CNIM Exam 2

Which of the following are most likely to cause airborne contamination in an operating room?

A- ventilation devices
B- Kerrison particles
C- dust particles
D- bloodborne pathogens

C- dust particles

Stimulus artifact during SSEPs can be decreased by

A- keeping the instrument away from florescent lights and video monitors
B- separating stimulating cables from cables of other equipment
C- lowering the impedances of ground and stimulating electrodes
D- using enough muscle relaxant

C- lowering the impedances of ground and stimulating electrodes

All of the following are true of "informed consent" for an operative procedure except

A- one of the purposes of the consent is to protect the surgeon and hospital from unauthorized operative procedures
B- the patient may have sedation before the consent is signed
C- the surgeon must be informed if the consent has not been signed before surgery starts
D- if illiterate, the patient signs with an "X", after which the witness writes "patient's mark"

B- the patient may have sedation before the consent is signed

If you have high frequency noise in a BAEP:

A- Change LFF to 30 Hz
B- Change LFF to 150 Hz
C- Change HFF from 3000 to 1500 Hz
D- Change HFF to 200 Hz

C- Change HFF from 3000 to 1500 Hz

Electromagnetic inductance

A- should never occur in the operating room
B- results only from wires that are not insulated
C- results only from poor ground wires
D- is produced when a wire carrying current induces a magnetic field that in turn creates current in other wires

D- is produced when a wire carrying current induces a magnetic field that in turn creates current in other wires

The area of greatest risk for ischemic injury during carotid endarterectomy is

A- the middle cerebral artery
B- the posterior cerebral artery
C- the anterior communicating artery
D- the posterior cerebral artery

A- the middle cerebral artery

When recording a posterior tibial nerve SSEP, the Fpz ‐ C5s channel records

A- subcortical near‐field potentials
B- stationary lumbar potentials
C- the Erb's point potential
D- subcortical far ‐ field potentials

D- subcortical far ‐ field potentials

Needle electrodes should be discarded and not resterilized if

A- the patient has Hodgkin's disease
B- the patient has Jakob ‐ Creutzfeldt disease
C- the patient has Meniere's disease
D- the patient has Korsakoff's psychosis

B- the patient has Jakob ‐ Creutzfeldt disease

Decreased synchronization of the auditory nerve firing will likely result in

A- a decrease in wave amplitude
B- no change in wave amplitude or latency
C- a decrease in wave latency
D- an increase in wave amplitude

A- a decrease in wave amplitude

Universal Precautions

A- Strategy for preventing disease protection
B- Handwashing after every meal
C- The assumption that every patient has AIDS
D- Use of PPDs with every patient

D- Use of PPDs with every patient

Upper extremity SEPs are transmitted through the:

A- the lateral lemniscus
B- gracilis nucleus
C- the medial geniculate bodies
D- cuneate nucleus

D- cuneate nucleus

Which describes a semi‐critical infectious device?

A- Requires low level disinfection after each
B- Requires high to intermediate disinfection after each use
C- Requires no disinfection after each use use
D- Requires sterilization after each use

B- Requires high to intermediate disinfection after each use

Low frequency sounds are



A- at the apex of the cochlea
B- near the stapes
C- perceived along Reissner's membrane
D- near the round window

A- at the apex of the cochlea

When monitoring with SSEPs, dural or direct cord recordings are advantageous because:

A- they have less chance of artifact during cauterization
B- the waveforms are higher in amplitude and require fewer averages
C- the waveforms better reflect cortical responses to stimulation
D- they present less discomfort to the patient than scalp leads

B- the waveforms are higher in amplitude and require fewer averages

Language

A- is in the right cerebral hemisphere in 85% of the population
B- is in the left cerebral hemisphere in 85% of the population
C- is localized in the parietal lobe
D- localization depends on the age of the patient

B- is in the left cerebral hemisphere in 85% of the population

Dwell time can be defined as

A- the D to A conversion
B- the intersample interval
C- the sample rate of the signal's amplitude
D- the A to D conversion

