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Neurodiagnostics \ Neurophysiology > CLTM - Board Prep > Flashcards

CLTM - Board Prep Flashcards

CLTM, Long Term Monitoring, EEG, Epilepsy, Surgery, ECoG, grid electrodes, ambulatory EEG, EMU

1
Q

What does OSHA stand for?

A

Occupational Safety & Health Administration

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2
Q

What is OSHA’s function?

  1. Prevent wrong-site surgery
  2. Protect Patient Health Information
  3. Insure an environment of patient safety
  4. Insures an environment of safety for all staff
A

Insures an environment of safety for all staff

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3
Q

What does CMS stand for?

A

Centers for Medicare & Medicaid Services

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4
Q

What does CMS administer?

  1. Medicare & Medicaid
  2. Medicare, Medicaid & HIPPA
  3. Affordable Care Act
  4. Joint Commission Accredidation
A

Medicare, Medicaid & HIPPA

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5
Q

Dysgeusia

A

Distortion of sense of taste.

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6
Q

Dystonia

A
  • Sustained muscle contractions
  • twisting
  • repetitive movements
  • abnormal posturing.
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7
Q

Ataxia

A

Loss of muscle coordination & movement.

causes gait disturbance.

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8
Q

Cataplexy

A

Sudden loss of consciousness triggered by laughing, crying, or fear.

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9
Q

EEG with Cataplexy

A

Normal

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10
Q

Narcolepsy

A

The brain’s inability to regulate sleep-wake cycles.

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11
Q

EEG with narcolepsy

A

Early onset REM during sleep

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12
Q

Wallenbergs Syndrome

A

Injury to the lateral medulla, resulting in tissue ischemia & necrosis, with sensory defecits in:

  • Trunk & extremities on contralateral side of Injury.
  • Face & cranial nerves on the ipsilateral side of the injury.
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13
Q

Dysphagia

A

Difficulty Swallowing

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14
Q

Vertigo

A

Dizziness

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15
Q

Nystagmus

A

Involuntary Rhythmic movement of the eye.

(vertically or horizontally)

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16
Q

Dysarthria

A

Slurred Speech

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17
Q

Ptosis

A

Drooping eyelid

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18
Q

Horners Syndrome

A

The unilateral combination of:

  • drooping eyelid (ptosis)
  • constricted pupil (miosis)
  • decreased sweating (anhidrosis)
  • eye redness
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19
Q

Cortical Dysplasia

  1. Absence Seizures
  2. Keppra
  3. Intractable Seizures
  4. Wests Syndrome
A

Intractable Seizures

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20
Q

Describe Hyperlexia

A

Fascination with letters or numbers & advanced reading ability.

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21
Q

Hyperpraphia

A

Overwhelming urge to write.

Associated with temporal lobe epilepsy.

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22
Q

Hippocampal Sclerosis

A

Neuronal cell loss & gliosis in hippocampus

Specifically the CA-1 (Cornu Ammonis Area 1) & subiculum.

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23
Q

How do you test for Hippocampal sclerosis

A

MRI

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24
Q

Hippocampal Sclerosis

  1. Neocortex of Temporal Lobe
  2. Globus Pallidus
  3. Mesial Temporal Lobe Epilepsy
  4. Supplemental Motor Cortex
A

Mesial Temporal Lobe Epilepsy

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25
Q

Neocortex of Temporal Lobe

  1. Medial Temporal Lobe Epilepsy
  2. Lateral Temporal Lobe Epilepsy
  3. Mesial Temporal Lobe Epilepsy
  4. Longitudinal Temporal Lobe Epilepsy
A

Lateral Temporal Lobe Epilepsy

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26
Q

Generic Dilantin®

A

Phenytoin

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27
Q

Generic Depakote®

A

Valproic Acid or Valproate

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28
Q

Side effect of Phenytoin (Dilantin®) withdrawl

A

Status Epilepticus

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29
Q

Drug of choice for Infantile Spasms

A

ACTH

Adreno-Cortico-Tropic Hormone

Adrenocorticotropic Hormone

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30
Q

Drug of choice for Juvenile Myoclonic Epilepsy

A

Depakote®

Valproic Acid / Valproate

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31
Q

Drug of choice for Juvenile Absence Seizures

A

Ethosuximide / Zarontin®

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32
Q

Drug of choice for Lennox-Gastaut

A

Depakote® / Valproic Acid / Valproate

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33
Q

Define ACTH

A

Adreno-Cortico-Tropic Hormone

Adrenocorticotropic Hormone

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34
Q

Drug of Choice for Complex Partial Epilepsy

A

Keppra® / Levetiracatam

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35
Q

Define Seizure

A

Sudden involuntary time-limited alteration in behavior, with change in motor activity, autonomic function, consciousness or sensation, accompanied by abnormal electrical discharge in the brain

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36
Q

Define Epilepsy

A
  • more than 2 Seizures
  • Nerve cell activity in your brain is disrupted, causing abnormal behavior, sensations, or loss of consciousnes.
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37
Q

Define Seizure Semiology

A
  • Clinical Manifestations
  • Seizure Description
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38
Q

Clinical manifestation of Gelastic Seizures

A

Laughing

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39
Q

Clinical manifestation for Dacrystic Seizures

A

Crying

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40
Q

Describe typical ictal progression for partial and convulsive seizures.

A

Ictal discharge begins with low-voltage fast activity and becomes slower with higher amplitude.

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41
Q

Most common co-morbidity in Gelastic & Dacrystic Seizures

A

Hypothalamic Hamartoma

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42
Q

Define Todd’s Paralysis

A
  • Partial or complete paralysis following seizure
  • Unilateral & may involve speech & vision
  • Duration: 30 min - 36 hrs (avg 15hrs)
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43
Q

Seizure begins with a tingling sensation or motor movement in the fingers, then affects movement in the hand and moves on to more proximal areas on the same side of the body with progression to the contralateral side of the body as the event crosses over the corpus callosum.

