CNIM ABRET Practice Exam Questions –
Certified Neurophysiologic Intraoperative
Monitoring Practice Test
What changes would you see with a right MCA stroke? - ANSWER ✔ Left UPPER cortical responses
decrease in amplitude or lost
What blood vessel is impacted with right PTN cortical loss? - ANSWER ✔ Left ACA
If you get artifact in your subcortical channel you...
A) Ask anesthesia to increase gas
B) Ask surgeon to move retractors
C) Disable the subcortical response
D) Use a spare C5s electrode - ANSWER ✔ D) Use a spare C5s electrode
There were epidural recordings to PTN stim from T5 and from C7. The T5 had a stable response
throughout the tumor surgery, while the C7 had no response and then a great one after the tumor
removal. Where was the tumor?
A) Caudal to T4 & rostral to C7
B) Caudal to T5
C) Rostral to C7
D) Rostral to T6 & Caudal to C7 - ANSWER ✔ D) Rostral to T6 & Caudal to C7
Which component would be most affected by a tumor by where the spinal cord & medulla intersect?
A) N13
B) P31
C) EP
D) N20 - ANSWER ✔ A) N13 --> this is the JUNCTION where medulla & cord intersect (CERVICAL
response)
,CNIM ABRET Practice Exam Questions –
Certified Neurophysiologic Intraoperative
Monitoring Practice Test
What is an appropriate filter for a short latency SSEP cortical response? - ANSWER ✔ 10-3000 Hz
(ALWAYS THE ANSWER with 3000 in it!!!)
Lumbar potential is generated from
A) Pre-synaptic responses
B) Post-synaptic responses
C) Spinal ganglion
D) Sciatic nerve - ANSWER ✔ B) Post-synaptic responses
From L to R pre-auricular points is measured 30 cm. The C3 electrode is located
A) 9 cm medial to the L point
B) 6 cm medial to the L point
C) 18 cm medial to the R point
D) 9 cm to the R point - ANSWER ✔ A) 9 cm medial to the L point
What peak and montage is horizontal dipole? - ANSWER ✔ -N13
-C5s-EPc --> C5s is ACTIVE electrode
What electrode would provide you with an N20 response from LEFT median nerve stimulation? -
ANSWER ✔ C4'
What responses would you still have if you have a stroke in the VBA? - ANSWER ✔ -For UE : you would
still have the cervical (N13) response & Erb's point
-For LE : you would still have the LP & PF response
**VBA perfuses subcortical responses. If stroke occurs, you will not have a subcortical or cortical
response.
,CNIM ABRET Practice Exam Questions –
Certified Neurophysiologic Intraoperative
Monitoring Practice Test
If N20 is lost on ONE side? - ANSWER ✔ MCA aclusion
During a scoliosis surgery, you recognize a gradual latency increase of 3.5 msec in the PTN cortical
response, the subcortical response appears to be shifted out almost as much. All response amplitudes
are unchanged. What is the appropriate action to take?
A) Ignore the change, it means nothing.
B) Inform the surgeon immediately that changes consistent with with spinal cord injury may have
occurred. Recommend a wake up test
C) Check the latencies of the PF and MN responses to see if they are also shifted, indicating a possible
temperature effect. Verify this by checking the pt's body temp
D) Ask anesthesia to reduce the gases. You are seeing changes consistent with increased depth of
anesthesia. - ANSWER ✔ C) Check the latencies of the PF and MN responses to see if they are also
shifted, indicating a possible temperature effect. Verify this by checking the pt's body temp
During a thoracic laminectomy, a rapid loss of the right PTN cortical responses occurs. The cervical
response is too poor to evaluate, the pop fossa responses are unchanged. What should you do first?
A) Run MN & check anesthetic levels
B) Inform the surgeon immediately & indicate that the changes are consistent with a right hemi-cord
injury
C) Check the right stimulator output with bar electrode
D) Reset the amplifier, check your recording parameters and wait to see if the response returns -
ANSWER ✔ B) Inform the surgeon immediately & indicate that the changes are consistent with a right
hemi-cord injury
During an anterior lumbar fusion (L4-5), a loss of all right PTN responses occurs over the course of about
five minutes. What should you do?
A) Inform the surgeon the right stimulator has failed, but that you will continue to diligently monitor the
left side
B) Check the current output & stimulator connections quickly. Then inform the surgeon you are seeing
changes consistent with ischemia of the right leg
, CNIM ABRET Practice Exam Questions –
Certified Neurophysiologic Intraoperative
Monitoring Practice Test
C) Inform the surgeon there may be spinal cord changes
D) Check MN responses for possibly anesthetic changes. - ANSWER ✔ B) Check the current output &
stimulator connections quickly. Then inform the surgeon you are seeing changes consistent with
ischemia of the right leg
What components of PTN would you lose for the above question?
A) Cortical
B) Subcortical
C) Peripheral
D) All the above - ANSWER ✔ D) All the above
For peroneal nerve stimulation, the ground should be placed:
A) Foot
B) Calf
C) Ankle
D) Thigh - ANSWER ✔ D) Thigh
For PTN stimulation, the ground should be placed:
A) Foot
B) Calf
C) Ankle
D) Thigh - ANSWER ✔ B) Calf
When testing SSEP from the upper extremity, a electrode placed at Erb's point will record activity
generated from
A) brachial plexus
B) lumbar plexus
Certified Neurophysiologic Intraoperative
Monitoring Practice Test
What changes would you see with a right MCA stroke? - ANSWER ✔ Left UPPER cortical responses
decrease in amplitude or lost
What blood vessel is impacted with right PTN cortical loss? - ANSWER ✔ Left ACA
If you get artifact in your subcortical channel you...
