CNIM 4

Which is the most common type of change observed during CEA?
A- Ipsilateral EEG slowing, reduced cortical SSEP to contralateral stimulation
B- Bilateral EEG slowing, reduced cortical SSEP to bilateral stimulation
C- Ipsilateral EEG slowing, reduced cortical SSEP to ipsilateral stimulation
D- Contalateral EEG slowing, reduced cortical SSEP to contralateral stimulation

A- Ipsilateral EEG slowing, reduced cortical SSEP to contralateral stimulation

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?
A- Erbs point potential
B- N20
C- Central conduction time
D- P22

A- Erbs point potential

Lumbar potential is generated from:
A- Pre-synaptic responses
B- Spinal ganglion
C- Sciatic nerve
D- Post-synaptic responses

D- Post-synaptic responses

When placing PF you want the active electrode:
A- Lateral to the PF
B- Medial to the PF
C- Above the PF crease
D- Below the PF crease

C- Above the PF crease

Which of the following nerve injuries usually does NOT produce spontaneous EMG activity during intraoperative monitoring?
A- Ischemia
B- Irrigation
C- Pressure
D- Heat

A- Ischemia

Which of the following is considered HIPPA protected patient information?
A- Sexual orientation
B- Patient name
C- Height
D- Weight

B- Patient name

Which of the following diseases results from infection by a bloodborne pathogen?
A- Hepatitis B
B- Varicella
C- Herpes zoster
D- Mononucleosis

A- Hepatitis B

Which is required to prevent aliasing of a signal?
A- Use a stimulus frequency below the Nyquist
B- Sampling below the Nyquist frequency
C- Setting the timebase to at least 100 mS
D- Sampling at least the Nyquist frequency

D- Sampling at least the Nyquist frequency

An objective measure of meaningful change to use to warn the surgeon is the
A- IPL decrease
B- 10% amplitude decrease
C- Latency decrease
D- 50% amplitude decrease

D- 50% amplitude decrease

During WADA language testing, what should you expect after injection of sodium amytal?
A- Bilateral cortex slow wave activity increase
B- Contralateral cortex slow wave activity increase
C- Ipsilateral cortex slow wave activity increase
D- Bilateral fast wave activity increase

C- Ipsilateral cortex slow wave activity increase

Which of the following is a common complication of microvascular decompression of cranial nerve VII?
A- Lower extremity weakness
B- Visual loss
C- Hearing loss
D- Upper extremity weakness

C- Hearing loss

The use of intraoperative monitoring during scoliosis surgery may replace the
A- Hoffman sign
B- Romberg test
C- Babinski sign
D- Stagnara test

D- Stagnara test

4-137 If you need 100 trials to get a SNR of 2:1, how many trials are needed for a SNR of 20:1?
A- 10,000
B- 1000
C- 20,000
D- 2000

A- 10,000

A dorsal rhizotomy involves:
A- Cutting motor roots
B- Resection of the filum terminale
C- Removing a tumor
D- Cutting sensory roots

D- Cutting sensory roots

Phase reversal of SSEPs following intraoperative median nerve stimulation is used for localizing:
A- Occipital cortex
B- Thalamic sensory pathway
C- Language area
D- Sensorimotor cortex

D- Sensorimotor cortex

While performing a posterior tibial SSEP, hypothermia of the lower extremities is most likely to cause
A- Increased T12‐P37 latency
B- Increased L3‐P37 latency
C- Abnormal prolongation of the P37‐N45 complex
D- Slowed peripheral conduction velocity

D- Slowed peripheral conduction velocity

Which is characteristic of AC polarity?
A- Abnormal I‐V intervals
B- No effect on wave I amplitude
C- Reduces stimulation artifact
D- Recommended for premature babies

C- Reduces stimulation artifact

According to the ACNS guidelines, system bandpass settings for monitoring facial nerve spontaneous muscle activity should be
A- 1‐250 to 1500 Hz
B- 100‐200 to 1000‐3000 Hz
C- 10‐30 to 16,000 Hz
D- 10‐30 to 2500‐3000 Hz

C- 10‐30 to 16,000 Hz

Assume your impedances for two recording electrodes are 5.1 kΩ and 2.1 kΩ. What should you do to reduce background noise and improve responses?
A- Reapply the ground
B- Equalize electrode impedances
C- Lower the stimulation rate
D- Move the electrodes closer together

