1
Q
What does OSHA stand for?
A
Occupational Safety & Health Administration
2
Q
What is OSHA’s function?
- Prevent wrong-site surgery
- Protect Patient Health Information
- Insure an environment of patient safety
- Insures an environment of safety for all staff
A
Insures an environment of safety for all staff
3
Q
What does CMS stand for?
A
Centers for Medicare & Medicaid Services
4
Q
What does CMS administer?
- Medicare & Medicaid
- Medicare, Medicaid & HIPPA
- Affordable Care Act
- Joint Commission Accredidation
A
Medicare, Medicaid & HIPPA
5
Q
Dysgeusia
A
Distortion of sense of taste.
6
Q
Dystonia
A
- Sustained muscle contractions
- twisting
- repetitive movements
- abnormal posturing.
7
Q
Ataxia
A
Loss of muscle coordination & movement.
causes gait disturbance.
8
Q
Cataplexy
A
Sudden loss of consciousness triggered by laughing, crying, or fear.
9
Q
EEG with Cataplexy
A
Normal
10
Q
Narcolepsy
A
The brain’s inability to regulate sleep-wake cycles.
11
Q
EEG with narcolepsy
A
Early onset REM during sleep
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.
13
Q
Dysphagia
A
Difficulty Swallowing
14
Q
Vertigo
A
Dizziness
15
Q
Nystagmus
A
Involuntary Rhythmic movement of the eye.
(vertically or horizontally)
16
Q
Dysarthria
A
Slurred Speech
17
Q
Ptosis
A
Drooping eyelid
18
Q
Horners Syndrome
A
The unilateral combination of:
- drooping eyelid (ptosis)
- constricted pupil (miosis)
- decreased sweating (anhidrosis)
- eye redness
19
Q
Cortical Dysplasia
- Absence Seizures
- Keppra
- Intractable Seizures
- Wests Syndrome
A
Intractable Seizures
20
Q
Describe Hyperlexia
A
Fascination with letters or numbers & advanced reading ability.
21
Q
Hyperpraphia
A
Overwhelming urge to write.
Associated with temporal lobe epilepsy.
22
Q
Hippocampal Sclerosis
A
Neuronal cell loss & gliosis in hippocampus
Specifically the CA-1 (Cornu Ammonis Area 1) & subiculum.
23
Q
How do you test for Hippocampal sclerosis
A
MRI
24
Q
Hippocampal Sclerosis
- Neocortex of Temporal Lobe
- Globus Pallidus
- Mesial Temporal Lobe Epilepsy
- Supplemental Motor Cortex
A
Mesial Temporal Lobe Epilepsy
25
**Neocortex of Temporal Lobe**
1. Medial Temporal Lobe Epilepsy
2. Lateral Temporal Lobe Epilepsy
3. Mesial Temporal Lobe Epilepsy
4. Longitudinal Temporal Lobe Epilepsy
**Lateral Temporal Lobe Epilepsy**
26
Generic **Dilantin**®
**Phenytoin**
27
Generic **Depakote**®
**Valproic Acid** or **Valproate**
28
Side effect of **Phenytoin** (**Dilantin**®) **withdrawl**
**Status Epilepticus**
29
**Drug** of choice **for Infantile Spasms**
**ACTH**
**A**dreno-**C**ortico-**T**ropic **H**ormone
Adrenocorticotropic Hormone
30
**Drug** of choice **for Juvenile Myoclonic Epilepsy**
**Depakote**®
**Valproic Acid** / **Valproate**
31
**Drug** of choice **for Juvenile Absence Seizures**
**Ethosuximide** / **Zarontin**®
32
**Drug** of choice **for Lennox-Gastaut**
**Depakote**® / **Valproic Acid** / **Valproate**
33
Define **ACTH**
**A**dreno-**C**ortico-**T**ropic **H**ormone
## Footnote
**Adrenocorticotropic Hormone**
34
**Drug** of Choice for **Complex Partial Epilepsy**
**Keppra**® / **Levetiracatam**
35
Define **Seizure**
**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**
36
Define **Epilepsy**
* more than **2 Seizures**
* Nerve cell **activity in your brain is disrupted**, causing abnormal behavior, sensations, or loss of consciousnes.
37
Define **Seizure _Semiology_**
* Clinical **Manifestations**
* Seizure **Description**
38
Clinical manifestation of **Gelastic Seizures**
**Laughing**
39
Clinical manifestation for **Dacrystic Seizures**
**Crying**
40
Describe typical ictal progression for **partial** and **convulsive seizures**.
Ictal discharge begins with **low-voltage fast activity** and **becomes slower with higher amplitude**.