A) Ask anesthesia to increase gas
B) Ask surgeon to move retractors
C) Disable the subcortical response
D) Use a spare C5s electrode - ANSWER ✔ D) Use a spare C5s electrode
There were epidural recordings to PTN stim from T5 and from C7. The T5 had a stable response
throughout the tumor surgery, while the C7 had no response and then a great one after the tumor
removal. Where was the tumor?
A) Caudal to T4 & rostral to C7
B) Caudal to T5
C) Rostral to C7
D) Rostral to T6 & Caudal to C7 - ANSWER ✔ D) Rostral to T6 & Caudal to C7
Which component would be most affected by a tumor by where the spinal cord & medulla intersect?
A) N13
B) P31
C) EP
D) N20 - ANSWER ✔ A) N13 --> this is the JUNCTION where medulla & cord intersect (CERVICAL
response)
,CNIM ABRET Practice Exam Questions –
Certified Neurophysiologic Intraoperative
Monitoring Practice Test
What is an appropriate filter for a short latency SSEP cortical response? - ANSWER ✔ 10-3000 Hz
(ALWAYS THE ANSWER with 3000 in it!!!)
Lumbar potential is generated from
A) Pre-synaptic responses
B) Post-synaptic responses
C) Spinal ganglion
D) Sciatic nerve - ANSWER ✔ B) Post-synaptic responses
From L to R pre-auricular points is measured 30 cm. The C3 electrode is located
A) 9 cm medial to the L point
B) 6 cm medial to the L point
C) 18 cm medial to the R point
D) 9 cm to the R point - ANSWER ✔ A) 9 cm medial to the L point
What peak and montage is horizontal dipole? - ANSWER ✔ -N13
-C5s-EPc --> C5s is ACTIVE electrode
What electrode would provide you with an N20 response from LEFT median nerve stimulation? -
ANSWER ✔ C4'
What responses would you still have if you have a stroke in the VBA? - ANSWER ✔ -For UE : you would
still have the cervical (N13) response & Erb's point
-For LE : you would still have the LP & PF response
**VBA perfuses subcortical responses. If stroke occurs, you will not have a subcortical or cortical
response.
,CNIM ABRET Practice Exam Questions –
Certified Neurophysiologic Intraoperative
Monitoring Practice Test
If N20 is lost on ONE side? - ANSWER ✔ MCA aclusion
During a scoliosis surgery, you recognize a gradual latency increase of 3.5 msec in the PTN cortical
response, the subcortical response appears to be shifted out almost as much. All response amplitudes
are unchanged. What is the appropriate action to take?
A) Ignore the change, it means nothing.
B) Inform the surgeon immediately that changes consistent with with spinal cord injury may have
occurred. Recommend a wake up test
C) Check the latencies of the PF and MN responses to see if they are also shifted, indicating a possible
temperature effect. Verify this by checking the pt's body temp
D) Ask anesthesia to reduce the gases. You are seeing changes consistent with increased depth of
anesthesia. - ANSWER ✔ C) Check the latencies of the PF and MN responses to see if they are also
shifted, indicating a possible temperature effect. Verify this by checking the pt's body temp
During a thoracic laminectomy, a rapid loss of the right PTN cortical responses occurs. The cervical
response is too poor to evaluate, the pop fossa responses are unchanged. What should you do first?
A) Run MN & check anesthetic levels
B) Inform the surgeon immediately & indicate that the changes are consistent with a right hemi-cord
injury
C) Check the right stimulator output with bar electrode
D) Reset the amplifier, check your recording parameters and wait to see if the response returns -
ANSWER ✔ B) Inform the surgeon immediately & indicate that the changes are consistent with a right
hemi-cord injury
During an anterior lumbar fusion (L4-5), a loss of all right PTN responses occurs over the course of about
five minutes. What should you do?
A) Inform the surgeon the right stimulator has failed, but that you will continue to diligently monitor the
left side
B) Check the current output & stimulator connections quickly. Then inform the surgeon you are seeing
changes consistent with ischemia of the right leg
, CNIM ABRET Practice Exam Questions –
Certified Neurophysiologic Intraoperative
Monitoring Practice Test
C) Inform the surgeon there may be spinal cord changes
D) Check MN responses for possibly anesthetic changes. - ANSWER ✔ B) Check the current output &
stimulator connections quickly. Then inform the surgeon you are seeing changes consistent with
ischemia of the right leg
What components of PTN would you lose for the above question?
A) Cortical
B) Subcortical
C) Peripheral
D) All the above - ANSWER ✔ D) All the above
For peroneal nerve stimulation, the ground should be placed:
A) Foot
B) Calf
C) Ankle
D) Thigh - ANSWER ✔ D) Thigh
For PTN stimulation, the ground should be placed:
A) Foot
B) Calf
C) Ankle
D) Thigh - ANSWER ✔ B) Calf
When testing SSEP from the upper extremity, a electrode placed at Erb's point will record activity
generated from
A) brachial plexus
B) lumbar plexus
