CNIM PRACTICE LATEST 2024-2025 QUESTIONS & CORRECT & VERIFIED ANSWERS. GRADED A+, Exams of Nursing

Download CNIM PRACTICE LATEST 2024-2025 QUESTIONS & CORRECT & VERIFIED ANSWERS. GRADED A+ and more Exams Nursing in PDF only on Docsity! CNIM PRACTICE LATEST 2024-2025 QUESTIONS & CORRECT & VERIFIED ANSWERS. GRADED A+ ___________ is the single most important step taken to avoid contamination. a. washing hands b. using a transportation barrier c. using gloves d. using protective eyewear - ANSa. washing hands "Case specific monitoring" should include: a. the number of channels you will use for each case b. the modality(s) you will monitor for a specific case c. the anesthetic regimen used for each case d. the machine you will use for each case - ANSb. the modality(s) you will monitor for a specific case "Electrode impedance" is defined as opposition to: a. direct current flow b. alternating current flow c. differential current flow d. 60 Hz artifact - ANSb. alternating current flow "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 - ANSa) average threshold intensity of normally hearing young adults "Hearing level" (HL) is defined as the: a. lowest intensity that an average ear drum can hear b. average threshold intensity of normally hearing young adults c. inverse of the sound pressure level d. intensity of a long duration sound that has the same amplitude as the peak SPL of a short duration sound - ANSb. average threshold intensity of normally hearing young adults "Separation of joint surfaces without rupture of their binding ligaments and without displacement" defines which term: a. derotation b. decompression c. distraction d. traction - ANSc. distraction 30-50% reduction in D-wave response amplitude coupled with unchanged TcMEP responses predicts which neurological outcome? a. unchanged b. permanent paralysis c. transient paralysis d. hemiparesis - ANSa. unchanged 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 - ANSc. Two separate devices are attached to the same patient and have two separate grounding connections 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 - ANSa) Be more specific in identifying structures A Carotid Endarterectomy is performed to remove __________ from the artery a. red blood cells b. plaque c. white blood cells d. edema - ANSb. plaque A condensation click: a. causes the tympanic membrane to move outward b. causes the headphone diaphragm to move away from the tympanic membrane c. causes the headphone diaphragm to displace toward the tympanic membrane d. delivers the loudest sounds to the tympanic membrane - ANSc. causes the headphone diaphragm to displace toward the tympanic membrane A constant voltage stimulator: a. varies the current in order to maintains a preset voltage level b. maintains a current level of 10 mA c. maintains a constant voltage of 100 volts A patient is admitted to the operating room diagnosed with a herniated cervical disc at C5/6. The most appropriate nerve(s) to monitor during the resulting surgical procedure would be the: a. median and auditory nerves b. tibial and ulnar nerves c. median and posterior tibial nerves d. ulnar nerve - ANSc. median and posterior tibial nerves 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 - ANSb) median and posterior tibial nerves 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 - ANSc) Tibial and median nerves 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 - ANS3. establish a standard for the patient A preop patient assessment should include all of the following except: a. dental HX if doing TCeMEP's b. preop complaints or symptoms c. known allergies d. what family member is at the hospital with the patient - ANSd. what family member is at the hospital with the patient A rarefaction click occurs when the: a. movement of a transducer diaphragm alternates in polarity relative to the tympanic membrane on a random basis b. initial movement of a transducer diaphragm is away from the tympanic membrane c. movement of a transducer diaphragm alternates in polarity relative to the tympanic membrane every second trial d. initial movement of a transducer diaphragm is towards the tympanic membrane - ANSb. initial movement of a transducer diaphragm is away from the tympanic membrane A recommendation to minimize stimulus artfact while recording BAEPs intraoperatively is to: a. use larger sized headphones b. use rarefaction clicks c. decrease the impedance of your stimulating electrodes d. use alternating clicks - ANSd. use alternating clicks A secure method for applying surface cup electrodes requires: a. collodion and compressed air b. water resistant tape c. a conductive paste and tape d. application the day before surgery - ANSa. collodion and compressed air A shift of the compressed spectral arrays spectral edge indicates _______ a. an increase or decrease of EEG frequency b. a significant change that always should be communicated to the surgeon c. artifact from a fluid warmer is detected d. an increase or decrease of EEG amplitude - ANSa. an increase or decrease of EEG frequency A stimulus pulse width that would tend to excite a larger population of motor fibers than sensory fibers is: a. 1 ms b. 0.05 ms c. 0.5. ms d. 0.2 ms - ANSb. 0.05 ms A surgeon slips and hits the spinal cord with an instrument and the SSEP and MEP are lost. What is the best thing to recommend at this time? a. give the patient a bolus of glucose to help the cells recover b. lower the blood pressure to prevent bruising c. ask the surgeon to suspend surgery, call interpreter d. pour cold irrigation on the spinal cord to protect it - ANSc. ask the surgeon to suspend surgery, call interpreter A systolic blood pressure lower than 100 and diastolic lower than 60 would indicate _________ a. severe hypertension b. mild hypertension c. hypotension d. moderate hypertension - ANSc. hypotension a unit of resistance or impedance is symbolized by: a. u. b. A. c. E. d. Hz. e. O (Omega symbol) - ANSe. O (Omega symbol) 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 - ANSc) Between the pons and the upper brainstem 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 - ANSb) 0.3 ms 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 - ANSd) 20 mV rms at 60 Hz According to current OSHA standards, needle electrodes should: a. be recapped before discarding b. not be handled with tongs or forceps while cleaning c. not be soaked in a sodium hypochlorite solution d. be reused whenever possible - ANSc. not be soaked in a sodium hypochlorite solution According to Nuwer, what is the criteria for alarm while monitoring carotid endarterectomies? a. greater than 50% loss of overall EEG amplitude or fast activity, or greater than 50% increase in slow activity b. loss of wave 3 c. increase in amplitude and frequency An EP recording system should allow averaging of: a. no more than 500 trials (sweeps) b. no more than 100 trials (sweeps) c. at least 4000 trials (sweeps) d. a maximum of 200 trials (sweeps) - ANSc. at least 400 trials (sweeps) An example of a non-physiologic artifact would be: a. electrical interference b. slow signals due to perspiration c. the ECG signal d. High levels of muscle tension - ANSa. electrical interference An increase in stimulation intensity cause a linear increase of which of the following SSEP components? 1. N20 2. N45 3. P31 4. P37 - ANS3. P31 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 - ANS2. 