B- the intersample interval

The BIS monitor

A- is used by anesthesia to determine the effect of TCMEP monitoring on the patient's EEG
B- uses the phase coupling between frequencies in the EEG signal to establish depth of anesthesia
C- squares the EEG power to produce a positive amplitude in the compressed spectral array
D- divides the EEG into 8 frequencies in order to determine grades of cortical ischemia

B- uses the phase coupling between frequencies in the EEG signal to establish depth of anesthesia

An electrode suggested as a sensitive stimulator during facial nerve recordings is the

A- single fiber needle
B- gelled surface electrode
C- bipolar concentric EMG needle
D- digital ring electrode

C- bipolar concentric EMG needle

A "MAC" (minimal alveolar concentration) is

A- 60% N20
B- the concentration at which 1/2 of subjects move in response to stimulation such as a surgical incision
C- 1% of an inhalation agent such as isoflurane
D- 10% of an inhalation agent such as isoflurane

B- the concentration at which 1/2 of subjects move in response to stimulation such as a surgical incision

One function of the circuitry in an isolated input board is to protect the patient from electrical shock by limiting the current flow to ______ at the patient leads when 120Vrms is applied to the inputs.

A- 1 uA
B- 20 uA
C- 60 uA
D- 100 uA

B- 20 uA

You are running TCMEP by stimulation via the C3 and C4 electrode sites. At an unknown polarity, stimulation activates muscle responses on the right side of the patient's upper and lower body. Which of the following is the most likely location of the cathode?

A- Unable to determine based on information
B- C4
C- Cz
D- C3

B- C4

Which type of surgery is least likely to require EMG monitoring of the external anal sphincter?

A- lipomyelomeningocele
B- surgery of the sacral plexus involving S2, S3 and S4
C- excision of masses of the cauda equina
D- herniated L5 disc

D- herniated L5 disc

To reduce artifact from electrode wire movement during surgery, it is best to

A- use only paste and gold disc electrodes
B- braid the wires
C- use long wires and tuck them under the patient
D- loop the wires under the patient's head

B- braid the wires

The SEP reaches adult form and latency by

A- 6 months
B- birth
C- 18 months
D- 8 years

D- 8 years

The gain of an amplifier, set to give an output signal of 1 volt for an input signal of 10 microV, is

A- 1,000
B- 100
C- 10,000
D- 100,000

D- 100,000

An "after-discharge" can occur on the cortical EEG recording following

A- electrical stimulation of the exposed cortex
B- a seizure recorded in the operating room
C- the introduction of 60 Hz artifact
D- electrocautery

A- electrical stimulation of the exposed cortex

A response similar to a nerve "burst" occurs in the "crossed sword" phenomena when metal touches metal due to

A- the cathode receiving a positive charge
B- a capacitive discharge from the metal
C- the anode receiving a negative charge
D- the metal insulation

B- a capacitive discharge from the metal

Which of the following should be documented during monitoring?

A- What the surgeon says in response to a report of changes
B- Blood loss during the case
C- Amount of urine collected during the case
D- Brand of subdermal needle electrodes used

A- What the surgeon says in response to a report of changes

When all raw traces are being rejected, you may need to:

A- Increase the repetition rate
B- Decrease the stimulus intensity
C- Turn off the artifact reject
D- Increase the vertical display sensitivity

C- Turn off the artifact reject

The ulnar nerve originates from nerve roots

A- C3 - C7
B- C7 - T1
C- C5 - C6
D- T1 - T2

B- C7 - T1

The method of transmission for the hepatitis virus is:

A- contact with blood
B- contact with feces or urine
C- contact with airborne dust
D- contact with respiratory tract droplets

A- contact with blood

Which is the most critical stage of a scoliosis surgery?

A- Placement of crosslinks
B- Closure
C- Exposure
D- Derotation

D- Derotation

To dissect a vestibular schwannoma, which surgical approach usually sacrifices hearing?