B- Equalize electrode impedances

If you get artifact in your subcortical channel you:
A- Ask the surgeon to move retractors
B- Disable the subcortical channel
C- Ask anesthesia to increase gases
D- Use a spare CS5 electrode

D- Use a spare CS5 electrode

What is the time between P14 and N20 for MN SSEPs?
A- Analysis period
B- Central conduction time
C- Thalamocortical time
D- Peripheral conduction time

B- Central conduction time

Which is the minimum required CMRR?
A- 10,000:1
B- 100:1
C- 5000:1
D- 1000:1

A- 10,000:1

Which is the most common cause of death from electric shock?
A- Destruction of critical nerve paths
B- Paralysis of breathing reflex
C- Ventricular fibrillation
D- 3rd degree skin burns

C- Ventricular fibrillation

One contraindication for the use of transcranial electrical motor evoked potentials is
A- Epilepsy
B- Cervical myelopathy
C- Scoliosis
D- Trigeminal neuralgia

A- Epilepsy

A pneumatic drill would introduce what kind of artifact?
A- 500 Hz
B- 1 Hz
C- 3000 Hz
D- 60 Hz

A- 500 Hz

What is the suggested intraoperative auditory stimulation accordig to ACNS guidelines?
A- 90 dB SL without masking
B- 100 dB pe SPL with masking
C- 90 dB HL with masking
D- 100 dB pe SPL without masking

B- 100 dB pe SPL with masking

What if the interstimulus interval of a 50 Hz click stimulus?
A- 0.20 msec
B- 0.50 msec
C- 0.02 msec
D- 20.00 msec

D- 20.00 msec

What would be the most appropriate EMG monitoring setup for a surgery at L5?
A- Gastrocnemius, sphincter ani
B- Peroneus longus, tibialis anterior
C- Vastus lateralis, iliopsoas
D- Abductor hallucis brevis, abductor digiti minimi

B- Peroneus longus, tibialis anterior

What do you do if you can't get a thumb twitch while performing upper extremity SSEPs?
A- Reposition the stimulating electrodes
B- Decrease stimulus intensity
C- Decrease stimulus duration
D- Re‐apply the ground

A- Reposition the stimulating electrodes

It is most important for intraoperative monitoring records to include notations of
A- Periodic impedance checks
B- Serial changes in hematocrit
C- Changes in anesthesia personnel
D- Surgical events

D- Surgical events

Standard precautions are used to reduce transmission of:
A- Tuberculosis
B- Reproductive spores
C- Bloodborne pathogens
D- Hepatitis A virus

C- Bloodborne pathogens

When performing electrocorticography an impedance test is:
A- Completely unnecessary given the brain is visible
B- Necessary to elicit motor stimulation
C- Never run as an impedance check delivers a stimulus to the brain
D- Always run to ensure a good electrode connection

D- Always run to ensure a good electrode connection

Which SSEP modality is recommended for monitoring during thoracolumbar procedures?
A- Radial nerve
B- Posterior tibial nerve
C- Median nerve
D- Ulnar nerve

B- Posterior tibial nerve

What sweep is appropriate for BAEPs?
A- 100 mS
B- 50 mS
C- 1 mS
D- 15 mS

D- 15 mS

Which will enhance the analog to digital conversion?
A- Make sure the sampling rate is at least half the signal frequency
B- Ensure that the range is appropriate to the size of the signal being recorded
C- Use the longest timebase possible
D- Use the shortest possible stimulus interval

B- Ensure that the range is appropriate to the size of the signal being recorded

When placing PTN stim you shouldn't
A- Secure the tape and bands around the whole ankle
B- Place the cathode behind the medial malleolus
C- Place the electrodes an inch apart
D- Use paste and conducting gel

A- Secure the tape and bands around the whole ankle

Upper extremity SSEPs would be monitored in lumbar patients to evaluate:
A- Positioning and anesthesia effects
B- Manipulation of the thoracic spine
C- Fracture at T12
D- Thoracic pain and lower extremity weakness

A- Positioning and anesthesia effects

Anterior spinal arter occlusion
A- Sensory loss
B- Hearing loss
C- Motor loss
D- Visual loss