41
Most common **co-morbidity** in **Gelastic** & **Dacrystic Seizures**
**Hypothalamic Hamartoma**
42
Define **Todd's Paralysis**
* Partial or complete **paralysis** following seizure
* **Unilateral** & may involve **speech** & **vision**
* Duration: **30 min** - **36 hrs** (**avg 15hrs**)
43
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
**Jacksonian March**
44
**Jacksonian March:**
1. Generalized Seizure
2. Primary focal, secondarily generalized.
3. Complex partial seizure
4. Simple partial seizure
**Simple partial seizure**
45
**Hypsarrhythmia** (in pediatrics)
1. Complex Partial Seizure
2. Hypnogogic Hypersynchrony
3. Infantile Spasms
4. Tonic Clonic Seizures
**Infantile Spasms**
46
**Hypsarrythmia** (in Adults)
1. Lennox Gastaut
2. Rasmussens Encephalitis
3. Juvenile Myoclonic Epilepsy
4. West Syndrome
**West Syndrome**
47
**Abdominal Epilepsy** (Stomach Pain)
1. Frontal Lobe
2. Temporal Lobe
3. Parietal Lobe
4. Occipital Lobe
**Temporal Lobe**
48
**Atonic Seizures**
1. Olfactory Aura
2. Drop Attacks
3. Infantile Seizures
4. Epileptic Syndrome
**Drop Attacks**
| (Drop Seizures)
49
**Atonic Seizures** are also referred to as:
1. Affective Epilepsy
2. Ataxic Epilepsy
3. Akinetic Seizures
4. Aphasic Seizures
**Akinetic** Seizures
50
**Treatment** for **Intractable** Atonic **Seizures**
**Corpus Callosotomy**
Corpus callosum is severed to stop seizures.
51
**Intractable Epilepsy** (in childhood)
1. Febrile Seizures
2. Paraneoplastic Neurologic Syndrome
3. Lennox Gaustox Syndrome
4. Benign Rolandic Epilepsy
**Lennox Gaustox** Syndrome
52
**Intractable epilepsy** (in Infancy)
1. Complex Partial
2. Absence
3. Jacksonian
4. Infantile Spasms
**Infantile Spasms**
53
**Seizure** involving **visual hallucination** of **un-formed images** (flashing lights, colors)
1. Frontal Lobe
2. Temporal Lobe
3. Parietal Lobe
4. Occipital Lobe
**Occipital Lobe**
54
**Seizure** involving **bilateral tonic posturing**
1. Frontal Lobe
2. Temporal Lobe
3. Parietal Lobe
4. Occipital Lobe
**Frontal Lobe**
55
**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)
Onset in **right frontal lobe** (**C4**)
56
**Dysgeusia**
1. Memory
2. Taste
3. Déjà vu
4. Smell
**Taste**
57
Seizure or aura involves **dysgeusia**
1. Globus Pallidus
2. Amydala
3. Insula
4. Hippocampus
**Insula**
58
**Seizure** or **aura involves formed images** or **hallucinations**
1. Globus Pallidus
2. Amydala
3. Insula
4. Amygdala\Hippocampus
**Amygdala** \ **Hippocampus**
59
**Seizure** or **aura involves formed images** or **hallucinations**
1. Posterior temporal lobe
2. Anterior temporal lobe
3. Occipital Lobe
4. Frontal lobe
**Posterior temporal lobe**
60
**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
**Anterior Parietal lobe** - **left** (Contralateral)
61
**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
**Posterior Frontal lobe** - **left**
62
**Seizure** or **aura** involves **epigastric sensations** & **salivation**
1. Insular-orbital frontal cortex
2. Hippocampus
3. Limbic system
4. Mid-temporal lobe
**Insula-orbitofrontal cortex**
63
**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
**Amygdala-opercular region**
64
**Seizure** **aura** involving **olfactory** (**Smell**) hallucinations
1. Insular-orbital frontal cortex
2. Hippocampus
3. Prefrontal Lobe
4. Anteromedial temporal lobe
**Anteromedial temporal lobe**
65
**Seizure** **aura** involves **olfactory** (**Smell**) hallucinations
1. Insular-orbital frontal cortex
2. Anterior Parietal lobe
3. Amygdala-opecular region
4. Occipital lobe
**Amygdala-opecular region**
66
**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
**Automatism**
67
What does **SUDEP** stand for
**S**udden **U**nexpected **D**eath in **Ep**ilepsy
68
What are the **6 criteria** for diagnosis of **SUDEP**
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
69
**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
**Temporal Lobe Epilepsy**
70
Which of the following is associated with** Hippocampal Sclerosis?**
a. Simple Partial Seizures
b. Complex Partial Seizures
c. Generalized Seizures
d. Status Epilepticus
**Complex Partial Seizures**
71
Age of **onset** & **peak** age for **Absence Seizures**
* *Onset**: **3-12** yrs
* *Peak**: **6-7** yrs
**Absence 3.6.7.12**
72
Age of **onset** for **_Juvenile_ Myoclonic Epilepsy**
**Onset**: **12-18** yrs
**Juvenile 12.18**
73
Age of **onset** & **peak** age for **Benign _Rolandic_ Epilepsy**
* *Onset**: **2-13** yrs
* *Peak**: **9-10** yrs
**Rolandic 2.9.10.13**
74
Age of **onset** & **peak** age for **Benign _Occipital_ Epilepsy**
* *Onset**: **15 months** **- 15** yrs
* *Peak**: **4-8** yrs
**Occipital 15.4.8.15**
75
Age of **onset** & **peak** age for **Wests Syndrome** (Infantile Spasms)
* *Onset**: **\< 1**yr
* *Peak**: **3-7** mo.