Name this seizure

A

Jacksonian March

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44
Q

Jacksonian March:

  1. Generalized Seizure
  2. Primary focal, secondarily generalized.
  3. Complex partial seizure
  4. Simple partial seizure
A

Simple partial seizure

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45
Q

Hypsarrhythmia (in pediatrics)

  1. Complex Partial Seizure
  2. Hypnogogic Hypersynchrony
  3. Infantile Spasms
  4. Tonic Clonic Seizures
A

Infantile Spasms

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46
Q

Hypsarrythmia (in Adults)

  1. Lennox Gastaut
  2. Rasmussens Encephalitis
  3. Juvenile Myoclonic Epilepsy
  4. West Syndrome
A

West Syndrome

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47
Q

Abdominal Epilepsy (Stomach Pain)

  1. Frontal Lobe
  2. Temporal Lobe
  3. Parietal Lobe
  4. Occipital Lobe
A

Temporal Lobe

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48
Q

Atonic Seizures

  1. Olfactory Aura
  2. Drop Attacks
  3. Infantile Seizures
  4. Epileptic Syndrome
A

Drop Attacks

(Drop Seizures)

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49
Q

Atonic Seizures are also referred to as:

  1. Affective Epilepsy
  2. Ataxic Epilepsy
  3. Akinetic Seizures
  4. Aphasic Seizures
A

Akinetic Seizures

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50
Q

Treatment for Intractable Atonic Seizures

A

Corpus Callosotomy

Corpus callosum is severed to stop seizures.

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51
Q

Intractable Epilepsy (in childhood)

  1. Febrile Seizures
  2. Paraneoplastic Neurologic Syndrome
  3. Lennox Gaustox Syndrome
  4. Benign Rolandic Epilepsy
A

Lennox Gaustox Syndrome

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52
Q

Intractable epilepsy (in Infancy)

  1. Complex Partial
  2. Absence
  3. Jacksonian
  4. Infantile Spasms
A

Infantile Spasms

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53
Q

Seizure involving visual hallucination of un-formed images (flashing lights, colors)

  1. Frontal Lobe
  2. Temporal Lobe
  3. Parietal Lobe
  4. Occipital Lobe
A

Occipital Lobe

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54
Q

Seizure involving bilateral tonic posturing

  1. Frontal Lobe
  2. Temporal Lobe
  3. Parietal Lobe
  4. Occipital Lobe
A

Frontal Lobe

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55
Q

Jacksonian March originating in left hand and fingers

  1. Onset in left temporal lobe (T3)
  2. Onset in right temporal lobe (T4)
  3. Onset in left frontal lobe (C3)
  4. Onset in right frontal lobe (C4)
A

Onset in right frontal lobe (C4)

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56
Q

Dysgeusia

  1. Memory
  2. Taste
  3. Déjà vu
  4. Smell
A

Taste

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57
Q

Seizure or aura involves dysgeusia

  1. Globus Pallidus
  2. Amydala
  3. Insula
  4. Hippocampus
A

Insula

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58
Q

Seizure or aura involves formed images or hallucinations

  1. Globus Pallidus
  2. Amydala
  3. Insula
  4. Amygdala\Hippocampus
A

Amygdala \ Hippocampus

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59
Q

Seizure or aura involves formed images or hallucinations

  1. Posterior temporal lobe
  2. Anterior temporal lobe
  3. Occipital Lobe
  4. Frontal lobe
A

Posterior temporal lobe

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60
Q

Seizure or aura involves tingling sensation of right hand\ arm

  1. Anterior Parietal lobe-right
  2. Anterior Parietal lobe-left
  3. Posterior Frontal lobe-right
  4. Posterior Frontal lobe-left
A

Anterior Parietal lobe - left (Contralateral)

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61
Q

Seizure or aura involves right eye deviation and head deviation with posturing

  1. Anterior Temporal lobe-left
  2. Anterior Parietal lobe-left
  3. Posterior Frontal lobe-right
  4. Posterior Frontal lobe-left
A

Posterior Frontal lobe - left

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62
Q

Seizure or aura involves epigastric sensations & salivation

  1. Insular-orbital frontal cortex
  2. Hippocampus
  3. Limbic system
  4. Mid-temporal lobe
A

Insula-orbitofrontal cortex

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63
Q

Seizure or aura involves epigastric sensations & salivation

  1. Insular-orbital frontal cortex
  2. Hippocampus
  3. Amygdala-opercular region
  4. Mesial aspect of the temporal lobe
A

Amygdala-opercular region

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64
Q

Seizure aura involving olfactory (Smell) hallucinations

  1. Insular-orbital frontal cortex
  2. Hippocampus
  3. Prefrontal Lobe
  4. Anteromedial temporal lobe
A

Anteromedial temporal lobe

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65
Q

Seizure aura involves olfactory (Smell) hallucinations

  1. Insular-orbital frontal cortex
  2. Anterior Parietal lobe
  3. Amygdala-opecular region
  4. Occipital lobe
A

Amygdala-opecular region

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66
Q

Non-purposeful stereotyped and repetitive behaviors such as picking, fumbling, patting aura , lip smacking, chewing and swallowing:

  1. Automatism
  2. Aura
  3. Dysplasia
  4. Apraxia
A

Automatism

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67
Q

What does SUDEP stand for

A

Sudden Unexpected Death in Epilepsy

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68
Q

What are the 6 criteria for diagnosis of SUDEP

A

The 6 criteria for SUDEP

  1. Suffered from Epilepsy (unprovoked seizures)
  2. They were in reasonable state of health
  3. Occurred suddenly
  4. During normal activities & circumstances
  5. No obvious cause of death found
  6. Not a direct cause of seizure or status epilepticus
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69
Q

Hippocampal Sclerosis is the most common type of neuropathological damage seen in individuals with:

  1. Absence Seizures
  2. Temporal Lobe Epilepsy
  3. Grand Mal Seizures
  4. Jacksonian March
A

Temporal Lobe Epilepsy

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70
Q

Which of the following is associated with** Hippocampal Sclerosis?**

a. Simple Partial Seizures
b. Complex Partial Seizures
c. Generalized Seizures
d. Status Epilepticus

A

Complex Partial Seizures

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71
Q

Age of onset & peak age for Absence Seizures

A
  • *Onset**: 3-12 yrs
  • *Peak**: 6-7 yrs

Absence 3.6.7.12

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72
Q

Age of onset for Juvenile Myoclonic Epilepsy

A

Onset: 12-18 yrs

Juvenile 12.18

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73
Q

Age of onset & peak age for Benign Rolandic Epilepsy

A
  • *Onset**: 2-13 yrs
  • *Peak**: 9-10 yrs

Rolandic 2.9.10.13

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74
Q

Age of onset & peak age for Benign Occipital Epilepsy

A
  • *Onset**: 15 months - 15 yrs
  • *Peak**: 4-8 yrs

Occipital 15.4.8.15

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75
Q

Age of onset & peak age for Wests Syndrome (Infantile Spasms)

A
  • *Onset**: < 1yr
  • *Peak**: 3-7 mo.

