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RPSGT Prep Time EXAM 2023 EXAM COMPLETE

SOLUTION FINAL EXAM REAL ACTUAL QUESTIONS

AND CORRECT ANSWERS VERIFIED LATEST 2023-

2024 GRADE A

What part of the brain generates EEG waveforms? - ANSWER>>>The thalamus What cells do we collect electrical activity data from - ANSWER>>>Pyramidal cells What is the resting potential for pyramidial cells - ANSWER>>>-60 to - 80 uv What is a capacitor - ANSWER>>>something that stores and electrical charge What is an A to D converter - ANSWER>>>Analog to digital converter What does the DC amplifier do - ANSWER>>>processes relatively constant or slowly fluctuating voltage i.e: oximetry What does the AC amplifier do - ANSWER>>>processes relatively fast signal frequency i.e: EEG, EOG, ECG

What amplifier precesses common mode rejection - ANSWER>>>AC amplifier *also called the differential amplifier What electrode is ALWAYS your exploring electrode - ANSWER>>>input 1 Input 2 is used as your reference electrode, what electrodes are referred to as your reference electrode? - ANSWER>>>M1 & M What electrodes are considered exploring electrodes - ANSWER>>>F3,F4,C3,C4,O1,O What k ohms is a desired impedence level - ANSWER>>>5 k ohms how does common mode rejection work - ANSWER>>>common frequencey is rejected and only the different frequencies are displayed Input voltage from C4 is at 53 uv. The input voltage of M1 is 76 uv, what is the output voltage - ANSWER>>>-23uv When a patient looks down, what will the tracing show - ANSWER>>>The tracing will spike up When the patient looks left what direction will the tracing be - ANSWER>>>An upward spike

What is the general rule for the sampling rate - ANSWER>>>The faster the sampling rate the more accurate the tracing What is the HFF set at for seizure activity - ANSWER>>>70 Hz The video card is set at what resolution - ANSWER>>>1600x What are the digital resolution settings - ANSWER>>>12 bits per sample minimum resolution of 4096 data points determined by ADC What is the nyquist principle - ANSWER>>>The sampling rate must be at least TWICE AS FAST AS THE FASTEST FREQUENCY that will be recorded What electrodes have a 500 Hz sampling rate - ANSWER>>>EEG, EOG, EMG, ECG What electrodes have a sampling rate of 100 Hz - ANSWER>>>Airflow, nasal pressure, EtCO2, PAP, esophageal pressure, rib cage, abdominal movement What are the labels used for voltage, sensitivity and deflection - ANSWER>>>V = voltage, S = sensitivity, D = deflection What will happen to your waveform if you decrese the sensitivity - ANSWER>>>It will make your waveform larger

What will happen to your brain wave tracing if you increase the gain - ANSWER>>>It will make your wave larger What is considered ideal impedence for all leads - ANSWER>>>less than 5 k ohms What is acceptable impedance for EMG leads - ANSWER>>>less than 10 k ohms What is the bandpass for the amplifier filters - ANSWER>>>LFF = less than 0.1 Hz, HFF = greater than 100 Hz What are the LFF settings for each electrode - ANSWER>>>EEG = 0.3 Hz, EOG = 0.3 Hz, EMG = 10 Hz, Snore = 10 Hz, Resp = 0.1 Hz, ECG = 0. Hz What is the HFF setting for each electrode - ANSWER>>>EEG = 35 Hz, EOG = 35 Hz, EMG = 100 Hz, Snore = 100 Hz, ECG = 70 Hz, Resp = 15 Hz What does it mean when you want to attenuate the amplitude - ANSWER>>>reduce the amplitude What are other names for HFF and LFF - ANSWER>>>HFF = high pass filter, LFF = low pass filter

