CNIM PRACTICE EXAM QUESTIONS 2024.

ANASTAMOSIS? - -CONNECTION or opening BETWEEN two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels. -COMMUNICATION BETWEEN ARTERIES What causes the most airborne bacteria in OR? a. blood on gown b. blood spill c. skin shed d. patient vent - c. skin shed Nerve that innervates 4th and 5th fingers? - Ulnar Nerve Problem with Bilateral Synchronus Stim? - Can mask unilateral problems No N20 at baseline could mean? - Stroke What should you check 1st if you lose all waves? - Stimulator Which of the following devices measures electrode resistance? 1. Ammeter 2. Ohmmeter 3. Voltmeter 4. Photometer - 2. Ohmmeter If an evoked potential has a voltage of 10uV and the associated noise has a voltage of 50uV, what is the signal to noise ratio after 100 averaged responses? 1. 1:1 2. 1:2 3. 2:1 4. 5:1 - 3. 2:1 To display median nerve SSEP response as an upward deflection, which of the following must be known? 1. Waveform polarity and latency of the response 2. Waveform polarity and polarity convention of the amplifier inputs 3. Polarity convention of amplifier inputs and amplitude of the response 4. Latency of the response and polarity convention of the amplifier inputs - 2. Waveform polarity and polarity convention of the amplifier inputs If an amplifier is rated as having 120 dB common mode rejection rate, which of the following ratios of in-phase to out-of-phase signals would be expected? 1. 10,000:1 2. 100,000:1 3. 500,000:1 4. 1,000,000:1 - 4. 1,000,000:1 Which of the following cranial nerves innervates the extraocular muscles? 1. Optic 2. Facial 3. Abducens 4. Trigeminal - 3. Abducens Which of the following is an example of a SSEP far-field subcortical potential? 1. N20 2. N34 3. Erbs point 4. Popliteal Fossa - 2. N34 Which of the following opposes any change in current? 1. Capacitance 2. Impedance 3. Inductance 4. Resistance - 3. Inductance Which of the following electrode materials has little electrode potential drift and a long time constant? 1. Tin 2. Gold 3. Silver 4. Stainless Steel - 2. Gold Where should epidural electrodes be placed? 1. On the dura 2. In the spinal cord 3. Within the dural membrane 4. Between the dura and the spinal cord - 1. on the dura With referential recording, maximal amplitude cortical evoked potentials following stimulation of the left posterior tibial nerve usually would be found between? 1. C3 and CZ 2. C4 and P4 3. FZ and CZ 4. C4 and CZ - 1. C3 and CZ For preoperative posterior tibial somatosensory evoked potentials, which of the following would be the best ipsilateral location for the ground electrode? 1. Forearm 2. Calf 3. Shoulder 4. Palm - 2. Calf To record the afferent volley after posterior tibial nerve stimulation, an electrode should be placed on the? 1. Mastoid 2. Erbs point 3. T5 spine 4. Index Finger - 3. T5 spine Impedances of applied electrodes should be? 1. balanced and below 5,000 ohms 2. balanced and above 5,000 ohms 3. unbalanced and below 5,000 ohms 4. unbalanced and above 5,000 ohms - 1. balanced and below 5,000 ohms An increase in stimulation intensity cause a linear increase of which of the following SSEP components? 1. N20 2. N45 3. P31 4. P37 - 3. P31 Epidural electrodes are made of platinum because? 1. it is the most durable metal 2. it is the lowest impedance metal 3. the chance of allergic reaction is eliminated 4. other metals may become toxic when currents are applied - 4. other metals may become toxic when currents are applied During a median nerve preoperative study, a patient has discomfort at the wrist. Stimulation electrodes are 10mm gold disk, stimulus intensity is 20 mA, and stimulus duration is 100 usec. Which of the following would most likely reduce the patient's discomfort while maintaining adequate stimulation? 1. Increase stimulus duration 2. Decrease number of repetitions 3. Use smaller stimulating electrodes 4. Decrease stimulus intensity below motor threshold - 2. Decrease number of repititions Which of the following would enhance Wave I of the BAEP? 1. Increase the rate 2. Increase the intensity 3. Decrease the analysis time 4. Decrease the number of repetitions - 2. Increase the intensity In BAEPs wave I can most easily be differentiated from cochlear microphonics based upon? 1. amplitude 2. morphology 3. click polarity 4. absence in contralateral recording - 3. click polarity What is the interstimulus interval of a 50hz click stimulus? 1. 0.02 msec 2. 0.20 msec 3. 0.50 msec 4. 20.00 msec - 4. 20.00 msec Contralateral masking should be used during BAEPs to? 1. help the patient relax 2. enhance wave 1 amplitude 3. seperate wave IV/V complex 4. prevent crossover responses - 4. prevent crossover responses The complete absence of a BAEP is most likely the result of? 1. sedation 2. multiple sclerosis 3. severe hearing loss 4. a normal age variant - 3. severe hearing loss Identification of Wave V of the BAEP may require? 1. tympanic electrodes 2. bilateral stimulation 3. decreasing stimulus intensity 4. use of nonncephalic reference - 3. decreasing stimulus intensity In spinal surgery, the primary purpose of the popiteal fossa recording electrode is to? 1. verify adequacy of stimulus 2. limit current spread 3. confirm amplitude integrity 4. provide evidence of a muscle twitch - 1. verify adequacy of stimulus While performing a posterior tibial SSEP, hypothermia of the lower extremities is most likely to cause? 1. increased L3-P37 latency 2. increased T12-P37 latency 3. slowed peripheral conduction velocity 4. abnormal prolongation of the P37-N45 complex - 3. slowed peripheral conduction velocity Which of the following peaks in tibal nerve SSEPs is most analogous to P14 of median nerve SSEP? 1. N20 2. N34 3. P31 4. P37 - 3. P31 During posterior fossa surgery, when BAEPs are used for monitoring brainstem function, it is important to? 1. record cranial nerve VII action potentials 2. monitor cranial nerve V function ipsilaterally 3. stimulate and record from the operative side only 4. stimuate and record from the contralateral side - 4. stimuate and record from the contralateral side Which of the following cranial nerves are most appropriate to monitor during resection of a 4cm vestibular schwannoma? 1. Optic 2. Facial 3. Abducens 4. Oculomotor - 2. Facial During Carotid endarterectomy, what SSEP modality is recommended for monitoring cerebral function? 1. Femoral 2. Median 3. Posterior Tibial 4. Common Peroneal - 2. Median If the EEG is preserved during carotid endarterectomy surgery, it indicates? 1. inadequate level of anesthesia 2. diffuse neuronal dysfunction 3. accurate electrode placement 4. adequate cortical perfusion and oxygenation - 4. adequate cortical perfusion and oxygenation SSEPs to posterior tibial nerve stimulation are most appropriate to monitor during surgery for? 1. scoliosis 2. hemifacial spasm 3. middle cerebral artery aneurysm 4. cerebellar pontine angle tumor - 1. scoliosis In recording electrocochleograms, it is best to stimulate using? 1. tone pips 2. tone bursts 3. alternating clicks 4. rarefaction clicks and condensation - 4. rarefaction clicks and condensation A post-incision baseline recording is used to? 1. evaluate hemodynamic status 2. determine long-term prognosis 3. establish a standard for the patient 4. compare patient's values to laboratory normative date - 3. establish a standard for the patient Which of the following would most likely be normal in the pre-operative baseline upper extremity SSEP of a patient with a lesion in the dorsal column? 1. N20 2. P22 3. Erbs point potential 4. Central Conduction Time - 3. Erbs point potential Selection of the nerve to be stimulated for preoperative baseline SSEPs is determined by the? 1. patient age 2. surgical procedure 3. dermatomal innervation 4. anesthesiologist - 2. surgical procedure For preoperative posterior tibial somatosensory evoked potential, which of the following would be the best ipsilateral location for the ground electrode? 