Infant/West 0.3.7.1

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76
Q

Age of onset & peak age for Lennox Gastaut

A
  • *Onset**: 1-8 yrs
  • *Peak**: 3-5 yrs

Lennox 1.3.5.8

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77
Q

Age of onset for Landau Kleffner

A

Onset: 2-12 yrs

Landau 2.12

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78
Q 
Name the two **epilepsy syndromes** that **have** a
cognitive delay (**mental retardation**) as a **characteristic**
A
  1. West Syndrome (Infantile Spasms)
  2. Lennox-Gastaut
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79
Q

Name the epilepsy syndrome that is characterized by speech arrest

A

Landau-Kleffner

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80
Q

Which of the following is typically associated with non-epileptic seizures:

  1. Episode lasting < two minutes
  2. Episode lasting > two minutes
  3. Episode of tongue biting
  4. Episode of tongue thrusting
A

Episode lasting over two minutes

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81
Q

Which of the following is typically associated with non-epileptic seizures:

  1. Blinking
  2. Lip smacking
  3. Side to side head movements
  4. Eye deviation to the right
A

Side to side head movements

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82
Q

Which of the following is typically associated with non-epileptic seizures:

  1. Teeth breakage
  2. Severe tongue biting
  3. Biting the inside of the mouth
  4. Biting the tip of the tongue
A

Biting the tip of the tongue

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83
Q

Which of the following is typically associated with non-epileptic seizures:

a. Bicycling actions of all limbs
b. Pelvic thrusting & Weeping
c. Picking or pulling at clothing
d. Masturbation

A

Pelvic thrusting & Weeping

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84
Q

Which of the following is typically associated with non-epileptic seizures:

  1. Blinking
  2. Staring
  3. Eye deviation
  4. Eyes dosed
A

Eyes closed

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85
Q

Brainstem Lesion:

  1. Spindle Coma
  2. Beta Coma
  3. Alpha Coma
  4. Theta Coma
A

Alpha Coma

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86
Q

Mesencephalic Lesion:

  1. Spindle Coma
  2. Beta Coma
  3. Alpha Coma
  4. Theta Coma
A

Spindle Coma

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87
Q

Locked-in Syndrome:

  1. Spindle Coma
  2. Beta Coma
  3. Alpha Coma
  4. Theta Coma
A

Alpha Coma

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88
Q

Alpha Coma Prognosis

  1. Poor
  2. Good
  3. Great
  4. Unknown
A

Poor

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89
Q

Spindle Coma Prognosis

  1. Poor
  2. Good
  3. Great
  4. Unknown
A

Good

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90
Q

Beta Coma Prognosis

  1. Poor
  2. Good
  3. Great
  4. Unknown
A

Good

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91
Q

Describe the reactivity of Alpha Coma

A

Non-reactive (EEG does not change with painful stimuli)

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92
Q

Name the coma type which involves paralysis of the lower cranial nerves.

A

Alpha Coma

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93
Q

Level of consciousness with Alpha Coma

A

Awake & Alert

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94
Q

S.I.R.P.I.Ds

  1. Slow irregular rhythmic polyphasic epileptiform discharges of sleep
  2. Sharp intermittent rhythmic polyphasic epileptiform discharges
  3. Stimulus Induced Rhythmic or Periodic or Ictal Discharges
  4. Spikes In REM Presenting Entirely with Delta
A

Stimulus Induced Rhythmic or Periodic or Ictal Discharges

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95
Q

S.I.R.P.I.Ds

  1. REM Sleep disorder
  2. Acute Brain Injury
  3. Brain Stem Infarction
  4. Brain Tumor
A

Acute Brain Injury

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96
Q

Define Long-Term Potentiation (LTP)

A
  • Lasting enhancement in signal transmission between neurons from synchronus stimulation.
  • Phenomena of synaptic plasticity, & ability of chemical synapses to change their strength.
  • Widely considered one of the cellular mechanisms that controll learning & memory.
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97
Q

Hippocampus

  1. Limbic System
  2. Reticular Formation
  3. Lymphatic System
  4. Cortical System
A

Limbic System

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98
Q

4 functions of the Hippocampus

A
  1. Short term memory
  2. Long Term Memory
  3. Spatial navigation
  4. Inhibition
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99
Q

Long Term Potentiation

  1. Neural Matrix
  2. Neural Tissue
  3. Neural Network
  4. Neural Plasticity
A

Neural Plasticity

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100
Q

Define Neural Plasticity

A

Changes in neural pathways & synapses from changes in behavior, environment or bodily injury.

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101
Q

Function of the Parahippocampal Gyrus

A

Memory Encoding & Retrieval

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102
Q

Functions of the Amygdala

A

Memory & Emotion

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103
Q

Resting Membrane Potential of a neuron

a. -70 µV
b. -70 mV
c. -70 mA
d. -70 µA

A

-70 mV (mV=Millivolts)

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104
Q

EPSPs & IPSPs

  1. Cortical Pyramidal Cells
  2. Frontal Lobe
  3. Neocortex
  4. Deep Brain Structures
A

Cortical Pyramidal Cells

Excitatory postsynaptic potential & Inhibitory postsynaptic potential

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105
Q

Define HIPAA

A

Health Insurance Portability & Accountability Act

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106
Q

Function of HIPAA

A

Protects a patient’s oral, written or electronic health information (PHI) from being disclosed.