**Infant/West 0.3.7.1**
76
Age of **onset** & **peak** age for **Lennox Gastaut**
* *Onset**: **1-8** yrs
* *Peak**: **3-5** yrs
**Lennox 1.3.5.8**
77
Age of **onset** for **Landau Kleffner**
**Onset**: **2-12** yrs
**Landau 2.12**
78
```
Name the two **epilepsy syndromes** that **have** a
cognitive delay (**mental retardation**) as a **characteristic**
```
1. **West Syndrome** (Infantile Spasms)
2. **Lennox-Gastaut**
79
Name the **epilepsy syndrome** that is **characterized by speech arrest**
**Landau-Kleffner**
80
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
Episode **last**ing **over two minutes**
81
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
**Side to side head movements**
82
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
**Biting the tip of the tongue**
83
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
**Pelvic thrusting** & **Weeping**
84
Which of the following is typically **associated with non-epileptic seizures**:
1. Blinking
2. Staring
3. Eye deviation
4. Eyes dosed
**Eyes closed**
85
**Brainstem Lesion**:
1. Spindle Coma
2. Beta Coma
3. Alpha Coma
4. Theta Coma
**Alpha Coma**
86
**Mesencephalic Lesion:**
1. Spindle Coma
2. Beta Coma
3. Alpha Coma
4. Theta Coma
**Spindle Coma**
87
**Locked-in Syndrome:**
1. Spindle Coma
2. Beta Coma
3. Alpha Coma
4. Theta Coma
**Alpha Coma**
88
**Alpha Coma Prognosis**
1. Poor
2. Good
3. Great
4. Unknown
**Poor**
89
**Spindle Coma Prognosis**
1. Poor
2. Good
3. Great
4. Unknown
**Good**
90
**Beta Coma Prognosis**
1. Poor
2. Good
3. Great
4. Unknown
**Good**
91
Describe the **reactivity** of **Alpha Coma**
**Non-reactive** (EEG does **no**t **change with painful stimuli**)
92
Name the **coma** type which **involves paralysis of** the **lower cranial nerves**.
**Alpha Coma**
93
**Level of consciousness** with **Alpha Coma**
**Awake** & **Alert**
94
**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
**S**timulus **I**nduced **R**hythmic or **P**eriodic or **I**ctal **D**ischarge**s**
95
**S.I.R.P.I.Ds**
1. REM Sleep disorder
2. Acute Brain Injury
3. Brain Stem Infarction
4. Brain Tumor
**Acute Brain Injury**
96
Define **Long-Term Potentiation** (LTP)