1. arm 2. calf 3. mastoid 4. sole of the foot - 2. calf To record the afferent volley during preoperative baseline studies after posterior tibial stimulation, an electrode should be placed on the? 1. Patella 2. metatarsal 3. popiteal fossa 4. medial malleolus - 3. popiteal fossa Routine intraoperative electrophysiological monitoring documentation should include? 1. heart rate 2. blood pressure 3. respiratory rate 4. blood plasma volume - 2. blood pressure If a technologist accidentally touches a sterile table, which of the following is the most appropriate action? 1. Change scrub suit immediately 2. remain silent until procedure is completed 3. Notify the scrub or circulating nurse at once 4. maintain safe distance from sterile field - 3. Notify the scrub or circulating nurse at once In a bipolar montage, the key element in localization is the? 1. instrument phase reversal 2. relative voltage in each channel 3. common mode rejection of in-phase noise 4. synchronization of discharges - 1. Instrument phase reversal SCALP-TO-NONCEPHALIC REFERENCE? 1. Fz-C5S 2. CPz-Fz 3. EPi-EPc 4. CPc-CPi - 1. Fz-C5S According to the ACNS guidelines, system bandpass settings for monitoring facial nerve spontatneous muscle activity should be? 1. 1-250 to 1500Hz 2. 10-30 to Hz 3. 10-30 to 16,000Hz 4. 100-200 to Hz - 3. 10-30 to 16000Hz According to the ACNS guidelines, facial nerve monitoring electrodes should be placed in which of the following muscles? 1. Masseter and trapezius 2. Frontalis and trapezius 3. Laryngeal and nasalis 4. Orbicularis oculi and oribularis oris - 4. Orbicularis oculi and orbicularis Harrington instrumentation includes? 1. rods 2. pedicle screws 3. sublaminal wires 4. segmental wires - 1. rods Intraoperative evoked potential monitoring criteria of abnormality are based on a comparison of amplitude and latency to? 1. preinduction baseline 2. postincision baseline 3. intraoperative normative date 4. laboratory normative date - 2. postincision baseline Which of the following anesthetic agents may increase the amplitude of cortical potentials? 1. Etomidate 2. Halothane 3. Pentobarbital 4. Nitrous Oxide - 1. Etomidate FENTANYL? 1. Narcotic agent 2. Volatile agent 3. Barbiturate agent 4. Neuromuscular blocking agent - 1. Narcotic agent The combination of nitrous oxide and volatile anesthetic gases affects SSEPs by? 1. increasing latency and decreasing amplitude 2. increasing latency and increasing amplitude 3. decreasing latency and increasing amplitude 4. decreasing latency and decreasing amplitude - 1. increasing latency and decreasing amplitude During posterior fossa surgery, wave V of the BAEPs may increase in latency due to? 1. Spinal drainage 2. warming of the nerve 3. retraction of the cerebellum 4. use of neuromuscular blocking agent - 3. retraction of the cerebellum Which of the following nerve injuries usually does NOT produce spontaneous EMG activity during intraoperative monitoring? 1. Heat 2. Pressure 3. Ischemia 4. Irrigation - 3. Ischemia Which of the following is the method for monitoring the facial nerve? 1. BAEPs 2. Blink reflex 3. Free run EMG 4. Visual observation of facial movement - 3. Free run EMG When monitoring facial nerve EMG, which of the following is an indicator of potential nerve damage? 1. Ocassional burst of fibrillation potentials 2. Continuous train of neurotonic discharges 3. CMAP to direct stimulation 4. Ocassional muscle faciculations - 2. Continuous train of neurotonic discharges What is the recommended bandpass setting for facial nerve compound muscle action potential recording? 1. 1-250 to 1500hz 2. 5-30 to 3000hz 3. 10-30 to 16,000hz 4. 100-200 to 1000hz - 1. 1-250 to 1500hz Neuromuscular blocking agents should NOT be used when recording which of the following evoked responses? 1. BAEPs 2. Peroneal SSEPs 3. Facial nerve EMG 4. ECochG - 3. Facial nerve EMG What is the most likely effect of isoflurane at MAC 1.5 on tibialis anterior CMAP amplitude in response to spinal stimulation? 1. Marked increase 2. Marked decrease 3. Minimal decrease 4. Minimal increase - 2. Marked decrease It is most important for intraoperative monitoring records to include notions of? 1. Surgical events 2. periodic impedance checks 3. serial changes in hematocrit 4. changes in anesthesia personnel - 1. Surgical events Which of the following is a critical surgical event? 1. Drilling of burr hole in skull 2. Decortication of vertebral elements 3. Placing of muscle plug in the internal auditory canal 4. Resecting of tumor fragments during acoustic neuroma resection - 4. Resecting of tumor fragments during acoustic neuroma resection Which of the following should be reported to the surgeon? 1. Loss of response 2. Change in time base 3. Switch to backup electrodes 4. increase in stimulus intensity - 1. loss of response D waves are recorded from which of the following electrodes? 1. Epidural electrodes over the spinal cord 2. Subdural electrodes over the motor strip 3. Surface electrodes over peripheral nerves 4. Needle electrodes in distal extremity muscles - 1. Epidural electrodes over the spinal cord An objective measure of meaningful change to use to warn the surgeon is the ? 1. latency decrease 2. 50% amplitude decrease 3. IPL decrease 4. 10% amplitude decrease - 2. 50% amplitude decrease Changes can be reported to the surgeon as quickly as possible when the surgeon is asked to? 1. alert the technologist when cautery is in use 2. keep the field dry of fluids 3. inform the technologist when critical structures are approached 4. avoid monopolar cautery use - 3. inform the technologist when critical structures are approached Pedicle screws are used for? 1. Spinal fixation 2. correction of curve 3. anterior fusion 4. derotation of spine - 1. spinal fixation The purpose of interbody cages is often? 1. employ multiple point fixation 2. restore lost disc height 3. restore sagittal contours 4. prevent migration prior to fixation - 2. restore lost disc height Transcranial motor evoked potentials are best elicited when using? 1. a train of stimuli 2. complete neuromuscular blockade 3. halogenated agents 4. stimulus rates above 20/sec - 1. a train of stimuli In Compressed Density Spectral Array, frequency is depicted by? 1. Y-axis 2. X-axis 3. Epoch 4. Data Points - 2. X-Axis Transcranial electrical motor evoked potentials are best recorded with which of the following anesthetic regiments? 1. Nitrous oxide 50% + midazolam bolus 2. Isoflurane .5 MAC + midazolam infusion 3. Nitrous oxide 50% + isoflurane <0.5 MAC 4. Propofol + Fentanyl infusion - 4. Propofol + Fentanyl infusion During carotid endarterectomies Spectral Edge Frequency is usually set to? 1. 60-67% 2. 70-77% 3. 80-87% 4. 90-97% - 4. 90-97% Which of the following anesthetic agent will obliterate the transcranial electric motor evoked potential? 1. Propofol 2. Desflurane 3. Fentanyl 4. Nitrous Oxide - 2. Desflurane Which of the following temperatures should be annotated as being hypothermic? 1. 34 degrees Celsius 2. 35 degrees Celsius 3. 38 decrees Celsius 4. 40 degrees Celsius - 1. 34 degrees Celsius Which of the following systolic blood pressure is most likely to attenuate the evoked potential? 1. 150 mm/Hg 2. 140 mm/Hg 3. 130 mm/Hg 4. 120 mm/Hg - 4. 120 mm/Hg One contraindication for the use of transcranial electrical motor evoked potential is? 1. epilepsy 2. trigeminal neuralgia 3. scoliosis 4. cervical myelopathy - 1. epilepsy RADICULOPATHY? 1. Meninges 2. Spinal cord 3. Nerve roots 4. Peripheral Nerves - 3. Nerve roots SPONDYLOSIS? 1. Tethered cord 2. Avulsed nerve roots 3. Spinal cord tumor 4. Degenerative spine disease - 4. Degenerative spine disease DIABETES MELLITUS? 