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107
Q

HIPAA requires that all medical record sharing to be preceded by:

  1. Oral or written authorization from patient
  2. Oral or written authorization from patient or patients family
  3. Written authorization from patient
  4. Written authorization from patient or the patients family
A

Written authorization from patient

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108
Q

Preferred stimulator type for direct cortical stimulation in epilepsy surgery

A

Bipolar, constant-current

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109
Q

Preferred intensity range of stimulation for direct cortical stimulation in epilepsy surgery

A

0-20 mA (mA=milliamps)

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110
Q

Describe stimulation period for direct cortical stimulation in epilepsy surgery

A

1-10 seconds

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111
Q

Define the threshold range typically used to define function over the motor cortex for direct cortical stimulation in epilepsy surgery

A

2-5 mA (mA=milliamps)

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112
Q

Define the threshold range typically used to define function over the language cortex for direct cortical stimulation in epilepsy surgery

A

8-15 mA (mA=milliamps)

113
Q

Define the EEG Sensitivity recommended for recording from grid electrodes over the exposed cortex for direct cortical stimulation in epilepsy surgery

A

50-100 µV (µV=microvolts)

114
Q

Amplifier bandpass for Motor Mapping

A

1 - 30 Hz to 250 - 1,500 Hz (-3dB)

115
Q

Analysis time for Motor Mapping

A

50 msec

(milliseconds or ms)

116
Q

Rate, Duration & Intensity for Motor Mapping

A
  • Rate: 3-5 /sec (Per second)
  • Duration: 100-300 µsec (microseconds)
  • Intensity: 30-60 mA (milliamps)
117
Q

Amplitude range of **Motor Mapping **responses

A

20 - 500 µV (microvolts)

118
Q

GOLD STANDARD in assessing patients for epilepsy surgery

119
Q

Phase One Epilepsy Monitoring Unit:

  1. Surface electrodes, Expanded international 10-10 System, Sphenoidal, Foreman Ovale, NP Electrodes
  2. Intracranial electrodes
  3. lntracranial electrodes & Neurosurgical resection
  4. Intracranial electrodes & MEG Monitoring
A

Surface electrodes, Expanded international 10-10 System, Sphenoidal, Foreman Ovale, NP Electrodes

120
Q

Phase two Epilepsy Monitoring Unit:

  1. Surface electrodes, Expanded international 10-10 System, Sphenoidal, Foreman Ovale, NP Electrodes
  2. Intracranial electrodes
  3. lntracranial electrodes & Neurosurgical resection
  4. Intracranial electrodes & MEG Monitoring
A

Intracranial electrodes

121
Q

Phase two Epilepsy Monitoring Unit:

  1. Surface electrodes, Expanded international 10-10 System, Sphenoidal, Foreman Ovale, NP Electrodes
  2. Intracranial electrodes
  3. lntracranial electrodes & Neurosurgical resection
  4. Intracranial electrodes & MEG Monitoring
A

lntracranial electrodes & Neurosurgical resection

122
Q

WADA

  1. Widespread Anti-epileptic Drug Analysis
  2. Sodium Amobarbital Test
  3. Seizure Focus
  4. Seizure Classificiation
A

Sodium Amobarbital Test

123
Q

WADA

  1. Language & Short Term Memory
  2. Language & Long Term Memory
  3. Speech & Short Term Memory
  4. Speech and Long Term Memory
A

Language & Short Term Memory

124
Q

WADA

  1. Sensori-motor Mapping
  2. After Discharge
  3. Epileptic Focus
  4. Hemispheric Dominance
A

Hemispheric Dominance

125
Q

WADA

a. Pre-surgical assessment for epilepsy
b. Bedside monitoring for NES
c. Diagnosis of Epilepsy
d. Classification of Epilepsy

A

Pre-surgical assessment for epilepsy

126
Q

WADA is performed in

  1. Surgery
  2. Bedside monitoring
  3. lnterventional Radiology
  4. EEG Department
A

lnterventional Radiology

127
Q

WADA: Medication used

  1. Pentobarbital
  2. Phenobarbital
  3. Propofol
  4. Sodium Amobarbital
A

Sodium Amobarbital

128
Q

A WADA is performed in conjunction with:

  1. MRI
  2. X-Ray
  3. Flouroscopy
  4. PET Scan
A

Flouroscopy

129
Q

During WADA testing, imaging is used to:

  1. Visualize the catheter and target vessel
  2. Visualize the epileptic focus
  3. Determine if the medication is needed
  4. Determine if the medication is necessary
A

Visualize the catheter and target vessel

130
Q

During WADA testing the medication is injected into:

  1. Femoral Artery through a femoral catheter
  2. Carotid Artery through a femoral catheter
  3. Middle Cerebral Artery through a carotid catheter
  4. Anterior Cerebral Artery through a carotid Catheter
A

Carotid Artery through a femoral catheter

131
Q

During WADA medication injection results in:

  1. EEG epileptiform activity ipsilateral to side of injection & functional loss contralateral to injection side
  2. EEG epileptiform activity contralateral to side of injection I functional toss ipsilateral to injection side
  3. EEG Slowing ispitateral to side of injection and functional loss contralateral to injection side
  4. EEG Slowing contralateral to side of injection and functional loss ipsilateral to injection side
A
  • *EEG Slowing ispitateral** to side of injection and
  • *functional loss contralateral** to injection side
132
Q

During WADA recall testing is performed using

  1. Words & Pictures
  2. Names & Faces
  3. Previous EEG
  4. Hemiparesis
A

Words & Pictures

133
Q

Short term memory

  1. Mammillary Body & Corpus Collosum
  2. Mammillary Body & Pre-frontal Gyrus
  3. Hippocampus & Globus Pallid us
  4. Hippocampus & Amygdala
A

Hippocampus & Amygdala

134
Q

Image Shows:

  1. Left Hippocampal Sclerosis
  2. Right Hippocampal Sclerosis
  3. Left Cortical Dysplagia
  4. Right Cortical Dysplagia
A

Right Hippocampal Sclerosis

135
Q

What type of image is this?

136
Q

Image Shows:

  1. Left Hippocampal Sclerosis
  2. Right Hippocampal Sclerosis
  3. Left Cortical Dysplagia
  4. Right Cortical Dysplagia
A

Left Cortical Dysplagia

137
Q

What does an Functional MRI (fMRI) measure?

A

Measures hemodynamic response of** neural activity**.

Can lateralize, but can’t localize, language & motor function.