* **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.**
97
**Hippocampus**
1. Limbic System
2. Reticular Formation
3. Lymphatic System
4. Cortical System
**Limbic System**
98
**4 functions** of the **Hippocampus**
1. **Short** term **memory**
2. **Long** Term **Memory**
3. Spatial **navigation**
4. **Inhibition**
99
**Long Term Potentiation**
1. Neural Matrix
2. Neural Tissue
3. Neural Network
4. Neural Plasticity
**Neural Plasticity**
100
Define **Neural Plasticity**
**Changes** in **neural pathways** & **synapses** from changes in **behavior**, **environment** or **bodily injury**.
101
**Function** of the **Parahippocampal Gyrus**
**Memory Encoding** & **Retrieval**
102
**Functions** of the **Amygdala**
**Memory **&** Emotion**
103
**Resting Membrane Potential of** a **neuron**
a. -70 µV
b. -70 mV
c. -70 mA
d. -70 µA
**-70 mV** (mV=Millivolts)
104
**EPSPs** & **IPSPs**
1. Cortical Pyramidal Cells
2. Frontal Lobe
3. Neocortex
4. Deep Brain Structures
**Cortical Pyramidal Cells**
_**E**xcitatory_ **p**ost**s**ynaptic **p**otential & _**I**nhibitory_ **p**ost**s**ynaptic **p**otential
105
Define **HIPAA**
**H**ealth **I**nsurance **P**ortability & **A**ccountability **A**ct
106
Function of **HIPAA**
**Protects** a patient's **oral**, **written** or **electronic health information** (PHI) from being disclosed.
107
**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
**Written authorization from patient**
108
**Preferred stimulator** type for **direct cortical stimulation** in **epilepsy surgery**
**Bipolar**, **constant-current**
109
**Preferred intensity** range of stimulation for **direct cortical stimulation** in **epilepsy surgery**
**0-20 mA** (mA=milliamps)
110
Describe **stimulation period** for **direct cortical stimulation** in **epilepsy surgery**
**1-10 seconds**
111
Define the **threshold** range typically used to **define function** over the **motor cortex** for **direct cortical stimulation** in **epilepsy surgery**
**2-5 mA** (mA=milliamps)
112
Define the **threshold range** typically used to **define function** over the **language cortex** for **direct cortical stimulation** in **epilepsy surgery**
**8-15 mA** (mA=milliamps)
113
Define the **EEG Sensitivity** recommended for **recording from grid electrodes** over the **exposed cortex** for **direct cortical stimulation** in **epilepsy surgery**
**50-100 µV** (µV=microvolts)
114
**Amplifier bandpass** for **Motor Mapping**
**1 - 30 Hz** to **250 - 1,500 Hz** (-3dB)
115
A**nalysis time** for **Motor Mapping**
**50 msec**
| (milliseconds or ms)
116
**Rate**, **Duration** & **Intensity** for **Motor Mapping**
* Rate: **3-5 /sec** (Per second)
* Duration**: 100-300 µsec** (microseconds)
* Intensity**: 30-60 mA** (milliamps)
117
**Amplitude** **range** of **Motor Mapping **responses
**20 - 500 µV** (microvolts)
118
**GOLD STANDARD** in **assessing** **patients for epilepsy surgery**
**MRI**
119
**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
**Surface electrodes, Expanded international 10-10 System, Sphenoidal, Foreman Ovale, NP Electrodes**
120
**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
**Intracranial electrodes**
121
**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
**lntracranial electrodes** & **Neurosurgical resection**
122
**WADA**
1. Widespread Anti-epileptic Drug Analysis
2. Sodium Amobarbital Test
3. Seizure Focus
4. Seizure Classificiation
**Sodium Amobarbital Test**
123
**WADA**
1. Language & Short Term Memory
2. Language & Long Term Memory
3. Speech & Short Term Memory
4. Speech and Long Term Memory
**Language** & **Short Term Memory**
124
**WADA**
1. Sensori-motor Mapping
2. After Discharge
3. Epileptic Focus
4. Hemispheric Dominance
**Hemispheric Dominance**
125
**WADA**
a. Pre-surgical assessment for epilepsy
b. Bedside monitoring for NES
c. Diagnosis of Epilepsy
d. Classification of Epilepsy
**Pre-surgical assessment for epilepsy**
126
**WADA** is performed in
1. Surgery
2. Bedside monitoring
3. lnterventional Radiology
4. EEG Department
**lnterventional Radiology**
127
**WADA**: Medication used
1. Pentobarbital
2. Phenobarbital
3. Propofol
4. Sodium Amobarbital
**Sodium Amobarbital**
128
A **WADA** is performed in conjunction with:
1. MRI
2. X-Ray
3. Flouroscopy
4. PET Scan
**Flouroscopy**
129
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
**Visualize the catheter and target vessel**
130
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
**Carotid Artery through a femoral catheter**
131
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
* *EEG Slowing ispitateral** to side of injection and
* *functional loss contralateral** to injection side
132
During **WADA recall test**ing is performed **using**
1. Words & Pictures
2. Names & Faces
3. Previous EEG
4. Hemiparesis
**Words** & **Pictures**
133
**Short term memory**
1. Mammillary Body & Corpus Collosum
2. Mammillary Body & Pre-frontal Gyrus
3. Hippocampus & Globus Pallid us
4. Hippocampus & Amygdala
**Hippocampus** & **Amygdala**
134
**Image Shows:**
1. Left Hippocampal Sclerosis
2. Right Hippocampal Sclerosis
3. Left Cortical Dysplagia
4. Right Cortical Dysplagia
**Right Hippocampal Sclerosis**
135
What **type of image** is this?
