CNIM 2026 MAIN EXAMINATION 2026 QUESTIONS AND
ANSWERS GRADED A+
✔✔When stimulating the posterior tibial nerve at the ankle, stimulation can be confirmed
by:
a. recording a cortical response at C4
b. turning the stimulator up to read 20MA
c. reducing the impedance of the sitmulating electrodes to less than 5,000 ohms
d. recording a response from the popliteal fossa - ✔✔d. recording a response from the
popliteal foss
✔✔Generally speaking, rate increases above 30 per second in BAEP studies:
a. will increase the amplitude of wave V
b. will decrease wave V amplitude and increase wave I amplitude
c. Will increase the latency and decrease the amplitude of the BAEP
d. Have little or no effect on BAEP responses - ✔✔c. will increase the latency and
decrease the amplitude of the BAEP
✔✔In an anterior cervical discectomy and fusion, an insult to the spinal cord would
result in what changes?
a. stable peripheral responses with delay of cervical, subcortical and cortical responses
b. attenuation of peripheral responses with preservation of cervical, subcortical cortical
responses
c. 40% attenuation of waveforms from peripheral to cortical responses
d. stable peripheral, cervical and subcortical responses and a delay in cortical
responses - ✔✔a. stable peripheral responses with delay of cervical, subcortical and
cortical responses
✔✔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 - ✔✔c.
level of anesthesia preventing movement in 50% of patients after painful stim
✔✔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 - ✔✔a. etomidate can produce myoclonic jerking
that resembles a seizure
✔✔Given an electrical circuit with a resistance of 1000 ohms and a voltage of 10 volts,
the current flow will be:
a. .10 ohms
,b. 10 A
c. 100 volts
d. .01 A - ✔✔d. .01 A
✔✔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- - ✔✔c. K+, Na+, and Cl-
✔✔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 - ✔✔c. synchronicity and repetitiveness
✔✔Continuous use of Bovie is an indication of:
a. exposure
b. decompression
c. derotation
d. closing - ✔✔a. exposure
✔✔Which of the following physiological changes will have little impact on IONM?
a. hypoxemia (PaO2 40 mmHg)
b. hypocarbia (PcCO2 25 mmHg)
c. hypothermia (esophageal temp 32 deg C)
d. hypotension (Mean pressure 50 mmHg) - ✔✔b. hypocarbia (PcCO2 25 mmHg)
✔✔The assumption that responses of excessive amplitude are likely to contain artifact
forms the basis for:
a. artifact rejection
b. dwell time
c. digital averaging
d. digital filtering - ✔✔a. artifact rejection
✔✔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 - ✔✔a. an increase in ABR latency
✔✔The suggested rate of stimulation for intraoperative posterior tibial nerve evoked
potential monitoring is:
,a. 10 to 20 per second
b. 20 to 30 per second
c. 2 to 10 per second
d. 30 to 40 per second - ✔✔c. 2 to 10 per second
✔✔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 - ✔✔c. loss of motor at the level
d. sacral sparing
e. loss of sensory at the level
✔✔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 - ✔✔d. posterior lumbar interbody fusion
✔✔ischemia means:
a. an increase in oxygen
b. a lack of carbon dioxide
c. a lack of oxygen
d. a lack of blood perfusion - ✔✔d. a lack of blood perfusion
✔✔What is preferred click polarity when performing intraoperative auditory evoked
potentials?
a. condensation clicks
b. alternating clicks
c. rarefaction clicks - ✔✔b. alternating clicks
✔✔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 - ✔✔b. post auricular muscle
✔✔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 - ✔✔c. median and posterior tibial nerves
✔✔What spinal tract is being stimulated when running transcranial motor evoked
potentials (TcMEP)
a. cortical spine
b. rubrospinal
c. dorsal column
d. tectospinal - ✔✔a. cortical spinal
✔✔Before the end of the IONM case, the surgeon turns to the monitoring professional
and says, "you can go". What is the appropriate response?
a. explain to the surgeon that he/she is not your boss
b. unplug your leads and leave the room
c. inform the surgeon that it is against your policy to leave before the case has ended
and he will need to sign a waver accepting the responsibility since you have a
professional responsibility to the patient to continue monitoring until the case is
completed - ✔✔c. inform the surgeon that it is against your policy to leave before the
case has ended and he will need to sign a waver accepting the responsibility since you
have a professional responsibility to the patient to continue monitoring until the case is
completed
✔✔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 - ✔✔b. provide details of
events associated with a functional loss
✔✔Neurogenic Motor Evoked Potential responses are:
a. mixed antidromic sensory and orthodromic motor and less reliable than Transcranial
Moto Evoked Potentials
b. more reliable than transcranial motor evoked potentials - ✔✔a. mixed antidromic
sensory and orthodromic motor and less reliable than Transcranial Moto Evoked
Potentials
✔✔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 - ✔✔b. EMG records muscle fiber generated electrical
potentials, generated when axon membrane is depolarized which can occur with
ANSWERS GRADED A+
✔✔When stimulating the posterior tibial nerve at the ankle, stimulation can be confirmed
by:
a. recording a cortical response at C4
b. turning the stimulator up to read 20MA
c. reducing the impedance of the sitmulating electrodes to less than 5,000 ohms
d. recording a response from the popliteal fossa - ✔✔d. recording a response from the
popliteal foss
✔✔Generally speaking, rate increases above 30 per second in BAEP studies:
a. will increase the amplitude of wave V
b. will decrease wave V amplitude and increase wave I amplitude
c. Will increase the latency and decrease the amplitude of the BAEP
d. Have little or no effect on BAEP responses - ✔✔c. will increase the latency and
decrease the amplitude of the BAEP
✔✔In an anterior cervical discectomy and fusion, an insult to the spinal cord would
result in what changes?