138
Q

What does a Magnetic Resonance Spectroscopy (MRS) measure

A

Measures the levels of different metabolites in body tissues. Lateralizes hippocampal sclerosis in some patients

139
Q

What is Stealth MRI

A

Combines 3-D MRI & CT Scans to recreate the placement of grids

140
Q

What is a PET Scan & what does it measure

A

Positron Emission Tomography (PET) scan uses a radioactive tracer to see disease in the body, which reveals the structure & blood flow to & from organs. Shows how organs and tissues are working (glucose metabolism)

141
Q

Define SPECT

A

Single Photon Emission Computed Tomography

142
Q

What does SPECT measure?

A

Used to image directly the regional increase in cerebral blood flow that occurs during an epileptic seizure, thereby imaging the epileptic focus

143
Q

Describe the window needed to inject the radioactive dye (tracer) for SPECT scan?

A

The injection is given during or following the seizure & the scan needs to be taken within 6 hours

144
Q

What is MEG and what does it measure?

A
  • Magnetoencephalography provides more accurate ability to estimate the dipole source, which provides noninvasive information on the normal or abnormal function of discrete cortical areas.
  • This is used for mapping the location of somatosensory and motor function during pre-surgical planning
  • Mapping of language and other cognitive functions is under development
145
Q

Neonatal Continuous EEG protocols are applicable for which age patient?

A

High risk neonates
Post-menstrual age less than 48 weeks

146
Q

Which of the following is characteristic of neonatal seizures:

  1. Generalized tonic clonic
  2. Paroxysmal increases in heart rate or blood pressure
  3. lateralized arm or leg movements
  4. Facial twitching
A

Paroxysmal increases in heart rate or blood pressure

147
Q

Name the 6 stereotypical manifestations of neonatal seizure

A
  1. **Focal Tonic **or clonic movements
  2. Intermittent forced, conjugate, horizontal gaze deviation
  3. Myoclonus
  4. Generalized tonic posturing
  5. Brainstem release phenomena, such as oral-motor stereotypes, reciprocal swimming movements or the upper extremities or bicycling movements of the legs
  6. Autonomic paroxysms such as unexplained apnea, pallor, flushing, tearing, and cyclic periods of tachycardia or elevated blood pressure
148
Q

Define the recommended extracerebral monitoring channels for Neonates

A
  • Electrocardiogram (ECG)
  • Electrooculogram (EOG)
  • Respiratory Channels
  • Electromyography (EMG)
149
Q

In which of the following conditions would you most expect seizures to occur with neonatal population (requiring EEG monitoring)

  1. Arterial ischemic stroke
  2. Hypoxic Ischemic encephalopathy
  3. Tuberous Sclerosis
  4. Metabolic encephalopathy
A

Tuberous Sclerosis

(A genetic disorder that causes non-malignant tumors to form in many different organs, primarily in the brain, eyes, heart, kidney, skin and lungs.)

150
Q

In which of the following conditions would you most expect seizures to occur with neonatal population (requiring EEG monitoring)

  1. Birth anoxia
  2. Cerebral dysgenesis
  3. Sinovenous thrombosis
  4. Meningeoencephalitis
A

Cerebral Dysgenesis

(improper brain development in utero)

151
Q

Name 2 medications used in the neonatal population for induced Burst Suppression

A
  1. Pentobarbital
  2. Midazolam (versed)
152
Q

Define Gestational Age

A

The time between the onset of the mother’s last menstrual period & the date of birth (In weeks)

153
Q

Define Conceptional Age

A

Gestational age plus the time since birth (In weeks)

154
Q

What is the recommended recording time for neonatal EEG?

A

> 60 Minutes (1 Hr)

155
Q

What is the first recordable EEG pattern in neonates?

A

Trace Discontinu

156
Q

Trace Discontinu:

  1. Active Sleep
  2. Quiet Sleep
  3. All states of wake & sleep
  4. Abnormal pattern
A

All states of wake & sleep

157
Q

Trace Discontinu:

  1. 24-26 Weeks CA
  2. 24-26 Weeks GA
  3. 27-28 Weeks CA
  4. 27-28 Weeks GA
A

24-26 Weeks CA (Conceptional Age)

158
Q

Trace Discontinu:

  1. Reactive to stimulation
  2. Non-reactive to stimulation
  3. State dependent reactive background
  4. Brief reactivity with generalized distribution
A

Non-reactive to stimulation

159
Q

When is background reactivity first seen in neonates?

  1. 29-30 weeks CA
  2. 31-33 weeks CA
  3. 34-35 weeks CA
  4. 38-40 Weeks CA
A

34-35 weeks CA (Conceptional Age)

160
Q

Normal sharp transients in the neonatal population:

  1. Frontal
  2. Temporal
  3. Central
  4. Parietal
  5. Occipital
161
Q

Age at which EEG is synchronous in the neonatal population:

  1. 36 weeks CA
  2. 38 weeks CA
  3. 40 weeks CA
  4. 42 weeks CA
A

40 weeks CA (Conceptional Age)

162
Q

Age at which Trace Alternant is first recorded in the neonatal population:

a. 29-30 weeks CA
b. 31-33 weeks CA
c. 34-35 weeks CA
d. 38-40 weeks CA

A

38-40 weeks CA (**Conceptional **Age)

163
Q

Another name for Frontal sharp transients in the neonatal recording.

A

Enchoches Frontales

164
Q

Frontal sharp transients:

  1. Asynchronous & Bilateral
  2. Synchronous & Bilateral
  3. Asynchronous and Lateralized
  4. Synchronous & Lateralized
A

Synchronous & Bilateral

165
Q

At what age do Delta Brushes occur in the **neonatal **recording.

A

26-32 weeks CA (Conceptional Age)

166
Q

At what age do Delta Brushes occur during REM (Active) sleep in the **neonatal **recording.

A

29-33 weeks CA (Conceptional Age)

167
Q

At what age do Delta Brushes occur during non REM (Quiet) sleep in the neonatal recording.

A

33-38 **weeks CA (Conceptional **Age)

168
Q

Name the 3 criteria associated with non-REM (Quiet) sleep.

A
  1. Regular Respiration
  2. Random Eye Movements
  3. Variable Muscle Tone
169
Q

Name the 3 criteria associated with REM (Active)
sleep.

A
  1. Irregular respiration
  2. Rapid Eye Movements
  3. Decreased Muscle tone
170
Q

When does the Trace Alternant pattern disappear in the neonatal EEG?