What effect will a HFF set at 35 Hz have on a 50 Hz sine wave - ANSWER>>>attenuate the amplitude How is time constant defined - ANSWER>>>The time it takes in seconds for a waveform to drop 37% of it's calculated amplitude What do barbituates do besides increase TST - ANSWER>>>*REM suppressor, increase sleep spindles, increase slow wave sleep, decrease WASO ** How do you figure TWT - ANSWER>>>total wake epochs divided by 2 When a person is awake what is the Hz measurement of the alpha wave? Asleep? - ANSWER>>>Awake = 8-13 Hz, Asleep = 7-10 Hz Parasomnias usually occur in what stage of sleep - ANSWER>>>N3 = the deepest stage of sleep What is the best way to measure airway resistance - ANSWER>>>esophageal manometry ** How do you figure sleep stage % - ANSWER>>># of epochs of sleep stage / 2 = # of min in sleep stage

of min / TST x 100 = % time in sleep stage

hypnotics decrese sleep latency, but what classes of drugs are considered hypnotics - ANSWER>>>barbituates, benzodiazepines, non- benzodiazepines How is hypopnea determined - ANSWER>>>a minimum desaturation of 3% medicare requires a desat of 4% The best way to measure a hypopnea is: - ANSWER>>>pressure transducer With shy-drager syndrome, what are some of the symptoms seen? - ANSWER>>>*low bp when standing, abnormal breathing during sleep, disrupted REM, decreased REM What is the cause of eye movement aritfact - ANSWER>>>corneal retinal potential In a narcoleptic patient, what will you see on the MSLT - ANSWER>>>sleep latency less than 5 min, 2 or more sleep onset REM periods What are the contraindications for oral appliances - ANSWER>>>patients less than 18 yrs old, patients with unhealthy mouths What are the indications for a person taking benzodiazepines - ANSWER>>>sleep anxiety, insomnia, to help treat PLM's

What effects on sleep will benzodiazepines have - ANSWER>>>*increased spindle activity, *increased N1 and N2, increased REM latency, decreased REM What can acute alcohol withdrawl lead to - ANSWER>>>decreased REM latency How many ohms should the resistance measure from chasis to ground - ANSWER>>>greater than 0.5 ohms What is the maximum leakage of amps for equipment in direct contact with the patient, and not in direct contact with the patient - ANSWER>>>direct contact = 100 micro amps, indirect contact = 300 micro amps What does electrical equipment need to be plugged into - ANSWER>>>an isolator transformer *How do you figure TST - ANSWER>>>lights on eoch - lights out epoch / 2 **How do you figure events index - ANSWER>>>(# of events / TST)x What are the 4 key symptoms of narcolepsy - ANSWER>>>EDS, cataplexy, hypnagogic hallucinations, sleep paralysis What is the frequency of each wave - ANSWER>>>Delta - less than 4 Hz Theta - 4 to 7 Hz

Alpha - 8 to 13 Hz Beta - less than 13 Hz spindles - 11 to 16 Hz What part of the night is typical for confusion arousals - ANSWER>>>first 1/3 of the night What is considered ideal impedence levels - ANSWER>>>less than 5 k ohms What is the DC output variable for oximetry - ANSWER>>>0 to 1 volt signal to DC amplifier *How do you figure sleep latency - ANSWER>>>sleep onset - lights out epoch/ What are the classiccations of sleep disorders - ANSWER>>>insomnia, sleep related breathing, hypersomna of central origin, circadian rhythm sleep disorder, parasomnia, sleep related movement disorder What is the general criteria for insomnia - ANSWER>>>fatigue or malaise, attention, concentration or memory impairment, social work/dysfunction, moodiness, daytime sleepiness, lack of motivation, GI upset, concerns or worries about sleep What is another name for sleep terrors - ANSWER>>>Pavor Nocturnis

