EEG Exam Prep 2026/2027 - 180 Questions and Answers Already
Graded A+ Premium Exam Tested And Verified
Subject Area Clinical Neurophysiology - Electroencephalography (EEG)
Description This exam assesses advanced knowledge of EEG principles, including normal and
abnormal patterns, activation procedures, artifacts, neonatal EEG, quantitative
EEG, and clinical correlations. It reflects the latest 2026/2027 guidelines from the
American Clinical Neurophysiology Society (ACNS) and the International
Federation of Clinical Neurophysiology (IFCN).
Expected Grade A+
Total Questions 180
Duration 3 hours
Learning Outcomes 1. Identify and interpret normal and abnormal EEG patterns across the lifespan.
2. Apply ACNS standardized terminology for rhythmic and periodic patterns.
3. Differentiate epileptiform discharges from normal variants and artifacts.
4. Analyze EEG findings in encephalopathy, coma, and status epilepticus.
5. Understand quantitative EEG methods and their clinical applications.
Accreditation This exam meets the content standards for ABRET board eligibility and
ACNS-endorsed EEG curriculum for US residency and fellowship programs.
Page 1
,1. A patient with refractory epilepsy undergoes long-term video-EEG
monitoring. During a seizure, the EEG shows a buildup of high-frequency
oscillations (HFOs) in the 80-200 Hz range localized to the left temporal lobe,
followed by a rhythmic theta discharge. According to the latest ACNS
guidelines, which of the following best characterizes the clinical significance of
HFOs in this context?
A. HFOs are normal variants seen during drowsiness and have no localizing value.
B. HFOs in the ripple band (80-200 Hz) are specific markers of the epileptogenic zone
and correlate with surgical outcome.
C. HFOs are exclusively an artifact of muscle activity and should be filtered out.
D. HFOs indicate a non-epileptic event and suggest psychogenic seizures.
Answer: B. HFOs in the ripple band (80-200 Hz) are specific markers of the
epileptogenic zone and correlate with surgical outcome.
HFOs, particularly ripples (80-200 Hz) and fast ripples (>200 Hz), are
increasingly recognized as biomarkers of epileptogenic tissue. ACNS guidelines
support their use in presurgical evaluation. Option A is incorrect because HFOs
are not normal; option C is false as HFOs are of cerebral origin; option D is
incorrect as HFOs are associated with epileptic seizures.
2. A 45-year-old individual with no prior neurological history presents with
acute confusion. EEG reveals generalized periodic discharges with a triphasic
morphology, maximal in the frontal regions, occurring at a frequency of 1-2
Hz. There is no clinical correlate. Which of the following is the most likely
underlying etiology?
A. Non-convulsive status epilepticus (NCSE)
B. Creutzfeldt-Jakob disease (CJD)
C. Metabolic encephalopathy due to hepatic failure
D. Herpes simplex encephalitis
Answer: C. Metabolic encephalopathy due to hepatic failure
Triphasic waves, especially with frontal predominance and 1-2 Hz frequency, are
classic for metabolic encephalopathies, most commonly hepatic encephalopathy.
While CJD can show periodic sharp waves, they are typically shorter duration
and not triphasic. NCSE may show rhythmic discharges but not typically
triphasic morphology. Herpes encephalitis shows temporal lobe periodic
lateralized epileptiform discharges (PLEDs).
Page 2
,3. During an EEG recording, a technologist observes a sudden, high-amplitude,
rhythmic delta activity that appears synchronously over both frontal regions.
The activity is not time-locked to any patient movement and disappears when
the recording is paused. Which of the following is the most likely source of this
artifact?
A. Eye movement artifact
B. Electrode pop due to poor contact
C. Sweat artifact
D. Glossokinetic artifact
Answer: D. Glossokinetic artifact
Glossokinetic artifact arises from tongue movement causing a dipole potential
that is maximal frontally and appears as rhythmic delta. It is often synchronous
and disappears when the recording is paused (patient stops moving). Eye
movement artifact is typically slower and has a characteristic eye field
distribution. Electrode pop is a single sharp transient. Sweat artifact produces
low-frequency, high-amplitude slow waves but is not typically rhythmic.
4. A 30-year-old woman with no prior seizures undergoes routine EEG because
of a single episode of loss of consciousness. During hyperventilation, the EEG
shows generalized, symmetric, high-amplitude 3 Hz spike-and-wave discharges
lasting 5 seconds without clinical correlate. Which of the following is the most
appropriate interpretation?
A. This is a normal variant and requires no further action.
B. This finding is diagnostic of childhood absence epilepsy and indicates a good
prognosis.
C. This pattern is highly suggestive of genetic generalized epilepsy and warrants
further evaluation.
