CNIM 2026 EVALUATION EXAM QUESTIONS AND
ANSWERS GRADED A+
✔✔Routine intraoperative electrophysiological monitoring documentation should
include?
1. heart rate
2. blood pressure
3. respiratory rate
4. blood plasma volume - ✔✔2. blood pressure
✔✔If a technologist accidentally touches a sterile table, which of the following is the
most appropriate action?
1. Change scrub suit immediately
2. remain silent until procedure is completed
3. Notify the scrub or circulating nurse at once
4. maintain safe distance from sterile field - ✔✔3. Notify the scrub or circulating nurse at
once
✔✔In a bipolar montage, the key element in localization is the?
1. instrument phase reversal
2. relative voltage in each channel
3. common mode rejection of in-phase noise
4. synchronization of discharges - ✔✔1. Instrument phase reversal
✔✔SCALP-TO-NONCEPHALIC REFERENCE?
1. Fz-C5S
2. CPz-Fz
3. EPi-EPc
4. CPc-CPi - ✔✔1. Fz-C5S
✔✔According to the ACNS guidelines, system bandpass settings for monitoring facial
nerve spontatneous muscle activity should be?
1. 1-250 to 1500Hz
2. 10-30 to 2500-3000Hz
3. 10-30 to 16,000Hz
4. 100-200 to 1000-3000Hz - ✔✔3. 10-30 to 16000Hz
✔✔According to the ACNS guidelines, facial nerve monitoring electrodes should be
placed in which of the following muscles?
,1. Masseter and trapezius
2. Frontalis and trapezius
3. Laryngeal and nasalis
4. Orbicularis oculi and oribularis oris - ✔✔4. Orbicularis oculi and orbicularis
✔✔Harrington instrumentation includes?
1. rods
2. pedicle screws
3. sublaminal wires
4. segmental wires - ✔✔1. rods
✔✔Intraoperative evoked potential monitoring criteria of abnormality are based on a
comparison of amplitude and latency to?
1. preinduction baseline
2. postincision baseline
3. intraoperative normative date
4. laboratory normative date - ✔✔2. postincision baseline
✔✔Which of the following anesthetic agents may increase the amplitude of cortical
potentials?
1. Etomidate
2. Halothane
3. Pentobarbital
4. Nitrous Oxide - ✔✔1. Etomidate
✔✔FENTANYL?
1. Narcotic agent
2. Volatile agent
3. Barbiturate agent
4. Neuromuscular blocking agent - ✔✔1. Narcotic agent
✔✔The combination of nitrous oxide and volatile anesthetic gases affects SSEPs by?
1. increasing latency and decreasing amplitude
2. increasing latency and increasing amplitude
3. decreasing latency and increasing amplitude
4. decreasing latency and decreasing amplitude - ✔✔1. increasing latency and
decreasing amplitude
✔✔During posterior fossa surgery, wave V of the BAEPs may increase in latency due
to?
,1. Spinal drainage
2. warming of the nerve
3. retraction of the cerebellum
4. use of neuromuscular blocking agent - ✔✔3. retraction of the cerebellum
✔✔Which of the following nerve injuries usually does NOT produce spontaneous EMG
activity during intraoperative monitoring?
1. Heat
2. Pressure
3. Ischemia
4. Irrigation - ✔✔3. Ischemia
✔✔Which of the following is the method for monitoring the facial nerve?
1. BAEPs
2. Blink reflex
3. Free run EMG
4. Visual observation of facial movement - ✔✔3. Free run EMG
✔✔When monitoring facial nerve EMG, which of the following is an indicator of potential
nerve damage?
1. Ocassional burst of fibrillation potentials
2. Continuous train of neurotonic discharges
3. CMAP to direct stimulation
4. Ocassional muscle faciculations - ✔✔2. Continuous train of neurotonic discharges
✔✔What is the recommended bandpass setting for facial nerve compound muscle
action potential recording?
1. 1-250 to 1500hz
2. 5-30 to 3000hz
3. 10-30 to 16,000hz
4. 100-200 to 1000hz - ✔✔1. 1-250 to 1500hz
✔✔Neuromuscular blocking agents should NOT be used when recording which of the
following evoked responses?
