Infection Control / Electrodes/ Electrical Safety/ Concepts

Gowned surgical personnel are considered sterile from the height of the sterile field up and from where?

2 inches above the elbows to the hands.

What is the main source of airborne bacteria?

Exfoliated skin particles from the operating room staff

What is the most frequent mode of infection transmission?

Contact

Items that contact mucous membranes or non-intact skin are semi-critical and requires what level of disinfection?

High level

Standard precautions are used to reduce the transmission of what?

Blood

Which organization is responsible for accreditation and certification standards and sets initiatives for national patient safety goals in the US?

The Joint Commission

How often are National Patient Safety Goals released?

Annually

Contact dermatitis is a common clinical reaction associated with what?

Latex

A patient has a latex allegy what should a technologist be most cautious about?

Gloves

SSEP stimulation of peripheral nerve, the pathway ascends where?

Ipsilateral dorsal columns

D waves are recorded from which of the following electrodes?

Epidural electrodes over the spinal cord

Define "Current"

Amount of electrons flowing between two points

Impedance is the opposition to what kind of flow?

Alternating current flow

Formula for Ohm's law?

V=IR

Common mode rejection of 100:1, is how many dB?

40

To display ptn SSEP response as downward deflection, which of the following must be known?

Polarity of the response and polarity of amplifier input

A positive event occuring in the lead connected to the negative terminal, will result in what kind of deflection?

Downward

If an amplifier is rated as 120 dB common mode rejection, which of the following ratios would be expected?

1,000,000:1

How often should routine electrical safety checks be scheduled?

At least twice a year

What is the maximum leakage current through the patient?

10 uA rms

Modalities for CEA surgery?

Ipsilateral EEG and Contralateral SSEP

Which cranial nerve should be monitored during resection of vestibular schwannoma

CN VII: Facial Nerve

Modalities for chiari malformation?

MEPS, SSEPS, BAEPs

The use of intraoperative monitoring during scoliosis surgery may replace what test?

Stagnara Test

What is a stagnara test?

Wake up test

Which cranial nerves should be monitoring for trigeminal neuralgia?

V and VII

What modalities for vestibular schwannoma?

BAEPs and CN VII

To monitor integrity of facial nerve during parotidectomy what should you do?

Stimulate proximally and record distally

Which acoustic neuroma surgical approach results in sacrificed ipsilateral hearing?

translabyrinthine

Monitoring PTN is most appropriate involving which artery?

Anterior Cerebral

What is severed during tethered cord surgery?

Filum terminale

Translabyrinthine approach is for

Cereabello-pontine angle tumor

What is the most common presenting symptom of an intramedullary tumor?

Pain

Medical history relevant to IONM for a thoracic aortic aneurysm repair includes:

Associated symptoms, associated Crawford levels and previous neurological deficits

Prior to IONM for PLIF, tech should obtain history that includes

Sensory or motor related issues and recent radiology findings.

Babinski sign in an adult

Indicates an upper motor neuron lesion that affects pyramidal tract

What MEP wave is most affected by rocuronium?

I waves

What is the neurological deficit related to compression of spinal cord?

Myelopathy

Spinal cord compression

Myelopathy

Pinching of nerve roots

Radiculopathy

Damage to the peripheral nerves, which can be caused by a number of factors, including diabetes, infections, or trauma

Neuropathy

Innervates four of the six extraocular muscles: medial rectus, superior rectus, inferior rectus, and inferior oblique

Cranial nerve III: Oculomotor

Innervates the superior oblique muscle

Cranial nerve IV: Trochlear

Innervates the lateral rectus muscle

Cranial nerve VI: Abducens

What is indicated by the presence of a unilateral Babinski Signs?

Pyrimidal tract dysfunction

What is indicated by the inability to stand without swaying with eyes closed?

Positive Romberg

What spinal disorder causes a forward displacement of the vertebra?