1. Ankylosis 2. Hearing loss 3. Facial palsy 4. Peripheral Neuropathy - 4. Peripheral Neuropathy Which of the following is a common complication of microvascular decompression of cranial nerve VII? 1. Visual loss 2. Hearing loss 3. Lower extremity weakness 4. Upper extremity weakness - 2. Hearing loss When monitoring evoked potentials during surgery, which of the following would most likely correlate with a postoperative abnormality or deficit? 1. Transient change in latency 2. Transient change in amplitude 3. Persistent decrease in latency and amplitude 4. Persistent increase in latency and decrease in amplitude - 4. Persistent increase in latency and decrease in amplitude When monitoring intraoperative evoked potentials, which of the following is most likely to correlate with postoperative deficits? 1. No change in latency or amplitude 2. Latency decreases and amplitude increases 3. Transient changes of latency or amplitude 4. Persistent loss of waveforms - 4. Persistent loss of waveforms Which of the following best describes a false negative case? 1. Evoked Potentials disappear but reappear within 15 minutes 2. Evoked Potential have a greater than 50% decrease of amplitude with no neurological deficit 3. Evoked Potentials remain relatively stable, but postoperative neurologic deficits occur 4. Evoked Potentials disappear during surgery and patient has no postoperative deficit - 3. Evoked Potentials remain relatively stable, but postoperative neurologic deficits occur When monitoring Brainstem auditory evoked potentials intraoperatively it is recommended to warn the surgeon when an increase of the following occurs? 1. the latency of wave V of less than 1.0 millisecond 2. the latency of wave I of 1 millisecond 3. the latency of wave V of 1.0 or greater 4. the interpeak latency of 1-V of 1.0 or less - 3. the latency of wave V of 1.0 or greater The use of intraoperative monitoring during scoliosis surgery may replace the? 1. Hoffman sign 2. Stagnara test 3. Romberg test 4. Babinski sign - 2. Stagnara test (wake up test - pt moves feet) HOFFMAN SIGN? - -Assess Myelopathy (spinal cord compression) -The test is done by quickly snapping or flicking the patient's middle fingernail. The test is positive for spinal cord compression when the tip of the index finger, ring finger, and/or thumb suddenly flex in response. ROMBERG TEST? - -TESTS BALANCE -PROPRIOCEPTION, VESTIBULAR FUNCTION & VISION Upon sudden loss of ipsilateral posterior tibial cortical and subcortical data which of the following should be performed? 1. Calibration 2. Stagnara test 3. Train of four 4. Tetanic stimulation - 2. Stagnara test Which of the following is a source of intraoperative physiologic artifacts? 1. Cell saver 2. Blood warmer 3. Electrocardiogram 4. Electrooculogram - 3. Electrocardiogram If there is a 60hz interference in all channels when recording preoperative median nerve SSEPs, which of the following electrodes should be adjusted first? 1. CPi 2. EPc 3. Grounding electrode 4. Stimulating electrode - 3. Grounding electrodes Which of the following would most affect the ability to record BAEPs? 1. Drill 2. Retractor 3. Coagulator 4. Anesthetic agent - 3. Coagulator Evoked potential data is obilterated with? 1. midas rex drilling 2. monopolar cautery 3. C-arm use 4. transcranial dopper use - 2. monopolar cautery Which of the following most often causes a temporary threshold shift on the Brainstem auditory evoked potentials during CPA surgery? 1. Drilling 2. bipolar cautery 3. warm irrigation 4. CUSA - 1. drilling To avoid a false positive the baseline is best taken? 1. In preoperative holding 2. post-incision 3. pre-intubation 4. post-intubation - 2. post-incision Vascular compromise of the posterior cerebral artery will most likely have what effect on the MNSEP? 1. loss of P14/N18 2. loss of N20/P22 3. loss of N13 4. loss of Erb's point - 1. loss of P14/N18 Standard (universal) precautions are used to reduce the transmission of? 1. Hepatitis A virus 2. reproductive spores 3. bloodborne pathogens 4. Mycobacterium tuberculosis - 3. bloodborne pathogens Which of the following diseases results from infection by a bloodborne pathogen? 1. Varicella 2. Hepatitis B 3. Mononucleosis 4. Herpes Zoster - 2. Hepatitis B When is leakage current present in an evoked potential instrument? 1. Only if the ground is broken 2. Only when used with an extension cord 3. Only when a ground loop is present 4. Whenever the instrument is connected to a power source - 4. Whenever the instrument is connected to a power source What is the maximum allowable leakage of evoked potential instrument chassis current? 1. 100 microamperes 2. 200 microamperes 3. 300 microamperes 4. 500 microamperes - 1. 100 microamperes The monitoring team must ensure that stimulus parameters are within safe limits to? 1. avoid tissue damage 2. protect equipment form breakdown 3. minimize 60hz interference 4. prevent chassis current leakage - 1. avoid tissue damage The pneumatic drill has which of the following effects on BAEP'S? 1. None 2. Prolongs Wave V 3. Increases I-III interpeak latency 4. Increase III-V interpeak latency - 2. Prolongs Wave V In posterior fossa craniotomy surgery for a large tumor with unilateral hearing loss, the appropriate modalities to monitor would be: a) Contralateral BAEP, median nerve and facial nerve b) Ipsilateral BAEP and facial nerve c) Facial nerve and contralateral median nerve d) Ipsilateral BAEP - a) Contralateral BAEP, median nerve and facial nerve During middle or posterior fossa surgery, what structure is most at risk? a) Cerebellum b) Brainstem c) Optic Nerve d) Spinal Cord - b) Brainstem In posterior fossa surgery, an increase in the III-V interpeak interval would most likely be due to: a) Traction on the cerebellum b) Compression of the upper midbrain c) Traction on the acoustic nerve d) Fluid in the middle ear - a) traction on the cerebellum What muscle would you monitor for EMG activity for cranial nerve XII? a) Tongue b) Trapezius c) Masseter d) Frontalis - a) tongue If CN VII were transected, you would get: a) Absence of all waves I-V b) Increased I-III latency c) Loss of wave V only d) No changes - d) No changes Loss of BAEP's during drilling of the internal auditory canal is most likely due to: a) Disruption of the blood supply b) Compression of the brainstem c) Transection of the auditory nerve d) Artifact from the drill - d) Artifact from the drill What would be the effect of fluid in the internal auditory canal? a) Increase of the absolute latencies b) Increased wave amplitudes c) Increased I-V latency d) Loss of all waves - a) increase of the absolute latencies The prominent wave for monitoring BAEP's is: a) Wave I b) Wave III c) Wave V d) ECoG - c) Wave V Which of these can enhance the wave I amplitude? a) Use condensation instead of rarefaction b) Increase click intensity c) Decrease sweep speed d) Increase rep rate - b) Increase click intensity What is the MINIMUM acceptable sweep for BAEPs? a) 5 msec b) 15 msec c) 25 msec d) 35 msec - b) 15 msec If wave I is present in the contralateral ear montage, this could be caused by: a) The wrong click polarity b) Insufficient contralateral masking c) Too rapid rep rate d) Stimulating the wrong ear - b) insufficient contralateral masking The intraoperative BAEP is most likely to be obscured by: a) Patient position b) Eye movement c) Muscle artifact d) Warming blanket - c) muscle artifact An optimal rep rate for BAEP's is: a) 4 Hz b) 31 Hz c) 66 Hz d) 72 Hz - b) 31 Hz Contralateral ear masking should be at: a) 160 dB SPL b) 60 dB HL c) 60 dB SL d) 75 dB SPL - c) 60 dB SL The peak equivalent SPL of a click should be: a) 500 Hz b) 3000 Hz c) 5000 Hz d) 10,000 Hz - b) 3000 Hz Which of the following potentials will change with click polarity? a) Wave I latency b) I-V interpeak c) Wave V latency d) Wave V amplitude - d) Wave V amplitude The proper filter settings