**MRI**
136
**Image Shows:**
1. Left Hippocampal Sclerosis
2. Right Hippocampal Sclerosis
3. Left Cortical Dysplagia
4. Right Cortical Dysplagia
**Left Cortical Dysplagia**
137
What does an **Functional MRI** (fMRI) measure?
Measures **hemodynamic response** of** neural activity**.
**Can lateralize**, but **can't localize**, **language** & **motor function**.
138
What does a **Magnetic Resonance Spectroscopy** (MRS) measure
Measures the **levels of** different **metabolites** in body tissues. **Lateralizes hippocampal sclerosis** in **some patients**
139
What is **Stealth MRI**
**Combines 3-D MRI** & **CT Scans** to recreate the **placement of grids**
140
What is a **PET Scan** & what does it **measure**
**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
# Define **SPECT**
**S**ingle **P**hoton **E**mission **C**omputed **T**omography
142
What does **SPECT** **measure**?
Used to image directly the **regional increase** in **cerebral blood flow** that occurs **during** an **epileptic seizure**, thereby **imaging** the **epileptic focus**
143
Describe the **window** needed **to inject** the **radioactive dye** (tracer) **for SPECT** scan?
The injection is given **during** or **following** the **seizure** & the scan needs to be taken **within _6 hours_**
144
What is **MEG** and what does it **measure**?
* 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
Neonatal Continuous EEG protocols are applicable for which age patient?
High risk neonates
Post-menstrual age less than 48 weeks
146
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
**Paroxysmal increases** in **heart rate** or **blood pressure**
147
Name the **6** stereotypical **manifestations** of **neonatal seizure**
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
Define the recommended **extracerebral monitoring channels** for **Neonates**
* Electrocardiogram (**ECG**)
* Electrooculogram (**EOG**)
* **Respiratory** Channels
* Electromyography (**EMG**)
149
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
**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
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
**Cerebral Dysgenesis**
| (improper brain development in utero)
151
Name **2 medications** used in the **neonatal population** **for** induced **Burst Suppression**
1. **Pentobarbital**
2. **Midazolam** (versed)
152
Define **Gestational Age**
The time **between** the onset of the mother's **last menstrual period** **&** the **date of birth** (In **weeks**)
153
Define **Conceptional Age**
**Gestational age plus** the **time since birth** (In **weeks**)
154
What is the **recommended recording time** for **neonatal EEG**?
**\> 60 Min**utes (1 Hr)
155
What is the **first recordable EEG pattern** in **neonates**?
**Trace Discontinu**
156
**Trace** **Discontinu**:
1. Active Sleep
2. Quiet Sleep
3. All states of wake & sleep
4. Abnormal pattern
All states of **wake** & **sleep**
157
**Trace Discontinu**:
1. 24-26 Weeks CA
2. 24-26 Weeks GA
3. 27-28 Weeks CA
4. 27-28 Weeks GA
**24**-**26 Weeks** CA (**Conceptional** Age)
158
**Trace Discontinu**:
1. Reactive to stimulation
2. Non-reactive to stimulation
3. State dependent reactive background
4. Brief reactivity with generalized distribution
**Non-reactive** to stimulation
159
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
**34**-**35 weeks** CA (**Conceptional** Age)
160
**Normal sharp transients** in the **neonatal** population:
1. Frontal
2. Temporal
3. Central
4. Parietal
5. Occipital
**Frontal**
161
**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
**40 weeks** CA (**Conceptional** Age)
162
**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
**38**-**40 weeks** CA (**Conceptional **Age)
163
**Another name** for **Frontal sharp transients** in the **neonatal** recording.
**Enchoches Frontales**
164
**Frontal sharp transients**:
1. Asynchronous & Bilateral
2. Synchronous & Bilateral
3. Asynchronous and Lateralized
4. Synchronous & Lateralized
**Synchronous** & **Bilateral**
165
At **what age** do **Delta Brushes** occur in the **neonatal **recording.
**26**-**32** **weeks** CA (**Conceptional** Age)
166
At **what age** do **Delta Brushes occur** **_during REM_** (Active) sleep in the **neonatal **recording.
**29**-**33 weeks** CA (**Conceptional** Age)
167
At **what age** do **Delta Brushes occur during** **_non REM_** (Quiet) sleep in the **neonatal** recording.
**33**-**38** **weeks **CA (**Conceptional **Age)
168
Name the **3 criteria** associated with **non-REM** (Quiet) **sleep**.
