Clinical Neurophysiology Board Review Board Clinical Neurophysiology Clinical Neurophysiology Board Review Q&A Clinical Puneet K. Gupta, MD, MSE • Pradeep N. Modur, MD, MS • Srikanth Muppidi, MD his high-yield, illustrated clinical neurophysiology board review is a comprehen- Neurophysiology sive resource for assessing and refining the knowledge tested on multiple board Texaminations. Written by authors who are collectively board certified in all of the areas covered, the book is a valuable study tool for candidates preparing for certifica- tion or recertification in clinical neurophysiology, neuromuscular medicine, epilepsy, Board Review sleep medicine, and neurology. Using structured question formats typically encountered on boards, this comprehensive review allows users to assess their knowledge in a wide range of topics, provides rationales for correct answers, and explains why the other choices are incorrect. A unique “Pearls” section at the end of the book allows for quick review of the most important concepts prior to exam day. Clinical Neurophysiology Board Review Q&A contains 801 questions with answers and detailed explanations. The book is divided into eight chapters covering anatomy Q and physiology, electronics and instrumentation, nerve conduction studies and EMG, & EEG, evoked potentials and intraoperative monitoring, sleep studies, ethics and safety, and advanced topics including QEEG, MEG, TES, autonomic testing, and more. A Liberal use of image-based questions illustrating the full spectrum of neurophysiologic & tests and findings build interpretive skills. Questions are randomized and include Q A both case-related questions in series and stand-alone items to familiarize candidates Gu with the question types and formats they will find on the exam. P ta • Mo ta Key Features: ◗◗ Contains 801 high-yield board-type questions covering all areas of the complex subspecialty of clinical neurophysiology D ur • Mu ◗◗ Q&A format with answers and detailed rationales to facilitate recall of must-know information and help identify knowledge gaps for further study ◗◗ P rovides case-based questions in series to simulate full range of board question types ◗◗ Includes 148 state-of-the-art digital images to ensure familiarity with studies and PP findings that form a significant part of any certifying exam i ◗◗ Contains unique “Pearls for Passing” section for quick review of key facts D i PUNEET K. GUPTA Recommended PRADEEP N. MODUR Shelving Category: Neurology SRIKANTH MUPPIDI 11 W. 42nd Street New York, NY 10036 www.demosmedical.com 9 781936 287871 Clinical Neurophysiology Board Review Q&A Clinical Neurophysiology Board Review Q&A Puneet K. Gupta, MD, MSE Assistant Professor Department of Neurology and Neurotherapeutics University of Texas Southwestern Medical Center Dallas, Texas Pradeep N. Modur, MD, MS Associate Professor Department of Neurology and Neurotherapeutics University of Texas Southwestern Medical Center Dallas, Texas Srikanth Muppidi, MD Clinical Assistant Professor Department of Neurology and Neurological Sciences Stanford School of Medicine Stanford, California New Yo rk Visit our website at www.demosmedical.com ISBN: 978-1-9362-8787-1 e-book ISBN: 978-1-6170-5144-9 Acquisitions Editor: Beth Barry Compositor: Newgen Knowledge Works © 2015 Demos Medical Publishing, LLC. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, pho- tocopying, recording, or otherwise, without the prior written permission of the publisher. Medicine is an ever-changing science. Research and clinical experience are continually expanding our knowledge, in particular our understanding of proper treatment and drug therapy. The authors, editors, and publisher have made every effort to ensure that all information in this book is in accordance with the state of knowledge at the time of pro- duction of the book. Nevertheless, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the contents of the publication. Every reader should examine carefully the package inserts accom- panying each drug and should carefully check whether the dosage schedules mentioned therein or the contraindi- cations stated by the manufacturer differ from the statements made in this book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Library of Congress Cataloging-in-Publication Data Gupta, Puneet K. (Puneet Kumar), author. Clinical neurophysiology board review Q & A / Puneet K. Gupta, Pradeep N. Modur, Srikanth Muppidi. p. ; cm. Includes bibliographical references and index. ISBN 978-1-936287-87-1 — ISBN 978-1-61705-144-9 (e-book) I. Modur, Pradeep, author. II. Muppidi, Srikanth, author. III. Title. [DNLM: 1. Nervous System Physiological Phenomena—Examination Questions. 