for recording BAEP's are: a) 1-25 to Hz b) 1-250 Hz c) 500-5000 Hz d) 1-1000 Hz - a) 1-25 to Hz If unavoidable muscle artifact is present in the BAEP, you can change the filters to: a) 500-1000 Hz b) 100-200 to 1500 Hz c) 10-500 Hz d) 1-1000 Hz - b) 100-200 to 1500 Hz Hearing level (HL) is defined by: a) An individual's hearing threshold b) The average hearing threshold of a normal population c) The absolute sound pressure relative to atmospheric pressure d) A table of clinical values - b) The average hearing threshold of a normal population Sensation level (SL) is defined by: a) An individual's hearing threshold b) The average hearing threshold of a normal population c) The absolute sound pressure relative to atmospheric pressure d) A table of clinical values - a) An individual's hearing threshold In the presence of irreducible artifact, the filters may be set at Hz for recording intraoperative: a) SSEPS b) EMG c) MEPs d) BAEPs - d) BAEPs Wave V of the BAEP is most affected by: a) Anesthesia below 1 MAC b) Retraction c) Muscle relaxants d) Temperature changes - b) retraction If the latency of Wave III of the BAEP is 4.5 using tube inserts it will be: a) 5.4 using headphones b) The same using headphones c) 3.6 using headphones d) 5.4 using small inserts - c) 3.6 using headphones The filter settings for recording BAEPs intraoperatively should be: a) 100-300 to 10,000 Hz b) 10-30 to 250-300 Hz c) 10-30 to Hz d) 10-30 to Hz - d) 10-30 to Hz The stimulus for BAEPs should be: a) Tone pips b) Broad-band clicks c) Narrow band clicks d) Broad band tone pips - b) Broad-band clicks The Cz' - Fpz channel of an SSEP recording represents? a) Subcortical far-field potentials b) Cortical near-field potentials c) Stationary lumbar potentials d) Erb's point potential - b) Cortical near-field potentials According ACNS guidelines, the duration of a monophasic rectangular pulse used for stimulation of a mixed nerve should be: a) 0.05 ms b) 0.3 ms c) 0.5 ms d) 1 ms - b) 0.3 ms In a normal adult, stimulation of the tibial nerve at the ankle: a) Will elicit a primary cortical response at about 37 ms b) Will elicit an ERb's point response at about 15 ms c) Will elicit a primary cortical response at about 20 ms d) Is the recommended stimulation site for VEP monitoring - a) Will elicit a primary cortical response at about 37 ms When stimulating the tibial nerve at the ankle, stimulation can be determined by: a) Turning the stimulator up to read 20 mA b) Recording an Erb's point response c) Confirming that the impedances of the stimulation electrodes are less than 5000 Ohms d) Recording a response from the popliteal fossa - d) Recording a response from the popliteal fossa Hypothermia: a) Has no effect on evoked potential latencies b) Decreases evoked potential latencies c) Has a variable effect on evoked potential latencies d) Increases evoked potential latencies - d) Increases evoked potential latencies Monitoring somatosensory function may fail to recognize changes in: a) Efferent motor pathways in the cord b) Dorsal Column function c) Peripheral Nerve function d) Ascending spinal cord tracts - a) Efferent motor pathways in the cord Cranial Nerves V and VII may be differentiated by: a) Latency in response to stimulation b) Amplitude in response to stimulation c) Morphology, regardless of electrode placement d) None of the above - a) Latency in response to stimulation Electronic devices used to store electrical charge are called: a) Resistors b) Insulators c) Capacitors d) Conductors - c) Capacitors Ohm's Law states: a) E = I x R b) R = I x E c) I = E x R d) E = I/R - a) E = I x R Impedance is defined as: a) The flow of alternating current b) Opposition to the flow of direct current c) Opposition to the flow of alternating current d) Opposition to the change in flow of current - c) Opposition to the flow of alternating current The basic unit for measuring current flow is: a) Coulomb b) Ampere c) Density d) Vold - b) Ampere Electrodes of dissimilar metals should not be used togehter because: a) Electrolyte only works with certain electrodes b) The amplifiers will only accept input form one type of electrode c) Dissimilar electrodes have no resistance d) The materials in different electrodes have different conductive properties - d) The materials in different electrodes have different conductive properties The basic unit of resistance is the: a) Ohm b) Coulomb c) Ampere d) Volt - a) Ohm Which of the following is most attenuated by a low frequency filter of 1 Hz? a) 5.0 Hz b) 0.8 Hz c) 10.0 Hz d) 1.5 Hz - b) 0.8 Hz The homonculus is a: a) Representation of the motor and sensory cortices of the brain b) Gyrus found in the temporal lobe c) A lateral loss of vision in one eye d) Type of tumor - a) Representation of the motor and sensory cortices of the brain Thrombosis of the right middle cerebral artery would most likely cause: a) Right homonymous hemianopsia b) Aphasia c) Left-sided paralysis, primarily of the leg d) Left-sided paralysis, primarily of the face & arm - d) Left-sided paralysis, primarily of the face & arm The maximum allowable chassis leakage current is: a) 100 uV b) 10 uA c) 1000 uA d) 100 uA - d) 100 uA A patient can become the pathway of least resistance and therefore electrically susceptible to shock when: a) Depth electrodes are used b) Not all equipment attached to the patient is connected to a common ground c) The electrode test is utilized d) The recording instrument is turned on - b) Not all equipment attached to the patient is connected to a common ground The stimulus intensity of SSEPs should not be set above: a) 20 mA b) 40 mA c) 60 mA d) 80 mA - b) 40 mA According to ACNS guidelines, a grounding device must be available so that under is measured across an impedance of 1000 Ohms: a) 50 uV rms at 60 Hz b) 60 mV rms at 50 Hz c) 20 uV rms at 60 Hz d) 20 mV rms at 60 Hz - d) 20 mV rms at 60 Hz What is the voltage delivered to a patient if the constant current stimulator is set at 50 mA and the skin resistance is 40 Ohms? (E = I x R) a) 100V b) 1V c) 200V d) 2V - d) 2V For patients showing clamp related EEG changes during CEA, 80% occur within the: a) 10-13 Hz alpha range b) Contralateral Hemisphere c) First minute d) First 10 seconds - c) FIRST MINUTE What is the frequency of a waveform that has a wavelength of 25 ms? a) 1000 Hz b) 1 kHz c) 40 Hz d) 400 Hz - c) 40 Hz (1/.025 = 40 Hz) Given a wavelength of 5.0 ms, what is the minimum sampling rate required to resolve the response with aliasing in it? a) 200 Hz b) 2000 Hz c) 0.0002 Hz d) 500 Hz - c) 0.0002 Hz (5msec=0.005sec=200Hz) Rarefaction clicks create? a) Positive pressure within the auditory canal b) Negative pressure within the auditory canal c) Alternating positive and negative pressure d) None of the above - b) Negative pressure within the auditory canal The generator site for the N9 response during median nerve stimulation is: a) Decussation of the posterior columns in the pyramidal region b) Superior olivary complex c) Near-Field conduction volley d) Sensory cortex - c) Near-Field conduction volley Which of the following drugs will have no effect on cortical SEPs? a) Vecuronium b) Narcotics c) Pentothal c) Isoflurane - a) Vecuronium Which of the following tibial nerve responses is NOT a near-field response? a) N45 b) Popilteal fossa response c) N30 d) P37 - c) N30 It is REQUIRED that the neurotechnologist be able to communicate effectively with: a) the circulating nurse b) the surgeon c) the surgeon and anesthesia staff d) all personnell in the room - c) the surgeon and anesthesia staff Meniere's disease: a) An inner ear disturbance b) Caused by Meningitis c) A disorder of the auditory cortex d) Caused by encephalitis - a) An inner ear disturbance The blood warmer can produce artifact that has a wavelength of: a) 12-15 ms b) 20-22 ms c) 15-17 ms d) 17-20 ms - c) 15-17 ms During a midline posterior fossa decompression surgery to remove a tumor, the most appropriate monitoring protocol is: a) ABR only b) MN SSEP, CN VII EMG, ABR c) PTN SSEP, CN V EMG, ABR d) SSEP, MEP, CN VII EMG - b) MN SSEP, CN VII EMG, ABR Facial Nerve CMAP responses are best recorded from the: a) Masseter muscle b) Orbicularis oris c) Facial Nerve d) Foramen Ovale - b) Orbicularis Oris In order to monitor the cranial nerve XI, the recording electrodes are placed in the: a) Trapezius muscle b) Soft Palate c) Tongue d) False vocal cords - d) False vocal cords Which of the following preoperative conditions does not interfere with AEP monitoring? a) Hearing loss b) Ruptured tympanic membrane c) Opthalmaplegia d) Brainstem compression - c) Opthalmaplegia Which of the following is the most appropriate time base for CN VII CMAP? a) 1 ms b) 20 ms c) 12 ms d) 5 ms - c) 12 ms In order to monitor the recurrent laryngeal nerve, the recording electrodes are placed in the: a) Trapezius muscle b) Soft palate c) Tongue d) False Vocal Cords - d) False Vocal Cords Monitoring procedures during carotid endarterectomy include: a) Monitoring of both hemispheres b) Cessation of monitoring following clamp removal c) Monitoring from the compromised hemisphere only d) Recording a full minute of EEG baseline - d) Recording a full minute of EEG baseline Which of the following is the most appropriate time base for an auditory evoked potential? a) 1 ms b) 6 ms c) 12 ms d) 20 ms - c) 12 ms Which of the following anatomic structures is NOT monitored by tibial nerve SSEP? a) Dorsal spinal columns b) Tibial Nerve c) Somatosensory portion of the brain in the midline region d) L4 nerve root - d) L4 nerve root Which of the following preoperative conditions does not affect the SEP of the tibial nerve with stimulation at the ankle? a) Cervical myelopathy b) Severe diabetes c) Paraplegia d) Cervical radiculopathy - d) Cervical radiculopathy Differential amplifiers should be rated with a common mode rejection ratio of at least: a) 1000:1 b) 60 dB c) 10,000:1 d) 1,000,000: 1 - c) 10,000:1 "Hearing Level" (HL) is defined as the: a) average threshold intensity of normally hearing young adults b) Intensity of long duration sound that has the same amplitude as the peak SP of a short duration sound c) Lowest intensity that an average eardurm can hear d) Inverse of the sound pressure level - a) average threshold intensity of normally hearing young adults Brain activity recorded directly from the cortex (ECoG) is very high in amplitude and usually requires sensitivities in the range of: a) 10-50 mV/mm b) 40-100 mV/mm c) 100-150 mV/mm d) 200-300 mV/mm - b) 40-100 mV/MM Pre-stimulus triggering: a) presents a positive signal to the average prior to initiating the display b) Includes a period of recording before the stimulus c) Eliminates the problems associated with recording the stimulus artifact d) Delays the synchronizing pulse to the computer - b) Includes a period of recording before the stimulus Cortical potentials are a compilation of: a) EPSPs and IPSPs b) Seizure activity and normal activity c) Summation potentials d) ISPSs only - a) EPSPs and IPSPs Evoked potential equipment makes use of differential amplifiers to: a) Filter out noise b) Increase the stimulus intensity c) Amplify biologic signals d) Make the machine safer for patients - c) Amplify biologic signals The innermost connective tissue membrane covering the brain is the: a) Dura b) Pia c) Arachnoid d) Falx cerbri - b) Pia The facial nerve is cranial nerve and innervates the muscles of ? a) V; facial expression b) VIII; eye movement c) V; mastication d) VII; facial expression - d) VII; facial expression Specral edge is a function of: a) Delta vs time b) Amplitude and latency vs time c) Power vs amplitude d) Power and frequency vs. time - d) Power and frequency vs. time What separates the sensory and motor cortical strips? a) Falx cerbri b) Sylvian fissure c) Central sulcus d) Frontal sulcus - c) Central sulcus Which of the following is NOT a safety concern regarding TCMEPs? a) Tongue lacerations b) History of seizure disorders c) History of cerebral palsy d) Pacemaker - c) History of cerebral palsy Which of the following drugs will increase the amplitude of cortical SSEPs? a) Diprovan b) Etomidate c) Pavulon d) Isoflurane - b) Etomidate Which of the following is a reason why false negatives can occur? a) Documentation is incomplete b) Changes were seen and communicated to the surgeon but no postoperative deficits were noted c) Physiological damage occurred d) The lesion occurs in a structure not involved in the pathways being monitored - d) The lesion occurs in a structure not involved in the pathways being monitored Spinal Cord Ischemia during aortic surgery is best detected by changes in the: a) Posterior tibial nerve SSEP b) Median nerve SSEP c) Tibial Nerve compound action potential d) Lumbar potential - a) Posterior tibial nerve SSEP Wave III of the BAEP is generated in the: a) Distal portion of the auditory nerve b) Cochlea c) Masseter d) Lower Brainstem - d) Lower brainstem When monitoring the facial nerve, wire electrodes should be placed in the: a) Masseter b) Contralateral nasalis c) Orbicularis oculi and orbicularis oris d) Frontalis and masseter - c) Orbicularis oculi and orbicularis oris During microvascular decompression to relieve hemifacial spasm: a) CN VI should be monitored b) CN V should be monitored c) CN VII should be monitored d) CN VIII should be monitored - c) CN VII should be monitored A bipolar stimulator allows the surgeon to: a) Be more specific in identifying structures b) Stimulate larger areas c) Use a higher stimulus intensity d) Use a shorter stimulus duration - a) Be more specific in identifying structures When sterilizing an epidural electrode, it should be considered a: a) Semi-critical item b) Disposable item c) Non-Critical item d) Critical item - d) critical item EP systems utilized for IOM should have: a) a 100uA leakage limit for isolated patient connections b) a 10 uA limit on chassis leakage c) Both A and B d) Neither A nor B - d) Neither A nor B Stimulus duration for tibial nerve SSEPs should be between? a) 200 and 500 microseconds b) 0.2 and 0.5 milliseconds c) 100 and 300 microseconds d) 0.1 and 0.3 Hz - c) 100 and 300 microseconds A grounding system must be available at each nonflammable anesthetizing location such that no voltage greater than: a) 20 uV rms at 60 hz shall be measured across an impedance of 1000 ohms b) 20 mV rms at 60 hz shall be measured across an impedance of 1000 ohms c) 50 mV rms at 60 hz shall be measured across an impedance fo 1000 ohms d) 50 uV rms at 60 hz shall be measured across an impedance of 1000 ohms - b) 20 mV rms at 60 hz shall be measured across an impedance of 1000 ohms The system bandpass for recording FACIAL NERVE EMG should be: a) 1-30 to 16,000 Hz b) 1-250 to 1,500 Hz c) 10-30 to 250-3000hz d) 1-250 to 1000ms - a) 1-30 to 16,000 Hz The system bandpass for recording CORTICAL SSEPs should be: a) 1-30 to 250-1000hz b) 10-30 to 1500ms c) 10-30 to 250-3000hz d) 1-250 to 1000ms - a) 1-30 to 250-1000hz How might you best decrease stimulus artifact while recording BAEPs intraoperatively? a) Use rarefaction clicks b) Use tone pips c) Use condensation clicks d) Use clicks of alternating polarity - d) Use clicks of alternating polarity A patient present for an L1 burst fracture repair. What is the most appropriate monitoring protocol? a) Tibial and auditory nerves b) Median and ulnar nerves c) Tibial and median nerves d) Tibial and peroneal nerves - c) Tibial and median nerves At the stage of surgical anesthesia, propofol affects the BAEPs by: a) Dramatically increasing all absolute latencies b) Decreasing all waveform amplitudes c) Aboloshing all waveforms d) Causing minimal changes - d) Causing minimal