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CMEG practice questions

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First 50 of 190 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

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Question 1MEG sensors, magnetic environment and quality assurance

An instrument specification states 300 femtotesla. Using 1 fT=10^-15 T, which listed value is equivalent?

  1. 3×10^-10 T
  2. 3×10^-15 T
  3. 3×10^-13 T Correct answer.
  4. 3×10^-18 T

Explanation

Three hundred multiplied by ten to the minus fifteen equals three multiplied by ten to the minus thirteen tesla. Keep the prefix conversion separate from any claim about clinical sensitivity.

Question 2MEG sensors, magnetic environment and quality assurance

Which distinction between a conventional SQUID system and an optically pumped magnetometer system is sound?

  1. Their sensor technology and operating requirements differ. Correct answer.
  2. Both must use an identical liquid-helium dewar.
  3. OPM means a modified electrode voltage amplifier.
  4. Changing sensor type removes all environmental magnetic noise.

Explanation

SQUID and optically pumped sensors use different physical principles and operating arrangements. An OPM system should not automatically inherit every cryogenic-SQUID assumption or be assumed immune to environmental interference.

Question 3Preparation, patient protection and equipment safety

A patient asks whether MEG uses the same strong static field and radiofrequency pulses as an MRI scan. Which explanation is appropriate?

  1. MEG intentionally magnetizes the brain before every run.
  2. MEG and MRI always use identical excitation hardware.
  3. The patient can ignore all implant screening because MEG is passive.
  4. MEG records weak magnetic signals; any separate MRI has its own safety assessment. Correct answer.

Explanation

MEG detects magnetic signals rather than using MRI excitation to form the recording. Screening remains necessary for the actual MEG system, accessories, implants and any separate MRI procedure.

Question 4Preparation, patient protection and equipment safety

An implanted stimulator produces a periodic artifact. What is the appropriate technologist response?

  1. Document it and consult the responsible team before any device or treatment change. Correct answer.
  2. Turn off the implant without authorization to improve the trace.
  3. Delete all affected data and report an entirely artifact-free study.
  4. Ask the patient to stop every medicine that affects the recording.

Explanation

Artifact management must preserve patient care and the actual record. The technologist should document the issue and obtain authorized clinical or device guidance rather than independently change treatment.

Question 5Neurophysiological signals, sampling and instrumentation

A supplied ideal averaging model assumes independent zero-mean noise and an unchanged time-locked signal. Increasing trials from 25 to 100 changes SNR by what factor?

  1. 10
  2. 4
  3. 0.25
  4. 2 Correct answer.

Explanation

The model gives signal-to-noise improvement proportional to the square root of trial count. The count ratio is four, so the SNR factor is the square root of four, or two.

Question 6Neurophysiological signals, sampling and instrumentation

Under the same independent-noise averaging model, how many trials are needed to triple the SNR obtained with 20 trials?

  1. 180 Correct answer.
  2. 60
  3. 90
  4. 400

Explanation

Tripling SNR requires nine times as many trials because the improvement is proportional to the square root of count. Nine multiplied by 20 gives 180 valid trials in the supplied model.

Question 7MEG acquisition, tasks and concurrent EEG

A stimulus trigger is stored when a computer command is issued, but sound reaches the ear later through tubing. What should quality testing establish?

  1. That the response peak is forced to zero milliseconds.
  2. Only that the trigger has the largest amplitude.
  3. The actual delivery delay and its stability relative to the stored trigger. Correct answer.
  4. That longer tubing always has no timing effect.

Explanation

The neural latency must be related to actual stimulus delivery. A measured and documented delay helps interpret responses without mistaking equipment timing for a biological change.

Question 8MEG acquisition, tasks and concurrent EEG

A supplied auditory system has a verified 12 ms trigger-to-sound delay. A response occurs 112 ms after the command trigger. What is its latency relative to sound arrival?

  1. 100 ms Correct answer.
  2. 124 ms
  3. 112 ms
  4. 12 ms

Explanation

Subtract the verified delivery delay from command-referenced latency. The result is 112 minus 12, or 100 milliseconds relative to sound arrival under the supplied timing model.

Question 9MEG source models, coregistration and interpretation

Two different distributed current models produce nearly identical sensor fields. What does this illustrate about MEG reconstruction?