A- suboccipital
B- middle cranial fossa
C- retrosigmoid
D- translabyrinthine

D- translabyrinthine

Movement artifact on the EEG is most likely to produce

A- slow EEG wave activity
B- burst‐suppression
C- asymmetrical activity at 60 Hz
D- fast EEG wave activity

A- slow EEG wave activity

All of the following are true of the use of operating room masks except

A- masks should not be saved from one operation to the next
B- the purpose of using a mask is filtration of breathable bacteria
C- masks act as a HEPA filter
D- masks should never be doubled because they would act as a barrier rather than a filter

C- masks act as a HEPA filter

Vasospasm of AICA will result in

A- Increased inter peak waves III-V ABR latencies
B- Complete loss of all ABR waves with exception of cochlear microphonic
C- Increased inter peak waves III-V ABR latencies
D- Loss of waves III-V

B- Complete loss of all ABR waves with exception of cochlear microphonic

Cardiac activity appears on the CSA/DSA display as:

A- intermittent theta
B- beta activity
C- delta activity
D- alpha activity

C- delta activity

Inflammation of the covering of the brain or spinal cord is called

A- meningitis
B- encephalitis
C- myelitis
D- myxedema

A- meningitis

Examples of "surgical manipulation" would include

A- blood pressure and heart rate fluctuations
B- core temperature changes
C- drilling and irrigation
D- oxygenation and ventilation alterations

C- drilling and irrigation

Hoffmann's sign is:

A- loss of deep pain sensation as evidenced by diminished sensation to the application of pressure to the ulnar nerve
B- loss of deep pain sensation as evidenced by diminished sensation to the application of pressure to the testicle
C- palmar flexion of the thumb when the distal phalanx of the middle finger of the same hand is rapidly stroked
D- plantar extension of the hallux when the sole of the foot is stroked

C- palmar flexion of the thumb when the distal phalanx of the middle finger of the same hand is rapidly stroked

P14 is a far ‐ field, subcortically generated response which probably reflects

A- caudal medial lemniscal activity
B- activity from the precentral gyrus
C- a stationary cervical potential
D- passage of the afferent volley

A- caudal medial lemniscal activity

Lying between the adjacent surfaces of the vertebral bodies and bonding them together, are the

A- supraspinous ligaments
B- spinal nerves
C- pedicles
D- intervertebral discs

D- intervertebral discs

The monitoring modality most likely to be affected by a large bolus of muscle relaxant is the

A- BAEP
B- cortical SSEP
C- NMEP
D- myogenic evoked potential

D- myogenic evoked potential

Wave III of the BAEP is generated by the



A- medial geniculate
B- inferior colliculus
C- lateral lemniscus
D- cochlear nuclues

D- cochlear nuclues

All of the following are opioids except

A- meperidine
B- sufentanil
C- morphine
D- propofol

D- propofol

Electrical hazards that exist for patients attached to medical equipment include all of the following except:

A- indwelling electrodes
B- leakage current
C- needle sticks
D- ground faults

C- needle sticks

The motor cervical spine C5 nerve root produces:

A- Arm abduction
B- Elbow extension
C- wrist extension
D- wrist flexion

A- Arm abduction

Stimulating electrodes during SEP

A- Should not be placed near catheters leading into the heart or the great vessels
B- Should be made of zinc to eliminate electrolysis
C- Should produce about 1/2 the current needed to cause a twitch
D- Should produce about 1/3 the current needed to cause a twitch

A- Should not be placed near catheters leading into the heart or the great vessels

To accurately represent the amplitude of an EP waveform, a match must be made between the

A- horizontal resolution and signal size
B- dwell time and sampling rate
C- signal size and the vertical capacity of the digitizer
D- high‐frequency noise and smoothing operation of the instrument

C- signal size and the vertical capacity of the digitizer

To minimize pain from stimulation during the recording of SSEPs, the contact impedance of the stimulator should be:

A- less than 50 kilohms
B- less than 5,000 ohms
C- more than 10,000 ohms
D- less than 10 megohms

