Comment . 16. [A 33-year-old woman is being seen for a 1-month history of spells consisting of fall, impaired responsiveness, and shaking. Each spell lasts 2–3 minutes, and they occur multiple times daily. Prior routine EEG was normal. She is currently on carbamazepine. The most appropriate next step would be to] Repeat another routine EEG Stop carbamazepine Obtain inpatient video-EEG monitoring Add levetiracetam None . 17. [A 43-year-old male with intractable epilepsy underwent right temporal lobectomy withelectrocorticography (ECoG; sampling rate 1000 Hz, filters: 1–300 Hz) using a 6-contactsubdural strip placed subtemporally with electrode 1 medial and electrode 6 lateral. What is the prominent finding on the ECoG shown below? (fig )] Sharply contoured slowing Pulse artifact Mesial temporal spikes Fast ripples None Comment . 18. [All of the following statements regarding the development of REM sleep are true except] REM sleep constitutes 30% of sleep at birth REM sleep is characterized by the presence of occipital sharp transients during infancy Brief apneic periods lasting 3–10 seconds can be seen in normal infants during REM sleep REM sleep shows increasing desynchronization by 6–12 years None . 19. [To ensure patient safety] The ground electrode should always be placed on the patient’s feet if possible The ground electrode should be connected to the earth ground The recording device plugged into the wall jack should have a second, direct earth ground connection The patient should not be connected to multiple recording devices simultaneously because of the risk of forming ground loops None . 20. [What structure is the source of Wave I of the brainstem auditory evoked potential (BAEP)?] Organ of corti Hair cells Cochlear nerve Cochlear nucleus None . 21. [Which electrodiagnostic feature on needle EMG is suggestive of a chronic neurogenic process?] Reduced recruitment Motor unit potentials with large duration and amplitude Fasciculation potentials Positive sharp waves and/or fibrillation potentials None . 22. [A median somatosensory evoked potential (SSEP) was performed in a 67-year-old male in a coma who was originally found down after an altercation. The findings on the study included intact N9 and N13 but absent P14 and N20 bilaterally. Which of the following conditions is likely?] Traumatic cervical syrinx Wallenberg syndrome Pontine hemorrhage Brain death None . 23. [Which of the following statements best describes generalized spike-and-wave discharges?] They are symmetric in morphology between anterior and posterior head regions They can be rarely seen in patients with focal seizures Frequency of less than 4 Hz in children is invariably associated with good prognosis They may be activated by hyperventilation (HV) but not photic stimulation None . 24. [Amplitude of EEG activity] Does not exceed 50 μV on the scalp Does not exceed 500 μV on electrocorticograms Is typically measured from peak to peak Needs to be accurately reported at least for the posterior dominant rhythm (PDR) None . 25. [A 43-year-old male, otherwise healthy, was running a 10K marathon when he had awitnessed generalized tonic–clonic seizure. He was able to stand and walk to the carwith minimal support but was noted to be “not himself.” When he arrived to the closestemergency department (ED) 30 miles away, he was still confused. A stat EEG (filter:1–70 Hz), as shown below, was significant for bitemporal independent and bifrontalindependent spike-wave discharges, as well as periodic seizures consistent with nonconvulsive status epilepticus. Considering the clinical scenario and EEG results, which of the following is the most likely etiology for his presentation? (fig)] Herpes simplex virus (HSV) type II Autoimmune disorder Stroke Anoxic brain injury None Comment .