  1. The inverse problem needs assumptions or constraints beyond the measured fields. Correct answer.
  2. The two models must represent the identical microscopic neuronal population.
  3. One additional notch filter guarantees a unique solution.
  4. MRI coregistration alone eliminates every source ambiguity.

Explanation

Different source distributions can explain similar measured fields. Reconstruction therefore depends on explicit assumptions, constraints and the clinical question rather than a unique direct photograph of neural activity.

Question 10MEG source models, coregistration and interpretation

A focal dipole has excellent goodness of fit but lies in an anatomically implausible location after a bad coregistration. What is the sound conclusion?

  1. High fit makes the coregistration error irrelevant.
  2. A good sensor-space fit does not validate the anatomical localization. Correct answer.
  3. The source must have moved outside the brain.
  4. Every high-fit dipole is necessarily epileptogenic.

Explanation

Goodness of fit describes a relationship between the model and measured fields. Coordinate and anatomical errors can still make the displayed location misleading despite an excellent fit.

Question 11Documentation, integrity and professional communication

A run contains 240 trials and the reviewed artifact rule rejects 60. How many valid trials remain?

  1. 120
  2. 300
  3. 60
  4. 180 Correct answer.

Explanation

Subtract the rejected 60 trials from the recorded 240. The result is 180 valid trials; retain the rejection rule and original data so the selection remains auditable.

Question 12Documentation, integrity and professional communication

A study records 400 raw trials. One hundred are rejected, then 50 of the remaining trials are identified as duplicates. How many distinct accepted trials remain?

  1. 150
  2. 350
  3. 300
  4. 250 Correct answer.

Explanation

First remove 100 rejected trials from 400, leaving 300. Remove 50 duplicate retained trials, leaving 250 distinct accepted trials under the supplied counting assumptions.

Question 13MEG sensors, magnetic environment and quality assurance

A magnetometer and a gradiometer are compared. What does the gradiometer principally measure?

  1. Only the patient’s arterial oxygen saturation.
  2. A spatial difference or gradient of magnetic field over its sensor geometry. Correct answer.
  3. The exact microscopic current of one identified neuron.
  4. An MRI radiofrequency excitation pulse.

Explanation

A gradiometer responds to spatial field differences according to its geometry. This can help reduce distant interference but does not directly identify one neuron or eliminate every artifact.

Question 14MEG sensors, magnetic environment and quality assurance

A conventional dewar has an unexpected rise in helium consumption. What is appropriate?

  1. Block the vent to prevent further gas loss.
  2. Document the trend and arrange qualified equipment assessment rather than improvising a repair. Correct answer.
  3. Add an unapproved insulating material inside the vessel.
  4. Continue indefinitely because all boil-off changes are harmless.

Explanation

An unexpected operational trend needs review through the equipment and safety process. Cryogenic pressure and thermal hazards make improvised repairs or blocked vents inappropriate.

Question 15MEG sensors, magnetic environment and quality assurance

An empty-room run is quiet, but a large artifact appears only when the patient moves the jaw. What does this suggest?

  1. The sensor labels should be changed until the artifact disappears.
  2. The empty-room recording proves all later signals are cerebral.
  3. Every jaw-linked signal must be an auditory evoked field.
  4. A patient-related artifact not excluded by the empty-room measurement. Correct answer.

Explanation

Empty-room recordings characterize aspects of environmental and system noise, not every patient-related source. Movement-linked muscle or magnetic artifact still needs documented evaluation.

Question 16MEG sensors, magnetic environment and quality assurance

A new nearby moving magnetic object contaminates many sensors during a run. Which comparison can assist investigation?

  1. Assume every broad sensor event is a seizure.
  2. Review timing, sensor pattern and appropriate environmental reference information. Correct answer.
  3. Change the patient history to fit the trace.
  4. Treat a single quiet channel as proof the environment is unchanged.

Explanation

Spatial and temporal patterns and reference information can help investigate interference. The technologist should document the event rather than assign a clinical cause or ignore the wider sensor pattern.

Question 17MEG sensors, magnetic environment and quality assurance

A system passes its phantom localization test. What does that support?

  1. Guaranteed accuracy despite any later head motion.
  2. Performance of the tested system under the phantom conditions, not every patient localization. Correct answer.
  3. Proof that every clinical source model is correct.
  4. Permission to omit patient-specific quality review.