2. Diagnostic Techniques, Neurological—Examination Questions. 3. Neurophysiology—Examination Questions. WL 18.2] QP356 612.8076--dc23 2014015701 Special discounts on bulk quantities of Demos Medical Publishing books are available to corporations, professional associations, pharmaceutical companies, health care organizations, and other qualifying groups. For details, please contact: Special Sales Department Demos Medical Publishing, LLC 11 West 42nd Street, 15th Floor New York, NY 10036 Phone: 800-532-8663 or 212-683-0072 Fax: 212-941-7842 Email: [email protected] Printed in the United States of America by McNaughton & Gunn. 1 2 3 4 5 / 17 16 15 14 To our parents—Vishnu and Sarla Gupta; Narasimha and Malathi Modur; and Venkat and Suguna Muppidi—for their love, inspiration, and encouragement Contents Prefaceâ ix Acknowledgmentsâ xi Share Clinical Neurophysiology Board Review Q&A Chapter 1: Anatomy and Physiology Questionsâ1 Answersâ11 Chapter 2: Electronics and Instrumentation Questionsâ21 Answersâ31 Chapter 3: Nerve Conduction Studies and Electromyography Questionsâ41 Answersâ117 Chapter 4: Electroencephalography Questionsâ147 Answersâ212 Chapter 5: Evoked Potentials and Intraoperative Monitoring Questionsâ253 Answersâ279 Chapter 6: Polysomnography and Other Sleep Studies Questionsâ301 Answersâ319 vii CONTENTS Chapter 7: Advanced Topics Questions 329 Answers 346 Chapter 8: Ethics and Safety Questions 357 Answers 362 Appendix: Pearls for Passingâ 367 Bibliographyâ 391 Abbreviationsâ 393 Indexâ 395 viii Preface If you are reading this book, then you are likely looking for a resource to help test and solidify your knowledge in Clinical Neurophysiology, possibly for an upcoming examination. It was not too long ago when we were in your shoes, and we found that there was a lack of com- prehensive self-assessment board review question books to supplement the core textbooks from which we were studying. The three of us came together to fill that unmet need with this Clinical Neurophysiology Board Review Q&A book. In this book, we share with you facts, illustrations, and examples from years of our learning from inspiring teachers, mentors, and patients we have encountered in our careers. We hope that the breadth and depth of the questions presented will solidify concepts, identify knowledge gaps, and more importantly, provide the confidence to not only pass but also to perform well in various testing environments, from attending rounds to board examinations. We feel that the topics covered in this book are useful for preparing for Clinical Neurophysiology, Neuromuscular Medicine, Epilepsy, Sleep Medicine, and Neurology board examinations. Technologists in these respective fields may also find this book useful for their education and examination preparation. We present the material using structured question formats typically encountered on the boards. We were keen to ensure that the questions were written or reviewed by a neurologist board certified for that section in order to illus- trate important as well as subtle points in a well-thought out and concise manner. We have included straightforward questions that test core knowledge as well as vignette-based ques- tions that test sequential decision making. For each question, we discuss the rationale behind the correct answer and the wrong answers. We have also added a novel “Pearls for Passing” section, which is a compilation of key facts to review for each section of the book and to serve as a quick refresher prior to an exami- nation. The questions and discussions found in this book are based on material found in the ix PREFACE Bibliography at the end of the book. These references can be used to learn more about the topics encountered in the book. With more than 800 questions and 3 years in the making, we were determined to make this book as comprehensive, user-friendly, and error free as possible. We hope the book helps you reach your goals. If not, we apologize in advance, but then hope your future will model the following words of Bill Gates: “I failed in some subjects in exam, but my friend passed in all. Now he is an engineer in Microsoft and I am the owner of Microsoft.” Good Luck! We welcome constructive feedback to help others with future editions. Puneet K. Gupta, MD, MSE Pradeep N. Modur, MD, MS Srikanth Muppidi, MD x Acknowledgments This book is the result of 3 years of working endless nights and weekends. We would like to express our gratitude to the many people