CNIM 2026 STUDY GUIDE 2026 QUESTIONS AND
ANSWERS GRADED A+
✔✔The median nerve SSEP can be helpful as a measure of?
a) cerebral blood flow
b) lower spinal cord funtion
c) blood pressure variability
d) anesthetic sensitivity - ✔✔a) cerebral blood flow
✔✔Spinal cord evoked potentials are best recorded using a low-frequency filter setting
of 100Hz. This setting is preferred because, relative to cortical somatosensory evoked
potentials, spinal cord potentials are:
a) of relatively short duration
b) less affected by changes in anesthesia
c) subject to 60 Hz interference
d) an extremely low voltage response - ✔✔a) of relatively short duration
✔✔In the operating room, the stimulus intensity for activating a sensory nerve:
a) should be set at double the sensory threshold
b) should be set for two to three times the motor threshold
c) does not have an established boundary
d) is set slightly above motor threshold - ✔✔c) does not have an established boundary
✔✔The suggested rate of stimulation for intraoperative posterior tibial nerve evoked
potential monitoring is:
a) 30 to 40 per second
b) 20 to 30 per second
c) 10 to 20 per second
d) 2 to 10 per second - ✔✔d) 2 to 10 per second
✔✔To record cortical SSEPs during intraoperative monitoring of cervical spinal cord
surgery, electrodes should be placed:
a) 2cm anterior to C3 and C4
b) 2cm posterior to C3 and C4
c) in the C3 and C4 positions of the International 10/20 system
d) between Cz and Pz, and between Pz and Oz - ✔✔b) 2cm posterior to C3 and C4
✔✔The amplitude of the cortical response to posterior tibial SSEP stimulation is at least
80% attenuated by:
,a) stimulation rate of 15 per second or higher
b) large doses of muscle relaxant
c) a HLF of 5000 Hz
d) a stimulation duration greater than 150 usec - ✔✔a) stimulation rate of 15 per second
or higher
✔✔During intraoperative EP monitoring, it is recommended that the technologist's data
sheet should include all of the following except:
a) operative events and communications with the surgeon
b) instruments passed to the surgeon and the number of sponges used
c) patient vital signs and anesthetic agents used
d) recorded artifacts and measures to eliminate them - ✔✔b) instruments passed to the
surgeon and the number of sponges used
✔✔When recording SSEP responses in an awake patient, the motor threshold should
be the:
a) level at which the patient can no longer tolerate the stimulus
b) minimum stimulus intensity that produces a muscle twitch in the appropriate muscle
group
c) stimulus rate at which tetany is achieved
d) threshold at which point the muscle groups being stimulated fail to respond to
stimulation - ✔✔b) minimum stimulus intensity that produces a muscle twitch in the
appropriate muscle group
✔✔When monitoring with SSEPs, dural or direct cord recordings are advantageous
because:
a) they present less discomfort to the patient than scalp leads
b) they have less chance of artifact during cauterization
c) the waveforms better reflect cortical responses to stimulation
d) the waveforms are higher in amplitude and require fewer responses - ✔✔d) the
waveforms are higher in amplitude and require fewer responses
✔✔Spectral analysis of rawa EEG data displays power as an upward delection and:
a) wave morphology in a compressed design
b) frequency as a linear display across the epoch line
c) time horizontally on the graph
d) time as a spectral edge - ✔✔b) frequency as a linear display across the epoch line
✔✔When monitoring somatosensory evoked potentials during a critical moment in an
intraoperative study, changing the setting of the high-frequency filter
,a) will be of limited consequence to the outcome of the study
b) may help isolate a true signal from background noise
c) may increase the number of single trial events required to resolve the evoked
potentials
d) may lead to false interpretation of the data - ✔✔d) may lead to false interpretation of
the data
✔✔Stimulation of the spinal cord to elicit motor evoked potentials is most useful for
monitoring:
a) anterior spinal cord function
b) dorsal column function
c) peripheral nerve function
d) ascending spinal cord tracts - ✔✔a) anterior spinal cord function
✔✔When monitoring the facial nerve:
a) long-lasting muscle relaxants must be avoided
b) bipolar electrodes should be placed in the larynx
c) needle electrodes should be placed in the masseter
d) inhalational anesthetic agents must be avoided - ✔✔a) long-lasting muscle relaxants
must be avoided
✔✔An appropriate BAEP stimulation rate to avoid synchronization with 60 Hz artifact,
would be:
a) 6 per second
b) 9.5 per second
c) 10 per second
d) 20 per second - ✔✔b) 9.5 per second