Explanation

A phantom tests defined aspects of system performance with known conditions. Patient geometry, motion, artifacts and modeling still require appropriate review in the actual study.

Question 18Preparation, patient protection and equipment safety

A cryogenic-lab oxygen alarm sounds. What is the safe priority?

  1. Leave the hazardous area and activate the trained emergency procedure without unprotected re-entry. Correct answer.
  2. Enter alone to find the leak before notifying anyone.
  3. Silence the alarm and complete the current calibration.
  4. Assume helium cannot be dangerous because it is chemically inert.

Explanation

In a cryogenic system, displaced oxygen can create a serious atmospheric hazard. Evacuation and the trained response take priority; chemical inertness does not make an oxygen-deficient space safe.

Question 19Preparation, patient protection and equipment safety

A patient develops a clinical event during MEG. What best preserves both safety and useful evidence?

  1. Assume any event without a visible MEG change is non-epileptic.
  2. Delay assistance until a source model has been fitted.
  3. Follow the clinical safety response and annotate observed behavior and timing when safe. Correct answer.
  4. Erase movement-contaminated data before the interpreting clinician sees it.

Explanation

Immediate patient protection takes priority. Accurate observations and timing can assist later interpretation, but absence of an obvious surface signal does not by itself classify the clinical event.

Question 20Preparation, patient protection and equipment safety

A child is uncomfortable and moves repeatedly in the sensor helmet. What should the technologist prioritize?

  1. Comfort, safety and an adapted recording plan through the responsible team. Correct answer.
  2. Immobilize the child by an improvised restraint without review.
  3. Hide all movement information to preserve an apparently clean report.
  4. Promise accurate localization regardless of head position.

Explanation

Comfort and safe adaptation can improve cooperation and data quality. Record limitations and work with the responsible team rather than improvise restraint or guarantee results despite movement.

Question 21Neurophysiological signals, sampling and instrumentation

A hypothetical system samples at 1000 samples per second. What is the interval between adjacent samples?

  1. 10 milliseconds
  2. 1 millisecond Correct answer.
  3. 100 milliseconds
  4. 1000 milliseconds

Explanation

The interval equals one divided by sampling frequency. One divided by 1000 seconds is 0.001 seconds, or one millisecond, before considering any later display resampling.

Question 22Neurophysiological signals, sampling and instrumentation

A supplied band-limited model includes signals through 180 Hz. Which listed sampling rate is above twice that frequency?

  1. 180 Hz
  2. 300 Hz
  3. 500 Hz Correct answer.
  4. 90 Hz

Explanation

Twice 180 is 360 Hz. The listed 500 Hz rate exceeds that model boundary; practical acquisition also needs appropriate antialias filtering and a suitable design margin.

Question 23Neurophysiological signals, sampling and instrumentation

In a supplied power-line example, a sinusoid completes 50 cycles each second. What is its period?

  1. 50 ms
  2. 20 ms Correct answer.
  3. 2 ms
  4. 500 ms

Explanation

Period equals one divided by frequency. One divided by 50 seconds is 0.02 seconds, or 20 milliseconds, for the stated sinusoidal model.

Question 24Neurophysiological signals, sampling and instrumentation

A notch filter reduces line noise but also changes a sharp transient. What should the reviewer conclude?

  1. The original data are no longer useful.
  2. A notch filter can affect only artifact and never brain signals.
  3. The changed transient must be a newly generated seizure.
  4. Filtering can alter signal morphology and needs a documented tradeoff. Correct answer.

Explanation

Filters act on signal content according to their design, not on clinical labels. Preserve raw data and document settings while considering whether a filter changes relevant morphology.

Question 25Neurophysiological signals, sampling and instrumentation

A recording clips because a large artifact exceeds the acquisition range. Can a later display-scale change restore the lost waveform?

  1. Yes, any smaller display amplitude reconstructs the original samples exactly.
  2. No; display scaling cannot recover information lost by acquisition clipping. Correct answer.
  3. Only changing the file name is needed.
  4. A notch filter guarantees recovery of all clipped samples.

Explanation

Clipping limits the recorded values at acquisition. Rescaling a display changes presentation, not the missing information beyond the recorded range; prevention and documented quality review are needed.

Question 26Neurophysiological signals, sampling and instrumentation

A coherent artifact repeats with every stimulus. Does the independent-random-noise averaging rule guarantee its removal?

