Welcome to your Neurophysiology Name Email 1. [Which of the following statements regarding malignant epilepsy syndromes is NOT correct?] Neonatal myoclonic encephalopathy may present with complex bursts of spikes and sharp waves with periods of discontinuity with evolution to hypsarrhythmia Early infantile epileptic encephalopathy may present with tonic spasms with a burstsuppression EEG pattern Severe myoclonic seizures of infancy may present as myoclonic seizures initially and progress to nonfebrile clonic seizures with generalized spike-wave and polyspikewave discharges Myoclonic astatic epilepsy may present with febrile seizures in patients with normal development progressing to multiple seizure types with generalized spike-wave discharges in the setting of diffuse theta activity None . 2. [The waveforms shown in the figure below may be found in all of the following conditions except (fig)] Steroid-induced myopathy Toxic myopathies Inflammatory myopathies Glycogen storage disorders None Comment . 3. [Obtaining serial EEGs can increase the sensitivity of detecting epileptiform abnormalities. What would be the sensitivity after 3 EEGs?] 10% 30% 50% 90% None . 4. [A tumor in the medulla can be expected to reduce or abolish all of the following waveforms except] N13 P14 N18 P31 None . 5. [Which of the following features is seen in primary generalized epileptic myoclonus?] It is triggered by voluntary movement Myoclonus is usually asynchronous It is usually associated with giant somatosensory evoked potentials It is preceded by generalized fronto-central activity on the EEG time-locked to the myoclonus None . 6. [All of the following sensors are part of a standard overnight polysomnogram (PSG) study except] 16-Channel scalp EEG electrodes Nasal thermistor Single-lead ECG electrode Single-chin EMG electrode None . 7. [Which of the following statements is true regarding sleep-related events that affect cardiac function?] Respiratory obstruction can cause tachycardia Arousals can lead to bradycardia REM sleep can be associated with autonomic changes None of the above None . 8. [When multiple capacitors are placed in a circuit, they exhibit the behavior opposite to that of] Inductors Resistors Invertors Operative amplifiers None . 9. [A 30-year-old South Asian man presented to the electrodiagnostic lab with slowly progressive weakness in the right hand over 18 months. He denies any sensory loss or pain. On examination, he has weakness in the right hand finger abductors, extensors, and flexors. Nerve conduction studies and EMG will likely reveal] Decreased median and ulnar sensory amplitudes Long-duration motor units with reduced recruitment patterns More than 100% increment after 15-second exercise Absent sural sensory response None . 10. [A 45-year-old male with a history of heart disease status post coronary artery bypass graft (CABG) surgery, and a left parietal meningioma status post resection, was brought to the emergency department (ED) unresponsive after collapsing and prolonged CPR. What is the most likely cause for the EEG findings shown below (filter: 1–70 Hz, vertical lines are 1 second apart)? (fig)] Anoxic injury Anesthetic effect Skull defect 60 Hz electrical noise artifact None Comment . 11. [During intraoperative monitoring (IOM) of somatosensory evoked potentials (SSEPs)] An electrode around the elbow can substitute for the Erb’s point electrode for median SSEP The spinal potentials, the median N13 and tibial N22, are crucial to record The cervicomedullary potentials, the median P14 and tibial P31, are best recorded using a dorsal scalp to noncephalic linkage Larger cortical potentials with median nerve stimulation are obtained using a CPc– CPi linkage None . 12. [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 . 13. [From term to 3 months of age, drowsiness typically consists of all of the following characteristics except] Eyes may be open Decrease in movement Decrease in muscle tone Temporal slowing None . 14. [While performing a sural sensory nerve conduction study, the examiner notices that the leg feels cold to the touch. Which of the following is the most appropriate step before continuing with the study?] Measure the temperature and proceed with nerve conduction study testing Compare the response to motor studies in the lower limb Measure the temperature and warm the lower limb Measure the temperature and use formulas to correct latency and velocity None . 