PNB 5104

  ______ is the single most important step taken to avoid contamination

  ______ is the single most important step taken to avoid contamination

washing hands

standard (universal) precautions are used to reduce the transmission of

bloodborne pathogens

which of the following is considered HIPAA protected patient information

patients name

standard precautions state that blood and body fluid precautions should be used:

for all patients regardless of infective status

  what do nursing guidelines indicate that the appropriate distance is from the sterile field

12 in

which of the following infectious agents is a bloodborne pathogen

HIV

electrical hazards that exist for patients attached to medical equipment include all the following except

a.        needle sticks

b.        ground faults

c.        indwelling electrodes

d.        leakage current

  the monitoring team must ensure that stimulus parameters are within safe limits to

avoid tissue damage

according to OSHA, when must equipment be checked for electrical safety

semi-annually

which of the following diseases results from infection by a bloodborne pathogen

Hep B

Which is the primary reason for measuring impedances of all electrodes

to evaluate electrode contact

unbalanced electrode impedances

degrade common mode rejection

  impedances for recording electrodes are 5.1 kohms and 2.1 kOhms  what should you do to reduce background noise and enhance responses

equalize electrode impedances

intraoperative EP monitoring criteria for abnormality are based on a comparison of amplitude and latency to:

post induction baselines

if there is a 60 Hz interference in all channels when recording preoperative median nerve SSEPs which electrode should be adjusted first

ground

which electrode site is optimal for recording the cortical response to PTN (post tib nerve) stimulation

CPz

when preparing a patient for intraoperative monitoring which is the most appropriate

 direct electrode wires away from the sterile field

why is it important to braid electrode wires in the operating room

reduce interference from ambient noise

to identify 60 Hz artifact on a 250 msec screen how many cycles must be present

15 cycles

during electrocautery use, which should be monitored to assess amplifier recovery

raw signals

oculomotor

medial rectus, superior rectus, inferior rectus, inferior oblique

trochlear

superior oblique

trigeminal

masseter, temporalis

abducens

lateral rectus

facial

frontalis, orbicularis oculi, orbicularis oris, mentalis, platysma

glossopharyngeal

soft palate

vagus

vocal cord

accessory

sternocleidomastoid, trapezius

hypoglossal

tongue

trapezius

spinal accessory C2-C4

deltoid

axillary C5-C6

Biceps

Musculocutaneous C5-C6

triceps

radial C6-C7

extensor digitorum communis

radial C7-C8

abductor pollicis brevis

median C8-T1

abductor digiti minimi

ulnar C8-T1

iliopsoas

femoral L1-L3

adductor

obturator L2-L3

quadriceps

femoral L2-L4

tibialis anterior

peroneal L4-L5

extensor hallicus longus

peroneal L5

gastrocnemius

tibial S1

abductor hallicus

tibial S1-S2

external anal sphincter

pudendal S2-S4

artifact rejection

excludes trials with artifacts exceeding set amplitude values

it is required that the monitoring clinician be able to communicate effectively with

anesthesiologist and surgeon

although the use of electrical cautery can obliterate EP waveforms intraoperative monitoring should be continued

by monitoring raw (unaveraged) data

stimulus artifact during SSEP can be decreased by

lowering impedances of ground and stimulating electrodes

a differential amplifier records

the difference between two inputs

for SSEP the stimulating cathode is placed proximally in order to

avoid anodal block

how do you avoid a ground loop

place only a single ground

electrical amplitude of the SSEP is

0.1-10 microvolts

while performing upper extremity SSEP what do you do if you cannot get a thumb twitch

reposition stimulating electrodes

when you stimulate PTN where do you want to record TOF

abductor hallicus brevis

the use of 60 Hz notch filter is discouraged while recording because it can

produce ringing activity that can contaminate the appearance of the response

examples of surgical manipulation would include

drilling and irrigation

if the OR is very cold, what component of your median nerve SSEP would you likely expect to see changes in latency

N20, N9, N13

when placing pop fossa you want the active electrode

above the PF crease

stimulation of the median nerve at the wrist will activate which muscle

APB

if you cannot evaluate motor twitch you

increase intensity until the peripheral response no longer increases

how many waves of a 60 Hz signal should you see in a 100 msec sweep

6

the criteria for which intraoperative response should be considered significantly changed should be based on

patients individual baseline responses

you must change you recording parameters during intraoperative monitoring

document the changes but do not inform the surgeon

why is changing filter parameters during monitoring discouraged

  because it may appear that a change has occurred due to surgery  

what is the most critical thing to document

important surgical events

well-maintained documentation is imperative throughout a surgical case in order to

provides details of events associated with a functional loss

a “false negative” test

means that the test results do not show an abnormality when a clinical abnormality is present

 during intraoperative EP monitoring it is recommended that the technologists data sheet includes all of the following except

a.        instruments passes to the surgeon and number of sponges used

b.        recorded artifacts and measures to eliminate them

c.        operative events and communications with the surgeon

d.        vital signs and anesthetic agents used

which of the following frequency bandwidths is appropriate for emgs

30-3000 Hz

which of the following is NOT true regarding the stimulation setup for TOF

a.        all are true

b.        rep rate is 2-3 Hz

c.        stimulation polarity is reversed

d.        duration of the stimulus is 200-500 micro sec

what is an appropriate recording epoch (time base) for upper SSEPs

5 msec per division

what is the appropriate low frequency filter for recording SSEPs

30 Hz

 recording of peripheral responses at Erb’s point and pop fossa is mostly beneficial for:

determining the adequate level of stimulation

 the depolarization for TceMEPs occurs under:

anode