50% amplitude decrease An optimal rep rate for BAEP's is: a) 4 Hz b) 31 Hz c) 66 Hz d) 72 Hz - ANSb) 31 Hz An unstable blood pressure during SSEP monitoring in the OR affects cortical EPs resulting in: a. fluctuating amplitudes b. fluctuating amplitudes and latencies c. minimal changes if the body temperature is maintained above 32 C d. fluctuating latencies - ANSa. fluctuating amplitudes ANASTAMOSIS? - ANS-CONNECTION or opening BETWEEN two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels. -COMMUNICATION BETWEEN ARTERIES Anesthesia "creep" has been noted in some cases. This refers to: a. the slow increase in inhalation anesthestic agent delivery levels in the patient due to errors in the delivery system of the anesthesia machine b. the ineffectiveness of anesthesia over time c. the gradual shift of IOM latency (increase) and amplitudes (decrease) during a case despite constant delivery of anesthetic agents - ANSc. the gradual shift of IOM latency (increase) and amplitudes (decrease) during a case despite constant delivery of anesthetic agents Anesthesia "induction" is the: a. time when the endotracheal tube is placed b. time when the patient begins to wake up c. time when the initial anesthesia drugs are given to get the patient to sleep d. time when the surgeon makes their surgical incision - ANSc. time when the initial anesthesia drugs are given to get the patient to sleep Anesthesia drugs have an impact on IONm via which mechanisms EXCEPT: a. blocking of motor pathways in the thalamus b. blocking of transmission through the neuromuscular junction c. alterations in physiology such as hypotension d. blocking of reflex activity in the spinal cord e. synaptic inhibition - ANSa. blocking of motor pathways in the thalamus 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 - ANSVecuronium Anesthesia is started and the patient is intubated. You set up TCeMEPs but see no response for 15-20 minutes after induction. Which muscle relaxant was used? a. none b. pancuronium c. vecuronium d. succinylcholine e. rocuronium - ANSd. succinylcholine Annotations on the flow sheets should be made: a. contemporaneously b. the day after the case c. only when the surgeon tells you to write something down d. only when the oversight physician tells you write something - ANSa. contemporaneously Anterior cerebral artery supplies: a. leg area of cerebral cortex b. mouth area of cerebral cortex c. hand area of cerebral cortex d. face area of cerebral cortex - ANSa. leg area of cerebral cortex Appropriate documentation of intraoperative data is essential because: (select all that apply) a. the scrub nurse will not remember any of the monitoring details b. the anesthesiologist will not remember any of the monitoring details c. the surgeon will not remember any of the monitoring details d. the circulating nurse will not remember any of the monitoring details - ANSall of the above Artifacts on the EEG during Carotid Endarterectomy can be caused by: (select all that apply) a. Bovie b. EKG or Pacemaker c. Suction d. Doppler - ANSall of the above At low doses, which agent increases the amplitude of the CMAP with TCeMEP? a. etomidate b. propofol c. desflurane d. midazolam - ANSa. etomidate 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 - ANSa) increasing the latencies of Waves I, III and V without changing their amplitudes 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 - ANSd) Causing minimal changes At the start of spinal case the cortical SSEP monitoring is too small to be usable. What recommendation to the anesthesiologist will help? a. use desflurane rather than isoflurane a) 160 dB SPL b) 60 dB HL c) 60 dB SL d) 75 dB SPL - ANSc) 60 dB SL 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 - ANS4. prevent crossover responses Cortical evoked potentials are largely produced by: a. action potentials of the connecting axonal tracts b. high energy magnetic fields of sodium ions within the cell membranes of the brain c. EPSPs and IPSPs d. depolarization propagated along the nerve fibers - ANSc. EPSPs and IPSPs Cortical potentials are a compilation of: a) EPSPs and IPSPs b) Seizure activity and normal activity c) Summation potentials d) ISPSs only - ANSa) EPSPs and IPSPs 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 - ANSa) Latency in response to stimulation Crossover sound stimulation conducted by the skull during BAEP stimulation, can be avoided by: a. repositioning the patient b. utilizing a mastoid recording electrode c. applying contralateral masking noise d. a using a bilateral click presentation - ANSc. applying contralateral masking noise 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 - ANS1. Epidural electrodes over the spinal cord D-wave cannot be recorded below: a. L1 b. D-wave can be recorded from any spinal level c. T9 d. T6 - ANSa. L1 Decreasing stimulator intensity causes what changes in the interpeak latency of the ABR components? a. A decrease in interpeak latency b. No change in interpeak latency c. An increase in interpeak latency - ANSb. no change in interpeak latency DIABETES MELLITUS? 1. Ankylosis 2. Hearing loss 3. Facial palsy 4. Peripheral Neuropathy - ANS4. Peripheral Neuropathy Different parts of the nervous system are more or less sensitive to ischemia. Which of the following is most sensitive (i.e. electrical activity fails first with comparable ischemia)? a. spinal cord white mater b. spinal cord grey matter c. peripheral nerves d. cortical grey matter - ANSd. cortical grey matter 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 - ANSc) 10,000:1 Disappearing evoked potentials over several minutes may be due to: (select all that apply) a. hypoxic insult b. ischemia in peripheral nerve c. patient positioning d. decreased blood pH - ANSall of the above Documentation during a Carotid Endarterectomy should include: (select all that apply) a. communication with the surgeon and anesthesia team b. induction and anesthesia given including times c. notation of clamp time - ANSall of the above Due to a smaller surface area, subdermal needle electrodes will have an impedance that is: a. improved by cleansing the skin with an abrasive gel before insertion b. higher than surface electrodes, but usually equal and balanced when all subdermal needle electrodes are used c. lower than disk electrodes d. unbalanced causing increased 60 Hz noise - ANSb. higher than surface electrodes, but usually equal and balanced when all subdermal need electrodes are used During a case using SSEP monitoring the cortical amplitude suddenly increases. Which of the following is the most likely explanation? a. the anesthesiologist turned off the nitrous oxide b. the anesthesiologist just increased the propofol infusion rate c. the anesthesiologist just gave a bolus of propofol d. none of the choices listed will increase the cortical amplitude - ANSa. the anesthesiologist turned off the nitrous oxide During a craniotomy for brain surgery which methods are used to reduce brain swelling (select all that apply) a. manitol b. sodium thiopental c. increase blood pressure d. hyperventilation - ANSa. manitol b. sodium thiopental d. hyperventilation 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 - ANS2. Decrease number of repititions 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 Electrical hazards that exist for patients attached to medical equipment include all of the following except: a. needle sticks b. indwelling electrodes c. leakage current d. ground faults - ANSa. needle sticks 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 - ANSd) The materials in different electrodes have different conductive properties Electronic devices used to store electrical charge are called: a) Resistors b) Insulators c) Capacitors d) Conductors - ANSc) Capacitors 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 - ANSd) Neither A nor B 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 - ANS4. other metals may become toxic when currents are applied Epidural electrodes are made of platinum for what reason? a. low current density b. decreased incidence of infection c. avoid neurotoxicity d. minimize movement of the electrode - ANSc. avoid neurotoxicity Evoked potential data is obilterated with? 1. midas rex drilling 2. monopolar cautery 3. C-arm use 4. transcranial dopper use - ANS2. monopolar cautery 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 - ANSc) Amplify biologic signals Evoked potential equipment used in the operating room should have current limiting present in every lead to allow for a maximum leakage current through each patient lead of: a. 1 microamp b. 100 microamps c. 10 milliamps d. 10 microamps - ANSd. 10 microamps Evoked potential responses are generally _________ in amplitude a. 120 volts b. up to 10 kilovolts c. aprox 10 microvolts for sensory and 1-5 millivolts motor d. near 50 millivolts - ANSc. aprox 10 microvolts for sensory and 1-5 millivolts motor Examples of "surgical manipulation" would include: a. Drilling and irrigation b. Blood pressure and heart rate fluctuations c. Oxygenation and ventilation alterations d. Core temperature changes - ANSa. Drilling and irrigation 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 - ANSc. quadraparesis due to ischemia in the upper thoracic spine Excitation of the postsynaptic neuron is caused by the neurotranmitter a) gamma amino butyric acid b) glycine c) para amino buryric acid d) glutamate - ANSd) glutamate Excitation of the postsynaptic neuron is caused by the neurotransmitter: a. glutamate b. para amino butyric acid c. glycine d. gamma amino butyric acid - ANSa. glutamate Facial Nerve CMAP responses are best recorded from the: a) Masseter muscle b) Orbicularis oris c) Facial Nerve d) Foramen Ovale - ANSb) Orbicularis Oris Facial nerve monitoring involves recording_______ a. spontaneous and triggered EMG b. spinal nerve root monitoring c. somatosensory evoked potentials d. visual evoked potentials - ANSa. spontaneous and triggered EMG FENTANYL? 