  1. Only reversing channel names removes the artifact.
  2. Yes; every artifact decreases exactly as the square root of trial count.
  3. No; time-locked interference can persist in the average. Correct answer.
  4. The artifact proves no stimulus was delivered.

Explanation

The usual averaging gain assumes suitable independent noise. A repeatable time-locked contaminant can survive averaging and require investigation of its source and the acquisition setup.

Question 27MEG acquisition, tasks and concurrent EEG

The study protocol records a 20-minute run with no gaps. How many seconds of acquisition does that represent?

  1. 200
  2. 1200 Correct answer.
  3. 60
  4. 7200

Explanation

Each minute contains 60 seconds. Multiplying 20 by 60 gives 1200 seconds of acquisition, without claiming that this hypothetical duration is an official clinical minimum.

Question 28MEG acquisition, tasks and concurrent EEG

An EEG discharge is clear but no corresponding MEG transient is visible. What is the most defensible interpretation?

  1. All MEG sensors should be relabeled until the traces match.
  2. The EEG discharge must be fabricated.
  3. The lack of MEG visibility proves no cortical activity occurred.
  4. The modalities have complementary sensitivities and the discrepancy needs review. Correct answer.

Explanation

Source orientation, extent, depth, noise and measurement properties can produce discordant visibility. Review the data and recording quality without assuming either modality is a perfect universal detector.

Question 29MEG acquisition, tasks and concurrent EEG

The head position changes between two runs. What should be checked before combining source estimates?

  1. Only whether both files have equal names.
  2. Run-specific head position and the validity of coordinate alignment or compensation. Correct answer.
  3. That all runs are assumed to have identical sensor-to-head geometry.
  4. Whether the plotting color is the same.

Explanation

Changing head position changes the relationship between brain and sensor coordinates. Combining runs requires an appropriate documented alignment or validated compensation approach rather than an untested fixed-geometry assumption.

Question 30MEG acquisition, tasks and concurrent EEG

An event marker is missing in some trials while the stimulus was delivered. What is the most important analysis concern?

  1. Time-locked averaging may be unreliable unless timing can be recovered validly. Correct answer.
  2. Missing markers improve latency precision automatically.
  3. The absent marker proves no neural response occurred.
  4. All trials should be shifted arbitrarily to match a preferred peak.

Explanation

Averaging depends on correct event alignment. Missing timing information needs investigation and a justified recovery or exclusion decision, not arbitrary adjustment to make a desired waveform.

Question 31MEG acquisition, tasks and concurrent EEG

A patient cannot perform the planned language task reliably. What should the record and interpretation reflect?

  1. The task should be reported as completed normally to simplify review.
  2. Successful task performance should be assumed because the instructions were read.
  3. Every absent activation proves absence of language function.
  4. The actual performance limitation and its implications for the mapping result. Correct answer.

Explanation

Task engagement and performance affect the meaning of functional mapping. Record what occurred and communicate limitations rather than interpreting a weak or absent response as proof that function is absent.

Question 32MEG acquisition, tasks and concurrent EEG

Response timing varies unpredictably between nominally identical trials. How can this affect their average?

  1. Latency jitter can blur or reduce a time-locked component. Correct answer.
  2. The average necessarily gains perfect temporal precision.
  3. The jitter proves every trial contains the same artifact.
  4. Only the file size can change.

Explanation

Variable response timing reduces alignment of a component across trials. The resulting average can become broader or smaller even when useful responses exist in individual trials.

Question 33MEG acquisition, tasks and concurrent EEG

A simultaneous EEG channel is saturated while MEG remains usable. What is the appropriate description?

  1. Erase the EEG channel from the acquisition log.
  2. Report that the entire EEG was normal.
  3. Assume MEG quality proves the EEG channel was intact.
  4. Document modality-specific quality and review the affected EEG channel. Correct answer.

Explanation

Concurrent modalities can have different technical problems. Document the saturated channel and assess its implications rather than claiming that another usable modality validates all recording components.

Question 34MEG source models, coregistration and interpretation

A supplied coordinate convention labels positive x as rightward. A point moves from x=-8 mm to x=+7 mm. What is the signed displacement?

  1. +15 mm Correct answer.
  2. -15 mm
  3. +1 mm
  4. -1 mm

Explanation

Signed displacement is final minus initial coordinate. Seven minus negative eight equals positive fifteen millimeters, meaning rightward movement in the explicitly supplied convention.