A

44 weeks
3-4 weeks post-term

171
Q

Define Trace Alternant:

A

EEG pattern of sleeping newborns, characterized by bursts of slow waves, at times intermixed with sharp waves, and intervening periods of relative quiescence with extreme low amplitude activity.

172
Q

In which sleep stage does Trace Alternant appear

A

Quiet Sleep (non REM)

173
Q

Which sleep stage appears first in the neonate?

A

Active Sleep (REM)

174
Q

At 27-34 weeks CA which sleep stage does the neonate spend most time in?

A

Active (REM)

At 27-34 weeks PMA, 40-45% is spent in active sleep, 25-30% in quiet sleep, and 30% in indeterminate sleep.

175
Q

Beyond 35 weeks which sleep stage does the neonate spend most time in?

A

Active

Beyond 35 weeks PMA, infants spend 55·65% of the time in active sleep, 20% in quiet sleep and 10-15% in indeterminate sleep.

176
Q

Sphenoidal, Foreman Ovale, Nasopharyngeal & T1 \ T2 Electrodes

  1. Invasive
  2. Mesial
  3. Medial
  4. Basal
177
Q

Explain Sphenoidal Electrode Placement

A
  1. invasive & placed by physician
  2. Records from anterior tip of temporal lobe
  3. Introduced through nasal cannula into the temporal and masseter muscles, the between the zygoma and sigmoid notch of the mandible.
  4. Tip lies lateral to the foramen ovale at the greater wing of the sphenoid bone
178
Q

Define Foreman Ovale Electrode Placement

A
  1. Record mesial temporal or frontal discharges
  2. Invasive with up to 4 leads along the wire Guide needle punctures the cheek 3cm lateral to the corner of the mouth
  3. Forman ovale & subarachnoid space are penetrated by the inducer & the electrode is inserted into the caudal end of the ambient cistern.
179
Q

Define Nasopharyngeal Electrode Placement

A
  1. Record inferior temporal & frontal discharges
  2. Flexible wire with insulated 2mm gold tips, 30-35cm long.
  3. S-Shaped, inserted thru the nasopharynx (nostrils) and rotated outward to rest within 2cm of the anterior mesial aspect of the temporal lobe.
  4. Respiratory & motion (swallow) artifact a problem.
180
Q

Define T1 & T2 Electrode Placement

A

Anterior Temporal Electrodes

One third the distance anterior from the external auditory canal and the outer canthus of the eye then up 1cm

181
Q

Metal of choice for Subdural & Depth Electrodes

A

Comprised of Platinum (preferred), stainless steet or gold

182
Q

5 Risks with Subdural & Depth Electrodes

A
  1. Hemorrhage
  2. Infection
  3. Reactive meningitis
  4. Edema
  5. Headache
183
Q

Most significant risks with Subdural & Depth Electrodes

184
Q

Disadvantage of Subdural & Depth Electrodes

A

Sampling rate errors (aliasing)

185
Q

4 Advantages of Subdural & Depth Electrodes

A
  1. Excellent signal to noise ratio
  2. Low Impedance
  3. Unaffected by muscle or movement artifact
  4. By-pass high resistance skull
186
Q

Which electrode is closest to the somatosensory reception region for the left hand

187
Q

LTME is limited to:

  1. Critical Care Monitoring
  2. Intra-Operative Monitoring
  3. Sleep Analysis Setting
  4. Epileptic or suspected epileptic seizure disorder
A

Epileptic or suspected epileptic seizure disorder

188
Q

In LTME, The term “monitoring” implies what?

  1. Real time physician interpretation is needed
  2. No real time analysis of the data
  3. Technologist Interpretation
  4. Neurologist Interpretation
A

No real time analysis of the data

189
Q

Sphenoidal electrodes record from?

  1. Mesial or anterior aspects of the temporal lobe in the area of the foreman ovale
  2. Medial temporal lobe in the area of the mandibular notch
  3. Hippocampus &Amygdala
  4. Limbic Structures
A

Mesial or anterior aspects of the temporal lobe in the area of the foreman ovale

190
Q

During an ECOG, What is the indicated activity

A

Cortical Stimulation artifact

191
Q

During an ECOG, What is the indicated activity

A

After Discharges

192
Q

Sphenoidal recording electrodes:

  1. Nasopharyngeal Electrode
  2. Braided stainless steel wire, insulated except to the tip
  3. Platinum or stainless steel disks
  4. Platinum hook-wire electrodes
A

Braided stainless steel wire, insulated except to the tip

193
Q

Which of the following electrodes should not be used in LTM:

  1. Sphenoidal
  2. Basal extracranial
  3. Nasopharyngeal
  4. Foreman ovale
A

Nasopharyngeal

194
Q

Epidural & Subdural Electrodes

  1. Metal disk
  2. Stainless steel wire, insulated except at the tip
  3. Nasophyaryngeal
  4. Platinum or stainless steel disks embedded in soft silastic
A

Platinum or stainless steel disks embedded in soft silastic

195
Q

Epidural & Subdural Electrode placement

  1. Epidural or subdural; over the cerebral cortex
  2. Mesial aspect of the temporal lobe
  3. Nasoethmoidal
  4. Supraoptic
A

Epidural or subdural; over the cerebral cortex

196
Q

Method of placement for Subdural Electrodes:

  1. Braided stainless steel wire placed by a physician
  2. Through a burr hole after open craniotomy
  3. Subdermal placement by a physician
  4. Subdermal by a qualified technologist
A

Through a burr hole after open craniotomy

197
Q

Intracranial or depth electrodes

  1. Platinum or stainless steel wire insulated to the tip
  2. Platinum disks embedded in soft silastic
  3. Pliable metal inserted into the nasal canal
  4. Stainless steel or MRI compatible nichrome
A

Stainless steel or MRI compatible nichrome

198
Q

Foreman Ovale Electrodes

  1. Surface of the brain placed after open craniotomy
  2. Mesial temporal structures placed in the ambient cistern
  3. Pliable metal inserted into the nasal canal
  4. Mesial temporal stuctures placed in the zygomatic arch
A

Mesial temporal structures placed in the ambient cistern

199
Q

Which of the following is best for recording mesial temporal EEG discharges best

  1. Foreman Ovale
  2. Nasopharyngeal
  3. Sphenoidal
  4. Nasoethmoidal
A

Foreman Ovale

200
Q

LTME recommended low frequency response setting (low frequency filter)?