changes A wave III to V interpeak latency increase can be indictive of a lesion in: a) the distal portion of cranial nerve VIII b) between the distal portion of the nerve and the pons c) Between the pons and the upper brainstem d) The middle ear - c) Between the pons and the upper brainstem Efferent pathways: a) Conduct impulses from the CNS to the peripheral nerves b) Are motor pathways c) are sensory pathways d) Both A and B - d) Both A and B If a sound intensity is increased from 20dB to 40dB, then the sound has increased by a factor of: a) 2 b) 10 c) 20 d) 100 - a) 2 When testing BAEPs, you get a Wave I on your contralateral montage. What should you do? a) Increase click intensity b) Check ear phones for proper side stimulation c) Change polarity of click to condensation d) Don't do anything - b) Check ear phones for proper side stimulation Which of the following would most likely result in an increased I-III interval? a) Decreased click intensity b) Acoustic Schwannoma c) Cochlear lesion d) Petrous osteoma - c) Cochelar lesion What montage will help you discern waves IV and V in BAEP? a) Ipsi ear - contra ear b) Cz - contra ear c) Ipsi ear - Fz d) Cz - Fz - b) Cz - Contra ear If the ear canal is occluded, you may expect: a) Increased I-V interval b) Prolongation of all wave latencies c) Increased wave I amplitude d) Increased I-III interval - b) Prolongation of all wave latencies What should be monitored during a vestibular neurectomy? a) Facial nerve b) Ipsilateral BAEP and Facial nerve c) Contralateral BAEP d) Peroneal SSEPs and Facial nerve - b) Ipsilateral BAEP and Facial Nerve The use of ER insert earphones (with the tube) results in: a) Lack of stimulus artifact b) Separating Wave I from the stimulus artifact c) Increased Wave I amplitude d) Increased I-V interval - B) Separating Wave I from the stimulus artifact Alternating clicks can be used to: a) Increase wave I amplitude b) Eliminate stimulus artifact c) Evaluate left and right sides simultaneously d) Mask the contralateral ear - b) Eliminate stimulus artifact Excitation of the postsynaptic neuron is caused by the neurotranmitter a) gamma amino butyric acid b) glycine c) para amino buryric acid d) glutamate - d) glutamate Wave III of the BAEP is generated by? a) Superior Olivary Complex b) Infereior Colliculus c) Lateral Lemnisucus d) Medial Geniculate - a) Superior Olivary Complex Lying between the adjacent surfaces of the verterbral bodies and bonding them together , are the: a) pedicles b) intervertebral discs c) supraspinous ligaments d) spinal nerves - b) intervertebral discs Which of the following upper extremity somatosensory responses is considered a "stationary potential"? a) N20 b) N13 c) P14 d) N18 - b) N13 The initial waveform recorded of a near-field potential is? a) always obscured by stimulus artifact b) negative due to depolarization of membrane potentials positive due to electrotonic depolarization c) of the membrane under the recording electrode d) of very low amplitude due to the significant distance between the generator and recording electrode - b) negative due to depolarization of membrane potentials positive due to electrotonic depolarization Nerves of the body, such as the ulnar, median, and femoral, are formed from the: a) white matter of the spinal cord b) dorsal and ventral rami c) cervical spinal cord d) ventral ganglion - b) dorsal and ventral rami On the SSEP, the electrode at records a spinal cord response: a) T12 b) CPz c) Iliac Crest d) the popliteal fossa - a) T12 Projecting laterally from the junction of the pedicle and lamina, and serving as a lever form muscle and ligaments, are the : a) intervertebral discs b) mamillary processes c) intervertebral foramen d) transverse process - d) transverse process Synaptic transmission, and/or changes in the thalomocortical projections, are believed to reproduce? a) subcortical potentials b) cortical potentials c) the Erb's point potential d) the P100 potential - b) cortical potentials The section of the brainstem that is continuous with the spinal cord and includes the decussaton of the pyramids, is the? a) medulla oblongata b) pons c) dorsal column d) midbrain - a) medulla oblongata The ulnar nerve originates from nerve roots at? a) C5-C6 b) C6-C7 c) C7-C8 d) C7-T1 - d) C7-T1 The common peroneal nerve arises form the superior angle of the popliteal fossa of the: a) superior tibial nerve b) superior femoral nerve c) internal popliteal nerve d) sciatic nerve - d) sciatic nerve The resting membrane potential of a neuron is: a) +20 mV b) +70 mV c) -20 mV d) -70 mV - d) -70 mV The facial nerve is cranial nerve and it supplies the muscle for a) V, jaw movement b) V, eye movement c) VI, facial expression d) VII, facial expression - d) VII, facial expression A nerve cell membrane can depolarize when: a) Sodium channels are closed and potassium channels are opened b) The summation of individual action potentials exceeds the membrane threshold c) the resting membrane threshold reached -70 mV d) chloride channels are opened - b) The summation of individual action potentials exceeds the membrane threshold Because generator sites are typically deep within anatomic structures, most EPs are considered to be: a) far-field responses b) multiwave complexes c) transient waveforms d) steady state potentials - a) far-field responses The posterior tibial nerve arises from which branch of the sciatic nerve? a) superior tibial b) superior peroneal c) internal popliteal d) external popliteal - a) superior tibial The gain of an amplifier, set to give an output signal of 1 volt for an input signal of 10 UV, is: a) 100 b) 1000 c) 10,000 d) 100,000 - d) 100,000 The following are examples of good insulating materials, inhibiting current flow: a) silicon and germanium b) silver and copper c) glass and rubber d) gold and platinum - c) glass and rubber In selecting the horizontal parameter of analysis, the: a) sampling rate should be at least two times greater than the highest frequency in the signal b) sampling rate should be the equivalent of the highest frequency in the signal c) analysis period should be at least twice the Nyquist frequency d) analysis period should approach the Nyquist frequency - a) sampling rate should be at least two times greater than the highest frequency in the signal Which of the following can inhibit the postsynaptic neuron? a) gamma amino butyric acid (GABA) b) acetylcholine c) para amino butyric acid d) glutamate - a) gamma amino butyric acid (GABA) The median nerve originates from nerve roots? a) C5 -T1 b) C3 -C7 c) C5 - C6 d) C4 - C6 - a) C5 - T1 The peroneal and tibial nerves are divisions of the: a) brachial plexus b) deep peroneal nerve c) sciatic nerve d) lumbar plexus - c) sciatic nerve Spinal nerves are attached in series to the sides of the spinal cord and emerge through the? a) filum terminale b) lamina c) spinous process d) intervertebral foramina - d) intervertebral formina P14 is a far-field, subcortically generated response which probably reflects? a) activity from the precentral gyrus (motor strip) b) caudal medial lemniscal activity c) passage of the afferent volley d) a stationary cervical potential - b) caudal medial lemniscal activity The assumption that responses of excessive amplitude are likely to contain artifact forms the basis of: a) digital filtering b) dwell time c) artifact rejection d) digital averaging - c) artifact rejection An advantage to using grid or strip electrodes over the "Crown of Thorn" for recording ECoG is the ability to: a) place electrodes precisely on gyri b) sterilize and reused them c) individually position each contact d) slide them under the dura to unexposed areas - d) slide them under the dura to unexposed areas Instrumentation systems used to distract, compress, and de-rotate the spine to restore normal vertebral column