Welcome to your Neurophysiology Name Email 1. [Lambdoid waves are] Surface-positive waveforms Seen during both wakefulness and light sleep Triggered by scanning complex visual patterns Relatively rare, being encountered in less than 10% of the healthy population None . 2. [Which of the following statements is true about steroid induced myopathy?] Type 1 muscle fiber atrophy is seen on muscle biopsy Type 2b muscle fiber atrophy is seen on muscle biopsy Irritative changes with positive sharp waves and fibrillation potentials are seen on EMG Nonflourinated corticosteroids are more likely to cause myopathy than fluorinated corticosteroids None . 3. [A 42-year-old woman underwent right anterior temporal lobectomy 6 months ago, and has remained seizure free since the surgery on lamotrigine monotherapy. She wants to drive since she satisfies the local law of 6 months of seizure freedom to be able to drive. Her neurologic examination is normal. An EEG shows rare right temporal sharp waves. The most appropriate recommendation would be to] Continue the driving restriction and repeat another routine EEG in 6 months Remove the driving restriction if she continues to take lamotrigine as prescribed Obtain inpatient video-EEG monitoring for 3 days while on lamotrigine to see if seizures occur spontaneously Obtain inpatient video-EEG monitoring after stopping lamotrigine to see if seizures can be induced None . 4. [A 20-year-old was stabbed with a long blade knife in the neck during a fight. He noticed weakness and numbness in his right hand after the injury. Which of the following findings will differentiate brachial plexopathy from cervical root injury?] Ulnar sensory amplitude Median H-reflex with flexor carpi radialis recording Median somatosensory evoked potential study Ulnar motor amplitude None . 5. [A 30-year-old woman presented with recent onset difficulty speaking and swallowing. In addition, she has ptosis and diplopia. She was given pyridostigmine but her symptoms worsened with this medication. Repetitive stimulation of the spinal accessory nerve revealed significant decrement. Acetylcholine receptor (AChR) antibody test was normal. What is the next best diagnostic step?] Voltage-gated calcium channel antibody Muscle-specific kinase antibody Single-fiber EMG (SFEMG) Muscle biopsy to evaluate mitochondrial diseases None . 6. [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 . 7. [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 . 8. [All of the following statements regarding EEG findings in coma are true except] Generalized burst suppression is invariably associated with poor prognosis regardless of etiology Diffuse monomorphic nonreactive alpha activity can be associated with brainstem lesions or hypoxic-ischemic injury Normal sleep features such as spindles may be seen with cyclic variability A pattern of low-voltage irregular (LVI) activity alternating with high-voltage slowing may be seen in patients with Cheyne–Stokes breathing None . 9. [Which of the following statements is true about electrical shock?] A current of 100 mA or higher applied to the skin can cause ventricular fibrillation in a patient Using 3-hole electrical receptacles eliminates risk of electrical shock to the patient Human susceptibility to electrical shock is maximal at 70 Hz Indwelling catheters do not pose additional risk for electrical shock None . 10. [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 . 11. [A 55-year-old man presents with severe fatigue and weakness for over 4 months and recent onset of dry mouth. He does not report any obvious diplopia. He is a chronic smoker. On examination, he has mild facial weakness, ptosis, mild to moderate weakness of neck flexion, and proximal limb weakness. Deep tendon reflexes are absent. Sensory examination is normal.Ulnar motor study done in this patient is shown below. Top trace is at baseline and thebottom trace is after 10 seconds of exercise. What does it reveal? (fig )] Normal test after 10 seconds of exercise Decreased motor amplitude on repeat stimulation, suggestive of postsynaptic neuromuscular junction (NMJ) disorder Increased motor amplitude on repeat stimulation, suggestive of presynaptic NMJ disorder Technically limited study None Comment . 12. [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 . 13. [Which of the following is true about F-wave latencies in children?] F-wave latency is similar to adult F-wave latency because slower conduction velocity and shorter limb length counteract each other F-wave latencies are longer in children than adults because of lack of complete myelination F-wave latencies are shorter as the limb length is shorter F-waves are absent in children, so latency cannot be assessed None . 14. [A 45-year-old man with suspected myasthenia gravis had a 3-Hz repetitive stimulation (slow repetitive stimulation) of the left ulnar nerve with abductor digiti minimi (ADM) recording, which was normal. The next most appropriate step for evaluation of neuromuscular junction dysfunction would include] Use a higher rate of stimulation such as 20 or 50 Hz Make sure the limb is not cold, and warm the limb by 3–4°C if needed Administer pyridostigmine and repeat the test Use a higher amplifier gain during the study None . 15. [Which of the following has not been shown to contribute to somatosensory evoked potentials (SSEPs)?] Joint afferents after median nerve stimulation Joint afferents after tibial nerve stimulation Muscle afferents after median nerve stimulation Muscle afferents after tibial nerve stimulation None . 16. [All of the following are advantages of using quantitative EEG (qEEG) except] It allows for rapid detection of seizures compared to review of raw EEG It can provide a quick overview of seizure location, frequency, and duration It can be used to assess response to therapy It can replace review of raw EEG None . 17. [A 30-second epoch of a polysomnogram (PSG) from a 30-year-old woman with insomnia is shown below. This is most consistent with (fig)] Normal wake epoch Normal N2 epoch Hypopnea Periodic limb movement disorder (PLMD) None Comment . 18. [The main contributor for the extracellular potential measured in EEG is] Calcium action potential Depolarizing afterpotential Hyperpolarizing afterpotential Postsynaptic potential None . 19. [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 . 20. [All of the following statements are true about the generators of the tibial somatosensory evoked potential (SSEP) waveforms except] Lumbar potential (LP) is a near-field potential reflecting postsynaptic activity in the lumbar cord P31 is a far-field potential reflecting activity in the caudal medial lemniscus N34 is a near-field potential reflecting activity in the brainstem and thalamus P37 is a near-field potential reflecting activity in the parietal cortex recorded ipsilateral to the stimulated side None . 21. [The accessory peroneal nerve supplies which of the following muscles?] Peroneus brevis Tibialis anterior Tibialis posterior Extensor digitorum brevis None . 22. [The needle EMG waveforms shown below may be seen in all of the following conditions except (fig)] Motor neuron disease Severe inflammatory polymyositis Severe axonal polyneuropathy Guillain–Barré syndrome (GBS) with demyelinating changes only None Comment . 23. [EEG reactivity to auditory or tactile stimulation in a term infant is characterized by all of the following except] Diffuse flattening Burst of generalized theta activity Burst of generalized delta activity Occipital delta activity None . 24. [Classify the following pattern using the American Clinical Neurophysiology Society’sestablished standardized critical care EEG terminology. (fig)] SI-GRDA LSW BIRDA SI-GSW None Comment . 25. [A demyelinating lesion in the pons is likely to show] Prolonged N9 absolute latency Prolonged N9–P14 interpeak latency (IPL) Prolonged P14 absolute latency Prolonged P14–N20 IPL None .