B- less than 5,000 ohms

An electrode measured 20% lateral to Cz on the right using 10 ‐ 20 system is

A- T3
B- C3
C- A2
D- C4

D- C4

When testing a patient with a conductive hearing loss using ABR

A- the stimulus rate should be decreased
B- the stimulus rate should be increased
C- the stimulus should be increased in intensity
D- no special change in protocol is required

C- the stimulus should be increased in intensity

During a posterior fossa approach for removal of an acoustic neuroma, an increase in the latency of wave V is most likely caused by:

A- a loss of blood supply to the cochlea
B- failure to stimulate
C- retraction of the cerebellum
D- fluid in the ear canal

C- retraction of the cerebellum

When monitoring the facial nerve:

A- needle electrodes should be placed in the masseter
B- bipolar electrodes should be placed in the larynx
C- inhalational anesthetic agents must be avoided
D- long-lasting muscle relaxants must be avoided

D- long-lasting muscle relaxants must be avoided

Increases in latency of both right and left ABR wave V of 0.9 msec in a 10 minute period would most likely indicate:

A- temperature effects
B- a "kink" in the sound delivery tubing
C- auditory nerve damage
D- ambient noise

A- temperature effects

What is the minimum required bandpass for an EP system?

A- 1 - 1000 Hz
B- 30 ‐ 1500 Hz
C- 1 Hz - 20 KHz
D- 0.1 ‐ 5000 Hz

D- 0.1 ‐ 5000 Hz

Ataxia

A- Inability to walk
B- Inability to speak
C- Inability to perform coordinated movements
D- Inability to pay taxes

C- Inability to perform coordinated movements

EEG waves with a frequency of 5 Hz can be classified as what type of EEG?

A- beta activity
B- alpha activity
C- theta activity
D- delta activity

C- theta activity

Epileptiform discharges in a bipolar linked chain are localized by:

A- a Mu rhythm
B- a referential montage
C- a phase reversal between two channels
D- patient movement

C- a phase reversal between two channels

According to current OSHA standards, needle electrodes should

A- be reused whenever possible
B- not be soaked in sodium hypochlorite solution
C- be recapped before discarding
D- not be handled with tongs or forceps while cleaning

B- not be soaked in sodium hypochlorite solution

Spectral analysis of raw EEG data displays power as un upward deflection and

A- wave morphology in a compressed design
B- time horizontally on the graph
C- frequency as a linear display across the epoch line
D- time as a spectral edge

C- frequency as a linear display across the epoch line

Which of the following is not true?

A- agents that sterilize are also injurious to the living tissues of the skin
B- sodium hypochlorite (bleach) is effective in the deactivation of HIV and hepatitis B virus
C- formaldehyde is highly germicidal and sporicidal in a strong concentration
D- boiling water can be used to sterilize surgical instruments

D- boiling water can be used to sterilize surgical instruments

A drop in the temperature of the patient's legs can cause

A- an increase in the conduction velocity of the tibial nerve
B- a decrease in the amplitude of SSEP waveforms
C- an increase in the amplitude of the L3S response
D- a prolongation of SSEP peak latencies

D- a prolongation of SSEP peak latencies

Which of the following best describes the value of collecting pre‐operative baseline SSEPs?

A- Pre‐operative data are useful for establishing the integrity of the somatosensory pathways prior to the onset of anesthesia
B- The SSEPs immediately following the critical events of the surgery can be compared to the pre‐operative baseline
C- Pre‐operative data are useful for ruling out the effects of anesthesia
D- Pre‐operative SSEPs have no value

A- Pre‐operative data are useful for establishing the integrity of the somatosensory pathways prior to the onset of anesthesia