What type of artifact s electrical in nature - ANSWER>>>60 Hz What part of the sleep phase would you expect to see sleep terrors - ANSWER>>>first 1/3 (N3 sleep predominates first 1/3) What are sawtooth waveform and when are they commonly seen - ANSWER>>>low amplitude, notched wave seen in REM What is the pathophysiology of narcolepsy - ANSWER>>>possible gentic link, hypocretin 2 deficiency How are arousals scored - ANSWER>>>an abrupt shift in EEG frequency, duration of at least 3 seconds, must have 10 sec of stable sleep preceding it What is not a possible cause of life threatening sleep apnea in an infant - ANSWER>>>parasomnias What is an acceptable way of measuring effort according to AASM - ANSWER>>>Polyvinyldine Flouride Film (PVDF) To test the amplifier, what is the known voltage that is put in to establish a constant for machine calibration - ANSWER>>>50 k ohms What are the 4 factors that limit adherence to PAP therapy - ANSWER>>>upper airway anatomy, type of PAP equipment, interface, patient attitude towards CPAP

What is a common PSG EEG finding from long term benzodiazepine usage

• ANSWER>>>increased spindle activity What is one common characteristic that all anti-depressants have - ANSWER>>>They are all REM suppressors What patient population would you use an expanded montage for - ANSWER>>>children, seizure activity What is ground loop electricity - ANSWER>>>Electricity that flows through the patient resulting in a microshock If the head circumference is 60 cm, what is the distance between F7 and T5 - ANSWER>>>20% the distance of the head circumferenece of 12 cm What is the distance of each electrode placement - ANSWER>>>10% the circumference of the head How is central apnea scored - ANSWER>>>greater than 5 events/hour over a period of at least 2 hours or more What is the rule for PLM's - ANSWER>>>4 or more consecutive LM, 0.5 to 90 sec between each movement , LM can't last less than 0.5 sec or greater than 10 sec, can't be scored if associated with a RERA

When is capnography ALWAYS used - ANSWER>>>pediatric patients less than 13 yrs old What is the downfall of the intercostal EMG - ANSWER>>>Will only see activation if the patient really uses the intercostal muscles What stages of sleep will you see PLM's on the PSG in a patient that has PLM's - ANSWER>>>PLM's usually appear at sleep onset persisting into N1,N2 and N3, movements are usually absent during REM Which electrodes are monitored during an MSLT - ANSWER>>>EEG, EOG, chin, EKG How can hypnogogic hallucinations present - ANSWER>>>auditory or visual, caused from anxiety of sleep paralysis, rarely greater than 20 min in length What electrodes pick up alpha waves - ANSWER>>>O1 and O What type of arrythmia is considered life threatening - ANSWER>>>V tach, V fib, 3rd degree heart block What is adjustment insomnia - ANSWER>>>usually temporary due to stress on conflict in your life whether good or bad What part of the sleep phase would you expect to see nightmares - ANSWER>>>last 1/3 (REM predominates the last 1/3)

When is stimulant use prescribed for recurrent hypersomnia - ANSWER>>>during episodes of hypersomnolence In UPPP, how effective is the surgery and how do you determine it's effectiveness - ANSWER>>>50% effective, 90% still need PAP , follow up PSG to determine how effective surgery is How is an HST scored - ANSWER>>>It is only scored on sleep time and not on actual sleep stages due to the fact that there are no EEG electrodes How long can an episode last in Klein-Levin syndrome - ANSWER>>>minimum of 3 days up to weeks at a time What is advanced sleep phase mean - ANSWER>>>Known as "early bird", the patient goes to bed early and rises very early in the am In OSA, what will you see in the REM cycle - ANSWER>>>increased apnea episodes due to poor muscle tone What are some other names used instead of OSA - ANSWER>>>sleep apnea, obstructive apnea, upper airway apnea, seep apnea syndrome What is the definition of OSA - ANSWER>>>Repetitive episodes of UPPER AIRWAY OBSTRUCTION THAT OCCURS DURING SLEEP, usually associated with a reduction in PaSO

What does cataplectic mean - ANSWER>>>sudden emotional shock to a narcoleptic causing sudden pralysis but still being awake What does ROC and LOC mean - ANSWER>>>ROC = right outter canthus, LOC = left outter canthus How long does an apnea have to last to be counted - ANSWER>>>minimum of 10 seconds What poses a higher fail rate on an HST - ANSWER>>>auto-titration What is the most common level of PSG used in HST's - ANSWER>>>Level III and there is usually no EEG electrodes What is double referencing mean - ANSWER>>>selecting the average between your M1 and M2 or by bridging or linking the ears In sleep apnea of infancy, what will you see in the REM stage - ANSWER>>>Improvement in CSA events during REM What are considered environmental signals - ANSWER>>>AC noise ( Hz) What happens to thoracic pressure on inspiration - ANSWER>>>In increases