D. This is an artifact from hyperventilation-induced hypoxia.
Answer: C. This pattern is highly suggestive of genetic generalized epilepsy
and warrants further evaluation.
Generalized 3 Hz spike-and-wave discharges, even if subclinical, are strongly
associated with genetic generalized epilepsies (e.g., childhood absence epilepsy,
juvenile absence epilepsy). While hyperventilation can provoke these discharges,
they are not normal variants. Option A is incorrect; option B is incorrect because
the patient is 30 years old, not a child; option D is incorrect because
hyperventilation does not produce such stereotyped discharges.
Page 3
, 5. In a comatose patient following cardiac arrest, EEG shows a
burst-suppression pattern with bursts consisting of mixed frequencies and
lasting 1-2 seconds, occurring every 5-10 seconds. According to the ACNS
standardized critical care EEG terminology, which of the following modifiers is
essential to include in the description?
A. Stimulus-induced
B. Generalized periodic discharges
C. Burst-suppression with identical bursts
D. Burst-suppression without reactivity
Answer: D. Burst-suppression without reactivity
The ACNS terminology requires specifying whether burst-suppression is reactive
to stimuli or not. In post-anoxic coma, absence of reactivity is a poor prognostic
sign. Option A is not a modifier for burst-suppression itself; option B is a
separate pattern; option C (identical bursts) is a specific subtype but not the
essential modifier; the key is reactivity status.
6. A 2-year-old child with developmental delay and microcephaly undergoes
EEG. The background shows high-amplitude, asynchronous, multifocal spikes
and sharp waves intermixed with near-suppression periods, giving a
'burst-suppression' appearance. This pattern is present during both
wakefulness and sleep. Which of the following is the most likely diagnosis?
A. Benign epilepsy with centrotemporal spikes (BECTS)
B. Ohtahara syndrome (early infantile epileptic encephalopathy)
C. West syndrome (infantile spasms)
D. Lennox-Gastaut syndrome
Answer: B. Ohtahara syndrome (early infantile epileptic encephalopathy)
The description of a burst-suppression pattern that persists in both wakefulness
and sleep is classic for Ohtahara syndrome (early infantile epileptic
encephalopathy). West syndrome typically shows hypsarrhythmia, which is
high-amplitude chaotic slow waves with multifocal spikes, but not
burst-suppression. BECTS shows centrotemporal spikes activated by sleep.
Lennox-Gastaut shows slow spike-wave complexes and generalized paroxysmal
fast activity.
Page 4
Graded A+ Premium Exam Tested And Verified
Subject Area Clinical Neurophysiology - Electroencephalography (EEG)
Description This exam assesses advanced knowledge of EEG principles, including normal and
abnormal patterns, activation procedures, artifacts, neonatal EEG, quantitative
EEG, and clinical correlations. It reflects the latest 2026/2027 guidelines from the
American Clinical Neurophysiology Society (ACNS) and the International
Federation of Clinical Neurophysiology (IFCN).
Expected Grade A+
Total Questions 180
Duration 3 hours
Learning Outcomes 1. Identify and interpret normal and abnormal EEG patterns across the lifespan.
2. Apply ACNS standardized terminology for rhythmic and periodic patterns.
3. Differentiate epileptiform discharges from normal variants and artifacts.
4. Analyze EEG findings in encephalopathy, coma, and status epilepticus.
5. Understand quantitative EEG methods and their clinical applications.
Accreditation This exam meets the content standards for ABRET board eligibility and
ACNS-endorsed EEG curriculum for US residency and fellowship programs.
Page 1
,1. A patient with refractory epilepsy undergoes long-term video-EEG
monitoring. During a seizure, the EEG shows a buildup of high-frequency
oscillations (HFOs) in the 80-200 Hz range localized to the left temporal lobe,
followed by a rhythmic theta discharge. According to the latest ACNS
guidelines, which of the following best characterizes the clinical significance of
HFOs in this context?
A. HFOs are normal variants seen during drowsiness and have no localizing value.
B. HFOs in the ripple band (80-200 Hz) are specific markers of the epileptogenic zone
and correlate with surgical outcome.
C. HFOs are exclusively an artifact of muscle activity and should be filtered out.
D. HFOs indicate a non-epileptic event and suggest psychogenic seizures.
Answer: B. HFOs in the ripple band (80-200 Hz) are specific markers of the
epileptogenic zone and correlate with surgical outcome.
HFOs, particularly ripples (80-200 Hz) and fast ripples (>200 Hz), are
increasingly recognized as biomarkers of epileptogenic tissue. ACNS guidelines
support their use in presurgical evaluation. Option A is incorrect because HFOs
are not normal; option C is false as HFOs are of cerebral origin; option D is
incorrect as HFOs are associated with epileptic seizures.