1. **Regular Respiration**
2. **Random Eye Movement**s
3. **Variable Muscle Tone**
169
Name the **3 criteria** associated with **_REM_** (Active)
**sleep**.
1. **Irregular respiration**
2. **Rapid Eye Movement**s
3. **Decreased Muscle tone**
170
**When** does the **Trace Alternant** pattern **disappear** in the **neonatal** EEG?
**44 weeks**
3-4 weeks post-term
171
Define Trace Alternant:
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
In which **sleep stage** does **Trace Alternant** appear
**Quiet Sleep** (non REM)
173
Which **sleep stage appears first** in the **neonate**?
**Active Sleep** (REM)
174
At **27-34 weeks** CA which **sleep stage** does the **neonate** spend **most time** in?
**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
**Beyond 35 weeks** which **sleep stage** does the **neonate** spend **most time** in?
**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
**Sphenoidal**, **Foreman Ovale**, **Nasopharyngeal** & **T1** \ **T2** Electrodes
1. Invasive
2. Mesial
3. Medial
4. Basal
**Basal**
177
Explain **Sphenoidal Electrode** Placement
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
Define **Foreman Ovale Electrode** Placement
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
Define **Nasopharyngeal Electrode** Placement
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
Define **T1** & **T2** Electrode **Placement**
Anterior Temporal Electrodes
**One third the distance anterior from the external auditory canal** **and** the **outer canthus of the eye then up 1cm**
181
**Metal** of choice for **Subdural** & **Depth** **Electrodes**
Comprised of **_Platinum_** (preferred), stainless steet or gold
182
**5 Risks** with **Subdural & Depth Electrodes**
1. **Hemorrhage**
2. **Infection**
3. **Reactive meningitis**
4. **Edema**
5. **Headache**
183
**Most significant risks** with **Subdural** & **Depth Electrodes**
**Infection**
184
**Disadvantage** of **Subdural** & **Depth Electrodes**
**Sampling rate** errors (**aliasing**)
185
**4 Advantages** of **Subdural** & **Depth Electrodes**
1. Excellent **signal to noise ratio**
2. **Low Impedance**
3. **Unaffected by muscle** or **movement artifact**
4. **By-pass** high resistance **skull**
186
**Which electrode** is closest to the **somatosensory** reception region for the **left hand**
**CP4**
187
**LTME** is limited to:
1. Critical Care Monitoring
2. Intra-Operative Monitoring
3. Sleep Analysis Setting
4. Epileptic or suspected epileptic seizure disorder
**Epileptic or suspected epileptic seizure disorder**
188
In **LTM**E, 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
**No real time analysis of the data**
189
**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
**Mesial** or **anterior** aspects of the **temporal lobe** in the area of the **foreman ovale**
190
During an **ECOG**, What is the **indicated activity**
**Cortical Stimulation artifact**
191
During an **ECOG**, What is the **indicated activity**
**After Discharges**
192
**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
**Braided stainless steel wire**, **insulated** except **to** the **tip**
193
Which of the following electrodes **should not be used** in **LTM**:
1. Sphenoidal
2. Basal extracranial
3. Nasopharyngeal
4. Foreman ovale
**Nasopharyngeal**
194
**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
**Platinum or stainless steel disks** embedded in **soft silastic**
195
**Epidural** & **Subdural Electrode placement**
1. Epidural or subdural; over the cerebral cortex
2. Mesial aspect of the temporal lobe
3. Nasoethmoidal
4. Supraoptic
Epidural or subdural; **over the cerebral cortex**
196
**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
**Through a burr hole after open craniotomy**
197
**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
**Stainless steel** or **MRI compatible nichrome**
198
**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
**Mesial temporal** structures placed in the **ambient cistern**
199
Which of the following is **best for recording mesial temporal** EEG **discharges** best
