CLTM CERTIFICATION EXAM QUESTIONS COMPLETE
WITH 100% VERIFIED ANSWERS AND DETAILED
EXPLANATION
1. Which type of functional imaging is most sensitive for localizing
interictal epileptiform discharges for presurgical planning?
Correct Answer: MEG
Explanation: Magnetoencephalography (MEG) provides both spatial and
temporal mapping of interictal epileptiform discharges by detecting
magnetic fields from neuronal activity. It is complementary to EEG and
useful for source localization before surgery.
2. During a WADA test with intracarotid amobarbital, what is the
typical duration of hemispheric dysfunction after injection?
Correct Answer: 4-8 minutes
Explanation: Amobarbital temporarily suppresses the injected
hemisphere for approximately 4–8 minutes, allowing assessment of
language and memory function in the opposite hemisphere.
3. What is the best imaging modality for identifying hippocampal
sclerosis in epilepsy patients?
Correct Answer: MRI
,*Explanation: High-resolution MRI, especially with T2/ FLAIR sequences,
is the gold standard for detecting hippocampal sclerosis—characterized
by atrophy and increased signal.*
4. What does FDG-PET typically show in the interictal phase of left
temporal lobe epilepsy?
Correct Answer: Decreased glucose uptake
Explanation: Interictally, the epileptogenic temporal lobe shows
hypometabolism on FDG-PET, helping lateralize the seizure focus even
when MRI is normal.
5. What is the primary memory function assessed during a WADA
test?
Correct Answer: Short-term memory
Explanation: After hemispheric inactivation, the patient is shown items;
recall is tested after recovery to evaluate contralateral hippocampal
function.
6. Which medication is first-line for status epilepticus?
Correct Answer: Lorazepam
Explanation: Benzodiazepines, particularly IV lorazepam, are first-line
due to rapid onset and efficacy in terminating convulsive status
epilepticus.
,7. What is the role of cerebral angiography before intracarotid
amobarbital testing?
Correct Answer: Assess arterial blood flow
Explanation: Angiography ensures correct catheter placement and
identifies vascular anomalies to prevent incorrect drug distribution or
complications.
8. In Rasmussen’s encephalitis, what is the expected PET finding?
Correct Answer: Widespread hemispheric hypometabolism
Explanation: Rasmussen’s causes chronic unilateral inflammation,
leading to diffuse hypometabolism across the affected hemisphere on
PET.
9. What is the full name of the imaging modality PET?
Correct Answer: Positron Emission Tomography
Explanation: PET uses positron-emitting radiotracers to measure
metabolic or molecular activity.
10. In which ICU patient population does continuous EEG (CEEG)
provide the greatest utility?
Correct Answer: Unexplained spells such as variations in vital signs or
twitching
Explanation: Nonconvulsive seizures and periodic discharges are
common in critically ill patients; CEEG detects these when clinical signs
are subtle.
, 11. What is the full name of SPECT?
Correct Answer: Single Photon Emitted Computed Tomography
Explanation: SPECT uses gamma-emitting tracers to measure cerebral
blood flow; ictal SPECT shows hyperperfusion, interictal shows
hypoperfusion.
12. During the WADA procedure, what other invasive procedure is
performed simultaneously?
Correct Answer: Angiography
Explanation: Catheter angiography is required to inject amobarbital into
the internal carotid artery under fluoroscopic guidance.
13. The interictal SPECT typically shows which perfusion abnormality
in the epileptic focus?
Correct Answer: Hypoperfusion
Explanation: Between seizures, the epileptogenic region has decreased
metabolic demand and blood flow, seen as focal hypoperfusion.
14. What effect does intracarotid amobarbital produce on the
ipsilateral hemisphere?
Correct Answer: Ipsilateral hemispheric dysfunction and transient
contralateral paralysis
Explanation: Amobarbital depresses the injected hemisphere, causing
contralateral weakness, which resolves as the drug is metabolized.
