Welcome to your Neurophysiology Name Email 1. [A 50-year-old man is admitted to the ICU with an unclear neurological disorder. He is sedated with propofol for severe agitation and is on ventilatory support. Electrodiagnostic study showed normal motor and sensory responses but absent F-wave responses. Which of the following is the most appropriate conclusion based on the available information?] He has Guillain–Barré syndrome (GBS) with agitation and needs spinal fluid analysis Absent F-wave responses can be due to sedation with propofol He will need somatosensory evoked potential (SSEP) studies to rule out peripheral processes Without repetitive nerve stimulation, it is not possible to come to a definitive conclusion None . 2. [Motor nerve conduction study of the right radial nerve is shown below. What does thisstudy show? (fig)] Severe diffuse distal demyelinating process Conduction block in the arm Severe temporal dispersion in the arm Normal study None Comment . 3. [Subclinical rhythmic electrographic discharge in adults (SREDA) is typically seen during the following scenarios except] Resting state Drowsiness Photic stimulation Hyperventilation (HV) None . 4. [What is the paroxysmal depolarization shift (PDS)?] The rising phase of the action potential A period of time when neurons are hyperpolarized A phenomena that helps to disrupt seizure propagation A wave of cortical depolarization, leading to synchronized neuronal spiking None . 5. [Transcranial magnetic stimulation (TMS) is not suitable for intraoperative monitoring of motor evoked potentials (MEPs) because of all of the following except] It does not effectively activate the motor cortex It does not produce D-waves It produces different MEPs with different orientation of the stimulating coil It can interfere with the functioning of other operating room equipment None . 6. [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 . 7. [A 60-year-old man with low back pain has a tibial H-reflex testing performed. The afferent and efferent loops of the H-reflex are] Antidromic sensory and orthodromic motor Orthodromic sensory and orthodromic motor Orthodromic sensory and antidromic motor Antidromic sensory and antidromic motor None . 8. [What is the typical morphology of end-plate spikes?] There is only a negative deflection There is only a positive deflection There is an initial negativity followed by a final positivity There is an initial positivity followed by negativity and ending with positive deflection None . 9. [All of the following statements regarding the EEG abnormalities observed after carotid clamping during carotid endarterectomy are true except] They return to the preclamp state with placement of shunt They can be caused by changes in the level of anesthesia Even transient changes can be associated with significant neurologic deficit They can sometimes be reversed by administration of IV fluids None . 10. [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 . 11. [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 . 12. [All of the following statements regarding infant audiologic screening are true except] Initial infant screening should be done within 3 months of birth Transient-evoked otoacoustic emissions (EOAE) test can be used instead of brainstem auditory evoked potentials (BAEPs) Infants failing the screening should be retested within 3 months False positive tests can occur because of middle ear infection None . 13. [Latency and conduction velocity measured on nerve conduction studies reflect which of the following fibers within the specific nerve?] All the nerve fibers Only the fastest nerve fibers Only the slowest nerve fibers Only the unmyelinated fibers None . 14. [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 . 15. [Which of the following statements is true regarding flash visual evoked potential (VEP)?] Flash VEP has less latency variability than pattern reversal VEP (PRVEP) Flash VEP is less sensitive to conduction defects than PRVEP Flash VEP assesses the visual pathway up to but not including the lateral geniculate nucleus Flash VEP requires that the subject’s eyes remain open None . 16. [The EEG waveforms that occur after scanning a complex pattern in a brightly lit room are characterized by all of the following except] They occur in the occipital and frontal regions near-simultaneously with a fixed latency They are biphasic or triphasic with the most prominent phase being positive They are time-locked to the saccadic eye movement They cannot be triggered by mental imagination of a complex picture None . 17. [Which of the following features is seen around 35–37 weeks of conceptional age?] Absence of reactivity of the EEG during wakefulness and active sleep (AS) Delta brushes are absent in quiet sleep (QS) Presence of tracé alternant instead of tracé discontinu pattern during AS Replacement of multifocal sharp transients by frontal sharp transients None . 18. [Which of the following is true in terms of recording D-waves and M-waves (myogenic motor evoked potentials [mMEPs]) with transcranial electrical stimulation (TES) during intraoperative monitoring (IOM)?] D-waves are less likely to be seen with inhalational anesthesia than M-waves D-waves are more consistent across multiple runs than M-waves D-waves are not affected by spinal cord pathology D-waves show changes earlier than M-waves when motor tracts are compromised None . 19. [Which of the following does not increase the EEG impedance?] Interface between the scalp and the electrode The wiring from the electrode to the amplifier Display of the acquired EEG waveform on the computer screen Skull thickness None . 20. [In a bipolar montage, if G1 is negative and G2 is positive, the waveform deflection in channel G1–G2 will be] Upward Downward Flat Equipotential None . 21. [A 42-year-old mother of 3 was noted to have excessive daytime sleepiness. She was noted to have a normal overnight polysomnogram (PSG). On the following day, she had a multiple sleep latency test (MSLT) with a mean sleep latency of 4 minutes and 1 sleep-onset REM period (SOREMP) during the first 2 naps. What is the most likely diagnosis?] Narcolepsy Idiopathic hypersomnia Insomnia Inadequate study None . 22. [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 . 23. [All of the following conditions can be associated with sleep-onset REM periods (SOREMPs) except] Narcolepsy Recent sleep deprivation Phenobarbital administration Circadian rhythm disorders None . 24. [A 45-year-old man presents with weakness for more than 20 years. On examination, he has predominantly symmetrical, proximal more than distal, weakness with diminished reflexes and intact sensation. He was previously told that he had a form of muscular dystrophy. Needle EMG revealed few positive sharp waves and fibrillation potentials along with long-duration and large-amplitude motor unit potentials with severely reduced recruitment. If a muscle biopsy is performed in this patient, it will most likely reveal] Rimmed vacuoles Perifascicular atrophy Fiber type grouping Glycogen positive vacuoles None . 25. [A 27” computer screen has a resolution of 1920 (horizontal) by 1080 (vertical) pixels with vertical borders of 250 pixels each. An EEG sampled at 1000 Hz is displayed at 15 seconds per page. How many pixels per inch (PPI) are present on the computer screen?] 40 63.1 71.1 81.6 None .