1. Narcotic agent 2. Volatile agent 3. Barbiturate agent 4. Neuromuscular blocking agent - ANS1. Narcotic agent 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 - ANSd) 30 minutes For median nerve stimulation, the cathode is placed: a. midway between the tendon and the posterior border of the medial malleolus b. 4 to 5 cm distal to the anode c. on the dorsal side of wrist, approximately 2 to 3 cm from the ulnar nerve d. between the tendons of palmaris longus and flexor carpi radialis muscle - ANSd. between the tendons of palmaris lonus and flexor carpi radialis muscle 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 4. segmental wires - ANS1. rods 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 - ANSb) The average hearing threshold of a normal population High doses of which drug would be expected to produce the least changes in sensory and motor evoked responses? a. propofol b. fentanyl c. isoflurane d. etomidate - ANSb. fentanyl HOFFMAN SIGN? - ANS-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. 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 - ANSd) Use clicks of alternating polarity How will severe hypothermia affect signals? a. Increase in latency b. decrease in latency c. no effect on evoked potentials (EPs) d. variable effect on EP latencies - ANSa. increase in latency 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 - ANSd) Increases evoked potential latencies Identification of Wave V of the BAEP may require? 1. tympanic electrodes 2. bilateral stimulation 3. decreasing stimulus intensity 4. use of nonncephalic reference - ANS3. decreasing stimulus intensity 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 - ANSa) 2 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 - ANS3. Notify the scrub or circulating nurse at once 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 - ANS4. 1,000,000:1 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 - ANS3. 2:1 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 - ANSd) No changes If muscle relaxation is used during pedicle screw testing, can it cause an elevated threshold reading? a. no b. yes - ANSb. yes If one has a signal to noise ratio of 1:2, averaging 64 responses will: a. improve the ratio to 4:1 b. improve the ratio to 8:1 c. reduce the noise by 50% d. not change the ratio - ANSa. improve the ratio to 4:1 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 - ANSb) Prolongation of all wave latencies 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 - ANS4. adequate cortical perfusion and oxygenation 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 - ANSc) 3.6 using headphones If the monitoring instrument develops an inability to average, steps to take would include all of the following except: a. check that all the cables are routed separately b. check electrode impedances c. consult with the anesthesiologist regarding anesthesia changes d. insure that the stimulus rate is not a multiple of the interference frequency - ANSc. consult with the anesthesiologist regarding anesthesia changes If the patient demonstrates a foot drop postoperatively, what levels have been affected in surgery? a. L4-S1 b. L1-3 c. L2-3 d. S1-S2 - ANSa. L4-S1 In Compressed Density Spectral Array, frequency is depicted by? 1. Y-axis 2. X-axis 3. Epoch 4. Data Points - ANS2. X-Axis In cranial nerve monitoring, the ________ of the CMAP indicates the conduction time of the fastest fibers, and the ___________ is approximately proportional to the number of available functional axons a. amplitude, onset latency b. onset latency, amplitude c. waveform duration, waveform latency d. morphology, frequency - ANSb. onset latency, amplitude In cranial nerve monitoring, the rational for using EMG is based on the principle that _________ a. EMG from cranial nerve stiluation, is not affected by neuromuscular blocking agents b. EMG records muscle fiber generated electrical potentials, generated when axon membrane is depolarized which can occur with mechanical, metabolic or thermal stimulation as well as ischemic or traumatic nerve injury c. evoked potentials take too long d. most of the patients in CN IONM are awake and would not tolerate TCeMEP or stimulation required for SSEP - ANSb. EMG records muscle fiber generated electrical potentials, generated when axon membrane is depolarized which can occur with mechanical, metabolic or thermal stimulation as well as ischemic or traumatic nerve injury In electrode application the term duplicate set means_____ a. after hook-up making sure electrodes are in the correct location by having a second, duplicate, look at the electrode placements b. using two silver electrodes in a recording channel c. using dissimilar metal sin a recording channel d. placing two electrodes near each other at each recording site so if one fails during the surgery the other can be used an monitoring can continue - ANSd. placing two electrodes near each other at each recording site so if one fails during the surgery the other can be used an monitoring can continue 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 - ANSa. CAP 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 - ANSb) CAP 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 - ANSd) false vocal cords In order to monitor cranial nerve X, the recording electrodes are placed on the: a. soft palate b. tongue c. false vocal cords d. trapezius muscle - ANSc. false vocal cords 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 - ANSd) False vocal cords 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 - ANSd) False Vocal Cords In order to stimulate both tibial nerves asynchronously, you need: a. to delay the first stimulator b. a positive trace delay c. to delay the second stimulator d. a negative trace delay - ANSc. to delay the second stimulator 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 - ANSa) Contralateral BAEP, median nerve and facial nerve 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 - ANSa) traction on the cerebellum In recording electrocochleograms, it is best to stimulate using? 1. tone pips 2. tone bursts 3. alternating clicks 4. rarefaction clicks and condensation - ANS4. rarefaction clicks and condensation 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 - ANSa) sampling rate should be at least two times greater than the highest frequency in the signal 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 - ANS1. verify adequacy of stimulus In tether cord syndrome, what causes traction on the conus medullaris? a. ossified posterior longitudinal ligaments b. a shortened filum terminale c. excessive CSF in the thecal sac d. L5-S1 Spondylolisthesis - ANSb. A shortened filum terminale In Tethered Cord Syndrome, what causes traction on the conus medullaris? a. a shortened filum terminale b. excessive CSF in the thecal sac c. ossified posterior longitudinal ligaments b. so a professional fee can be billed c. to prove you looked at the chart d. in case the circulating nurse doesn't remember your name - ANSa. as an attestation that you actually were present doing the monitoring It is most appropriate to monitor the median nerve, not the tibial nerve, for: a. anterior cerebral artery aneurysms b. vertebral basilar artery aneurysms c. middle cerebral artery aneurysms d. posterior cerebral artery aneurysms - ANSc. middle cerebal artery aneurysms 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 - ANS1. Surgical events It is most important that electrode impedances are balanced. Ideally, sub-dermal electrode impedances would be between what range? a. 5-7 Ohms b. 5k-7 K Ohms c. 12k=20 K Ohms d. 9k-11 K Ohms - ANSb. 5k - 7 K Ohms 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 - ANSc) the surgeon and anesthesia staff Kerrison forceps are used in the following phase: a. exposure b. exposure c. decompression d. dural repair - ANSc. decompression Ketamine has which of the following side effects that is of concern to some anesthesiologists? (select all that apply) a. very expensive and in short supply b. can cause hallucinations c. can increase intracranial pressure d. can produce seizure like activity - ANSb. can cause hallucinations c. can increase intracranial pressure d. can produce seizure like activity Kyphosis (select all that apply) a. comes form the Greek "Kypho" meaning hump and is commonly called hunchback b. is a type of spinal instrumentation used