WITH 100% VERIFIED ANSWERS AND DETAILED
EXPLANATION
1. Which type of functional imaging is most sensitive for localizing
interictal epileptiform discharges for presurgical planning?
Correct Answer: MEG
Explanation: Magnetoencephalography (MEG) provides both spatial and
temporal mapping of interictal epileptiform discharges by detecting
magnetic fields from neuronal activity. It is complementary to EEG and
useful for source localization before surgery.
2. During a WADA test with intracarotid amobarbital, what is the
typical duration of hemispheric dysfunction after injection?
Correct Answer: 4-8 minutes
Explanation: Amobarbital temporarily suppresses the injected
hemisphere for approximately 4–8 minutes, allowing assessment of
language and memory function in the opposite hemisphere.
3. What is the best imaging modality for identifying hippocampal
sclerosis in epilepsy patients?
Correct Answer: MRI
,*Explanation: High-resolution MRI, especially with T2/ FLAIR sequences,
is the gold standard for detecting hippocampal sclerosis—characterized
by atrophy and increased signal.*
4. What does FDG-PET typically show in the interictal phase of left
temporal lobe epilepsy?
Correct Answer: Decreased glucose uptake
Explanation: Interictally, the epileptogenic temporal lobe shows
hypometabolism on FDG-PET, helping lateralize the seizure focus even
when MRI is normal.
5. What is the primary memory function assessed during a WADA
test?
Correct Answer: Short-term memory
Explanation: After hemispheric inactivation, the patient is shown items;
recall is tested after recovery to evaluate contralateral hippocampal
function.
6. Which medication is first-line for status epilepticus?
Correct Answer: Lorazepam
Explanation: Benzodiazepines, particularly IV lorazepam, are first-line
due to rapid onset and efficacy in terminating convulsive status
epilepticus.
,7. What is the role of cerebral angiography before intracarotid
amobarbital testing?
Correct Answer: Assess arterial blood flow
Explanation: Angiography ensures correct catheter placement and
identifies vascular anomalies to prevent incorrect drug distribution or
complications.
8. In Rasmussen’s encephalitis, what is the expected PET finding?
Correct Answer: Widespread hemispheric hypometabolism
Explanation: Rasmussen’s causes chronic unilateral inflammation,
leading to diffuse hypometabolism across the affected hemisphere on
PET.
9. What is the full name of the imaging modality PET?
Correct Answer: Positron Emission Tomography
Explanation: PET uses positron-emitting radiotracers to measure
metabolic or molecular activity.
10. In which ICU patient population does continuous EEG (CEEG)
provide the greatest utility?
Correct Answer: Unexplained spells such as variations in vital signs or
twitching
Explanation: Nonconvulsive seizures and periodic discharges are
common in critically ill patients; CEEG detects these when clinical signs
are subtle.
, 11. What is the full name of SPECT?
Correct Answer: Single Photon Emitted Computed Tomography
Explanation: SPECT uses gamma-emitting tracers to measure cerebral
blood flow; ictal SPECT shows hyperperfusion, interictal shows
hypoperfusion.
12. During the WADA procedure, what other invasive procedure is
performed simultaneously?
Correct Answer: Angiography
Explanation: Catheter angiography is required to inject amobarbital into
the internal carotid artery under fluoroscopic guidance.
13. The interictal SPECT typically shows which perfusion abnormality
in the epileptic focus?
Correct Answer: Hypoperfusion
Explanation: Between seizures, the epileptogenic region has decreased
metabolic demand and blood flow, seen as focal hypoperfusion.
14. What effect does intracarotid amobarbital produce on the
ipsilateral hemisphere?
Correct Answer: Ipsilateral hemispheric dysfunction and transient
contralateral paralysis
Explanation: Amobarbital depresses the injected hemisphere, causing
contralateral weakness, which resolves as the drug is metabolized.