2. A 45-year-old individual with no prior neurological history presents with
acute confusion. EEG reveals generalized periodic discharges with a triphasic
morphology, maximal in the frontal regions, occurring at a frequency of 1-2
Hz. There is no clinical correlate. Which of the following is the most likely
underlying etiology?
A. Non-convulsive status epilepticus (NCSE)
B. Creutzfeldt-Jakob disease (CJD)
C. Metabolic encephalopathy due to hepatic failure
D. Herpes simplex encephalitis
Answer: C. Metabolic encephalopathy due to hepatic failure
Triphasic waves, especially with frontal predominance and 1-2 Hz frequency, are
classic for metabolic encephalopathies, most commonly hepatic encephalopathy.
While CJD can show periodic sharp waves, they are typically shorter duration
and not triphasic. NCSE may show rhythmic discharges but not typically
triphasic morphology. Herpes encephalitis shows temporal lobe periodic
lateralized epileptiform discharges (PLEDs).
Page 2
,3. During an EEG recording, a technologist observes a sudden, high-amplitude,
rhythmic delta activity that appears synchronously over both frontal regions.
The activity is not time-locked to any patient movement and disappears when
the recording is paused. Which of the following is the most likely source of this
artifact?
A. Eye movement artifact
B. Electrode pop due to poor contact
C. Sweat artifact
D. Glossokinetic artifact
Answer: D. Glossokinetic artifact
Glossokinetic artifact arises from tongue movement causing a dipole potential
that is maximal frontally and appears as rhythmic delta. It is often synchronous
and disappears when the recording is paused (patient stops moving). Eye
movement artifact is typically slower and has a characteristic eye field
distribution. Electrode pop is a single sharp transient. Sweat artifact produces
low-frequency, high-amplitude slow waves but is not typically rhythmic.
4. A 30-year-old woman with no prior seizures undergoes routine EEG because
of a single episode of loss of consciousness. During hyperventilation, the EEG
shows generalized, symmetric, high-amplitude 3 Hz spike-and-wave discharges
lasting 5 seconds without clinical correlate. Which of the following is the most
appropriate interpretation?
A. This is a normal variant and requires no further action.
B. This finding is diagnostic of childhood absence epilepsy and indicates a good
prognosis.
C. This pattern is highly suggestive of genetic generalized epilepsy and warrants
further evaluation.
D. This is an artifact from hyperventilation-induced hypoxia.
Answer: C. This pattern is highly suggestive of genetic generalized epilepsy
and warrants further evaluation.
Generalized 3 Hz spike-and-wave discharges, even if subclinical, are strongly
associated with genetic generalized epilepsies (e.g., childhood absence epilepsy,
juvenile absence epilepsy). While hyperventilation can provoke these discharges,
they are not normal variants. Option A is incorrect; option B is incorrect because
the patient is 30 years old, not a child; option D is incorrect because
hyperventilation does not produce such stereotyped discharges.
Page 3
, 5. In a comatose patient following cardiac arrest, EEG shows a
burst-suppression pattern with bursts consisting of mixed frequencies and
lasting 1-2 seconds, occurring every 5-10 seconds. According to the ACNS
standardized critical care EEG terminology, which of the following modifiers is
essential to include in the description?
A. Stimulus-induced
B. Generalized periodic discharges
C. Burst-suppression with identical bursts
D. Burst-suppression without reactivity
Answer: D. Burst-suppression without reactivity
The ACNS terminology requires specifying whether burst-suppression is reactive
to stimuli or not. In post-anoxic coma, absence of reactivity is a poor prognostic
sign. Option A is not a modifier for burst-suppression itself; option B is a
separate pattern; option C (identical bursts) is a specific subtype but not the
essential modifier; the key is reactivity status.
6. A 2-year-old child with developmental delay and microcephaly undergoes
EEG. The background shows high-amplitude, asynchronous, multifocal spikes
and sharp waves intermixed with near-suppression periods, giving a
'burst-suppression' appearance. This pattern is present during both
wakefulness and sleep. Which of the following is the most likely diagnosis?
A. Benign epilepsy with centrotemporal spikes (BECTS)
B. Ohtahara syndrome (early infantile epileptic encephalopathy)
C. West syndrome (infantile spasms)
D. Lennox-Gastaut syndrome
Answer: B. Ohtahara syndrome (early infantile epileptic encephalopathy)
The description of a burst-suppression pattern that persists in both wakefulness
and sleep is classic for Ohtahara syndrome (early infantile epileptic
encephalopathy). West syndrome typically shows hypsarrhythmia, which is
high-amplitude chaotic slow waves with multifocal spikes, but not
burst-suppression. BECTS shows centrotemporal spikes activated by sleep.
Lennox-Gastaut shows slow spike-wave complexes and generalized paroxysmal
fast activity.
Page 4