alignment, include: a) Cotrel-Dubousset and Isola b) CMRR and CMRO c) DuBois and Reymond d) TCD and pedicle screw - a) Cotrel-Dubousset and Isola In order to monitor cranial nerve X, the recording electrodes are placed on the: a) Trapezius muscle b) Soft palate c) tongue d) false vocal cords - d) false vocal cords When recording a posterior tibial nerve SSEP, the FPz-C5s channel records: a) subcortical far-field potentials b) subcortical near-field potentials c) stationary lumbar potentials d) the Erb's point potential - a) subcortical far-field potentials When recording BAEPs in the OR, some auditory simulators utilize several inches of tubing to connect the transducer and ear inserts which: a) do not affect the latencies of the waveforms b) are comparable to acoustically shielded headphones c) delay the signal to the transducer and can cause 60 Hz artifact d) delays the arrival of the sound to the ear and separates stimulus artifact - d) delays the arrival of the sound to the ear and separates stimulus artifact Following the final application of connective forces to the spinal column, the spinal cord should typically be monitored for at least: a) 5 minutes b) 10 minutes c) 20 minutes d) 30 minutes - d) 30 minutes A contraindication for the use of transcranial magnetic stimulation is: a) patient obesity b) a cardiac pacemaker in place c) multiple sclerosis d) transverse myelitis - b) cardiac pacemaker in place In order to assess the stimulating circuitry, stimulating electrodes, and the peripheral nerve while recording SSEPs intraoperatively, the peripheral nerve should also be recorded: a) INM b) CAP c) CEA d) TCeMEP - b) CAP Preoperative baseline, sensory evoked potential values are essential to intraoperative neurophysiological monitoring because: a) latencies and amplitudes are highly variable b) it is necessary to compare intraoperative values with laboratory normative date c) absolute boundaries for EPs obtained intraoperatively are not available d) they help to establish the appropriate level of anesthesia - c) absolute boundaries for EPs obtained intraoperatively are not available A patient is admitted to the operating room diagnosed with a herniated cervical disc at C5/6. The most appropriate nerves to monitor during the resulting surgical procedure would be the? a) tibial and ulnar nerves b) median and posterior tibial nerves c) median and auditory nerves d) ulnar nerve - b) median and posterior tibial nerves The median nerve SSEP can be helpful as a measure of? a) cerebral blood flow b) lower spinal cord funtion c) blood pressure variability d) anesthetic sensitivity - a) cerebral blood flow Spinal cord evoked potentials are best recorded using a low-frequency filter setting of 100Hz. This setting is preferred because, relative to cortical somatosensory evoked potentials, spinal cord potentials are: a) of relatively short duration b) less affected by changes in anesthesia c) subject to 60 Hz interference d) an extremely low voltage response - a) of relatively short duration In the operating room, the stimulus intensity for activating a sensory nerve: a) should be set at double the sensory threshold b) should be set for two to three times the motor threshold c) does not have an established boundary d) is set slightly above motor threshold - c) does not have an established boundary The suggested rate of stimulation for intraoperative posterior tibial nerve evoked potential monitoring is: a) 30 to 40 per second b) 20 to 30 per second c) 10 to 20 per second d) 2 to 10 per second - d) 2 to 10 per second To record cortical SSEPs during intraoperative monitoring of cervical spinal cord surgery, electrodes should be placed: a) 2cm anterior to C3 and C4 b) 2cm posterior to C3 and C4 c) in the C3 and C4 positions of the International 10/20 system d) between Cz and Pz, and between Pz and Oz - b) 2cm posterior to C3 and C4 The amplitude of the cortical response to posterior tibial SSEP stimulation is at least 80% attenuated by: a) stimulation rate of 15 per second or higher b) large doses of muscle relaxant c) a HLF of 5000 Hz d) a stimulation duration greater than 150 usec - a) stimulation rate of 15 per second or higher During intraoperative EP monitoring, it is recommended that the technologist's data sheet should include all of the following except: a) operative events and communications with the surgeon b) instruments passed to the surgeon and the number of sponges used c) patient vital signs and anesthetic agents used d) recorded artifacts and measures to eliminate them - b) instruments passed to the surgeon and the number of sponges used When recording SSEP responses in an awake patient, the motor threshold should be the: a) level at which the patient can no longer tolerate the stimulus b) minimum stimulus intensity that produces a muscle twitch in the appropriate muscle group c) stimulus rate at which tetany is achieved d) threshold at which point the muscle groups being stimulated fail to respond to stimulation - b) minimum stimulus intensity that produces a muscle twitch in the appropriate muscle group When monitoring with SSEPs, dural or direct cord recordings are advantageous because: a) they present less discomfort to the patient than scalp leads b) they have less chance of artifact during cauterization c) the waveforms better reflect cortical responses to stimulation d) the waveforms are higher in amplitude and require fewer responses - d) the waveforms are higher in amplitude and require fewer responses Spectral analysis of rawa EEG data displays power as an upward delection and: a) wave morphology in a compressed design b) frequency as a linear display across the epoch line c) time horizontally on the graph d) time as a spectral edge - b) frequency as a linear display across the epoch line When monitoring somatosensory evoked potentials during a critical moment in an intraoperative study, changing the setting of the high-frequency filter a) will be of limited consequence to the outcome of the study b) may help isolate a true signal from background noise c) may increase the number of single trial events required to resolve the evoked potentials d) may lead to false interpretation of the data - d) may lead to false interpretation of the data Stimulation of the spinal cord to elicit motor evoked potentials is most useful for monitoring: a) anterior spinal cord function b) dorsal column function c) peripheral nerve function d) ascending spinal cord tracts - a) anterior spinal cord function When monitoring the facial nerve: a) long-lasting muscle relaxants must be avoided b) bipolar electrodes should be placed in the larynx c) needle electrodes should be placed in the masseter d) inhalational anesthetic agents must be avoided - a) long-lasting muscle relaxants must be avoided An appropriate BAEP stimulation rate to avoid synchronization with 60 Hz artifact, would be: a) 6 per second b) 9.5 per second c) 10 per second d) 20 per second - b) 9.5 per second Vascular malformations of the posterior fossa associated with hemifacial spasm and facial paresis may cause: a) a loss of Wave I on the BAEP b) BAEP latency abnormalities c) increased amplitude if tubal inserts are used for stimulation d) BAEP abnormalities if the auditory cortex is involved - b) BAEP latency abnormalities At the stage of surgical anesthesia, propofol affects the BAEP by: a) increasing the latencies of Waves I, III and V without changing their amplitudes b) decreasing the amplitude in all waveforms c) causing very minimal changes d) abolishing all waveforms - a) increasing the latencies of Waves I, III and V without changing their amplitudes Functional cortical stimulation is used to localize brain areas that must be: a) identified before clamping b) most at risk during aneurysm clipping c) monitored futher by somatosensory EPs