R.EEG.T. Exam Flashcards

Q: How is the R.EEG.T. exam structured in 2026?

The ABRET R.EEG.T. exam is a 4-hour computer-based multiple-choice test delivered through Prometric (with a live remote proctoring option). The content outline weights Pre-Study/Patient Preparation at 25% and Performing the Study at 75%, so the majority of study time should focus on recording, montages, artifacts, and waveform identification.

Q: What score do I need to pass the R.EEG.T. exam?

ABRET uses a criterion-referenced passing standard with equated scoring set by board members and psychometric analysis, not a fixed percentage. Different exam forms are statistically equated for difficulty so candidates are judged against a consistent competency standard regardless of which form they receive.

Q: What is the R.EEG.T. exam pass rate?

ABRET 2024 Exam Statistics report a 53% first-time pass rate across all eligibility pathways, with CAAHEP-accredited program graduates around 51% and bachelor's-degree candidates around 59%. ABRET has noted declining pass rates across the field since 2022, underscoring the need for thorough preparation.

Q: Who is eligible for the R.EEG.T. exam?

Pathways include graduating from a CAAHEP-accredited neurodiagnostic technology program, completing a formal NDT program with documented EEGs, or holding an associate degree or higher with documented clinical EEG experience (commonly 50-150 routine EEGs depending on pathway). Current CPR/BLS certification is required for all pathways.

Q: What happens if I fail the R.EEG.T. exam?

Candidates may reapply and retake the exam. After 3 unsuccessful attempts within a 2-year timeframe, a candidate must wait 6 months and submit 20 EEG ASET continuing education credits before reapplying. The $700 exam fee is nonrefundable and not transferable.

Question 1

International 10-20 System

Accepted Answer

Standardized electrode placement using 10% and 20% fractions of nasion-inion and preauricular distances. The fractions make placement reproducible across head sizes so recordings are comparable between patients and labs.

Question 2

10-20 electrode nomenclature

Accepted Answer

Letters denote brain region (Fp frontopolar, F frontal, C central, P parietal, T temporal, O occipital). Odd numbers are left hemisphere, even numbers are right, and 'z' marks the midline (Fz, Cz, Pz).

Question 3

Fp1 placement

Accepted Answer

Located 10% of the nasion-to-inion distance above the nasion along the midline, then 10% of the transverse distance to the left. Correct measurement is essential because mislocated frontopolar electrodes distort frontal and eye-movement interpretation.

Question 4

Conductive paste/gel purpose

Accepted Answer

Provides a low-impedance electrical pathway between the electrode and scalp, reducing resistance, improving signal quality, and minimizing artifact. Poor contact raises impedance and introduces 60 Hz and pop artifact.

Question 5

Electrode impedance standard

Accepted Answer

Keep impedances between 100 and 5,000 ohms (under 5 kilohms) and reasonably balanced. High or unequal impedance degrades common mode rejection and produces 60 Hz interference; re-prep the site rather than relying on filters.

Question 6

Scalp wound/laceration handling

Accepted Answer

Place electrodes around the wound, avoid direct contact to prevent infection and discomfort, and document the modification so the interpreter knows which positions were repositioned and why the montage deviates from standard.

Question 7

Corpus callosum

Accepted Answer

The largest white-matter commissure connecting the cerebral hemispheres and enabling interhemispheric communication. Relevant to EEG because it underlies bilateral synchrony and the spread of generalized discharges.

Question 8

Thalamus role in EEG rhythms

Accepted Answer

The thalamus acts as a pacemaker generating and synchronizing cortical rhythms, including sleep spindles and the thalamocortical 3 Hz spike-and-wave of absence epilepsy. EEG largely reflects cortical postsynaptic potentials modulated by the thalamus.

Question 9

Source of the scalp EEG signal

Accepted Answer

Scalp EEG reflects summated excitatory and inhibitory postsynaptic potentials of cortical pyramidal neurons, not action potentials. Large synchronous populations are required for a deflection to be visible at the scalp.

Question 10

REM sleep neurotransmitter

Accepted Answer

Acetylcholine is the primary neurotransmitter generating REM sleep; brainstem cholinergic (REM-on) neurons interact reciprocally with aminergic (REM-off) neurons. Understanding state control aids correlation of EEG sleep patterns.

Question 11

Alpha rhythm

Accepted Answer

8-13 Hz posterior dominant rhythm seen in a relaxed adult with eyes closed; it attenuates with eye opening or attention. Slowing of the posterior dominant rhythm suggests encephalopathy or a structural process.

Question 12

Beta, theta, delta bands

Accepted Answer

Beta: above 13 Hz (alert, drowsy, sedative-induced). Theta: 4 to under 8 Hz (drowsiness, children). Delta: under 4 Hz (deep sleep; pathologic if focal/persistent in awake adults).

Question 13

Mu rhythm

Accepted Answer

A 7-11 Hz arch-shaped rhythm over the central (sensorimotor) regions that attenuates with contralateral movement or its intention. Recognizing mu prevents mislabeling a normal variant as abnormal.