1. Foreman Ovale
2. Nasopharyngeal
3. Sphenoidal
4. Nasoethmoidal
**Foreman Ovale**
200
**LTM**E **recommended** low frequency response setting (**low frequency filter**)?
**0.5 Hz** or Lower
201
**LTM**E **recommended** High frequency response setting (**high frequency filter**)?
**70 Hz** or Higher
202
**LTM**E **recommended Noise level** of the **amplifier**s?
**1 µV rms**
or
**1** (**microvolt**) (**root mean squared**)
203
**LTM**E **recommended Input Impedance** of the **amplifier**s?
(At least) **1 M ohm**
1 million ohms
204
**LTM**E recommended **Common Mode Rejection**?
**60 dB**
205
**LTM**E recommended **Dynamic Range**?
(At least) **40 dB**
206
**LTM**E recommended **minimum recording/storage time** with **video**?
Recording & Storage: **24 hours**
| (**32-64 channels** or 128 channels if needed)
207
**LTM**E recommended **minimum retrieval/review** **storage time** **with video**?
**30 gigabytes** or **24 hrs** of **Video\EEG**
208
What is the main/**major objective of LTM**E:
1. Classification of seizures
2. Identify Non-epileptic seizures
3. Correlation of behavior with EEG findings
4. Identify non-convulsive status epilepticus
Correlation of behavior with EEG findings
209
**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
**Self reporting**, **Observer reporting**, **Video Recording**
210
**LTM**E 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
**Eye movement EMG & Cognitive Tasks**
211
**LTM**E 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
**Reaction time tasks with stimulus & response times recorded on an event marker channel**
212
**LTM**E recommended **Ictal event testing**: Name (**4**)
**G.L.A.M.**
1. **G**ross Motor Function
2. **L**anguage
3. **A**wareness
4. **M**emory
213
**LTM**E recommended **color perceived optical resolution** of **display** monitor.
**250 Line Pairs**
214
**LTM**E recommended optimal **pixel standards of display monitor**.
**1600 X 1200** pixels
215
**LTM**E recommended **screen diagonal size** of display monitor .
**20 inch**es or more
216
**LTM**E recommended **archive of events** should include what **period of time before and after** events?
**2mm** Along with a **log of** contents of **event**
217
**LTM**E recommended **electrode insertion** **for Sphenoidals**.
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
**LTM**E recommended **impedance measurement** with **epidural**, **subdural**, **intracerebral** & **foreman ovale electrodes**.
1. In the **range of 10 nA**
2. **1,000 times less than disk electrodes**
219
**LTM**E recommended **number of channels** for **standard recording** (**non pre-surgical**)
**8-12 channels**
220
**LTM**E recommended **number of channels** for **pre-surgical record**ing
* *32-64 channels recommended**
* *Minimum of 16** channels
221
**LTM**E recommended **number of channels for ambulatory**.
**8 channels**
222
**LTM**E recommended **number of channels** for **diagnosis** of **nonepileptic seizures**.
**8 channels**
223
**LTM**E recommended **number of channels** for **classification** and **characterization** of **epileptic events**.
**18 channels**
* **16 EEG**
* **1 EOG**
* **1 EKG**
224
**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
**Biological**
225
**Most common biological artifact** seen with **Sphenoidal electrodes**
**Pulse**
226
**How often** should the ongoing **status of the EEG recording be checked**?
**At LEAST once a day**
227
**Name the pattern** seen in **1 year old child** with **cognitive delay** & **frequent seizures**
**Hypsarythmia**
228
**Name this pattern** seen in a **5 yr old child** with **HX of staring spells**
**3 per sec Spike** & **Wave**
229
**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
**Patient name** & **Birth date**
230
Medical **phone orders require**:
1. Confirmation number
2. Read Back of order
3. Return call confirming order
4. Physician confirmation
**Read Back** of order
231
Describe the **required ****procedure**for **relieving someone for**a**break**or at the the **end of**a**shift.**
1. Hand off Procedure
2. Read Back of case events
3. Time out
4. End of shift report
**Hand off Procedure**
232
**Hand washing duration**
1. 10 seconds
2. 15 seconds
3. 20 seconds
4. 25 seconds
**15 seconds**
233
**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
**Alcohol** based **hand sanitizer**
234
"**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
* **Patient**
* **Surgery**
* **Side** of Surgery
235
**Patient care and supervision for EEG, LTM & cEEG diagnostic lab is defined by:**
1. ACNS
2. ABRET
3. ASET
4. ASNM
**ACNS**
236
**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**MERICAN **C**LINICAL **N**EUROPHYSIOLOGY **S**OCIETY
237
