EEG BOARD PREP ASAP T COMPLETE STUDY GUIDE 2025/2026 | VERIFIED
EEG BOARD EXAM QUESTIONS AND ANSWERS WITH DETAILED RATIONALES |
COMPREHENSIVE REVIEW OF ELECTROENCEPHALOGRAPHY PRINCIPLES,
WAVEFORM INTERPRETATION, NEUROLOGICAL DISORDERS, PATIENT
PREPARATION, SAFETY PROTOCOLS, AND CLINICAL CASE STUDIES | INTENSIVE
BOARD REVIEW MATERIAL FOR FAST TRACK EXAM SUCCESS
Question 1: Which electrode placement in the International 10-20 System is located at the midpoint
between Fz and Cz?
A. Fpz
B. FCz
C. CPz
D. Pz
CORRECT ANSWER: B. FCz
RATIONALE: In the International 10-20 System, FCz is positioned at the midpoint between Fz (frontal
midline) and Cz (central midline). This standardized placement ensures consistent electrode positioning
across recordings and laboratories, facilitating accurate comparison of EEG data.
Question 2: What is the typical frequency range of alpha rhythm in a relaxed adult with eyes closed?
A. 1-3 Hz
B. 4-7 Hz
C. 8-13 Hz
D. 14-30 Hz
CORRECT ANSWER: C. 8-13 Hz
RATIONALE: Alpha rhythm, also known as the posterior dominant rhythm, typically occurs in the 8-13
Hz frequency range in awake, relaxed adults with eyes closed. It is most prominent over the occipital
regions and attenuates with eye opening or mental activity, a phenomenon called alpha blockade.
Question 3: Which of the following EEG patterns is most characteristic of absence seizures?
A. Polyspike-and-wave discharges at 4-6 Hz
B. 3 Hz generalized spike-and-wave discharges
C. Hypsarrhythmia
D. Temporal lobe spikes at 2-4 Hz
CORRECT ANSWER: B. 3 Hz generalized spike-and-wave discharges
RATIONALE: Absence seizures are classically associated with generalized, symmetric, 3 Hz spike-and-
wave discharges on EEG. These discharges have a sudden onset and offset, correlate with brief lapses in
consciousness, and are typically activated by hyperventilation.
Question 4: During EEG recording, a 60 Hz artifact is most likely caused by:
,A. Electrode pop
B. Sweat artifact
C. Electrical interference from power lines
D. Eye blink artifact
CORRECT ANSWER: C. Electrical interference from power lines
RATIONALE: A 60 Hz artifact (50 Hz in some countries) typically results from electromagnetic
interference from alternating current power lines or improperly grounded equipment. This appears as a
fast, regular sinusoidal activity across multiple channels and can be minimized by checking grounding,
electrode impedance, and using notch filters appropriately.
Question 5: Which sleep stage is characterized by the presence of sleep spindles and K-complexes?
A. N1
B. N2
C. N3
D. REM
CORRECT ANSWER: B. N2
RATIONALE: Stage N2 sleep is defined by the presence of sleep spindles (12-14 Hz bursts) and K-
complexes (high-amplitude biphasic waves) on EEG. These features distinguish N2 from N1 (which has
theta activity and vertex waves) and N3 (which has high-amplitude delta activity comprising ≥20% of the
epoch).
Question 6: What is the recommended minimum sampling rate for digital EEG recording according to
ACNS guidelines?
A. 100 Hz
B. 200 Hz
C. 500 Hz
D. 1000 Hz
CORRECT ANSWER: C. 500 Hz
RATIONALE: The American Clinical Neurophysiology Society (ACNS) recommends a minimum sampling
rate of 500 Hz for routine digital EEG to adequately capture frequencies up to 70 Hz without aliasing, per
the Nyquist theorem which requires sampling at least twice the highest frequency of interest.
Question 7: Which of the following is a normal variant EEG pattern seen in healthy adolescents and
young adults?
A. Triphasic waves
B. Mu rhythm
C. Periodic lateralized epileptiform discharges (PLEDs)
D. Generalized periodic discharges
CORRECT ANSWER: B. Mu rhythm
,RATIONALE: Mu rhythm is a normal variant characterized by arch-shaped waves at 8-13 Hz over central
regions, often asynchronous between hemispheres. It is blocked by contralateral motor activity or
intention to move, distinguishing it from epileptiform activity. It is commonly seen in healthy
adolescents and adults.