Question 14

Lambda waves

Accepted Answer

Sharp, positive occipital transients occurring during visual scanning of a complex image in the awake patient with eyes open. A normal variant; not epileptiform, but can be confused with occipital sharp waves.

Question 15

POSTS (positive occipital sharp transients of sleep)

Accepted Answer

Sharp, positive occipital waves occurring in light sleep, often in runs. A normal sleep variant that must be distinguished from occipital epileptiform discharges.

Question 16

Vertex sharp waves and K-complexes

Accepted Answer

Vertex sharp waves are sharp negative transients maximal at Cz in N1-N2 sleep. K-complexes are large biphasic transients (often with spindles) in N2. Both are normal sleep features, not epileptiform.

Question 17

Wicket spikes and BETS

Accepted Answer

Wicket spikes (temporal arciform runs) and benign epileptiform transients of sleep (BETS/SSS) are normal variants frequently mistaken for epileptiform activity. Misidentification can lead to an incorrect epilepsy implication.

Question 18

Referential vs bipolar montage

Accepted Answer

Referential montage measures each electrode against a common reference and best shows the amplitude/field of widespread activity. Bipolar montage links adjacent electrodes in chains and best localizes a focus by phase reversal.

Question 19

Phase reversal

Accepted Answer

In a bipolar chain, deflections pointing toward each other (or away) at adjacent channels localize the maximum of a discharge to the shared electrode. It is the key bipolar localization principle, not a sign of abnormality itself.

Question 20

Common reference contamination

Accepted Answer

If the reference electrode is active (e.g., ECG, near a discharge), the artifact appears in all channels using that reference. Recognizing reference contamination prevents misreading shared activity as widespread cerebral activity.

Question 21

Minimum recording requirements

Accepted Answer

A standard adult EEG uses the full 10-20 array, includes wakefulness and (when possible) drowsiness/sleep, runs at least about 20-30 minutes of artifact-free recording, and uses multiple montages for adequate sampling.

Question 22

Common mode rejection ratio (CMRR)

Accepted Answer

The differential amplifier's ability to cancel signals common to both inputs (e.g., 60 Hz). High CMRR with balanced low impedances suppresses environmental noise; degraded CMRR is a leading cause of mains artifact.

Question 23

Sensitivity in EEG

Accepted Answer

The ratio of input voltage to pen/display deflection (e.g., 7 microvolts/mm). Lower numeric sensitivity values yield larger deflections. Sensitivity must be adjusted so low-voltage records are not missed and high-voltage records are not clipped.

Question 24

Low-frequency (high-pass) filter effect

Accepted Answer

The LFF attenuates slow activity below its setting (typical 1 Hz or time constant 0.3 s). Raising it too high removes legitimate delta/slow waves and can mask slowing; lowering it admits sweat and movement artifact.

Question 25

High-frequency (low-pass) filter effect

Accepted Answer

The HFF attenuates fast activity above its setting (typically 70 Hz). Set too low, it rounds spikes and muscle/fast activity, potentially blunting epileptiform sharpness; this can cause under-recognition of true spikes.

Question 26

Notch (60 Hz) filter caution

Accepted Answer

The 60 Hz notch filter suppresses mains interference but can attenuate or distort genuine activity near 60 Hz and masks an underlying impedance problem. Fix electrode contact first; use the notch as a last resort.

Question 27

Sampling rate and aliasing

Accepted Answer

By the Nyquist principle the sampling rate must exceed twice the highest frequency of interest; clinical EEG typically samples at 256 Hz or higher. Under-sampling causes aliasing, falsely representing fast activity as slower waveforms.

Question 28

Calibration signal purpose

Accepted Answer

A known square-wave or sine voltage applied to all channels verifies equal amplifier gain, filter settings, and pen/display response before recording. Unequal calibration invalidates amplitude and asymmetry interpretation.

Question 29

Digital EEG advantage: reformatting

Accepted Answer

Digitally acquired EEG referenced to a common reference can be reformatted into any montage, filter, and sensitivity after acquisition. This lets the interpreter re-examine events without re-recording the patient.

Question 30

Hyperventilation activation

Accepted Answer

3-5 minutes of overbreathing induces hypocapnia and cerebral vasoconstriction, normally producing diffuse slowing (buildup) and notably activating absence (3 Hz spike-wave) epilepsy. Contraindicated in recent stroke, significant cardiopulmonary disease, sickle cell, or moyamoya.

Question 31

Photic stimulation

Accepted Answer

Flashing light at varying frequencies tests for a photoparoxysmal response (generalized spike-wave) and helps assess photosensitive epilepsy. A photic driving response time-locked to the flash is a normal occipital finding.

Question 32

Sleep deprivation as activation

Accepted Answer

A sleep-deprived recording increases the yield of epileptiform discharges, especially in generalized epilepsies, by promoting drowsiness and sleep, the states when many abnormalities appear. It is a planned activation, not an artifact source to suppress.