C- Motor loss

After T12 laminectomy, the patient can move both lower extremities but has left upper extremity weakness. Which of the following could explain this?
A- Trauma to the left brachial plexus
B- Thrombosis
C- Injury to the right dorsal column at the surgery site
D- Intraoperative cardiac complications

A- Trauma to the left brachial plexus

Which of the following can improve horizontal resolution?
A- Decreasing the number of data points
B- Increasing the HFF
C- Increasing the stimulation rate
D- Decreasing the analysis time

D- Decreasing the analysis time

You want to have matching impedances so that:
A- Horizontal resolution will be optimized
B- You can maximize your common mode rejection
C- Vertical resolution will be optimized
D- You can minimize your common mode rejection

B- You can maximize your common mode rejection

Why is it important to braid electrode wires in the operating room?
A- Avoid interfering with the surgeon's work
B- Reduce interference from ambient noise
C- Reduce the amplifier's common mode rejection
D- Shorten overall length

B- Reduce interference from ambient noise

Which of the following is an appropriate bandpass for BAEPs?
A- 5-1000 Hz
B- 10-2500 Hz
C- 1-100 Hz
D- 250-3000 Hz

B- 10-2500 Hz

During posterior fossa surgery, when BAEPs are used for monitoring brainstem function, it is most important to:
A- Record cranial nerve VIII action potentials
B- Stimulate and record from the contralateral side
C- Stimulate and record from the operative side only
D- Monitor cranial nerve V function ipsilaterally

B- Stimulate and record from the contralateral side

The best anesthesia for SSEPs:
A- Infusion fentanyl
B- Infusion midazolam
C- Bolus midazolam
D- Bolus fentanyl

A- Infusion fentanyl

What bp is most likely to attenuate the evoked potential?
A- 140 mm/Hg
B- 130 mm/Hg
C- 120 mm/Hg
D- 150 mm/Hg

D- 150 mm/Hg

To avoid a false positive the baseline is best taken
A- Pre‐intubation
B- Post‐intubation
C- In preoperative holding
D- Post‐incision

D- Post‐incision

If you can't replace an electrode that has come out during surgery you:
A- Ask the surgeon to stop and replace it
B- Discontinue monitoring
C- Ignore the missing recording channel and continue to monitor
D- Use a duplicate

D- Use a duplicate

What nerve roots are being monitored using the Peroneus longus muscle?
A- S2 - S4
B- L4 - S1
C- L5 - S2
D- L2 - L4

C- L5 - S2

D waves are recorded from which of the following electrodes?
A- Subdural electrodes over the motor strip
B- Needle electrodes in distal extremity muscles
C- Surface electrodes over peripheral nerves
D- Epidural electrodes over the spinal cord

D- Epidural electrodes over the spinal cord

Which of the following temperatures should be annotated as being hypothermic?
A- 34 degrees C
B- 36 degrees C
C- 38 degrees C
D- 40 degrees C

A- 34 degrees C

What is the machine that measures current leakage?
A- Ammeter
B- Photometer
C- Ohmmeter
D- Voltmeter

A- Ammeter

SCALP-TO-NONCEPHALIC REFERENCE
A- Fz‐C5S
B- CPz‐Fz
C- CPc‐CPi
D- EPi‐EPc

A- Fz‐C5S

You have 60 Hz interference in all channels during preoperative median nerve SSEP recording. Which electrode should be adjusted first?
A- CPi
B- Stimulator
C- Ground
D- EPc

C- Ground

How do you monitor a dorsal rhizotomy?
A- Free‐run EMG
B- SSEP
C- Stimulus testing of sensory rootlets
D- TCMEP

C- Stimulus testing of sensory rootlets

Intraoperative evoked potential monitoring criteria of abnormality are based on a comparison of amplitude and latency to
A- Intraoperative normative data
B- Preinduction baseline
C- Postincision baseline
D- Laboratory normative data

C- Postincision baseline

What is the most common result of anterior spinal artery occlusion?
A- Loss of Erb's point response
B- Motor deficits
C- Loss of N13
D- Loss of proprioception

B- Motor deficits

Which of the following components is most likely to be increased in amplitude by synchronous bilateral stimulation of tibial nerves?
A- P37
B- PF
C- N13
D- N20