Question 8: In neonatal EEG, what is the typical background pattern for a full-term infant at 40 weeks
conceptional age during quiet sleep?
A. Trace discontinu
B. Trace alternant
C. Continuous low-voltage irregular
D. Hypsarrhythmia
CORRECT ANSWER: B. Trace alternant
RATIONALE: Trace alternant is the characteristic quiet sleep pattern in full-term neonates at 40 weeks
conceptional age, consisting of bursts of high-voltage slow waves (3-6 seconds) alternating with periods
of low-voltage activity (2-6 seconds). Trace discontinu is seen in premature infants, while
hypsarrhythmia is pathological and associated with infantile spasms.
Question 9: Which filter setting is most appropriate to reduce slow-wave artifact from sweating
during EEG recording?
A. High-frequency filter at 35 Hz
B. Low-frequency filter at 1 Hz
C. Low-frequency filter at 0.1 Hz
D. Notch filter at 60 Hz
CORRECT ANSWER: B. Low-frequency filter at 1 Hz
RATIONALE: Sweat artifact produces very slow waveforms (<0.5 Hz). Setting the low-frequency filter
(high-pass filter) to 1 Hz attenuates these slow artifacts while preserving clinically relevant EEG
frequencies. However, this should be used judiciously as it may also attenuate genuine slow activity of
pathological significance.
Question 10: What EEG finding is most suggestive of herpes simplex encephalitis?
A. Generalized spike-and-wave discharges
B. Periodic lateralized epileptiform discharges (PLEDs) over temporal regions
C. Burst-suppression pattern
D. Frontal intermittent rhythmic delta activity (FIRDA)
CORRECT ANSWER: B. Periodic lateralized epileptiform discharges (PLEDs) over temporal regions
RATIONALE: Herpes simplex encephalitis typically affects the temporal lobes and often produces PLEDs
(also called lateralized periodic discharges) over temporal or frontotemporal regions. These are
repetitive, stereotyped discharges occurring at 0.5-2.0 Hz and are highly suggestive of acute focal
cerebral pathology such as viral encephalitis or stroke.
, Question 11: Which of the following best describes the montage where each channel displays the
difference between two adjacent scalp electrodes?
A. Referential montage
B. Bipolar montage
C. Average reference montage
D. Laplacian montage
CORRECT ANSWER: B. Bipolar montage
RATIONALE: In a bipolar montage, each channel represents the voltage difference between two
adjacent electrodes in a chain (e.g., Fp1-F3, F3-C3, C3-P3). This arrangement helps localize electrical
fields by identifying phase reversals, whereas referential montages compare each electrode to a
common reference point.
Question 12: What is the primary clinical significance of recognizing benign epileptiform transients of
sleep (BETS)?
A. They indicate high risk for developing epilepsy
B. They are often misinterpreted as epileptiform activity but are normal variants
C. They require immediate antiepileptic drug initiation
D. They are pathognomonic for temporal lobe epilepsy
CORRECT ANSWER: B. They are often misinterpreted as epileptiform activity but are normal variants
RATIONALE: BETS (also called small sharp spikes) are low-amplitude, brief spikes seen during
drowsiness and light sleep in healthy adults. They lack after-going slow waves, do not disrupt
background activity, and are not associated with epilepsy. Recognizing them prevents misdiagnosis and
unnecessary treatment.
Question 13: During hyperventilation activation in EEG, which finding is considered abnormal in an
adult?
A. Buildup of high-amplitude delta activity that resolves within 30 seconds post-hyperventilation
B. Generalized slowing that persists for more than 60 seconds after cessation
C. Mild increase in theta activity during the procedure
D. Symmetric posterior slowing in a cooperative patient
CORRECT ANSWER: B. Generalized slowing that persists for more than 60 seconds after cessation
RATIONALE: While some generalized slowing during and immediately after hyperventilation is normal
due to respiratory alkalosis, persistence of slowing beyond 60 seconds post-procedure may indicate
underlying cerebral dysfunction, such as metabolic encephalopathy, cerebrovascular disease, or
epilepsy.
Question 14: Which EEG pattern is most characteristic of Creutzfeldt-Jakob disease?