15. [Which of the following is true on a median motor study in patients with Martin–Gruber anastomosis (MGA) and carpal tunnel syndrome (CTS)?] Delayed distal latency only Delayed distal latency and spuriously increased conduction velocity Delayed distal latency, spuriously increased conduction velocity and positive dip on proximal stimulation MGA corrects for carpal tunnel compression, and so the median motor study is normal None . 16. [A 46-year-old male was found down and intubated at the scene. He was taken to the nearest facility, and the patient was too unstable to get head imaging. Continuous video-EEG monitoring was started. From top to bottom: fast Fourier transform (FFT) of left hemisphere, FFT of right hemisphere, amplitude-integrated EEG (aEEG), and peak envelope trend. Color bar indicates the power, black being the lowest and white being the highest. What is the correct interpretation of the following quantitative EEG (qEEG) panels at the blue vertical line just past time marker 17:26? (fig)] The increase in the peak envelope trend correlates with bihemispheric asymmetry, right more than left, indicating relative ischemia The increase in the fast Fourier transform (FFT) spectrogram indicates that there is increasing higher power at the higher frequencies, indicating a state change from sleep to wakefulness The deflection of the amplitude-integrated EEG (aEEG) is most likely indicative of a burst of activity in the background of relative suppression The color spectrogram indicates that the activity, in this case likely a seizure discharge, is involving the right hemisphere more than the left hemisphere None Comment . 17. [An absent P100 waveform after monocular stimulation can be associated with all of the following conditions except] Cataract Optic neuritis Technical problem with the hardware Cortical blindness None . 18. [A patient is referred to the neuromuscular clinic for evaluation of a brachial plexopathy. On examination, he was noted to have weakness in the deltoid and triceps; however, the pronator teres muscle and biceps brachii were strong. Presuming that the pathology is in the brachial plexus, these findings are best localizable to which of the following structures?] Medial cord Lateral cord Posterior cord C5–C6 roots None . 19. [Studies on monitoring brainstem auditory evoked potentials (BAEPs) during intraoperative monitoring (IOM) suggest] No role for BAEP monitoring as it does not improve postoperative neurologic outcome Adverse neurologic outcome even after a transient loss of all BAEP waves Potential for hearing impairment only when Wave V latency is delayed by greater than 2 ms Preservation of functional hearing after acoustic neuroma resection if BAEP and electrocochleogram waves are present at the end of surgery None . 20. [Giant somatosensory evoked potential (SSEP) can be seen in all of the following conditions except] Lafora body disease Conditions causing focal motor seizures Juvenile myoclonic epilepsy Hemispheric hemorrhagic stroke None . 21. [Visual evoked potential (VEP) abnormalities in optic neuritis are characterized by all of the following except] Abnormal VEP to smaller check size is more common during the initial stages VEP latency can remain prolonged after recovery of vision in up to 50% of patients VEP can be abnormal in greater than 50% of multiple sclerosis (MS) patients with normal visual function and neuro-ophthalmologic examination Abnormalities in VEP are more common than abnormalities in optical coherence tomography None . 22. [What clinical scenario could lead to the following EEG pattern (filter: 1–70 Hz)? (fig)] A 29-year-old male with acute left middle cerebral artery (MCA) stroke An 18-year-old male with lithium overdose A 61-year-old with female early-onset Alzheimer’s disease A 2-year-old boy with brainstem glioma None Comment . 23. [Which of the following EMG responses is generated from the motor unit?] Complex repetitive discharges Fibrillation potentials Myokymic discharges Myotonic discharges None . 24. [Subclinical rhythmic electrographic discharge in adults (SREDA) is typically seen during the following scenarios except] Resting state Drowsiness Photic stimulation Hyperventilation (HV) None . 25. [Which of the following agents is likely to cause EEG suppression only at very high doses?] Enflurane Isoflurane Halothane Desflurane None .