✔✔Vascular malformations of the posterior fossa associated with hemifacial spasm and
facial paresis may cause:
a) a loss of Wave I on the BAEP
b) BAEP latency abnormalities
c) increased amplitude if tubal inserts are used for stimulation
d) BAEP abnormalities if the auditory cortex is involved - ✔✔b) BAEP latency
abnormalities
✔✔At the stage of surgical anesthesia, propofol affects the BAEP by:
a) increasing the latencies of Waves I, III and V without changing their amplitudes
b) decreasing the amplitude in all waveforms
c) causing very minimal changes
, d) abolishing all waveforms - ✔✔a) increasing the latencies of Waves I, III and V without
changing their amplitudes
✔✔Functional cortical stimulation is used to localize brain areas that must be:
a) identified before clamping
b) most at risk during aneurysm clipping
c) monitored futher by somatosensory EPs
d) preserved during resection - ✔✔d) preserved during resection
✔✔The surgical procedure that would have the greatest risk for changes in
cardiovascular and respiratory efforts would:
a) involve the posterior fossa
b) be the removal of an occipital tumor
c) be temporal lobectomy
d) be in the area of the posterior spinal segments - ✔✔a) involve the posterior fossa
✔✔With significant changes in cervical and cortical SSEPs during intraoperative
monitoring, adequate stimulation of the median nerve is indicated by: - ✔✔NO
CHANGE IN THE PERIPHERAL RESPONSES
✔✔When using constant voltage for facial nerve stimulation and the nerve becomes
bathed in CSF, what will occur after the area is suctioned? - ✔✔CURRENT FLOW WILL
VARY IN ORDER TO MAINTAIN THE PRESENT VOLTAGE LEVEL
✔✔When blood supply to the brainstem is markedly reduced, an expected change in
the BAEP would be: - ✔✔AN INCREASED LATENCY OF WAVE V
✔✔The anesthetic agent that has the least effect on SSEP waveforms is? -
✔✔VECURONIUM
✔✔Using a montage consisting of C5 spine to Fpz with lower extremity stimulation, the
expected response is generated at the? - ✔✔CAUDAL MEDICAL LEMNISCUS AND IS
A FAR-FIELD RESPONSE
✔✔The recommended criteria for surgeon notification when moitoring BAEPS
intraoperatively include an increase in? - ✔✔THE LATENCY OF WAVE V OF
GREATER THAN OR EQUAL TO 1.0 msec OR THE DISAPPEARANCE OF WAVE V
✔✔When placing screws during an open procedure, at what threshold is the screw
considered breached?
a. 6 mA
b. 10 mA
ANSWERS GRADED A+
✔✔The median nerve SSEP can be helpful as a measure of?
a) cerebral blood flow
b) lower spinal cord funtion
c) blood pressure variability
d) anesthetic sensitivity - ✔✔a) cerebral blood flow
✔✔Spinal cord evoked potentials are best recorded using a low-frequency filter setting
of 100Hz. This setting is preferred because, relative to cortical somatosensory evoked
potentials, spinal cord potentials are:
a) of relatively short duration
b) less affected by changes in anesthesia
c) subject to 60 Hz interference
d) an extremely low voltage response - ✔✔a) of relatively short duration
✔✔In the operating room, the stimulus intensity for activating a sensory nerve:
a) should be set at double the sensory threshold
b) should be set for two to three times the motor threshold
c) does not have an established boundary
d) is set slightly above motor threshold - ✔✔c) does not have an established boundary
✔✔The suggested rate of stimulation for intraoperative posterior tibial nerve evoked
potential monitoring is:
a) 30 to 40 per second
b) 20 to 30 per second
c) 10 to 20 per second
d) 2 to 10 per second - ✔✔d) 2 to 10 per second
✔✔To record cortical SSEPs during intraoperative monitoring of cervical spinal cord
surgery, electrodes should be placed:
a) 2cm anterior to C3 and C4
b) 2cm posterior to C3 and C4
c) in the C3 and C4 positions of the International 10/20 system
d) between Cz and Pz, and between Pz and Oz - ✔✔b) 2cm posterior to C3 and C4
✔✔The amplitude of the cortical response to posterior tibial SSEP stimulation is at least
80% attenuated by:
,a) stimulation rate of 15 per second or higher
b) large doses of muscle relaxant
c) a HLF of 5000 Hz
d) a stimulation duration greater than 150 usec - ✔✔a) stimulation rate of 15 per second
or higher
✔✔During intraoperative EP monitoring, it is recommended that the technologist's data
sheet should include all of the following except:
a) operative events and communications with the surgeon
b) instruments passed to the surgeon and the number of sponges used
c) patient vital signs and anesthetic agents used
d) recorded artifacts and measures to eliminate them - ✔✔b) instruments passed to the
surgeon and the number of sponges used
✔✔When recording SSEP responses in an awake patient, the motor threshold should
be the:
a) level at which the patient can no longer tolerate the stimulus
b) minimum stimulus intensity that produces a muscle twitch in the appropriate muscle
group
c) stimulus rate at which tetany is achieved
d) threshold at which point the muscle groups being stimulated fail to respond to
stimulation - ✔✔b) minimum stimulus intensity that produces a muscle twitch in the
appropriate muscle group
✔✔When monitoring with SSEPs, dural or direct cord recordings are advantageous
because:
a) they present less discomfort to the patient than scalp leads
b) they have less chance of artifact during cauterization
c) the waveforms better reflect cortical responses to stimulation
d) the waveforms are higher in amplitude and require fewer responses - ✔✔d) the
waveforms are higher in amplitude and require fewer responses
✔✔Spectral analysis of rawa EEG data displays power as an upward delection and:
a) wave morphology in a compressed design
b) frequency as a linear display across the epoch line
c) time horizontally on the graph
d) time as a spectral edge - ✔✔b) frequency as a linear display across the epoch line
✔✔When monitoring somatosensory evoked potentials during a critical moment in an
intraoperative study, changing the setting of the high-frequency filter
,a) will be of limited consequence to the outcome of the study
b) may help isolate a true signal from background noise
c) may increase the number of single trial events required to resolve the evoked
potentials
d) may lead to false interpretation of the data - ✔✔d) may lead to false interpretation of
the data
✔✔Stimulation of the spinal cord to elicit motor evoked potentials is most useful for
monitoring:
a) anterior spinal cord function
b) dorsal column function
c) peripheral nerve function
d) ascending spinal cord tracts - ✔✔a) anterior spinal cord function
✔✔When monitoring the facial nerve:
a) long-lasting muscle relaxants must be avoided
b) bipolar electrodes should be placed in the larynx
c) needle electrodes should be placed in the masseter
d) inhalational anesthetic agents must be avoided - ✔✔a) long-lasting muscle relaxants
must be avoided
✔✔An appropriate BAEP stimulation rate to avoid synchronization with 60 Hz artifact,
would be:
a) 6 per second
b) 9.5 per second
c) 10 per second
d) 20 per second - ✔✔b) 9.5 per second
✔✔Vascular malformations of the posterior fossa associated with hemifacial spasm and
facial paresis may cause:
a) a loss of Wave I on the BAEP
b) BAEP latency abnormalities
c) increased amplitude if tubal inserts are used for stimulation
d) BAEP abnormalities if the auditory cortex is involved - ✔✔b) BAEP latency
abnormalities
✔✔At the stage of surgical anesthesia, propofol affects the BAEP by:
a) increasing the latencies of Waves I, III and V without changing their amplitudes
b) decreasing the amplitude in all waveforms
c) causing very minimal changes
, d) abolishing all waveforms - ✔✔a) increasing the latencies of Waves I, III and V without
changing their amplitudes
✔✔Functional cortical stimulation is used to localize brain areas that must be:
a) identified before clamping
b) most at risk during aneurysm clipping
c) monitored futher by somatosensory EPs
d) preserved during resection - ✔✔d) preserved during resection
✔✔The surgical procedure that would have the greatest risk for changes in
cardiovascular and respiratory efforts would:
a) involve the posterior fossa
b) be the removal of an occipital tumor
c) be temporal lobectomy
d) be in the area of the posterior spinal segments - ✔✔a) involve the posterior fossa
✔✔With significant changes in cervical and cortical SSEPs during intraoperative
monitoring, adequate stimulation of the median nerve is indicated by: - ✔✔NO
CHANGE IN THE PERIPHERAL RESPONSES
✔✔When using constant voltage for facial nerve stimulation and the nerve becomes
bathed in CSF, what will occur after the area is suctioned? - ✔✔CURRENT FLOW WILL
VARY IN ORDER TO MAINTAIN THE PRESENT VOLTAGE LEVEL
✔✔When blood supply to the brainstem is markedly reduced, an expected change in
the BAEP would be: - ✔✔AN INCREASED LATENCY OF WAVE V
✔✔The anesthetic agent that has the least effect on SSEP waveforms is? -
✔✔VECURONIUM
✔✔Using a montage consisting of C5 spine to Fpz with lower extremity stimulation, the
expected response is generated at the? - ✔✔CAUDAL MEDICAL LEMNISCUS AND IS
A FAR-FIELD RESPONSE
✔✔The recommended criteria for surgeon notification when moitoring BAEPS
intraoperatively include an increase in? - ✔✔THE LATENCY OF WAVE V OF
GREATER THAN OR EQUAL TO 1.0 msec OR THE DISAPPEARANCE OF WAVE V
✔✔When placing screws during an open procedure, at what threshold is the screw
considered breached?
a. 6 mA
b. 10 mA