A. Triphasic waves
B. Generalized periodic discharges at 0.5-2 Hz
EEG BOARD EXAM QUESTIONS AND ANSWERS WITH DETAILED RATIONALES |
COMPREHENSIVE REVIEW OF ELECTROENCEPHALOGRAPHY PRINCIPLES,
WAVEFORM INTERPRETATION, NEUROLOGICAL DISORDERS, PATIENT
PREPARATION, SAFETY PROTOCOLS, AND CLINICAL CASE STUDIES | INTENSIVE
BOARD REVIEW MATERIAL FOR FAST TRACK EXAM SUCCESS
Question 1: Which electrode placement in the International 10-20 System is located at the midpoint
between Fz and Cz?
A. Fpz
B. FCz
C. CPz
D. Pz
CORRECT ANSWER: B. FCz
RATIONALE: In the International 10-20 System, FCz is positioned at the midpoint between Fz (frontal
midline) and Cz (central midline). This standardized placement ensures consistent electrode positioning
across recordings and laboratories, facilitating accurate comparison of EEG data.
Question 2: What is the typical frequency range of alpha rhythm in a relaxed adult with eyes closed?
A. 1-3 Hz
B. 4-7 Hz
C. 8-13 Hz
D. 14-30 Hz
CORRECT ANSWER: C. 8-13 Hz
RATIONALE: Alpha rhythm, also known as the posterior dominant rhythm, typically occurs in the 8-13
Hz frequency range in awake, relaxed adults with eyes closed. It is most prominent over the occipital
regions and attenuates with eye opening or mental activity, a phenomenon called alpha blockade.
Question 3: Which of the following EEG patterns is most characteristic of absence seizures?
A. Polyspike-and-wave discharges at 4-6 Hz
B. 3 Hz generalized spike-and-wave discharges
C. Hypsarrhythmia
D. Temporal lobe spikes at 2-4 Hz
CORRECT ANSWER: B. 3 Hz generalized spike-and-wave discharges
RATIONALE: Absence seizures are classically associated with generalized, symmetric, 3 Hz spike-and-
wave discharges on EEG. These discharges have a sudden onset and offset, correlate with brief lapses in
consciousness, and are typically activated by hyperventilation.
Question 4: During EEG recording, a 60 Hz artifact is most likely caused by:
,A. Electrode pop
B. Sweat artifact
C. Electrical interference from power lines
D. Eye blink artifact
CORRECT ANSWER: C. Electrical interference from power lines
RATIONALE: A 60 Hz artifact (50 Hz in some countries) typically results from electromagnetic
interference from alternating current power lines or improperly grounded equipment. This appears as a
fast, regular sinusoidal activity across multiple channels and can be minimized by checking grounding,
electrode impedance, and using notch filters appropriately.
Question 5: Which sleep stage is characterized by the presence of sleep spindles and K-complexes?
A. N1
B. N2
C. N3
D. REM
CORRECT ANSWER: B. N2
RATIONALE: Stage N2 sleep is defined by the presence of sleep spindles (12-14 Hz bursts) and K-
complexes (high-amplitude biphasic waves) on EEG. These features distinguish N2 from N1 (which has
theta activity and vertex waves) and N3 (which has high-amplitude delta activity comprising ≥20% of the
epoch).
Question 6: What is the recommended minimum sampling rate for digital EEG recording according to
ACNS guidelines?
A. 100 Hz
B. 200 Hz
C. 500 Hz
D. 1000 Hz
CORRECT ANSWER: C. 500 Hz
RATIONALE: The American Clinical Neurophysiology Society (ACNS) recommends a minimum sampling
rate of 500 Hz for routine digital EEG to adequately capture frequencies up to 70 Hz without aliasing, per
the Nyquist theorem which requires sampling at least twice the highest frequency of interest.
Question 7: Which of the following is a normal variant EEG pattern seen in healthy adolescents and
young adults?
A. Triphasic waves
B. Mu rhythm
C. Periodic lateralized epileptiform discharges (PLEDs)
D. Generalized periodic discharges
CORRECT ANSWER: B. Mu rhythm
,RATIONALE: Mu rhythm is a normal variant characterized by arch-shaped waves at 8-13 Hz over central
regions, often asynchronous between hemispheres. It is blocked by contralateral motor activity or
intention to move, distinguishing it from epileptiform activity. It is commonly seen in healthy
adolescents and adults.