A- P37

The criteria of abnormality during intraoperative EP monitoring are based on a comparison of amplitude and latency to:
A- Post-induction baselines
B- Lab normative data
C- Intraoperative normative data
D- Pre-induction baselines

A- Post-induction baselines

Which of the following is most likely to happen when fluids enter the electrode jackbox?
A- Various inputs may be short circuited
B- Nothing will happen to the data
C- Current limiters in the jackbox will continue to function normally
D- Evoked potential amplitude is enhanced

A- Various inputs may be short circuited

Which pre-existing condition could compromise EEG in CEA?
A- Hemifacial spasm
B- Stroke
C- Migraine
D- Trigeminal neuralgia

B- Stroke

The post-central gyrus handles which function?
A- Somatosensory
B- Memory
C- Motor
D- Vision

A- Somatosensory

In spinal surgery, the primary purpose of the popliteal fossa recording electrode is to
A- Verify adequacy of stimulus
B- Confirm amplifier integrity
C- Provide evidence of a muscle twitch
D- Limit current spread

A- Verify adequacy of stimulus

Fentanyl infusion will:
A- Increase latency and decrease amplitude
B- Have no affect on amplitude or latency
C- Increase amplitude and increase latency
D- Decrease amplitude only

A- Increase latency and decrease amplitude

Surgical procedures within the posterior fossa may directly result in postoperative deficits from damage to the:
A- Spinal cord
B- Brainstem
C- One cerebral hemisphere
D- Cauda equina

B- Brainstem

Which evoked potential is a combination of near and far field?
A- SSEP
B- P300
C- Electroretinogram
D- Pattern reversal VEP

A- SSEP

Dyskinesia
A- Abnormal sensation
B- Abnormal proprioception
C- Abnormal ringing in ears
D- Involuntary movement

D- Involuntary movement

Where should epidural electrodes be placed?
A- Within the dural membrane
B- On the dura
C- In the spinal cord
D- Between the dura and the spinal cord

B- On the dura

Imbalanced impedances:
A- Reduce 60 Hz artifact
B- Degrade common mode rejection
C- Reduce stimulus artifact
D- Cause electrode polarization

B- Degrade common mode rejection

If you were recording MN SSEPs in the OR and it was very cold, what would you expect to see?
A- Elongation of central conduction with no change in peripheral response latency
B- An elongation of the central conduction time with a later onset of peripheral response
C- A later onset of the peripheral response but no change in central conduction time
D- No effect on the waveforms

C- A later onset of the peripheral response but no change in central conduction time

SSEPs are most appropriate for:
A- Microvascular decompression of facial nerve
B- Spinal instrumentation for scoliosis
C- Vestibular nerve section
D- Transsphenoidal resection of a pituitary adenoma

B- Spinal instrumentation for scoliosis

Which derivation is scalp to non-cephalic?
A- CPc‐CPi
B- EPi‐EPc
C- Fz‐C5S
D- CPz‐Fz

C- Fz‐C5S

For phase reversal, which response is pre-central and which is post-central?
A- P22, N20
B- P25, N20
C- N20, P22
D- N20, P25

A- P22, N20

N34:
A- Cervical potential
B- Cortical potential
C- Near field potential
D- Far field potential

D- Far field potential

SSEPs to posterior tibial nerve stimulation are most appropriate to monitor during surgery for
A- Scoliosis
B- Hemifacial spasm
C- Middle cerebral artery aneurysm
D- Cerebellar pontine angle tumor

A- Scoliosis

For ECochG recordings, it is best to stimulate using:
A- Tone pips
B- Alternating clicks
C- Rarefaction of condensation clicks
D- Tone bursts

B- Alternating clicks

What would be the appropriate monitoring for a lumbar fusion with cage insertion?
A- PTN SSEP with pedicle screw testing
B- PTN SSEP with lower extremity EMG
C- Lower extremity EMG with Pedicle screw testing
D- MN SSEP with lower extremity EMG

B- PTN SSEP with lower extremity EMG

The monitoring team must ensure that stimulus parameters are within safe limits to
A- Minimize 60 Hz interference
B- Avoid tissue damage
C- Prevent chassis current leakage
D- Protect equipment from breakdown

B- Avoid tissue damage

Which is not a role of the technologist?
A- Troubleshooting instruments
B- Interpreting data
C- Collecting data
D- Documenting patient history