A

0.5 Hz or Lower

201
Q

LTME recommended High frequency response setting (high frequency filter)?

A

70 Hz or Higher

202
Q

LTME recommended Noise level of the amplifiers?

A

1 µV rms

or

1 (microvolt) (root mean squared)

203
Q

LTME recommended Input Impedance of the amplifiers?

A

(At least) 1 M ohm

1 million ohms

204
Q

LTME recommended Common Mode Rejection?

205
Q

LTME recommended Dynamic Range?

A

(At least) 40 dB

206
Q

LTME recommended minimum recording/storage time with video?

A

Recording & Storage: 24 hours

(32-64 channels or 128 channels if needed)

207
Q

LTME recommended minimum retrieval/review storage time with video?

A

30 gigabytes or 24 hrs of Video\EEG

208
Q

What is the main/major objective of LTME:

  1. Classification of seizures
  2. Identify Non-epileptic seizures
  3. Correlation of behavior with EEG findings
  4. Identify non-convulsive status epilepticus
A

Correlation of behavior with EEG findings

209
Q

Types of behavioral monitoring

  1. Clinical description, Mental Alerting, Level of Awareness testing
  2. Self reporting, Observer reporting, Video Recording
  3. Event push button, EEG comments, Video Recording
  4. Test word, math problems, technologist comments
A

Self reporting, Observer reporting, Video Recording

210
Q

LTME recommended ictal event monitoring:

  1. Eye movement EMG & Cognitive Tasks
  2. EEG comments & Clinical description
  3. Event push button & level of awareness
  4. Test word & math problems
A

Eye movement EMG & Cognitive Tasks

211
Q

LTME recommended cognitive disturbance documentation:

  1. Call patient name & document response
  2. Clinical signs observed or no clinical signs observed
  3. Reaction time tasks with stimulus & response times recorded on an event marker channel
  4. Test word of color or simple word: Red, Blue, Cat, Dog
A

Reaction time tasks with stimulus & response times recorded on an event marker channel

212
Q

LTME recommended Ictal event testing: Name (4)

A

G.L.A.M.

  1. Gross Motor Function
  2. Language
  3. Awareness
  4. Memory
213
Q

LTME recommended color perceived optical resolution of display monitor.

A

250 Line Pairs

214
Q

LTME recommended optimal pixel standards of display monitor.

A

1600 X 1200 pixels

215
Q

LTME recommended screen diagonal size of display monitor .

A

20 inches or more

216
Q

LTME recommended archive of events should include what period of time before and after events?

A

2mm Along with a log of contents of event

217
Q

LTME recommended electrode insertion for Sphenoidals.

A
  1. Inserted bilaterally below the zygomatic arches, 3-4 mm deep
  2. In the direction of the foramen ovale
  3. By a qualified physician
218
Q

LTME recommended impedance measurement with epidural, subdural, intracerebral & foreman ovale electrodes.

A
  1. In the range of 10 nA
  2. 1,000 times less than disk electrodes
219
Q

LTME recommended number of channels for standard recording (non pre-surgical)

A

8-12 channels

220
Q

LTME recommended number of channels for pre-surgical recording

A
  • *32-64 channels recommended**
  • *Minimum of 16** channels
221
Q

LTME recommended number of channels for ambulatory.

A

8 channels

222
Q

LTME recommended number of channels for diagnosis of nonepileptic seizures.

A

8 channels

223
Q

LTME recommended number of channels for classification and characterization of epileptic events.

A

18 channels

  • 16 EEG
  • 1 EOG
  • 1 EKG
224
Q

Eye movements, blinking, muscle tension, ECG, respiration, sweating, tremor, tooth brushing and glossokenetic are examples of what type of artifact?

  1. Instrumental
  2. Mechanical
  3. External
  4. Biological
A

Biological

225
Q

Most common biological artifact seen with Sphenoidal electrodes

226
Q

How often should the ongoing status of the EEG recording be checked?

A

At LEAST once a day

227
Q

Name the pattern seen in 1 year old child with cognitive delay & frequent seizures

A

Hypsarythmia

228
Q

Name this pattern seen in a 5 yr old child with HX of staring spells

A

3 per sec Spike & Wave

229
Q

Two patient identifiers are required prior to delivering care. Examples are:

  1. Hospital ID Bracelet & Patient Name
  2. Medical Record # & Birth date
  3. Patient name & Birth date
  4. Birthdate & Hospital ID Bracelet
A

Patient name & Birth date

230
Q

Medical phone orders require:

  1. Confirmation number
  2. Read Back of order
  3. Return call confirming order
  4. Physician confirmation
A

Read Back of order

231
Q

Describe the required **procedurefor relieving someone forabreakor at the the end ofashift.**

  1. Hand off Procedure
  2. Read Back of case events
  3. Time out
  4. End of shift report
A

Hand off Procedure

232
Q

Hand washing duration

  1. 10 seconds
  2. 15 seconds
  3. 20 seconds
  4. 25 seconds
A

15 seconds

233
Q

When there is no visible soiling on hands what is the preferred hand sanitizing method?

  1. Washing with soap and water for 10 seconds
  2. Washing with soap and water for 15 seconds
  3. Alcohol based hand sanitizer
  4. Washing with soap and water followed by alcohol based hand sanitizer
A

Alcohol based hand sanitizer

234
Q

“Time out” confirms which of the following prior to surgery:

  1. Electrode Placement, Surgery & Impedance
  2. Monitoring Type (EEG or EP), Surgery & Surgery
  3. Patient, Surgery & Side of Surgery
  4. Patient, monitoring (EEG\EP) & Surgery
A
  • Patient
  • Surgery
  • Side of Surgery
235
Q

Patient care and supervision for EEG, LTM & cEEG diagnostic lab is defined by:

  1. ACNS
  2. ABRET
  3. ASET
  4. ASNM
236
Q

ACNS stands for:

  1. AMERICAN CLINICAL NEUROLOGY SOCIETY
  2. AMERICAN CENTRAL NEUROMONITORING SOCIETY
  3. ASSOCIATION of CLINICAL NEUROPHYSIOLOGY STUDIES
  4. AMERICAN CLINICAL NEUROPHYSIOLOGY SOCIETY
A