in patients with ruptured discs c. is a common condition of a curvature of the upper spine. It can be either the result of degenerative disease (such as arthritis), developmental problems, osteoporosis with compression fractures of the vertebrae, and/or trauma d. is another name for Herniated Nucleus Pulposus - ANSa. comes form the Greek "Kypho" meaning hump and is commonly called hunchback c. is a common condition of a curvature of the upper spine. It can be either the result of degenerative disease (such as arthritis), developmental problems, osteoporosis with compression fractures of the vertebrae, and/or trauma 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 - ANSd) Artifact from the drill Loss of TCeMEP with preservation of D-waves of at least 50% of baseline amplitude during intramedullary spinal cord tumor resection predicts which outcome? a. no post-op motor deficit b. permanent sensory loss c. transient motor deficit d. permanent paralysis - ANSc. transient motor deficit 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 - ANSb) intervertebral discs MAC is _________ a. level of anesthesia preventing movement in 75% of patients after painful stim b. level of anesthesia preventing movement in 95% of patients after painful stim c. level of anesthesia preventing movement in 50% of patients after painful stim d. level of anesthesia preventing movement in 100% of patients after painful stim - ANSc. level of anesthesia preventing movement in 50% of patients after painful stim Meniere's disease: a) An inner ear disturbance b) Caused by Meningitis c) A disorder of the auditory cortex d) Caused by encephalitis - ANSa) An inner ear disturbance 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 - ANSall of the above Mixing electrodes made of various electrode metals is discouraged because: a. creates a lower averaged current density b. it creates a lower averages current density c. introduces artifact because it introduces a "difference" in the inputs that can be amplified by the differential amplifier - ANSc. introduces artifact because it introduces a "difference" in the inputs that can be amplified by the differential amplifier Monitoring modalities most likely affected by a large bolus of muscle relaxant is: a. subcortical SSEPs b. Cortical SSEPs c. EEG d. TCeMEP - ANSd. TCeMEP 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 - ANSa. relaxation is measured by counting the number of muscle responses to 4 stimuli at 2 Hertz 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 - ANSd) Recording a full minute of EEG baseline 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 - ANSa) Efferent motor pathways in the cord d. activity from the precentral gyrus - ANSa. caudal medial lemniscal activity 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 - ANSb) caudal medial lemniscal activity PAM response, a high amplitude late appearing component of some BAEP responses is caused by: a. pre auricular mastoid b. post auricular muscle c. premanticular acoustical manifestation d. prominent auditory mandible - ANSb. post auricular muscle Partial neuromuscular blockade has been used in some cases. Which of the following modalities will be the least effected if the relaxation is too deep? a. Facial nerve monitoring b. CMAP recording with MEP c. Pedicle screw stimulation d. D wave recording with MEP - ANSd. D wave recordings with MEP Pedicle screws are used for? 1. Spinal fixation 2. correction of curve 3. anterior fusion 4. derotation of spine - ANS1. spinal fixation Perfusion pressure to the central nervous system (select all that apply) a. may be varied by disease processes b. may be compromised by occlusive disease c. may vary during daily activities d. may be varied by drugs - ANSall of the above Posterior cerebral artery supplies: a. hand area of cerebral cortex b. face area of cerebral cortex c. leg area of cerebral cortex d. none of these options are correct - ANSd. none of these options are correct 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 - ANSb) Includes a period of recording before the stimulus 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 - ANSc) absolute boundaries for EPs obtained intraoperatively are not available Preoperative EEG baseline recordings are obtained: a. before incision b. after incision c. 24-48 hours after completion of the Carotid Endarterectomy d. during clamp time - ANSa. before incision Problem with Bilateral Synchronus Stim? - ANSCan mask unilateral problems Processed EEG can be used for titration of a. neuromuscular blockade b. ventilation c. IV fluids d. sufentanil e. propofol - ANSe. propofol Projecting laterally from the junction of the pedicle and lamina, and serving as a lever for muscle and ligaments, are the: a. intervertebral discs b. intervertebral foramen c. transverse processes d. mammillary processes - ANSc. transverse processes 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 - ANSd) transverse process RADICULOPATHY? 1. Meninges 2. Spinal cord 3. Nerve roots 4. Peripheral Nerves - ANS3. Nerve roots 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 - ANSb) Negative pressure within the auditory canal Raw (unprocessed) EEG should always be available for review when monitoring quantitative EEG in order to: a. localize the source of all artifacts b. assist in identifying asymmetries or focal abnormalities c. alert the technologist when cautery is in use d. check for eye opening and closing - ANSb. assist in identifying asymmetries or focal abnormalities Reduction of the high frequency filter: a. decreases evoked potential latency b. decreases evoked potential latency c. has no effect on evoked potential latency d. has an unpredictable effect on evoked potential latency e. increases evoked potential latency - ANSe. increases evoked potential latency Repetitive electrographic bursts slowing and/or spike wave activity that occur in response to electrical stimulation of the surface of the brain a. mu rhythm b. transcranial electrical motor evoked potentials c. wicket spikes d. hypnagogic hypersynchrony e. after discharges - ANSe. after discharges Roccuronium is an example of what type of muscle relaxant? a. long acting b. nondepolarizing c. depolarizing d. it is not a muscle relaxant - ANSb. nondepolarizing ROMBERG TEST? - ANS-TESTS BALANCE -PROPRIOCEPTION, VESTIBULAR FUNCTION & VISION Routine intraoperative electrophysiological monitoring documentation should include? 1. heart rate 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 - ANSa) Posterior tibial nerve SSEP 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 - ANSd) intervertebral formina SPONDYLOSIS? 1. Tethered cord 2. Avulsed nerve roots 3. Spinal cord tumor 4. Degenerative spine disease - ANS4. Degenerative spine disease SSEP recordings typically require a wide bandpass of _______ but may be narrowed in OR monitoring because the signal is not compared to normative data but to the patient's own baseline, and narrowing the filters can sometimes record a more reliable signal in the noisy environment of the OR a. 5 Hz to 3,000 Hz b. .5 Hz to 200 Hz c. 1 Hz to 1,000 Hz d. 5 Hz to 5,000 Hz - ANSa. 5 Hz to 3,000 Hz 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 - ANS1. scoliosis Standard (universal) precautions are used to reduce the transmission of? 1. Hepatitis A virus 2. reproductive spores 3. bloodborne pathogens 4. Mycobacterium tuberculosis - ANS3. bloodborne pathogens 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 - ANSa) anterior spinal cord function 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 - ANSc. Lowering the impedances of ground and stimulating electrodes 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 - ANSc) 100 and 300 microseconds Structural functional anatomy may be altered by: (select all that apply) a. previous lesions b. pressure c. plasticity d. current - ANSall of the above Subdermal Needle Electrodes considerations include which of the following: a. place needles in awake patients b. track the NO# of needles placed and removed during the case c. use corkscrews for all cases d. remove all needles before the drapes are removed - ANSb. track the NO# of needles placed and removed during the case Synaptic transmission, and/or changes in the thalamocortical projections, are believed to produce: a. subcortical potentials b. cortical potentials c. the P100 potential d. the Erb's point potential - ANSb. cortical potentials 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 - ANSb) cortical potentials TAP's is an acronym which can help categorize reasons for END