Question 33

Sleep stage hallmarks in EEG

Accepted Answer

N1: vertex waves, slow eye movements. N2: spindles and K-complexes. N3: high-amplitude delta. REM: low-voltage mixed frequency, sawtooth waves, lowest chin tone. Correct staging supports identification of state-dependent abnormalities.

Question 34

Eye-movement (EOG) artifact

Accepted Answer

Eye movements create frontal deflections from the corneoretinal dipole: eye blink shows symmetric frontal downward deflections; lateral gaze produces out-of-phase frontotemporal deflections. Recognize so it is not read as frontal slowing/sharp waves.

Question 35

Muscle (EMG) artifact

Accepted Answer

Brief, high-frequency, spiky activity from scalp/facial muscle tension, often temporal and worse with jaw clenching. Reassure and reposition the patient or use slight HFF; do not mistake bursts for fast epileptiform discharges.

Question 36

ECG artifact

Accepted Answer

Regular sharp transients time-locked to the QRS complex, more common in short-necked patients and with reference issues. Use a simultaneous ECG channel to confirm timing; manage by re-referencing rather than mislabeling as periodic discharges.

Question 37

Electrode pop artifact

Accepted Answer

An abrupt, single-channel high-amplitude transient with a sudden vertical jump from a momentarily disconnected or unstable electrode. It is confined to one electrode's derivations, distinguishing it from a cerebral discharge with a logical field.

Question 38

60 Hz interference

Accepted Answer

Rhythmic 60 Hz contamination from environmental electrical sources, usually worsened by high/unbalanced impedance or a loose electrode. Correct impedance and remove offending devices before applying a notch filter.

Question 39

Physiologic vs technical artifact

Accepted Answer

Physiologic artifact arises from the patient (eye, muscle, ECG, sweat, pulse, glossokinetic). Technical artifact arises from equipment/environment (electrode pop, 60 Hz, cable movement). Source identification dictates the correct correction.

Question 40

Sweat and glossokinetic artifact

Accepted Answer

Sweat causes very-slow (under 0.5 Hz) undulating baseline sway; tongue movement (glossokinetic) produces slow potentials maximal frontally. Both are slow, non-cerebral, and corrected by cooling/drying or by reducing the LFF appropriately.

Question 41

Spike vs sharp wave

Accepted Answer

By convention a spike has a duration of 20-70 ms and a sharp wave 70-200 ms. Both are epileptiform when they stand out from background with a physiologic field; duration only differs, not clinical implication.

Question 42

3 Hz spike-and-wave

Accepted Answer

Generalized, symmetric, frontally maximal 3 Hz spike-and-wave discharges, classically activated by hyperventilation, are the signature of childhood/juvenile absence epilepsy and correlate with brief impaired awareness.

Question 43

Periodic lateralized discharges (PLDs/LPDs)

Accepted Answer

Repetitive lateralized sharp/spike complexes at near-regular intervals over one region. In a febrile patient with temporal PLDs, strongly suspect herpes simplex encephalitis; PLDs generally indicate an acute focal destructive process.

Question 44

Triphasic waves

Accepted Answer

Bilateral, often frontally predominant waves with a characteristic three-phase morphology and an anterior-posterior lag, classically associated with metabolic/hepatic encephalopathy rather than a primary epileptic focus.

Question 45

Burst-suppression pattern

Accepted Answer

Alternating high-amplitude bursts and near-flat suppression, indicating severe diffuse cerebral dysfunction (deep anesthesia, hypothermia, severe anoxic injury). It signals critical depression of cortical activity and warrants prompt physician notification.

Question 46

Electrocerebral inactivity recording

Accepted Answer

EEG performed in the brain-death evaluation requires a specialized technical protocol: extended interelectrode distances, increased sensitivity (e.g., 2 microvolts/mm), defined filters, and documentation of reactivity, following ACNS guidelines.

Question 47

Neonatal vs adult EEG differences

Accepted Answer

Neonatal EEG is discontinuous (tracé alternant/discontinu), has slower frequencies, and is interpreted by conceptional age. Applying adult criteria to a neonatal record leads to misinterpretation; age-appropriate norms are essential.

Question 48

Medication effects on EEG

Accepted Answer

Benzodiazepines and barbiturates increase fast (beta) activity; many sedatives and anticonvulsants alter background and can suppress or slow it. Documenting current medications lets the interpreter avoid attributing drug effects to disease.

Question 49

Patient history before recording

Accepted Answer

Document age, clinical question, medications, last seizure, sleep deprivation status, and relevant neurologic history. The reason for the study guides montage and activation choices and is essential context for clinical correlation.

Question 50

ABRET Code of Ethics: reporting an error

Accepted Answer

If a technologist discovers an error in a patient's EEG report, the obligation is to report it through appropriate professional channels to the interpreting physician, maintaining accuracy and patient safety rather than concealing the mistake.

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