AMERICAN CLINICAL NEUROPHYSIOLOGY SOCIETY

237
Q

Treat patients in an ethical fashion & do not discriminate

  1. ACNS GUIDELINES
  2. ABRET CODE OF ETHICS
  3. ASET PRACTICE GUIDELINES
  4. AAN CODE OF ETHICS
A

ABRET - CODE OF ETHICS

238
Q

Do not divulge information from the exam

  1. ACNS GUIDELINES
  2. ABRET CODE OF ETHICS
  3. ASET PRACTICE GUIDELINES
  4. AAN CODE OF ETHICS
A

ABRET - CODE OF ETHICS

239
Q

If a patient has a seizure during EEG recording, you should:

  1. Continue recording
  2. Call a code and assist the patient at bedside
  3. Discontinue recording & call a code
  4. Insert a tongue depressor in the patients mouth and turn pt. on side
A

Continue recording

240
Q

The current CPR: Chest compression to rescue breath ratio is:

241
Q

What is does RAWOD stand for

A

Regional Attenuation Without Delta

242
Q

Describe this pattern seen in a 68 year old patient following clamping of the left middle cerebral artery.

A

RAWOD (Regional Attenuation Without Delta)

243
Q

Describe Heschl’s gyrus

A

A convolution of the temporal lobe that is the cortical center for hearing and runs obliquely outward and forward from the posterior part of the lateral sulcus. Included as part of the primary auditory cortex.

244
Q

What area is #1 indicating

A

Heschl’s gyrus

245
Q

Brodmann area 44

A

Broca’s area

246
Q

Brodmann Area 45

A

Broca’s area

247
Q

Brodmann area 22

A

Wernicke’s area

248
Q

Which electrode pair is most likeley to correspond to Broca’s area

  1. 15 & 16
  2. 21 & 22
  3. 33 & 34
  4. 46 & 47
249
Q

Which electrode pair is most likeley to correspond to Werneckie’s area

  1. 47 & 48
  2. 28 & 29
  3. 59 & 60
  4. 31 & 32
250
Q

What is MELAS syndrome

A

Mitochondrial myopathy, Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes

MELAS is one of the family of mitochondrial cytopathies. It is aused by defects in the mitochondrial genome which is inherited purely from the female parent

251
Q

What types of seizures would you see in Todd’s Paralysis

A

Partial

Clonic

Focal

252
Q

Explain Eyeball polarity

A

**Cornea **(front of the eye) is positive
**retina **(back of the eye) is negative
this forms a dipole
this dipole movment produces eye movment artifact

253
Q

Polarity of the tounge

A
  • *positive** at root (back of tounge)
  • *negative** at tip
254
Q

Where is Heschl’s Gyrus is located

(Transverse Temporal Gyri)

A
  • Primary auditory cortex
  • Brodmann’s area 41&42
  • Temporal lobe
255
Q

Which electrode inicates the location of the primary somatosensory cortex

  1. 2
  2. 3
  3. 4
  4. 5
256
Q

Define Beneficence

A

When doing research, studies or clinical trials, the welfare of the patient should always be one of the goals.

257
Q

Seizure classifications associated with Todd’s Paralysis.

A
  • Partial
  • Clonic
  • Focal
258
Q

Febrile Seizures (West Syndrome) typically evolves into what?

A

Lennox Gastaut

259
Q

When you have no visible soiling on your hands, what is the preferred method of hand sanitation?

  1. Alcohol based hand sanitizer
  2. Soap & water for 30 seconds
  3. Soap & water for 1 minute
  4. Soap & water for 15 seconds
A

Alcohol based hand sanitizer

260
Q

Define Slow Wave

A
  • Frequency: 0 - 4 Hz
  • Duration: **> **300 msec
261
Q

Define Sharp Wave

A
  • Frequency: 5 - 14 Hz
  • Duration: 70 - 200 msec
262
Q

Define a Spike

A
  • Frequency: 14 -50 Hz
  • Duration: 20 - 70 msec
263
Q

Define Triphasic waves

A
  • Generalized
  • Anteriorly predominant
  • Anterior to posterior lag
  • 100 - 300 uV
  • 150 - 250 msec
  • Periodic 1 - 2.5 /sec
264
Q

Triphasic waves are frequently associated with what

A
  • Creutzfeldt-Jakob
  • Renal or hepatic encephalopathy
  • Kidney or liver problems
265
Q

Name this pattern

A

Triphasic waves

266
Q

Derfine Burst Suppression

A

Variable (1 - 3 /sec) periods of spikes, polyspikes and sharp waves followed by periods of electrographic flattening.

267
Q

Non-medically induced Burst suppression could be associated with:

A
  • Drug overdose
  • Reye’s Syndrome
  • Hypothermia
  • End stage: Sub-acute sclerosingpanencephalitis (SSPE)
  • Poor prognosis (except in children)
268
Q

What does FIRDA stand for

A

Frontal Intermittent Rhythmic Delta Activity

(Adults)

269
Q

What does OIRDA stand for

A

Occipital Intermittent Rhythmic Delta Activity

(Pediatric)

270
Q

Name this pattern

A

FIRDA

Frontal intermittent rhythmic delta

271
Q

Common causes of PLEDS

A
  • Herpes Encephalitis
  • Stroke
  • Tumor
  • Focal lesion
272
Q

What are PLEDS

A

Periodic Lateralized Epileptiform Discharges

Intermittent or continuous periodic biphasic or triphasic sharp waves or spikes on one side of the brain.

273
Q

EEG with Cereberal Blood Flow (CBF) of 35 - 70

A

Normal

No Injury

274
Q

**EEG **with Cereberal Blood Flow (CBF) of 25 - 35

A

Loses Beta Frequencies

Reversible

275
Q

EEG with Cereberal Blood Flow (CBF) of **18 **- 25

A

Slowing to theta (5 -7 Hz)

Potentially Reversible

276
Q

**EEG **with Cereberal Blood Flow (CBF) of **12 **- 18

A

Slowing to Delta (1 - 4 Hz)

Potentially Reversible

277
Q

**EEG **with Cereberal Blood Flow (CBF) of <8 - 10

A

Complete suppression of all frequencies

Neuronal Death

278
Q

Hyperlexia is commonly associated with which disorders or syndromes

A
  • Autism
  • Landau Kleffner

Neurodiagnostics \ Neurophysiology (1 decks)

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