changes during a case. Which letter is not identified as a potential reason for data change? (select all that apply) a. P-refers to physiological state of the patient b. S- refers to surgical factors affecting responses c. T-refers to troubleshooting responsibilities d. A- integrate anesthetic information - ANSall of the above are correct The amplifier input impedance (not the electrode impedance) of a differential amplifier must be at least: a. <10 megohms b. 10 megohms c. 100 megohms d. < 5 K ohms - ANSb. 10 megohms 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 - ANSa) stimulation rate of 15 per second or higher The anesthesiologist has just informed you that he has increased the concentration of sevoflurane from 1.0% to 3.0% inspired. What would be the initial (first) effect on median nerve somatosensory evoked potentials that you might see? (it would be seen within the first minute or two of increase sevoflurane) a. an increased amplitude/decreased latency in the P/N13 response b. a decreased amplitude/increased latency in the N20/P22 response c. an increased latency/decreased amplitude at Erb's point d. an increased latency in the P14/N18 response - ANSb. a decreased amplitude/increased latency in the N20/P22 response The anesthetic agent that has the least effect on SSEP waveforms is: a. nitrous oxide b. vecuronium c. midazolam d. halothane - ANSb. vecuronium The anesthetic agent that has the least effect on SSEP waveforms is? - ANSVECURONIUM e. glia cells 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 - ANS1. increasing latency and decreasing amplitude 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 - ANSd) sciatic nerve 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 - ANS3. severe hearing loss The components of an anesthetic include: (select all that apply) a. analgesia (pain relief) b. sedation/amnesia c. immobility - ANSall of the above 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 - ANSb) Cortical near-field potentials The effect of severe hypotension on the evoked potential includes: a. a decrease in amplitude and an increase latency b. an increase in amplitude and a decrease in latency c. a decrease in amplitude and variable changes in latency d. variable changes in amplitude and an increase in latency - ANSa. a decrease in amplitude and an increase latency The effects of pharmacological or surgical manipulations can be mimicked by the inappropriate manipulation of: a. filter settings b. the stimulus intensity c. the ground electrode d. the stimulus rate - ANSa. filter settings The facial nerve is cranial nerve _____ and it supplies the muscle for ____________ a. VI, facial expression b. V, eye movement c. V, jaw movement d. VII, facial expression - ANSd. VII, facial expression 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 - ANSd) VII; facial expression 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 - ANSd) VII, facial expression 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 2500-3000 Hz d) 10-30 to 2500-3000 Hz - ANSd) 10-30 to 2500-3000 Hz 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 - ANSc) glass and rubber 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 - ANSd) 100,000 The general range of amplitude of EKG is _________ a. 1-2 millivolts b. 1-2 kilovolts c. 1-2 microvolts d. 1-2 volts - ANSa. 1-2 millivolts 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 - ANSc) Near-Field conduction volley 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 - ANSa) Representation of the motor and sensory cortices of the brain The horizontal resolution of an evoked potential system: a. is one half the Nyquist frequency b. has no effect on the aliasing properties of the instrument c. should be 20 microseconds per data point or less d. should be greater than 30 milliseconds per data point - ANSc. should be 20 microseconds per data point or less 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 - ANSb) negative due to depolarization of membrane potentials positive due to electrotonic depolarization The innermost connective tissue membrane covering the brain is the: a) Dura b) Pia c) Arachnoid d) Falx cerbri - ANSb) Pia The interpreting physician must have the ability to communicate in real time with whom? (select all that apply) 3. minimize 60hz interference 4. prevent chassis current leakage - ANS1. avoid tissue damage The Monitorist's report should contain: (select all that apply) a. anesthesia levels b. times and description of waveform data c. % of change, resolution or continuation of change d. vital signs of the patient, temp and BP - ANSall of the above The most common mode rejection ratio of amplifiers used for EP recording should be at least: a. 100,000: 1 b. 100:1 c. 1,000:1 d. 10,000:1 - ANSd. 10,000:1 The name of this nerve refers to it's 3 branches: a. trigeminal nerve (CN V) b. optic c. oculomotor d. trochlear - ANSa. trigeminal nerve (CN V) The patient presenting prior to surgery for removal of an acoustic neuroma would likely have symptoms including: a. slurred speech, aphasia, and focal weakness b. nystagmus and decreased visual acuity c. hearing loss, headaches, and unsteady gait d. muscle weakness and gait disturbance - ANSc. hearing loss, headaches, and unsteady gait The peak equivalent SPL of a click should be: a) 500 Hz b) 3000 Hz c) 5000 Hz d) 10,000 Hz - ANSb) 3000 Hz The peroneal and tibial nerves are divisions of the: a) brachial plexus b) deep peroneal nerve c) sciatic nerve d) lumbar plexus - ANSc) sciatic nerve The peroneal and tibial nerves are divisions of the: a. deep peroneal nerve b. sciatic nerve c. brachial plexus d. lumbar plexus - ANSb. sciatic nerve The phenomenon called "aliasing": a. refers to an erroneous representation of an analog signal by digital values b. occurs when the analysis period is more than twice the nyquist frequency c. Is common during intraoperative recording of evoked potentials d. may be avoided by proper placement of the ground and stimulating electrodes - ANSa. refers to an erroneous representation of an analog signal by digital values 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 - ANS2. Prolongs Wave V The posterior tibial nerve arises from which branch of the sciatic nerve? a) superior tibial b) superior peroneal c) internal popliteal d) external popliteal - ANSa) superior tibial The prefix myelo-pertains to_________ a. muscle b. spinal cord c. nerve roots d. anoxia - ANSb. spinal cord The prominent wave for monitoring BAEP's is: a) Wave I b) Wave III c) Wave V d) ECoG - ANSc) Wave V The proper filter settings for recording BAEP's are: a) 1-25 to 2500-3000 Hz b) 1-250 Hz c) 500-5000 Hz d) 1-1000 Hz - ANSa) 1-25 to 2500-3000 Hz 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 - ANS2. restore lost disc height The purpose of isolated amplifier inputs is to: a. restrict current flow to the instrument b. prevent a flow of stray currents through connecting lines to the patient c. allow only the high voltage biological signals to pass d. restrict current flow to ground at 20uA - ANSb. prevent a flow of stray currents through connecting lines to the patient The recommended criteria for surgeon notification when moitoring BAEPS intraoperatively include an increase in? - ANSTHE LATENCY OF WAVE V OF GREATER THAN OR EQUAL TO 1.0 msec OR THE DISAPPEARANCE OF WAVE V The recommended filter settings for the facial nerve CMAP are: a. 10-15 kHz b. 10 1.5 kHz c. 1-15 kHz d. 1-1.5 kHz - ANSd. 1 - 1.5 kHz The recommended location for recording the cervical cord responses to median nerve stimulation is: a. C8 b. C1 c. C2 d. C5 - ANSd. C5 The resting membrane potential is created by differences between the inside and outside of the cell in ion concentrations of: a. K+ and Ca++ b. K+ c. K+, Na+, and Cl- d. Na+, Ca++, and Cl- - ANSc. K+, Na+, and Cl- The resting membrane potential of a neuron is: a) +20 mV b) +70 mV c) -20 mV d) -70 mV - ANSd) -70 mV The section of the brainstem that is continuous with the spinal cord and includes the decussation of the pyramids, is the: c. kirsher electrode d. sub-dermal electrode - ANSd. sub-dermal electrode The ulnar nerve originates from nerve roots at? a) C5-C6 b) C6-C7 c) C7-C8 d) C7-T1 - ANSd) C7-T1 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 - ANSB) Separating Wave I from the stimulus artifact The use of intraoperative monitoring during scoliosis surgery may replace the? 1. Hoffman sign 2. Stagnara test 3. Romberg test 4. Babinski sign - ANS2. Stagnara test (wake up test - pt moves feet) The use of the 60 Hz notch filter is discouraged while recording because it can: