Questions - Clinical Tree

Chapter 1

Q1.
The thin and thick arrows point to what findings on the EEG? ( Fig. 1Q1 )
- A.
  They both indicate frontal slowing, which is worse in B.
- B.
  They both indicate eye movements, which are slower in B.
- C.
  The thin arrow points to eye flutter and the thick arrow points to frontally predominant generalized rhythmic delta activity (GRDA).
- D.
  The thin arrow points to frontally predominant GRDA and the thick arrow points to eye flutter.
Q2.
The figure depicts frontotemporal sharp waves (boxes) ( Fig. 1Q2 ). What is the best statement regarding these sharp waves?
- A.
  A sharp wave on EEG is the summation of at least 150 action potentials.
- B.
  For a sharp wave to be apparent on EEG, at least 1 cm ² of cortex must be involved.
- C.
  A sharp wave is generated by the summation of a large number of inhibitory post-synaptic potentials (IPSP).
- D.
  A sharp wave is generated by the summation of a large number of excitatory post-synaptic potentials (EPSP).
Q3.
The above diagram of an EEG ( Fig. 1Q3 ) makes it clear that:
- A.
  There is nothing of interest happening at the F8, T8, P8 electrodes as there is no potential difference.
- B.
  In a bipolar recording, channels which are relatively flat may involve electrodes which are more electronegative than the surrounding electrodes.
- C.
  There is a large electronegative field here and O2 and Fp2 are maximally electronegative.
- D.
  The amplitude is highest at the O2 electrode. This indicates that O2 is more electronegative than the surrounding electrodes.
Q4.
After a busy day as a neurophysiology fellow, your mentor reviews EEGs with you. You read this EEG as normal ( Fig. 1Q4 ). Your attending is shaking her head. What did you miss?
- A.
  You missed nothing. This EEG is normal and your attending needs a vacation.
- B.
  This EEG is not normal. It represents alpha coma.
- C.
  The eye deflections are asymmetric and there is likely something wrong with the left eye.
- D.
  The eye deflections are asymmetric and there is likely something wrong with the right eye.
Q5.
You report the findings found in this EEG ( Fig. 1Q5 ) as follows:
- A.
  Ongoing right beating lateral nystagmus.
- B.
  Bilateral independent frontal rhythmic delta activity (BI-LRDA).
- C.
  Bilateral frontal focal status epilepticus.
- D.
  Electrode pop at the F7 and F8 electrodes.
Q6.
What phrase best describes a high frequency filter (HFF) or low pass filter:
- A.
  A HFF attenuates the amplitude of frequencies above the cutoff frequency. In a HFF the input signal is placed across a resistor and capacitor in series and the output signal is measured across the capacitor alone.
- B.
  A HFF slows the frequencies above the cutoff frequency. In a HFF the input signal is placed across a resistor and capacitor in series and the output signal is measured across the capacitor alone.
- C.
  A HFF attenuates the amplitude of frequencies above the cutoff frequency. In a HFF the input signal is placed across a capacitor and a resistor in series and the output signal is measured across the resistor alone.
- D.
  A HFF slows the frequencies above the cutoff frequency. In a HFF the input signal is placed across a capacitor and a resistor in series and the output signal is measured across the resistor alone.
Q7.
While reading an EEG you change the display from 7 µV/mm to 15 µV/mm. You have:
- A.
  Increased the sensitivity. The EEG will appear higher in amplitude.
- B.
  Increased the sensitivity. The EEG will appear lower in amplitude.
- C.
  Decreased the sensitivity. The EEG will appear higher in amplitude.
- D.
  Decreased the sensitivity. The EEG will appear lower in amplitude.

Chapter 2

Q1.
What abnormal condition is most likely to arise out of this stage of sleep ( Fig. 2Q1 )?
- A.
  Frontal lobe seizures.
- B.
  REM behavior disorder. The eye leads indicate rapid eye movements.
- C.
  Sleep walking.
- D.
  Sleep paralysis.
Q2.
The sinusoidal rhythm seen in the box ( Fig. 2Q2 ) represents:
- A.
  Mu rhythm and would attenuate with eye opening.
- B.
  Wicket spikes and would attenuate by moving the arms.
- C.
  Mu rhythm and would attenuate by thinking about moving the arms.
- D.
  A brief potentially ictal rhythmic discharge (BIRD).
Q3.
A 5-year-old child is referred to you for frequent episodes of inattention noticed by his teachers. His neurological exam is normal. You do an EEG and hyperventilate the child ( Fig. 2Q3 ). This EEG indicates
- A.
  The child is engaging in the task and hyperventilating well.
- B.
  The child has childhood absence epilepsy.
- C.
  The child may have a toxic metabolic disturbance.
- D.
  Diffuse slowing suggestive of diffuse cerebral dysfunction.
Q4.
A 16-year-old girl comes to you after having a witnessed GTCC after a weekend of not sleeping. You do a routine EEG ( Fig. 2Q4 ). The technician stops the photic stimulation due to the finding pictured. You tell the technician,
- A.
  This is a photoparoxysmal response to photic stimulation. Continuing the photic stimulation could lead to a convulsion.
- B.
  This is photic driving and a perfectly normal response to photic stimulation.
- C.
  This is a photomyogenic response to photic stimulation. Continuing the photic stimulation could lead to a convulsion.
- D.
  This is a photomyogenic response to photic stimulation and a perfectly normal response to photic stimulation.