Both SSEP and BAEP waveforms can be affected by structural manipulation using

A- grounding pads
B- retractors
C- blood pressure transducers
D- suction

B- retractors

The agent least depressing SEP monitoring is probably

A- sevoflurane
B- pancuronium
C- vecuronium
D- ketamine

D- ketamine

The ABR electrode montage would include

A- M1, M2, Oz
B- Cz, A1, A2
C- CP3, CP4, Cpz
D- Fpz, CP4, CPz

B- Cz, A1, A2

A unit of resistance is symbolized by

A- micro
B- ohms
C- A
D- E

B- ohms

Spondylosis is

A- deterioration of the spinal cord gray matter which is replaced by a large cyst
B- degeneration of the spine
C- neurofibromatosis
D- Forward movement of the body of one of the lower lumbar vertebrae on the vertebra below it, or upon the sacrum

B- degeneration of the spine

All of the following are benefits of EEG monitoring during carotid endarterectomy except:

A- detection of hypoxia
B- detection of hypotension
C- detection of occlusion-associated ischemia
D- detection of heparin dosage

D- detection of heparin dosage

If the patients threshold is 25 dB and the stimulator is set to 85 dB, then the intensity is

A- 60 dB HL
B- 85 dB SL
C- 110 dB SL
D- 60 dB SL

D- 60 dB SL

All of the following help to decrease microorganisms in the operating room except:

A- decreased movement of personnel in the OR
B- filtered air
C- air currents caused by swinging doors
D- positive pressure in the OR greater than in corridors

C- air currents caused by swinging doors

Monitoring of aneurysms involving the posterior fossa should include

A- median nerve SEP
B- both SEP and ABR
C- tibial nerve SEP
D- ABR

B- both SEP and ABR

Normal EEG activity in the wakeful adult

A- Beta and delta with spindle formations
B- Primarily alpha and beta activity
C- Burst suppression
D- Primarily delta and theta activity

B- Primarily alpha and beta activity

An example of a non‐physiologic artifact would be

A- high levels of muscle tension
B- electrical interference
C- slow signals due to perspiration
D- the ECG signal

B- electrical interference

For patients showing clamp-related EEG changes during carotid endarterectomy, 80% of the changes appear within the

A- first 10 seconds
B- first 60 seconds
C- alpha frequency range
D- frontal leads only

B- first 60 seconds

If the surgeon's arm unknowingly brushes an undraped microscope

A- Ask the circulating nurse to clean and drape the microscope
B- Inform the surgeon
C- Place a sticker marked "contaminated" on the microscope
D- There is no need for any action

B- Inform the surgeon

In general, filter settings for SEP recordings

A- should always include 60 Hz band pass filters
B- can be narrower for cortical than peripheral responses
C- can be narrower for peripheral than cortical responses
D- should always be 30 ‐ 3000 Hz

B- can be narrower for cortical than peripheral responses

Determining sensory from motor cortex can be accomplished when the

A- ABR increases in latency
B- SEP increases in latency
C- SEP shows a was phase reversal
D- SEP decreases in amplitude

C- SEP shows a was phase reversal

The peroneal and tibial nerves are divisions of the

A- lumbar plexus
B- deep peroneal nerve
C- sciatic nerve
D- brachial plexus

C- sciatic nerve

A dorsal rhizotomy involves:

A- Sectioning of sensory rootlets
B- Sectioning of the filum terminale
C- Placement of a dorsal column stimulating electrode implant
D- Sectioning of motor rootlets

A- Sectioning of sensory rootlets

Fomites are:

A- inanimate objects that may be contaminated with infectious organisms and serves to transmit diseases
B- objects that can be autoclaved
C- a type of disinfectant
D- a type of instrument used in spinal surgery

A- inanimate objects that may be contaminated with infectious organisms and serves to transmit diseases

In the 10 ‐ 20 system of electrode placement, the point 20% (of the nasion‐inion distance) anterior to Cz is called

A- Fpz
B- Pz
C- C1
D- Fz

D- Fz

The difference between the voltages in input 1 and input 2 will make the display of the amplifier move:

A- in a sinusoidal pattern
B- either up or down
C- up
D- down

B- either up or down

The most productive electrode placement for electrocochleography is:

A- at the ear canal
B- at the earlobe
C- at the promontory of the cochlea
D- at Fpz

C- at the promontory of the cochlea

When placing stimulating electrodes over a peripheral nerve to elicit a muscle response:

A- The positive electrode must be directly over the nerve whereas the negative electrode needn't be
B- the positive electrode should be toward the peripheral portion of the nerve to be stimulated
C- neuromuscular blockade must be in effect during stimulation
D- the negative electrode should be toward the peripheral portion of the nerve to be stimulated

D- the negative electrode should be toward the peripheral portion of the nerve to be stimulated

An average individual sheds skin at the rate of approximately:

A- 10 ‐ 40 cells per minute
B- 40 ‐ 400 cells per minute
C- 400 ‐ 4000 cells per minute
D- 4000 ‐ 10,000 cells per minute

D- 4000 ‐ 10,000 cells per minute

An erroneous representation of an analog wave by A to D conversion suggesting a lower frequency due to a low sampling rate is called

A- over sampling
B- amplitude perversion
C- wave form perversion
D- aliasing

D- aliasing

Which of the following signs could indicate abnormal PTN SSEPs?

A- Moro's reflex
B- Otoacoustic reflex
C- Patellar reflex
D- Babinski's reflex

D- Babinski's reflex

Trigeminal nerve stimulation will elicit a CMAP from which of the following:

A- Temporalis
B- Trigeminalis
C- Mentalis
D- Tongue

A- Temporalis

Monitoring of aneurysms involving the anterior cerebral artery should include

A- tibial nerve SEP
B- median nerve SEP
C- ABR
D- visual evoked potentials

A- tibial nerve SEP

When recording BAEPs in the OR, some auditory stimulators utilize several inches of tubing to connect the transducer and ear inserts which:

A- delays the arrival of the sound to the ear and separates stimulus artifact
B- do not affect the latencies of the waveforms
C- are comparable to acoustically shielded headphones
D- delay the signal to the transducer and can cause 60 Hz artifact

A- delays the arrival of the sound to the ear and separates stimulus artifact

Meckle's Cave is defined as:

A- Foramen from which the facial nerve exits the skull to innervate the face
B- Depression in the medial middle fossa where the trigeminal nerve ganglion sits
C- Spinal tract by which the posterior tibial nerve pathway runs
D- Cranial depression directly above the fourth ventricle

B- Depression in the medial middle fossa where the trigeminal nerve ganglion sits

Which of the following neurotransmitters always causes excitation of postsynaptic neurons?

A- dopamine
B- glutamate
C- glycine
D- gamma amino butyric acid

B- glutamate

In the reverse Trendelenburg's position,

A- the head of the bed is tilted toward the floor
B- the patient is in the dorsal recumbent position
C- the foot of the bed is tilted toward the floor
D- the patient is in the modified Fowler's position but on the left side

C- the foot of the bed is tilted toward the floor

TCMEP monitoring during scoliosis surgery may replace a need for the

A- the O'Hara clonus test
B- the Ruben hematocrit test
C- neurologic exam
D- the Stagnara wake up test

D- the Stagnara wake up test

An advantage of referential, as opposed to bipolar recording of spinal cord somatosensory evoked potentials, is

A- the elimination of electromyographic artifact from the paraspinous muscles
B- the ease of electrode placement
C- less invasion of the surgical field
D- avoiding cancellation of the potentials as a result of recording from adjacent levels

D- avoiding cancellation of the potentials as a result of recording from adjacent levels

The effect of volatile anesthetic agents on cortical evoked potentials is to

A- prolong latencies and decrease amplitudes
B- decrease latencies
C- decrease amplitudes and decrease latencies
D- increase amplitudes

A- prolong latencies and decrease amplitudes

During BAEP from posterior fossa craniotomy, if reversible loss of all ipsi BAEP responses occurs:

A- drug effect
B- complete recovery of neuronal function
C- hypothermia
D- probable neuronal deficit post-op

B- complete recovery of neuronal function

Which of the following will cause burst-suppression on the EEG?

A- succinylcholine chloride
B- barbiturates
C- loss of a ground electrode
D- decrease of inhalational anesthetics

B- barbiturates