What is the GOLD standard for detecting respiratory effort - ANSWER>>>esophageal manometry What is corneal retinal potential - ANSWER>>>As the eye changes direction so does the dipole (charge) due to the cornea being postively (+) charged and the retina being negatively (-) charged. This is the potential that is being measured with the eye electrodes that detect eye movement If a patient has CJD, what do you do with the electrodes - ANSWER>>>Throw them away Where is the EXACT measurement for the placement of the eye electrodes

• ANSWER>>>Right eye - 1cm above the outer canthus, Left eye - 1 cm below the outer canthus What are the signs of hypoxia - ANSWER>>>arrythmia, altered mental status, cyanosis, decreased SpO2, increased HR, increased WOB, dusky skin What does a negative deflection look like on the eye tracing - ANSWER>>>an upward deflection Who is an HST for - ANSWER>>>patients with moderate to severe OSA WITH NO CO-MORBIDITIES, urgent treatment is needed but a standard PSG is unavailable or an in lab study isn't possible, to monitor the response to non CPAP treatment for OSA

Where are the leg electrodes placed - ANSWER>>>2 electrodes placed over the anterior tibialis muscle, 2-3 cm apart or 1/3 of the length of the anterior tibialis What are some uses for actigraphy - ANSWER>>>used to assess ADHD, used to see if someone has circadian rhythm disorder, pain management, PLMD, insomnia, hypersomnia What is the equation for deflection - ANSWER>>>D =V/S What will your waveform look like if your nasal flow is limited - ANSWER>>>the waveform will be flattened out What is actigraphy - ANSWER>>>-non-invasive method of monitoring human rest/activity cycles.

• usually a small monitor worn around the wrist What is the equation for voltage - ANSWER>>>V = S x D What is low density REM - ANSWER>>>There are very few if any eye movement during REM How is N3 sleep identifed on the PSG - ANSWER>>>amount of delta waves in the entire epoch, usually at least 20% What is the peak age of narcolepsy - ANSWER>>>adolescence (15 - 25 yrs old)

What is a K complex and when is it commonly seen - ANSWER>>>sharp negative/positive wave seen in N2 sleep How do you score a hypopnea that also has an apnea waveform - ANSWER>>>If a portion of an event that meets criteria for hypopnea also meets criteria for apnea, then the entire event is scored as an apnea What is hypocretin 2 - ANSWER>>>protein found in the brain and CSF narcoleptics have an absence of hypocretin in CSF To be diagnosed for narcolepsy, what should be the average sleep latency

• ANSWER>>>less than 8 minutes What do RIP belts stand for - ANSWER>>>Respiratory Inductance Plethysmography How is an actigraphy typically used - ANSWER>>>logs movements for a minimum of 72 hrs up to 14 days, patients also have to keep a daily journal of daily activities If your sleep patient has a beard, where is an alternative site for the jaw electrodes - ANSWER>>>The masseter muscle at the back of the jaw How are the EKG electrodes placed - ANSWER>>>1 electrode prallel to the right shoulder 1 electrode parallel to the left hip

True or false, in CSA there is an intermittent obstruction of the oropharyngeal airway - ANSWER>>>False Most nocturnal seizures happen in what part of the brain - ANSWER>>>Frontal and temporal lobes What type of patients are more likely to present with CSA - ANSWER>>>greater than 60 yrs old, CHF (25-40%), Stroke (10%), A fib, hypocapnic *How do you figure REM latency - ANSWER>>>REM onset epoch - sleep onset epoch / 2 What is considered the GOLD standard for treating OSA - ANSWER>>>CPAP Who has to prescribe oral appliances - ANSWER>>>a dentist Where are the eye leads placed - ANSWER>>>Right eye is placed on upper corner of the eye Left eye is placed on lower corner of eye If you can't get the impedance below the desired levels, what can/should you do - ANSWER>>>reposition and replace electrodes as necessary