**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
**ABRET** - **CODE OF ETHICS**
238
**Do not divulge information from the exam**
1. ACNS GUIDELINES
2. ABRET CODE OF ETHICS
3. ASET PRACTICE GUIDELINES
4. AAN CODE OF ETHICS
**ABRET** - **CODE OF ETHICS**
239
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
**Continue recording**
240
The current **CPR**: **Chest compression** to rescue breath **ratio** is:
**30:2**
241
What is does **RAWOD** stand for
**R**egional **A**ttenuation **W**ith**o**ut **D**elta
242
**Describe this pattern** seen in a **68 year old patient** following **clamping of the left middle cerebral artery.**
**RAWOD** (**R**egional **A**ttenuation **W**ith**o**ut **D**elta)
243
Describe **Heschl's gyrus**
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
**What area** is **#1** indicating
**Heschl's gyrus**
245
**Brodmann** area **44**
**Broca's** area
246
**Brodmann** Area **45**
**Broca's** area
247
**Brodmann** area **22**
**Wernicke's** area
248
Which electrode pair is most likeley to correspond to **Broca's area**
1. 15 & 16
2. 21 & 22
3. 33 & 34
4. 46 & 47
33 & 34
249
Which electrode pair is most likeley to correspond to Werneckie's area
1. 47 & 48
2. 28 & 29
3. 59 & 60
4. 31 & 32
47 & 48
250
What is **MELAS** syndrome
_**M**itochondrial_ myopathy, _**E**ncephalomyopathy_, _**L**actic **A**cidosis_, and _**S**troke_-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
What types of **seizures** would you see in **Todd's Paralysis**
**Partial**
**Clonic**
**Focal**
252
Explain **Eyeball** polarity
**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
**Polarity** of the **tounge**
* *positive** at **root** (back of tounge)
* *negative** at **tip**
254
Where is **Heschl's Gyrus** is located
| (**Transverse Temporal Gyri**)
* **Primary auditory cortex**
* **B****rodmann's area 41**&**42**
* **Temporal lobe**
255
Which electrode inicates the location of the primary somatosensory cortex
1. 2
2. 3
3. 4
4. 5
**4**
256
Define **Beneficence**
When doing research, studies or clinical trials, the welfare of the patient should always be one of the goals.
257
Seizure classifications associated with **Todd's Paralysis.**
* **Partial**
* **Clonic**
* **Focal**
258
**Febrile Seizures** (**West Syndrome**) typically evolves into what?
**Lennox Gastaut**
259
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
**Alcohol based hand sanitizer**
260
Define **Slow Wave**
* Frequency: **0 - 4 Hz**
* Duration: **\> ****300 msec**
261
Define **Sharp** Wave
* Frequency: **5 - 14 Hz**
* Duration: **70 - 200 msec**
262
Define a **Spike**
* Frequency: **14 -50 Hz**
* Duration: **20 - 70 msec**
263
Define **Triphasic** waves
* Generalized
* Anteriorly predominant
* Anterior to posterior _lag_
* 100 - 300 uV
* 150 - 250 msec
* Periodic 1 - 2.5 /sec
264
**Triphasic waves** are frequently associated with what
* **Creutzfeldt-Jakob**
* **Renal** or **hepatic encephalopathy**
* **Kidney** or **liver** problems
265
Name this pattern
**Triphasic waves**
266
Derfine **Burst Suppression**
Variable (1 - 3 /sec) periods of spikes, polyspikes and sharp waves followed by periods of electrographic flattening.
267
Non-medically induced **Burst suppression** could be associated with:
* Drug overdose
* Reye's Syndrome
* Hypothermia
* End stage: Sub-acute sclerosingpanencephalitis (SSPE)
* Poor prognosis (except in children)
268
What does **FIRDA** stand for
**F**rontal **I**ntermittent **R**hythmic **D**elta **A**ctivity
(Adults)
269
What does **OIRDA** stand for
**O**ccipital **I**ntermittent **R**hythmic **D**elta **A**ctivity
(Pediatric)
270
Name this pattern
**FIRDA**
Frontal intermittent rhythmic delta
271
Common causes of **PLEDS**
* **Herpes Encephalitis**
* **Stroke**
* Tumor
* Focal lesion
272
What are **PLEDS**
**P**eriodic **L**ateralized **E**pileptiform **D**ischarges
Intermittent or continuous periodic biphasic or triphasic sharp waves or spikes on one side of the brain.
273
**EEG** with **Cereberal Blood Flow** (CBF) of **35 - 70**
**Normal**
No Injury
274
**EEG **with **Cereberal Blood Flow** (CBF) of **25** - **35**
**Loses Beta** Frequencies
Reversible
275
**EEG** with **Cereberal Blood Flow** (CBF) of **18 **- **25**
**Slowing** **to theta** (5 -7 Hz)
_Potentially_ Reversible
276
**EEG **with **Cereberal Blood Flow** (CBF) of **12 **- **18**
**Slowing to Delta** (1 - 4 Hz)
_Potentially_ Reversible
277
**EEG **with **Cereberal Blood Flow** (CBF) of **\<8** - **10**
**Complete suppression** of all frequencies
**Neuronal Death**
278
**Hyperlexia** is commonly associated with which disorders or syndromes
* **Autism**
* **Landau Kleffner**
Neurodiagnostics \ Neurophysiology
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