a. filter slow activity, distorting the response b. cause the recording electrodes to form a salt bridge c. produce ringing activity that can contaminate the appearance of the response d. produce a risk to the patient - ANSc. produce ringing activity that can contaminate the appearance of the response This short acting, muscle relaxant is often used during intraoperative EMG monitoring: a. pancuronium b. robinol c. succinylcholine d. ethrane - ANSc. succinylcholine 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 - ANSd) Left-sided paralysis, primarily of the face & arm TIVA for TCeMEP may consist of an anesthetic mixture of following except? a. opioid (sufentanil) b. muscle relaxant (vecuronium) c. ketamine d. sedative (propofol) - ANSb. muscle relaxant (vecuronium) TIVA, or the technique of total intravenous anesthesia, without the use of muscle relaxants, is a suitable anesthetic technique for recording which of the following monitored responses? (select all that apply) a. auditory brainstem responses (BAER's) and Cranial Nerve Monitoring b. Posterior tibial nerve SSEP's c. spontaneously evoked or stimulated electromyography (EMG) d. TCeMEP - ANSall of the above To accurately represent the amplitude of an EP waveform, a match must be made between the: a. dwell time and sampling rate b. horizontal resolution and signal size c. signal size and the vertical capacity of the digitizer d. high-frequency noise and smoothing operation of the instrument - ANSc. signal size and the vertical capacity of the digitizer To avoid a false positive the baseline is best taken? 1. In preoperative holding 2. post-incision 3. pre-intubation 4. post-intubation - ANS2. post-incision 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 - ANS2. Waveform polarity and polarity convention of the amplifier inputs To optimally monitor cranial nerve VIII function in the operating room, it is desirable to be able to simultaneously perform: a. BAEPs and SSEPs b. BAEPs and electrocochleograms (ECochG) median SSEPs and CMAPs d. BAEPs and EEEP - ANSb. BAEPs and electrocochleograms (ECochG) To prevent the risk of infection the IONM professional should _________ (Select all that apply) a. wear sterile gown and sterile gloves during monitoring b. disinfect equipment daily c. use universal precautions d. properly discard disposable items such as needle electrodes e. keep monitoring equipment in the OR hallway and do not enter the operating room itself - ANSb. disinfect equipment daily c. use universal precautions d. properly discard disposable items such as needle electrodes To prove negligence against a neuro-monitoring technologist in a medical legal case, it must be demonstrated that: a. the surgeon is guilty b. there was no supervision provided c. there was a breach in duty of the technologist that was owed the patient d. the equipment was faulty - ANSc. there was a breach in duty of the technologist that was owed the patient 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 - ANSb) 2cm posterior to C3 and C4 To record cortical SSEPs during intraoperative monitoring of cervical spinal cord surgery, electrodes should be placed: a. 2 cm posterior to C3 and C4 b. in the C3 and C4 positions of the International 10/20 system c. 2 cm anterior to c3 and c4 d. between cz and pz and between pz and oz - ANSa. 2 cm posterior to C3 and C4 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 - ANS3. T5 spine 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 Wave III of BAEP is thought to be generated by the: a. lateral lemniscus b. superior olivary complex c. medial geniculate d. inferior colliculus - ANSb. superior olivary complex Wave III of the BAEP is generated by? a) Superior Olivary Complex b) Infereior Colliculus c) Lateral Lemnisucus d) Medial Geniculate - ANSa) Superior Olivary Complex Wave III of the BAEP is generated in the: a) Distal portion of the auditory nerve b) Cochlea c) Masseter d) Lower Brainstem - ANSd) Lower brainstem Wave III of the BAEP is thought to be generated by the: a. superior olivary complex b. lateral lemniscus c. inferior colliculus d. medial geniculate - ANSa. superior olivary complex Wave V of the BAEP is most affected by: a) Anesthesia below 1 MAC b) Retraction c) Muscle relaxants d) Temperature changes - ANSb) retraction Well-maintained documentation is imperative throughout a surgical case in order to: a. all of the above b. provide details of events associated with a functional loss c. justify billing for the monitoring serve d. require the technologist to focus on the operative procedure - ANSb. provide details of events associated with a functional loss What are common alarm ccriteria for changes in SSEPs? a. 50% decrease in amplitude, 10% decrease in latency b. 50% increase in amplitude, 10% decrease in latency c. 50% increase in amplitude, 10% increase in latency d. 50% decrease in amplitude, 10% increase in latency - ANSd. 50% decrease in amplitude, 10% increase in latency What are common numbers of stimuli in a train of stimulation during TCeMEPs? a. 3-5 b. 1-2 c. 5-9 d. 1-6 - ANSc. 5-9 What are common numbers of stimuli in a train of stimulation during TcMEPs? a. 3-5 b. 5-9 c. 1-6 d. 1-2 - ANSb. 5-9 What are some of the most common contraindications for running TCeMEPs? a. none b. bipolar disorder c. seizures and pacemaker d. hypertension - ANSc. seizures and pacemaker What are the commonly monitored peaks for lower SSEPs in the operating room, according to the ACNS Guidelines for labeling SSEPs? a. P37, N45 b. P40, N45 c. N40, P45 d. N37, P45 - ANSa. P37, N45 What are the obligatory peaks for upper extremity SSEPs? a. N20 and P25; N13 and P14; N9 and P10 b. P20 and N25; P13 and N14; P9 and N10 c. P25 and N30; P15 and N18; P12 and N13 d. N25 and P30; N15 and P18; N12 and P13 - ANSa. N20 and P25; N13 and P14; N9 and P10 What artery primarily perfuses the lower spinal cord? a. vena cava b. adamkiewicz c. middle cerebral artery d. carotid - ANSb. adamkiewicz What attributes differentiate a train from a burst while monitoring FREMG? a. the color of the waveforms b. frequency and latency c. synchronicity and repetitiveness d. latency and amplitude - ANSc. synchronicity and repetitiveness What causes the most airborne bacteria in OR? a. blood on gown b. blood spill c. skin shed d. patient vent - ANSc. skin shed What does a PLIF stand for? a. posterior lower interbody fusion b. posterior lower interventricular fusion c. posterior lumbar involuntary fusion d. posterior lumbar interbody fusion - ANSd. posterior lumbar interbody fusion What drug will most likely affect SSEPs? a. Remifentanyl b. Roccuronium c. Sevoflurane d. Morphine - ANSc. Sevoflurane What is a syrinx? a. central cord stroke b. fluid-filled cavity in the center of the cord c. inferior displacement of the cerebellar tonsils d. calcification of the spinal soft tissue, creating cord compression - ANSb fluid-filled cavity in the center of the cord What is best described as a disturbance or loss of the ability to use objects appropriately such as zippers and buttons? a. ankylosis b. apraxia c. ataxia d. aphasia - ANSb. apraxia What is preferred click polarity when performing intraoperative auditory evoked potentials? a. condensation clicks b. alternating clicks c. rarefaction clicks - ANSb. alternating clicks What is the active contact in TCeMEP stimulation? a. mechanical b. anodal c. bipolar d. cathodal - ANSb. anodal What is the active contact in TcMEP stimulation? a. anodal 1. 1-250 to 1500hz 2. 5-30 to 3000hz 3. 10-30 to 16,000hz 4. 100-200 to 1000hz - ANS1. 