Question 35MEG source models, coregistration and interpretation

A spatial filter suppresses a source that is strongly correlated with another source. What should the analyst consider?

  1. That every beamformer must preserve all correlated sources perfectly.
  2. That correlation proves the source is nonphysiological.
  3. The chosen beamformer assumptions and possible signal cancellation. Correct answer.
  4. That changing the image colors fixes the source estimate.

Explanation

Spatial filtering depends on model and covariance assumptions. Correlated sources can challenge some beamformer approaches, so apparent suppression needs methodological review rather than an automatic biological conclusion.

Question 36MEG source models, coregistration and interpretation

The analyst changes the MRI head model while keeping sensor data unchanged. Why may the reconstructed source change?

  1. Head models cannot influence any inverse estimate.
  2. The stored magnetic measurements have physically changed.
  3. The patient’s neurons must have shifted after recording.
  4. The forward relationship used by the inverse estimate has changed. Correct answer.

Explanation

The source reconstruction uses a forward model relating candidate currents to sensors. Changing that model can alter the estimated source even though the original recorded measurements remain identical.

Question 37MEG source models, coregistration and interpretation

Why does a radial source in an ideal spherical conductor require care when generalizing MEG sensitivity?

  1. The result proves every gyral source is clinically invisible.
  2. MEG measures all current orientations equally in every head.
  3. The ideal model can be insensitive to radial currents, while real geometry and source orientation complicate practice. Correct answer.
  4. It means EEG and MEG are the same measurement.

Explanation

Radial insensitivity is a useful result of an idealized model. Real anatomy, geometry and distributed currents limit a categorical claim about every source or patient.

Question 38MEG source models, coregistration and interpretation

A dipole cluster is concordant with other investigations. Which statement preserves the proper limitation?

  1. It removes the need to consider seizure history.
  2. It independently proves the exact tissue that must be removed.
  3. It adds evidence to multidisciplinary interpretation without alone defining resection or guaranteeing outcome. Correct answer.
  4. It guarantees that surgery will prevent future seizures.

Explanation

Concordant localization can inform the clinical assessment, but the epileptogenic zone and operative plan require integration of the wider evidence. A cluster is not an outcome guarantee.

Question 39MEG source models, coregistration and interpretation

A coregistration algorithm has a small average surface error but one fiducial is clearly mislabeled. What should happen?

  1. Remove the warning from the report without correction.
  2. Accept automatically because the average is small.
  3. Investigate the mislabeled landmark and inspect the complete alignment. Correct answer.
  4. Change the patient identifier to match another MRI.

Explanation

A summary error metric can conceal an important local or labeling failure. Inspect landmarks, surface correspondence and the actual anatomy before accepting the coordinate relationship.

Question 40MEG source models, coregistration and interpretation

Which distinction between forward and inverse modeling is correct?

  1. Forward modeling diagnoses epilepsy without recorded data.
  2. Both terms mean the physical movement of the dewar.
  3. Forward modeling predicts sensor fields from an assumed source; inverse modeling estimates sources from measured fields. Correct answer.
  4. Inverse modeling removes the need for a head model.

Explanation

Forward and inverse models address opposite directions of the source-to-measurement relationship. Inverse estimates depend on assumptions and supporting geometry rather than replacing the forward relationship.

Question 41MEG source models, coregistration and interpretation

A source estimate changes substantially when a few channels are excluded. What should be evaluated?

  1. Sensitivity to channel selection, noise and the modeling assumptions. Correct answer.
  2. The estimate with the preferred location should be selected without disclosure.
  3. All excluded channels must have contained only artifact.
  4. Source instability proves that no brain activity was recorded.

Explanation

A strong dependence on channel selection can reveal sensitivity to data quality or model assumptions. Review and report the effect rather than conceal the choice or draw a categorical biological conclusion.

Question 42MEG source models, coregistration and interpretation

A reconstruction uses a very restrictive one-dipole model for a complex distributed field. What is a relevant limitation?

  1. A one-dipole fit removes all uncertainty about source extent.
  2. Every complex field must arise from one microscopic neuron.
  3. The model may not represent the actual source complexity adequately. Correct answer.
  4. MRI resolution alone guarantees the model is correct.

