Welcome to your Neurophysiology Name Email 1. [How often is REM sleep thought to occur in adults?] Every 30 minutes Every 60 minutes Every 90 minutes Every 120 minutes None . 2. [A 34-year-old woman with chronic fatigue and various types of somatic pain is referredfor evaluation of myasthenia gravis (MG). On examination, there is no clear weakness.Her slow repetitive stimulation studies performed at baseline and immediately afterexercise are shown below. What is the interpretation? (fig)] Significant decrement and repair Significant decrement and facilitation Normal repetitive stimulation Significant decrement only None Comment . 3. [Which electrode placement system is shown in the figure below? (fig)] International 10–10 system International 10–20 system Modified Combinatorial Nomenclature (MCN) American Clinical Neurophysiology Society (ACNS) system None Comment . 4. [A repeat EMG was performed in a patient diagnosed with acute motor axonal neuropathy after he noticed mild improvement in strength. The key finding was the presence of a few short-duration, small-amplitude polyphasic motor unit potentials. Which of the following helps in interpreting the clinical significance of these potentials?] Spontaneous activity Degree of activation of muscle Recruitment pattern Findings on muscle biopsy None . 5. [A very well-built 40-year-old guitar player presents with muscle stiffness that he has had most of his life and also weakness in cold weather. On examination, he does not have any limb weakness. A routine EMG revealed repetitive discharges that wax and wane in frequency and amplitude. What does this patient most likely have?] Periodic paralysis Myotonic dystrophy type I Myotonic dystrophy type II Myotonia congenita None . 6. [A 41-year-old female with ataxia is being evaluated for suspected multiple sclerosis. Median somatosensory evoked potential (SSEP) shows intact potentials with the only abnormality being prolonged P14–N20 interpeak latency (IPL). The differential diagnosis includes all of the following except] Neuromyelitis optica Friedreich’s ataxia Midbrain tumor Demyelination in the thalamocortical radiation None . 7. [A 35-year-old, previously healthy female with sudden onset of bilateral visual loss undergoes a visual evoked potential (VEP) study as shown below (left panel shows left eye stimulation, right panel shows right eye stimulation). Her history is significant for stress related to recent job loss. All of the following interpretations are correct except(fig)] Pituitary tumor compressing the optic chiasm Bilateral optic neuritis Psychogenic blindness Bilateral parieto-occipital metastatic tumors None Comment . 8. [All of the following statements regarding EEG changes observed after carotid crossclamping during carotid endarterectomy are true except] EEG changes usually occur within the first 20 seconds in the majority of patients Decrease of anterior alpha and beta activity on the clamped side suggests ischemia Increase of delta amplitude on the clamped side suggests progression of ischemia Bilateral EEG changes always suggest change in anesthesia or blood pressure None . 9. [The following EEG (filter: 1–70 Hz; sensitivity: 10 μV/mm; solid vertical lines are 1 second apart) is most consistent with which of the following epilepsy syndromes? (f ig)] Autosomal dominant nocturnal frontal lobe epilepsy Mesial temporal sclerosis Benign Rolandic epilepsy (BRE) Cingulate epilepsy None Comment . 10. [All of the following responses can be seen during intermittent photic stimulation (IPS) except] Photosensitive response Photomyogenic response (PMR) Photoparoxysmal response (PPR) Photoelectric response None . 11. [Which of the following features of the motor unit action potential is most suggestive of proximity of the needle electrode to the motor unit?] Duration Rise time Amplitude Number of phases None . 12. [The standard paper speed for EEG recording in the United States is] 15 mm/sec 30 mm/sec 45 mm/sec 60 mm/sec None . 13. [A 50-year-old presents with a 25-year history of bilateral ptosis and double vision. In addition, she has a history of cardiac arrhythmia for which she eventually needed a cardiac pacemaker. On examination, she has bilateral ptosis, limitation of the extraocular movement, and mild proximal weakness. Which of the following findings is likely to be seen on electrodiagnostic testing?] Greater than 10% decrement on slow repetitive stimulation Greater than 100% on increment on fast repetitive stimulation Short duration motor unit potentials on needle EMG Long duration motor unit potentials on needle EMG None . 14. [Alexander disease is likely to be associated with which of the following EEG findings?] Bifrontal slowing Generalized periodic discharges (GPDs) Temporal spikes Burst suppression None . 15. [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 . 16. [Incomplete recovery from Guillain–Barré syndrome (GBS) can be characterized by all of the following pathological changes in the peripheral nerves except] Longer internodes Shorter internodes Onion bulb formation Decrease in nerve fibers on skin biopsy None . 17. [Absence seizures are characterized by all of the following features except] Rhythmic eye blinking Repetitive oral automatisms Loss of postural control Impairment of working memory None . 18. [A single electrical stimulus applied to the motor cortex during transcranial electrical stimulation (TES)] Produces a single volley in the descending motor tracts Produces D-waves in the pyramidal axons Blocks I-waves in the pyramidal neurons Produces M-waves in the pyramidal neurons None . 19. [A new clinical neurophysiology fellow was assisting the technologist during a brainstem auditory evoked response procedure. He noted that there was a fairly sudden increase in all of the absolute latencies. Which of the following could the fellow have noted in addition to the above change?] Decrease in all the interpeak latencies (IPL) Increase in the amplitude of all waveforms The knob for the click intensity was inadvertently decreased The patient had fallen asleep None . 20. [All of the following statements regarding periodic leg movement sequences are true except] They have amplitude of at least 25% above the resting EMG They consist of at least 4 consecutive leg movements The interval between leg movements should be 5–60 seconds Leg movements between 2 legs separated by 5 seconds or less are counted as a single movement None . 21. [All of the following statements regarding the clinical utility of pattern electroretinogram (PERG) are true except] Normal PERG accompanied by abnormal visual evoked potential (VEP) suggests optic nerve demyelination Abnormal PERG accompanied by abnormal VEP suggests severe macular degeneration Abnormal PERG after recent optic neuritis predicts poor visual recovery Progressive decrease in PERG amplitude after recent optic neuritis correlates with development of optic nerve atrophy None . 22. [The American Academy of Sleep Medicine (AASM) recommended parameters to be reported in a routine polysomnogram (PSG) include all of the following except] Body position Electrooculogram (EOG) Leg EMG Snoring monitor None . 23. [Which of the following is the earliest needle EMG change seen in a patient with acute demyelinating polyneuropathy?] Abundant positive sharp waves and fibrillation potentials Polyphasic motor unit potentials Complex repetitive discharges Decreased recruitment of motor units None . 24. [A 47-year-old male with HIV presents with fever and new-onset seizure. What does hisEEG (filter 1–70 Hz) below show? (fig)] Periodic lateralized discharges (PLDs) Intermittent rhythmic delta activity (IRDA) Breach rhythm Seizure None Comment . 25. [Decreased limb temperature may cause the following electrodiagnostic changes on motor nerve conduction studies:] Increased motor amplitudes Prolonged distal latencies Slowed nerve conduction velocities All of the above None .