d) preserved during resection - d) preserved during resection The surgical procedure that would have the greatest risk for changes in cardiovascular and respiratory efforts would: a) involve the posterior fossa b) be the removal of an occipital tumor c) be temporal lobectomy d) be in the area of the posterior spinal segments - a) involve the posterior fossa With significant changes in cervical and cortical SSEPs during intraoperative monitoring, adequate stimulation of the median nerve is indicated by: - NO CHANGE IN THE PERIPHERAL RESPONSES When using constant voltage for facial nerve stimulation and the nerve becomes bathed in CSF, what will occur after the area is suctioned? - CURRENT FLOW WILL VARY IN ORDER TO MAINTAIN THE PRESENT VOLTAGE LEVEL When blood supply to the brainstem is markedly reduced, an expected change in the BAEP would be: - AN INCREASED LATENCY OF WAVE V The anesthetic agent that has the least effect on SSEP waveforms is? - VECURONIUM Using a montage consisting of C5 spine to Fpz with lower extremity stimulation, the expected response is generated at the? - CAUDAL MEDICAL LEMNISCUS AND IS A FAR-FIELD RESPONSE The recommended criteria for surgeon notification when moitoring BAEPS intraoperatively include an increase in? - THE LATENCY OF WAVE V OF GREATER THAN OR EQUAL TO 1.0 msec OR THE DISAPPEARANCE OF WAVE V When placing screws during an open procedure, at what threshold is the screw considered breached? a. 6 mA b. 10 mA c. 15 mA d. 20 mA - 6 mA Anesthesia is start and the patient is intubated. You set up TCeMEPs but see no response until 45-50 minutes after induction. a. None b. Mivacurium c. Succinylcholine d. Pancuronium e. Vecuronium - Vecuronium Which of the following combinations of anesthetic agents is recommended by ASNM for transcranial motor evoked potentials (TCeMEP) stimulated electrically? a. Propofol infusion with 50% N20, 0.25 ug/kg/hr sufentanil infusion b. 0.5 MAC Sevoflurane, 70% Nitrous oxide and 0.25 ug/kg/hr sufentanil infusion c. 1.0 MAC of Desflurane, 50% N20, and a vecuronium infusion d. 1.0 MAC of Isoflurane, 50% N20, 0.25 ug/kg/hr sufentanil infusion e. 1.0 MAC of Sevoflurane, 50% N20, 0.25 ug/kg/hr sufentanil infusion - a. Propofol infusion with 50% N20, 0.25 ug/kg/hr sufentanil infusion Excessive neck flexion in the sitting position can result in which of the following? a. cortical ischemia from carotid artery compression b. paraplegia due to compromise of the artery of Adamkiewicz c. quadraparesis due to ischemia in the upper thoracic spine d. kinking of the subclavian artery with ischemia to the upper arm - c. quadraparesis due to ischemia in the upper thoracic spine Stimulus artifact during SSEPs can be decreased by: a. Separating stimulating cables from cables of other equipment b. Keeping the instrument away from fluorescent lights and video monitors c. Lowering the impedances of ground and stimulating electrodes d. Using enough muscle relaxant - c. Lowering the impedances of ground and stimulating electrodes Middle cerebral artery supplies: (select all that apply) a. mouth area of cerebral cortex b. hand area of cerebral cortex c. face area of cerebral cortex d. auditory area of cerebral cortex - all of the above With exposure provided by laminectomy, needle electrodes can record spinal activity with placement: a. in the spinal muscle b. in the pedicle c. on the spinal cord d. in the epidural space - d. in the epidural space D-wave cannot be recorded below: a. L1 b. D-wave can be recorded from any spinal level c. T9 d. T6 - a. L1 Universal precautions eliminate potential contact with body fluids that transmit: a. Electrical current b. Bacteriostatic viruses c. Meningitis d. Bloodborne pathogens - d. Bloodborne pathogens Monitoring of muscle relaxation is usually done with the train of four. Which of the following is true? a. relaxation is measured by counting the number of muscle responses to 4 stimuli at 2 Hertz b. relaxation is monitored by examining the muscle contractions to continuous stimulation at 4 Hertz c. relaxation is monitored by examining the CMAP to four rapid stimuli and 500 Hz - a. relaxation is measured by counting the number of muscle responses to 4 stimuli at 2 Hertz In order to assess the stimulating circuitry, stimulating electrodes, and the peripheral nerve while recording SSEPs intraoperatively, the peripheral nerve should also be recorded. a. CAP b. CEA c. INM d. TCeMEP - a. CAP What is the definition of a propagated response and give an example of one? a. N13 in the upper SSEP. The electrode moves and only the amplitude changes b. N9 response in the upper SSEP. The electrode moves and so does the latency c. p37 response in the lower SSEP. The electrode moves and so does the latency d. Wave V in BAEP - b. N9 response in the upper SSEP. the electrode moves and so does the latency The brain and spinal cord is thought to autoregulate its blood flow over a range of blood pressures. Is it safe to lower the blood pressure in all patients to a mean blood pressure of 50 mmHg? a. No b. Yes - a. No A "ground loop" is created when: a. Two recording electrodes are connected to two separate input boxes of the same instrument b. The patient is grounded by the large electrocautery ground that resembles a loop c. Two separate devices are attached to the same patient and have two separate grounding connections d. Separate equipment attached to the same patient have current-limiting grounds - c. Two separate devices are attached to the same patient and have two separate grounding connections What is the primary source of infectious organisms in hospitals? a. Waste b. Dirt c. Air d. Dust e. People - e. People When there is bilateral noise in the free-running EMG channels and the patient is getting "light," what does one expect to see in the SSEPs? a. High artifact rejection in channels with electrodes place over muscle b. the patient begins to yell c. high rejection in every channel and unobtainable waveforms. d. The surgeon discontinues surgery - a. High artifact rejection in channels with electrodes placed over muscle For stimulation in motor evoked potential (MEP) studies, the anode should be placed: a. caudal to the cathode b. lateral to the cathode c. rostral to the cathode d. medial to the cathode - c. rostral to the cathode The surgeon has informed you that he would like to do pedical screw testing. The anesthesiologist has kindly asked you what conditions are needed during the testing period. Your response should include which of the following? a. Absolutely no inhalational agents in the patient at the time of testing b. four twitches with little or no fade at the time of testing c. it doesn't really matter what you do d. Absolutely no intravenous agents in the patient at the time of testing e. Switch to a shorter-acting muscle relaxant such as succinylcholine - b. four twitches with little or no fade at the time of testing When used as an induction agent, which of the following drugs will have the least effect on the somatosensory evoked potential? a. isoflurane b. etomidate c. halothane d. propofol - d. propofol Which of the following monitoring modalities is affected the least by 1 MAC of desflurane? a. cortical auditory evoked potentials b. Epidural recording of transcranial motor evoked potentials (D wave) c. Compound muscle action potential recording of transcranial MEP d. Cortical somatosensory evoked potentials - b. Epidural recording of transcranial motor evoked potentials (D wave) The recommended location for recording the cervical cord responses to median nerve stimulation is: a. C8 b. C1 c. C2 d. C5 - d. C5 When running T-EMG, what are you recording? a. CMAP b. SSEP c. SNAP d. MEP - a. CMAP With significant changes in cervical and cortical SSEPs during intraoperative monitoring, adequate stimulation of the median nerve is indicated by