a. stable peripheral responses with delay of cervical, subcortical and cortical responses
b. attenuation of peripheral responses with preservation of cervical, subcortical cortical
responses
c. 40% attenuation of waveforms from peripheral to cortical responses
d. stable peripheral, cervical and subcortical responses and a delay in cortical
responses - ✔✔a. stable peripheral responses with delay of cervical, subcortical and
cortical responses
✔✔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 - ✔✔c.
level of anesthesia preventing movement in 50% of patients after painful stim
✔✔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 - ✔✔a. etomidate can produce myoclonic jerking
that resembles a seizure
✔✔Given an electrical circuit with a resistance of 1000 ohms and a voltage of 10 volts,
the current flow will be:
a. .10 ohms
,b. 10 A
c. 100 volts
d. .01 A - ✔✔d. .01 A
✔✔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- - ✔✔c. K+, Na+, and Cl-
✔✔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 - ✔✔c. synchronicity and repetitiveness
✔✔Continuous use of Bovie is an indication of:
a. exposure
b. decompression
c. derotation
d. closing - ✔✔a. exposure
✔✔Which of the following physiological changes will have little impact on IONM?
a. hypoxemia (PaO2 40 mmHg)
b. hypocarbia (PcCO2 25 mmHg)
c. hypothermia (esophageal temp 32 deg C)
d. hypotension (Mean pressure 50 mmHg) - ✔✔b. hypocarbia (PcCO2 25 mmHg)
✔✔The assumption that responses of excessive amplitude are likely to contain artifact
forms the basis for:
a. artifact rejection
b. dwell time
c. digital averaging
d. digital filtering - ✔✔a. artifact rejection
✔✔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 - ✔✔a. an increase in ABR latency
✔✔The suggested rate of stimulation for intraoperative posterior tibial nerve evoked
potential monitoring is:
,a. 10 to 20 per second
b. 20 to 30 per second
c. 2 to 10 per second
d. 30 to 40 per second - ✔✔c. 2 to 10 per second
✔✔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 - ✔✔c. loss of motor at the level
d. sacral sparing
e. loss of sensory at the level
✔✔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 - ✔✔d. posterior lumbar interbody fusion
✔✔ischemia means:
a. an increase in oxygen
b. a lack of carbon dioxide
c. a lack of oxygen
d. a lack of blood perfusion - ✔✔d. a lack of blood perfusion
✔✔What is preferred click polarity when performing intraoperative auditory evoked
potentials?
a. condensation clicks
b. alternating clicks
c. rarefaction clicks - ✔✔b. alternating clicks
✔✔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 - ✔✔b. post auricular muscle
✔✔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 - ✔✔c. median and posterior tibial nerves
✔✔What spinal tract is being stimulated when running transcranial motor evoked
potentials (TcMEP)
a. cortical spine
b. rubrospinal
c. dorsal column
d. tectospinal - ✔✔a. cortical spinal
✔✔Before the end of the IONM case, the surgeon turns to the monitoring professional
and says, "you can go". What is the appropriate response?
a. explain to the surgeon that he/she is not your boss
b. unplug your leads and leave the room
c. inform the surgeon that it is against your policy to leave before the case has ended
and he will need to sign a waver accepting the responsibility since you have a
professional responsibility to the patient to continue monitoring until the case is
completed - ✔✔c. inform the surgeon that it is against your policy to leave before the
case has ended and he will need to sign a waver accepting the responsibility since you
have a professional responsibility to the patient to continue monitoring until the case is
completed
✔✔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 - ✔✔b. provide details of
events associated with a functional loss
✔✔Neurogenic Motor Evoked Potential responses are:
a. mixed antidromic sensory and orthodromic motor and less reliable than Transcranial
Moto Evoked Potentials
b. more reliable than transcranial motor evoked potentials - ✔✔a. mixed antidromic
sensory and orthodromic motor and less reliable than Transcranial Moto Evoked
Potentials
✔✔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 - ✔✔b. EMG records muscle fiber generated electrical
potentials, generated when axon membrane is depolarized which can occur with