1-250 to 1500hz 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 - ANSd) 2V What is true about Central Cord syndrome? (select all that apply) a. injury located in the basal ganglia b. result of cortical contra coup injury c. loss of motor at the level d. sacral sparing e. loss of sensory at the level - ANSc. loss of motor at the level d. sacral sparing e. loss of sensory at the level What is true about intramedullary spinal tumor resection? (select all that apply) a. TCeMEP changes are unreliable and may not indicate an actual problem b. dissection through the dorsal column can lead to a decrease/loss of lower SSEP c. tumor resection can lead to TCeMEP change due to axonal damage d. loss of vascular perfusion can lead to TCeMEP changes during resection - ANSb. dissection through the dorsal column can lead to a decrease/loss of lower SSEP c. tumor resection can lead to TCeMEP change due to axonal damage d. loss of vascular perfusion can lead to TCeMEP changes during resection What is true Anterior Cord Syndrome? a. loss of proprioception b. loss of motor function and often involves anterior spinal artery ischemia c. loss of balance d. loss of sensation - ANSb. loss of motor function and often involves anterior spinal artery ischemia What kind of changes can result in the ABR response when there is a decrease in temperature? a. an increase in ABR latency b. no change c. a decrease in ABR latency - ANSa. an increase in ABR latency What kind of signal changes would be present during a positioning effect of the left arm? a. loss of left erb's point signal, with preservation of all other potentials b. loss of all SSEP signals bilaterally c. Diminished amplitude, delay or lsos of left Erbs, subcortical, and right cortical d. loss of left cortical signal with preservation of Erbs and subcortical - ANSc. Diminished amplitude, delay or loss of left Erbs, subcortical, and right cortical What levels in the spine innervate the ulnar nerve? a. C3-5 b. C7-T1 c. C4-6 d. C2-C3 - ANSb. C7-T1 What mixed nerve contains only a small motor component to the stylopharyngeus muscle can be monitored by placing recording electrodes in the lateral aspect of the soft palate? a. trochlear nerve (cn IV) b. vagus nerve (cn X) c. Oculomotor Nerve (CN III) d. Glossopharyngeal Nerve (CN IX) - ANSd. glossopharyngeal nerve (CN IX) 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 - ANSb) Cz - Contra ear What motor action is achieved upon appropriate stimulation of the ulnar nerve? a. abduction of the pinky and half ring finger b. Babinski response c. flexion of the pinky and half ring finger d. plantar flexion - ANSc. flexion of the pinky and half ring finger What motor function is interhemispheric? a. face b. upper extremities c. lower extremities d. lips - ANSc. lower extremities What muscle would you monitor for EMG activity for cranial nerve XII? a) Tongue b) Trapezius c) Masseter d) Frontalis - ANSa) tongue What procedure would benefit from Auditory Evoked Potential monitoring during surgery? a. cervical spine surgery b. acoustic neuroma c. hematoma d. carotid endarterectomy - ANSb. acoustic neuroma What separates the sensory and motor cortical strips? a) Falx cerbri b) Sylvian fissure c) Central sulcus d) Frontal sulcus - ANSc) Central sulcus What should an IONM professional document during surgery? (select all that apply) a. times in which other OR staff (circulator and scrub tech) enter and exit the room b. pertinent discussion with surgeon and other OR staff c. offhand comments and good jokes told during surgery d. changes and corrective action taken e. surgical events f. troubleshooting g. anesthetic levels h. patient's physiologic state - ANSb. pertinent discussion with surgeon and other OR staff d. changes and corrective action taken e. surgical events f. troubleshooting g. anesthetic levels h. patient's physiologic state 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 - ANSb) Ipsilateral BAEP and Facial Nerve What should you check 1st if you lose all waves? - ANSStimulator What should you do to make sure anesthesia is aware of your needs for neuromonitoring monitoring? a. demand that every patient be given TIVA b. Be very assertive as you enter the room and let everyone know what you require of them When intravenous anesthesia is used instead of inhaled gas monitored data quality can be significantly and rapidly degraded when ________ a. intravenous anesthesia is administered as a constant infusion b. intravenous anesthesia is administered as a bolus c. the anesthesiologist leaves the OR room for more than two minutes d. intravenous anesthesia level becomes too light over a long time period - ANSb. intravenous anesthesia is administer as a bolus 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 - ANS4. Whenever the instrument is connected to a power source When measuring a patient's head in accordance with the 10-20 international system of electrode placement, the measurements are taken in what unit of measurement? a. kg b. inches c. cm and mm - ANSc. cm and mm 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 - ANS3. the latency of wave V of 1.0 or greater When monitoring CNVIII, why is it important to have a pre-operative audiogram? a. hearing loss will affect the ability to obtain an ABR b. the presence of hearing loss will not have an effect on the ABR c. not necessary - ANSa. hearing loss will affect the ability to obtain an ABR 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 - ANS4. Persistent increase in latency and decrease in amplitude 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 - ANS2. Continuous train of neurotonic discharges 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 - ANS4. Persistent loss of waveforms 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 - ANSd) may lead to false interpretation of the data When monitoring somatosensory evoked potentials during a critical moment in an intraoperative study, changing the setting of the high-frequency filter: a. may increase the number of single trial events required to resolve the evoked response b. may help isolate a true signal from background noise c. may lead to a false interpretation of the data d. will be of limited consequence to the outcome of the study - ANSc. may lead to a false interpretation of the data 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 - ANSc) Orbicularis oculi and orbicularis oris 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 - ANSa) long-lasting muscle relaxants must be avoided When monitoring the facial nerve: a. bipolar electrodes should be placed in the larynx b. needle electrodes should be placed in the masseter c. inhalational anesthetic agents must be avoided d. long-lasting muscle relaxants must be avoided - ANSd. long-lasting muscle relaxants must be avoided 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 - ANSd) the waveforms are higher in amplitude and require fewer responses When placing screws during an open procedure, at what threshold (average warning criteria) is the lumbosacral screw considered to have a defect in the pedicle wall? a. <7.5 mA b. <14 mA c. <2 mA d. <5 mA e. <20 mA - ANSa. <7.5 mA 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 - ANS6 mA 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 - ANSa) subcortical far-field potentials When recording a posterior tibial nerve SSEP, the Fpz-C5s channel records: a. the Erb's point potential b. stationary lumbar potentials c. subcortical far-field potentials Where are compound muscle action potentials (CMAP) recorded? a. spine b. muscle c. nerve d. brain - ANSb. muscle Where is the Cv5-FPZ response generated from? a. brainstem b. motor cortex c. somatosensory cortex d. mibrain - ANSa. brainstem 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 - ANS1. on the dura Which group of patients is it most desirable to use a ketamine based anesthetic (with no propofol) when motor evoked potentials are monitored? a. adolescents with scoliosis b. children less than 6-10 years c. adults (30-50 years) having spine surgery d. adults having spine surgery who have myelopathy - ANSb. children less than 6-10 years Which is a complication of an intravenous agent? a. etomidate can produce myoclonic jerking that resembles a seizure b. high dose propofol for extended periods (many days) produces renal failure c. high dose dexmeditomidine produces tachycardia and hypertension d. midazolam produces hallucinations - ANSa. etomidate can produce myoclonic jerking that resembles a seizure Which is not true about nitrous oxide? a. it is thought to be a weak anesthetic agent b. it can be synergistic in its effects on IOM when mixed with isoluane c. it is an inhalational anesthetic agent d. it is very soluble in body tissues - ANSd. it is very soluble in body tissues Which landmark of the international 10-20 system of electrode placement is sometimes challenging to locate due to anatomic variation in prominence? a. vertex b. nasion c. inion d. pre-auricular poins - ANSc. inion Which muscle relaxant wears off the fastest when used for intubation? a. atracurium b. pancuronium c. rocuonium d. succinylcholine - ANSd. succinylcholine Which of the cranial nerves in most commonly injured? a. Trigeminal Nerve (CN V) b. Facial Nerve (CN VII) c. Auditory Nerve (CN VIII) d. Optic (CN I) - ANSb. Facial Nerve ( CN VII) 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 - ANSd) L4 nerve root Which of the following anesthestic agents is not a good amnestic? a. dexmeditomidine b. etomidate c. propofol d. midazolam - ANSa. dexmeditomidine Which of the following anesthetic agent will obliterate the transcranial electric motor evoked potential? 