Spondylolisthesis

Snellin chart

Visual acuity

Elements of neurologic exam

Motors, sensory, cranial nerves

Sensory evaluation of Opthalmic, maxillary and mandibular branches is used during a neurological exam of which CN?

Trigeminal - CN V

Foot drop is associated with kind of nerve injury?

L5 radiculopathy and traumatic damage to the common peroneal nerve

If electrolyte from one stimulation electrodes spreads to another electrode what happens?

Current shunting

Lateral curvature of the spine

Scoliosis

Forward displacement of vertebra which may cause moderate to severe back pain

Spondylolisthesis

What part of the spinal cord is most at risk of ischemia?

Thoracic

Narrowing of the spinal canal or a foramen

Stenosis

What is the latest acceptable time during a surgery to begin monitoring

Before any surgical manipulations

What is the suffix for a removal of something?

-ectomy

What is the medical term for on top or upon?

Epi

Upper extremity SSEPs are transmitted through which spinal cord tract?

Fasciculus Cuneatus

The third ventricle is connected to the fourth by

cerebral aqueduct

Damage to which structure/tract would cause motor deficits?

Lateral corticospinal tract

Which of the following is an excitatory neurotransmitter?

Glutamate

Glutamate

excitatory neurotransmitter

What type of action potential contribute to the pop fossa response?

Orthodromic and Antidromic

Which of the following ions are involved in a neuronal action potential?

Potassium (K+) and Sodium (Na+)

Lower motor neurons primarily exit the spinal cord through

Ventral nerve roots

Which cranial nerve travels above the cerebellopontine space?

Trigeminal

Flexion of 4th and 5th digit of the hand would represent which nerve?

Ulnar

During a CEA collateral perfusion is maintained by:

Circle of Willis

What is not a branch of the facial nerve?

Maxillary

Which are motor ONLY cranial nerves?

3-4, 6-7, 11-12

Which are sensory cranial nerves?

1, 2, 8

What are mixed cranial nerves?

5, 9-10

Kyphosis

excessive outward curvature of the spine, causing hunching of the back (thoracic)

Lordosis

abnormal anterior curvature of the lumbar spine (sway-back condition)

Which spinal artery is responsible for 1/3 of the spinal cord perfusion?

Posterior Spinal Artery

Blood is supplied to the spinal cord bv

One anterior and two posterior spinal arteries

What section of the spinal cord is considered a watershed zone?

Thoracic

Conus medallaris in adults

L1, L2

What abnormality can a defect in lower motor neurons cause?

Flaccid paralysis

C7 nerve root emerges from the inter-vertebral foramen between:

C6-C7

What is the motor innervation of the peroneus longus?

L4, L5, S1

Which cranial nerve innervates the extraocular (lateral rectus) muscles?

Abducens

Which cranial nerve allows turning the head and lifting the shoulders?

CN XII: Accessory

The vertebral arteries pass through foreman magnum and form what?

Basilar Artery

Anterior spinothalamic tract carries the sensory modalities of

Crude Touch

Glial cells in PNS

Schwann cells

Glial cells in CNS

astrocytes, ependymal cells, microglia, oligodendrocytes

Resting membrane potential of a neuron?

-70 mV

Suspecting nerve damage in a patients exam, should indicate what study to be performed?

NCV/EMG

Fibers anterior to the optic chiasm are called

Optic nerves

C8 nerve roots exit the spinal cord where?

Above T1

Trigeminal nerve is responsible for

Facial touch, temp, sensation and mastication

Which area of the spinal cord is most likely to have poorest blood supply?

Thoracic

Artery of adamkiewicz originates

T8-L1

Dorsal column pathways synapse at which location on their way to the sensory cortex?

Nucleus cuneatus and thalamus

Trigeminal can be monitored from which muscle?

Masseter

Thalamus and hypothalmus make up the

Diencephalon

Diencephalon

Contains thalamus and hypothalamus