Question 8: In neonatal EEG, what is the typical background pattern for a full-term infant at 40 weeks
conceptional age during quiet sleep?
A. Trace discontinu
B. Trace alternant
C. Continuous low-voltage irregular
D. Hypsarrhythmia
CORRECT ANSWER: B. Trace alternant
RATIONALE: Trace alternant is the characteristic quiet sleep pattern in full-term neonates at 40 weeks
conceptional age, consisting of bursts of high-voltage slow waves (3-6 seconds) alternating with periods
of low-voltage activity (2-6 seconds). Trace discontinu is seen in premature infants, while
hypsarrhythmia is pathological and associated with infantile spasms.
Question 9: Which filter setting is most appropriate to reduce slow-wave artifact from sweating
during EEG recording?
A. High-frequency filter at 35 Hz
B. Low-frequency filter at 1 Hz
C. Low-frequency filter at 0.1 Hz
D. Notch filter at 60 Hz
CORRECT ANSWER: B. Low-frequency filter at 1 Hz
RATIONALE: Sweat artifact produces very slow waveforms (<0.5 Hz). Setting the low-frequency filter
(high-pass filter) to 1 Hz attenuates these slow artifacts while preserving clinically relevant EEG
frequencies. However, this should be used judiciously as it may also attenuate genuine slow activity of
pathological significance.
Question 10: What EEG finding is most suggestive of herpes simplex encephalitis?
A. Generalized spike-and-wave discharges
B. Periodic lateralized epileptiform discharges (PLEDs) over temporal regions
C. Burst-suppression pattern
D. Frontal intermittent rhythmic delta activity (FIRDA)
CORRECT ANSWER: B. Periodic lateralized epileptiform discharges (PLEDs) over temporal regions
RATIONALE: Herpes simplex encephalitis typically affects the temporal lobes and often produces PLEDs
(also called lateralized periodic discharges) over temporal or frontotemporal regions. These are
repetitive, stereotyped discharges occurring at 0.5-2.0 Hz and are highly suggestive of acute focal
cerebral pathology such as viral encephalitis or stroke.
, Question 11: Which of the following best describes the montage where each channel displays the
difference between two adjacent scalp electrodes?
A. Referential montage
B. Bipolar montage
C. Average reference montage
D. Laplacian montage
CORRECT ANSWER: B. Bipolar montage
RATIONALE: In a bipolar montage, each channel represents the voltage difference between two
adjacent electrodes in a chain (e.g., Fp1-F3, F3-C3, C3-P3). This arrangement helps localize electrical
fields by identifying phase reversals, whereas referential montages compare each electrode to a
common reference point.
Question 12: What is the primary clinical significance of recognizing benign epileptiform transients of
sleep (BETS)?
A. They indicate high risk for developing epilepsy
B. They are often misinterpreted as epileptiform activity but are normal variants
C. They require immediate antiepileptic drug initiation
D. They are pathognomonic for temporal lobe epilepsy
CORRECT ANSWER: B. They are often misinterpreted as epileptiform activity but are normal variants
RATIONALE: BETS (also called small sharp spikes) are low-amplitude, brief spikes seen during
drowsiness and light sleep in healthy adults. They lack after-going slow waves, do not disrupt
background activity, and are not associated with epilepsy. Recognizing them prevents misdiagnosis and
unnecessary treatment.
Question 13: During hyperventilation activation in EEG, which finding is considered abnormal in an
adult?
A. Buildup of high-amplitude delta activity that resolves within 30 seconds post-hyperventilation
B. Generalized slowing that persists for more than 60 seconds after cessation
C. Mild increase in theta activity during the procedure
D. Symmetric posterior slowing in a cooperative patient
CORRECT ANSWER: B. Generalized slowing that persists for more than 60 seconds after cessation
RATIONALE: While some generalized slowing during and immediately after hyperventilation is normal
due to respiratory alkalosis, persistence of slowing beyond 60 seconds post-procedure may indicate
underlying cerebral dysfunction, such as metabolic encephalopathy, cerebrovascular disease, or
epilepsy.
Question 14: Which EEG pattern is most characteristic of Creutzfeldt-Jakob disease?
A. Triphasic waves
B. Generalized periodic discharges at 0.5-2 Hz