B- Interpreting data

Fentanyl
A- Neromuscular blocking agent
B- Volatile agent
C- Narcotic agent
D- Barbiturate agent

C- Narcotic agent

What is the average number of trials for BAEPs?
A- 700-800
B- >1000
C- 500-600
D- <200

B- >1000

What is the most common reason for loss of BAEPs during retromastoid microvascular decompression?
A- Injury to the facial nerve
B- Opening of the dura
C- Compromise vascular supply
D- Cut the cochlear nerve

C- Compromise vascular supply

If there is a 60 Hz interference in all channels when recording preoperative median nerve SSEPs, which of the following electrodes should be adjusted first?
A- Ground electrode
B- CPi
C- EPc
D- Stimulating electrode

A- Ground electrode

You would expect a loss of BAEPs in which surgery:
A- Temporal resection
B- Pontine glioma
C- Parotidectomy
D- Foramen magnum decompression

B- Pontine glioma

For which of the following procedures would it be important to monitor cochlear function?
A- Myringotomy
B- Vestibular neurectomy
C- Temporal lobectomy
D- Parotidectomy

B- Vestibular neurectomy

If a technologist accidentally touches a sterile table, which of the following is the most appropriate action?
A- Maintain safe distance from sterile field
B- Remain silent until procedure is completed
C- Change scrub suit immediately
D- Notify the scrub or circulating nurse at once

D- Notify the scrub or circulating nurse at once

If you are doing a C6 decompression which should you monitor?
A- PTN and PN
B- UN and PTN
C- UN and MN
D- Sural and Radial

B- UN and PTN

Artifact rejection:
A- Excludes trials with artifacts exceeding set amplitude values
B- Is needed only for intraoperative recordings
C- Substitutes for common mode rejection
D- Eliminates all artifacts regardless of amplitude

A- Excludes trials with artifacts exceeding set amplitude values

What is an appropriate alternate hicut filter setting for an ABR when a high frequency noise is introduced?
A- 500 Hz
B- 250 Hz
C- 1500 Hz
D- 100 Hz

C- 1500 Hz

Routine intraoperative electrophysiological monitoring documentation should include
A- Respiratory rate
B- Blood pressure
C- Blood plasma volume
D- Heart rate

B- Blood pressure

You do not want to use a power extension cord because:
A- It will mean that more current could be delivered to the patient if the ground fails
B- It may interfere with the operation of other devices in the operating room
C- It is a fire hazard
D- It will increase your risk of ground leakage

D- It will increase your risk of ground leakage

Which of the following is the method for monitoring the facial nerve?
A- BAEPs
B- Visual observation of facial movement
C- Blink reflex
D- Free run EMG

D- Free run EMG

When setting up for BAEP monitoring, which is more critical?
A- Using a Q-tip to clean the ear
B- Sealing the ear canal
C- Use only surface electrodes for BAEP
D- Using a foam insert

D- Using a foam insert

Which of the following anesthetic agents will obliterate the transcranial electric motor evoked potential?
A- Desflurane
B- Propofol
C- Nitrous oxide
D- Fentanyl

A- Desflurane

Evoked potential data is obliterated with
A- Midas rex drilling
B- C‐arm use
C- Transcranial doppler use
D- Monopolar cautery

D- Monopolar cautery

A post incision baseline recording is used to
A- Determine long‐term prognosis
B- Compare patient's values to laboratory normative data
C- Establish a standard for the patient
D- Evaluate hemodynamic status

C- Establish a standard for the patient

Penetration of the sterile surgical field occurs when:
A- A surgical tool falls on the floor
B- The OR door is opened for personnel passage
C- The anesthesiologist administers intravenous medication
D- The surgeon's arm brushes recording equipment

D- The surgeon's arm brushes recording equipment

Standard (universal) precautions are used to reduce the transmission of
A- Bloodborne pathogens
B- Reproductive spores
C- Hepatitis A virus
D- Mycobacterium tuberculosis

A- Bloodborne pathogens

What will cause a delay in PTN SSEP responses?
A- Anterior cord syndrome
B- Meniere's disease
C- Charcot Marie Tooth disease
D- Optic neuritis

C- Charcot Marie Tooth disease

How many cycles must be present to indicate 60 Hz artifact on a 250 msec screen?
A- 2.4
B- 4.8
C- 15
D- 6

C- 15