1. Propofol 2. Desflurane 3. Fentanyl 4. Nitrous Oxide - ANS2. Desflurane Which of the following anesthetic agents is limited in its use because it causes hallucinations? a. Desflurane b. Ketamine c. Dexmeditomidine d. Propofol e. Etomidate - ANSb. Ketamine Which of the following anesthetic agents is not a potent inhalational agent? a. isoflurane b. dexmeditomidine c. sevoflurane d. desflurane - ANSb. dexmeditomidine Which of the following anesthetic agents may increase the amplitude of cortical potentials? 1. Etomidate 2. Halothane 3. Pentobarbital 4. Nitrous Oxide - ANS1. Etomidate Which of the following anesthetic agents produces a state of sleep which most mimics normal sleep such that awakening form sedation allows the most normal neurological examination? a. dexmeditomidine b. etomidate c. propofol d. desflurane - ANSa. dexmeditomidine Which of the following anesthetic agents would not be good during brainsurgery? a. low dose isoflurane b. ketamine c. an infusion of propofol d. sufentanil - ANSb. ketamine Which of the following anesthetics enhances evoked responses? a. etomidate b. ketamine c. propofol - ANSa. etomidate Which of the following anesthetics have effects on the neuromuscular junction? a. sufentanil b. propofol c. dexmeditomidine d. etomidate e. isoflurane - ANSe. isoflurane Which of the following are complications of CEA? (select all that apply) a. hypoperfusion b. thrombosis c. embolism d. hyperperfusion - ANSall of the above Which of the following best describes a false negative case? 1. Evoked Potentials disappear but reappear within 15 minutes 1. Tin 2. Gold 3. Silver 4. Stainless Steel - ANS2. Gold Which of the following have been promoted as indicators of adequate anesthetic depth? a. diffuse high frequency cortical EEG activity b. EMG activity in the forehead contaminating the EEG c. burst suppression on the EEG d. very high indices on the processed EEG machines (over 80) - ANSc. burst suppression on the EEG 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 - ANS2. Hearing loss 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 - ANS4. Resecting of tumor fragments during acoustic neuroma resection Which of the following is a reason why a "false-negative" could occur? a. the lesion occurs in a structure not involved in the pathway being monitored b. the documentation was incomplete c. no significant changes were noted and communicated d. the surgical procedure was revised due to data changes - ANSa. the lesion occurs in a structure not involved in the pathway being monitored 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 - ANSd) The lesion occurs in a structure not involved in the pathways being monitored Which of the following is a source of intraoperative physiologic artifacts? 1. Cell saver 2. Blood warmer 3. Electrocardiogram 4. Electrooculogram - ANS3. Electrocardiogram Which of the following is an example of a SSEP far-field subcortical potential? 1. N20 2. N34 3. Erbs point 4. Popliteal Fossa - ANS2. N34 Which of the following is an uncommon side effect of propofol? a. seizures b. hypertension c. hallucinations d. myoclonic jerking e. lactic acidosis - ANSe. lactic acidosis 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 - ANSb) 0.8 Hz 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 - ANSc) History of cerebral palsy Which of the following is NOT true of the pulsatility index? a. pulsatility index increases distal to a stenosis b. pulsatility index is influenced by heart function c. pulsatility index is a reflection of peripheral resistance d. pulsatility index decreases with age - ANSa. pulsatility index increases distal to a stenosis 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 - ANS3. Free run EMG 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 - ANSc) 12 ms 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 - ANSc) 12 ms Which of the following is true? a. if a CMAP is absent then the D wave must also be absent b. in spinal cord monitoring, the loss of the SSEP always means the motor system is also injured c. when the evoked responses fail the nerves are irreversibly injured d. when the SSEP fails, the time to irreversible injury is inversely related to the blood flow - ANSd. when the SSEP fails, the time to irreversible injury is inversely related to the blood flow 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 - ANSb. Epidural recording of transcranial motor evoked potentials (D wave) 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 - ANS1. drilling Which of the following nerve injuries usually does NOT produce spontaneous EMG activity during intraoperative monitoring? 1. Heat b. shunting of current by irrigation fluid c. insertion of hardware d. anesthetic agents - ANSd. anesthetic agents Which of the following would be a goo dresponse to a surgeon? a. "I lost my corticals." b. "There has been a decrease in the signal over the last 3 minutes." c. "I lost my Pop. Fossa." d. "I lost my N13 and N20" - ANSb. "There has been a decrease in the signal over the last 3 minutes." 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 - ANS2. Increase the intensity Which of the following would most affect the ability to record BAEPs? 1. Drill 2. Retractor 3. Coagulator 4. Anesthetic agent - ANS3. Coagulator 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 - ANS3. Erbs point potential 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 - ANSc) Cochelar lesion 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 - ANSb) Increase click intensity Which PTN SSEP response is affected the most by volatile inhalational agents? a. responses recorded by epidural electrodes b. responses recorded over the sensory cortex c. responses measured at the popliteal fossa d. responses measured over the posterior cervical spine - ANSb. responses recorded over the sensory cortex Which technique is most useful in monitoring the integrity of corticospinal tracts during resection of intramedullary spinal cord tumors? a. H-reflex b. D-waves c. TCeMEP d. SSEP - ANSc. TCeMEP Which two medications can increase cortical potentials? a. propofol and diprovan b. desflourane and fentanyl c. zemuron and aspirin d. etomidate and ketamine - ANSd. etomidate and ketamine Which type of EMG response is suggestive of some degree of neural insult? a. train b. burst c. silence - ANSa. train Which type of instrumentation is most likely to cause trauma to the spinal cord? a. subdural needle electrodes b. the strain guage c. sublaminar wires d. the Wyatt bolt - ANSc. Sublaminar wires Which type of stimulator is utilized for anatomical mapping of a nerve? a. hook wire electrode b. bipolar c. monopolar - ANSc. monopolar Which vertebrae in the cervical spine has the most prominent spinous process? a. C3 b. C5 c. C7 d. C2 e. C4 - ANSc. c7 Which vessel does not comprise the circle of Willis: a. posterior communicating artery b. internal carotid artery c. anterior communicating artery d. posterior cerebral artery - ANSd. posterior cerebral artery 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 - ANS3. slowed peripheral conduction velocity While stimulating cranial nerve VII, a bipolar type stimulator has an advantage over a monopolar stimulator by: a. having greater specificity b. requiring less current c. being less expensive d. presenting less risk of damage to the neural tissue - ANSa. having greater specificity Why is it important to monitor upper SSEPs for a lumbar surgery? a. to protect corticospinal tracts b. it may identify positional changes and is a good control of anesthesia effects c. to detect temperature changes d. to protect the dorsal columns - ANSb. it may identify positional changes and is a good control of anesthesia effects Why is it important to monitor upper SSEPs for a lumbar surgery? a. to protect the dorsal columns b. it may identify positional changes and is a good control for anesthesia's impact on waveforms c. to protect corticospinal tracts d. to detect temperature changes - ANSb. it may identify positional changes and is a good control for anesthesia's impact on waveforms Why is the placement of the arterial line in the pre-op holding area a concern for the IONM monitorist? a. it will generate movement artifact, contaminating the recording b. it may interfere with the recording electrode placements c. it may interfere with optimal stimulator placement d. it may generate electrical interference - ANSc. it may interfere with optimal stimulator placement With a sampling rate of 10 kHz the shortest sine wave resolved would be: a. 2 msec b. 0.4 msec