If the eyes move towards either electrode, what will the positve and negative charge look like - ANSWER>>>There will be a postive charge in the direction the eyes are looking What does behaviorally induced insufficient sleep syndrome meand - ANSWER>>>a person isn't spending enough time in bed What are the different classifications of PSG - ANSWER>>>Level I = done in a sleep lab Level II = uses 7 channels Level III = uses 4 channels Level IV = uses 3 channels How does respiratory artifact appear - ANSWER>>>low frequency baseling sway and is usually positional and will appear rhythmic If an HST fails, what is the next step in the testing process - ANSWER>>>In lab study How are apnea and hypopnea scored - ANSWER>>>from the lowest point of the last normal breath to the start of the next normal breath What is the averaging time for oximetry - ANSWER>>>3 seconds Where do you place the piezoelectric sensor - ANSWER>>>slightly off midline of the trachea

What percentage of time is a person in each stage of sleep - ANSWER>>>N1 = 2-5%, N2 = 40-50%, N3 = 24%, REM = 25% If a patient has rhythmic movement disorder that primarily involves the arms, where can you place the leg leads - ANSWER>>>on the arms What electrodes pick up beta waves - ANSWER>>>C3, C What is the best way to dispose of cidex - ANSWER>>>according to the manufacturers directions HFF is automatically set at what Hz setting - ANSWER>>>35 Hz What is normal paper speed for a PSG and an EEG - ANSWER>>>PSG - 10 mm/sec, EEG - 30 mm/sec What is shy-drager syndrome - ANSWER>>>degenerative multiple system atrophy *symptoms resemble Parkinson What is the equation for sensitivity - ANSWER>>>S = V/D What are some aternative treatment for OSA other than a PSG - ANSWER>>>oral appliances, tracheostomy, weight loss, surgery on the upper airway

What type of electrical charge will there be if the eyes are looking toward the direction of an electrode - ANSWER>>>a positive charge What does a positive deflection look like on the eye tracing - ANSWER>>>a downward deflection Why do hypoxemic patients usually complain of morning headaches - ANSWER>>>as a result of hypercapnia What is a common c/o an OSA patient - ANSWER>>>insomnia due to fragmented sleep, not feeling rested What are some other names used to describe infant sleep apnea - ANSWER>>>apnea of prematurity, SIDS, APNEA OF INFANCY MWT trial durations are how long - ANSWER>>>40 min Hypoxemic syndrome and sleep related hypoventilation are typically seen in what types of patients - ANSWER>>>patients with neuromuscular diseases What is the preferred alternative measuring device instead of esophageal manometry - ANSWER>>>intercostal EMG *How do you figure the average sleep latency in an MSLT - ANSWER>>>add up all the sleep onset times then divide by the number of naps taken

What are the key steps to an MSLT - ANSWER>>>series of 5 naps, 1st nap 1.5 to 3 hrs after normal wake time, light breakfast and lunch after first 2 naps, awake nap lasts 15 min after sleep onset, if no sleep onset then the nap lasts 20 min What does it mean when you see bradytachycardia during an apnea event

• ANSWER>>>through one episode of apnea the HR will slow then towards the end of the apnea the HR will become fast How long does an apnea episode have to last for it to be counted - ANSWER>>>At least 10 sec What would likely cause a cataplectic attack on a narcoleptic - ANSWER>>>humor What is required for a postive MWT - ANSWER>>>average sleep latency of less than 8 min In a narcoletic patient what will you see on the PSG - ANSWER>>>decreased sleep latency, sleep onset REM, increased N1 sleep True or false, esophageal manometry is the best method to detect breathing effort - ANSWER>>>True