Explanation

A simple model can be useful for an appropriate question but can misrepresent distributed or overlapping activity. Evaluate assumptions, residuals and the clinical purpose rather than accepting simplicity as proof.

Question 43MEG source models, coregistration and interpretation

A source map is thresholded to show only the strongest activity. What should the reader understand?

  1. The colored edge is necessarily an exact anatomical disease boundary.
  2. The displayed boundary depends partly on analysis and display choices. Correct answer.
  3. All activity outside the display is proven absent.
  4. Changing a color threshold changes the original neuronal currents.

Explanation

A thresholded map presents an analysis result under selected criteria. Its visible boundaries are not automatically precise anatomical or pathological borders, and the processing choices should be documented.

Question 44Documentation, integrity and professional communication

A preprocessing program silently overwrites the only raw recording. What is the central quality problem?

  1. The original evidence and ability to reproduce processing have been lost. Correct answer.
  2. A derived file is always a superior substitute for raw data.
  3. The file is safe if its name contains the word final.
  4. Only the number of displayed channels matters.

Explanation

Preserving raw data and a traceable processing history supports reanalysis and audit. A derived result should not silently replace the only original recording, even when it looks cleaner.

Question 45Documentation, integrity and professional communication

A cleaned recording uses excluded channels, ICA components and a changed filter. What must accompany the analysis?

  1. Only a screenshot of the most attractive result.
  2. A reproducible record of those decisions and software settings. Correct answer.
  3. A statement that no processing occurred.
  4. Deletion of all rejected epochs from the original archive.

Explanation

Documented processing decisions allow qualified review of what was changed and why. A cleaner display does not justify concealing exclusions, transformations or the original data.

Question 46Documentation, integrity and professional communication

A reviewer discovers left and right sensor labels were exchanged in an exported display. What is the priority?

  1. Assume the patient’s language dominance changed.
  2. Protect interpretation and correct the traceable export error before clinical use. Correct answer.
  3. Keep the labels because the waveforms look plausible.
  4. Delete the raw study to avoid a discrepancy.

Explanation

Laterality errors can mislead anatomical interpretation and clinical decisions. Preserve the original data, correct the export through the quality process and communicate any affected interpretation.

Question 47Documentation, integrity and professional communication

A research export removes names but retains identifiable facial MRI anatomy and linked dates. What is the sound privacy assessment?

  1. Scientific collaboration removes all confidentiality duties.
  2. Removing the name alone always makes the dataset anonymous.
  3. De-identification needs review of remaining identifying information and the actual sharing framework. Correct answer.
  4. A filename without the patient name guarantees compliance.

Explanation

Identifying information can remain outside a name field, including anatomy and linked metadata. Use the applicable authorized sharing and de-identification process rather than a single-field assumption.

Question 48Documentation, integrity and professional communication

A report draft states that the MEG result guarantees seizure-free surgery. What correction is needed?

  1. State that all other investigations are unnecessary.
  2. Keep the guarantee if the source cluster is visually tight.
  3. Replace the guarantee with a promise based only on goodness of fit.
  4. Describe the localization evidence and limitations without an outcome guarantee. Correct answer.

Explanation

MEG can contribute localization information to a wider clinical assessment. Neither a tight cluster nor a model-fit measure guarantees the outcome of surgery or replaces the multidisciplinary evidence.

Question 49Documentation, integrity and professional communication

A reviewer requests only the processed figure without the source file or parameter history. What is the quality concern?

  1. Reproducibility is irrelevant if the image looks clear.
  2. Figures always contain the complete raw evidence.
  3. Parameter history matters only for billing.
  4. The interpretation may not be reproducible or adequately audited. Correct answer.

Explanation

A figure can summarize a result but does not retain every acquisition and processing decision. Appropriate source data and history support review, correction and reproducibility.

Question 50Documentation, integrity and professional communication

A patient withdraws agreement for an optional research task while accepting the clinical study. What should the technologist do?

  1. Respect the distinction and follow the authorized clinical and research consent arrangements. Correct answer.
  2. Treat clinical attendance as automatic consent for all research.
  3. Continue the research task without documenting the refusal.
  4. Cancel necessary care as punishment for refusal.

Explanation

Clinical care and optional research can have separate purposes and consent processes. Respect the actual decision and communicate the change through the authorized team without coercion or concealment.