What does hypnopompic mean - ANSWER>>>occurs in the morning when you wake up What does hypnogogic mean - ANSWER>>>occurs at sleep onset What chemical do you use to clean up after all patiens - ANSWER>>>cidex After baseline is established, what type of measurement would you see in a capnography if the patient is hypoventilating - ANSWER>>>a spike of greater than 10 mmHg EtCO2 What do you use to clean up after a patient with AIDS - ANSWER>>>cidex What s a vertex wave and when is it commonly seen - ANSWER>>>sharp negative wave and is commonly seen in the theta frequency What are 3 drug names for non-benzodiazepines - ANSWER>>>zolpidem (ambien), zalepon (sonata, lunesta What class of drugs aggrevates PLM's - ANSWER>>>tricyclic antidepressants Generally SSRI's as a class may do what with the sleep EEG patterns - ANSWER>>>increase REM latency What is the ideal range for impedance in EMG electrodes - ANSWER>>>less than 10 k ohms

What are some other names for recurrent hypersomnia - ANSWER>>>periodic hypersomnia, Kein-Levin syndrome* What would you see on the PSG in the chronic hypoxc/hypoventilation patient - ANSWER>>>periods of decreased Vt lasting from minutes to hours with sustained O2 desat. Will typically be worse in REM sleep How are RERA and hypopnea scored - ANSWER>>>based off of pressure flow What will a hyperventilating waveform look like in the EtCO2 monitor - ANSWER>>>The waveform will have low readings of less than 10 mmHg **How do you measure sleep efficiency - ANSWER>>>(TST/TRT)x100 = SE% How is OSA defined on the PSG - ANSWER>>>absence of airflow but with a presence of effort What are the benefits of the intercostal EMG - ANSWER>>>shorter distance between electrodes, less EKG artifact, increased sensitivity How does esophageal manometry work - ANSWER>>>measures 2- 10 mmHg deflection

• increase with increase effort adjust according to PAP

What is the ideal range for impedance on EOG and EMG electrodes to perform an effective PSG - ANSWER>>>less than 5 k ohms How would the PSG appear in a patient with recurrent hypersomnia - ANSWER>>>sound sleep c/o deep seep, low voltage EEG patterns or diffuse alpha patterns, decreased delta sleep, high sleep efficiency What is the post dictal phase - ANSWER>>>events that happen immediately following a seizure What are the indications for doing an MSLT - ANSWER>>>diagnose narcolepsy, validation of sleepiness What are the treatment for circadium rhythm disorders - ANSWER>>>photo therapy, chromotherapy, better sleep hygeine What is unequivocal sleep - ANSWER>>>3 epoc of undisturbed N1 after sleep onset durin an MSLT What are some treatment options for CSA syndrome in children - ANSWER>>>nocturnal ventilation, CPAP with pressure cycled ventilation, nasal CPAP for patients with pharyngeal collapse, O2, CAN PUT CHILD ON AN APNEA MONITOR, medications

In CSA what would you typically see on the PSG - ANSWER>>>CENTRAL EVEN GREATER THAN 5/HOUR, mild desaturation, increased N1 sleep, DECREASE OCCURENCE OF APNEA IN REM, Cheyn-stokes respiration What is the purpose of an MWT - ANSWER>>>validate the ability to stay awake where the inability to stay awake is a public or personal safety issue What are the steps of an MWT - ANSWER>>>place patient in bed, not a chair, 4 TRIALS OF 40 MIN NAPS AT 2 HR INTERVALS OCCURING 1.5 TO 2 HR AFTER NORMAL WAKE TIME, instruct patient to stay awake as long as possible w/o extraordinary measures to stay awake, end trial when unequivocal sleep is acheived, calculate latency using sleep onet not unequivocal sleep How is narcolepsy treated - ANSWER>>>with orexin What are considered normal varients during sleep - ANSWER>>>long/short sleeper, sleep talking, sleep starts What will a hyoventilating waveform look like on the EtCO2 monitor - ANSWER>>>elevated waveform measuring greater than 10 mmHg To end scoring in REM, what is the ONLY thing needed - ANSWER>>>rise in amplitude of the chin Who is an HST NOT for - ANSWER>>>CHF, severe COPD, uncontrolled HTN, children under 18, neurological disorders, any other sleep disorders