1. BAEPs
2. Peroneal SSEPs
3. Facial nerve EMG
4. ECochG - ✔✔3. Facial nerve EMG
, ✔✔What is the most likely effect of isoflurane at MAC 1.5 on tibialis anterior CMAP
amplitude in response to spinal stimulation?
1. Marked increase
2. Marked decrease
3. Minimal decrease
4. Minimal increase - ✔✔2. Marked decrease
✔✔It is most important for intraoperative monitoring records to include notions of?
1. Surgical events
2. periodic impedance checks
3. serial changes in hematocrit
4. changes in anesthesia personnel - ✔✔1. Surgical events
✔✔Which of the following is a critical surgical event?
1. Drilling of burr hole in skull
2. Decortication of vertebral elements
3. Placing of muscle plug in the internal auditory canal
4. Resecting of tumor fragments during acoustic neuroma resection - ✔✔4. Resecting of
tumor fragments during acoustic neuroma resection
✔✔Which of the following should be reported to the surgeon?
1. Loss of response
2. Change in time base
3. Switch to backup electrodes
4. increase in stimulus intensity - ✔✔1. loss of response
✔✔D waves are recorded from which of the following electrodes?
1. Epidural electrodes over the spinal cord
2. Subdural electrodes over the motor strip
3. Surface electrodes over peripheral nerves
4. Needle electrodes in distal extremity muscles - ✔✔1. Epidural electrodes over the
spinal cord
✔✔An objective measure of meaningful change to use to warn the surgeon is the ?
1. latency decrease
2. 50% amplitude decrease
3. IPL decrease
4. 10% amplitude decrease - ✔✔2. 50% amplitude decrease
ANSWERS GRADED A+
✔✔Routine intraoperative electrophysiological monitoring documentation should
include?
1. heart rate
2. blood pressure
3. respiratory rate
4. blood plasma volume - ✔✔2. blood pressure
✔✔If a technologist accidentally touches a sterile table, which of the following is the
most appropriate action?
1. Change scrub suit immediately
2. remain silent until procedure is completed
3. Notify the scrub or circulating nurse at once
4. maintain safe distance from sterile field - ✔✔3. Notify the scrub or circulating nurse at
once
✔✔In a bipolar montage, the key element in localization is the?
1. instrument phase reversal
2. relative voltage in each channel
3. common mode rejection of in-phase noise
4. synchronization of discharges - ✔✔1. Instrument phase reversal
✔✔SCALP-TO-NONCEPHALIC REFERENCE?
1. Fz-C5S
2. CPz-Fz
3. EPi-EPc
4. CPc-CPi - ✔✔1. Fz-C5S
✔✔According to the ACNS guidelines, system bandpass settings for monitoring facial
nerve spontatneous muscle activity should be?
1. 1-250 to 1500Hz
2. 10-30 to 2500-3000Hz
3. 10-30 to 16,000Hz
4. 100-200 to 1000-3000Hz - ✔✔3. 10-30 to 16000Hz
✔✔According to the ACNS guidelines, facial nerve monitoring electrodes should be
placed in which of the following muscles?
,1. Masseter and trapezius
2. Frontalis and trapezius
3. Laryngeal and nasalis
4. Orbicularis oculi and oribularis oris - ✔✔4. Orbicularis oculi and orbicularis
✔✔Harrington instrumentation includes?
1. rods
2. pedicle screws
3. sublaminal wires
4. segmental wires - ✔✔1. rods
✔✔Intraoperative evoked potential monitoring criteria of abnormality are based on a
comparison of amplitude and latency to?
1. preinduction baseline
2. postincision baseline
3. intraoperative normative date
4. laboratory normative date - ✔✔2. postincision baseline
✔✔Which of the following anesthetic agents may increase the amplitude of cortical
potentials?
1. Etomidate
2. Halothane
3. Pentobarbital
4. Nitrous Oxide - ✔✔1. Etomidate
✔✔FENTANYL?
1. Narcotic agent
2. Volatile agent
3. Barbiturate agent
4. Neuromuscular blocking agent - ✔✔1. Narcotic agent
✔✔The combination of nitrous oxide and volatile anesthetic gases affects SSEPs by?
1. increasing latency and decreasing amplitude
2. increasing latency and increasing amplitude
3. decreasing latency and increasing amplitude
4. decreasing latency and decreasing amplitude - ✔✔1. increasing latency and
decreasing amplitude
✔✔During posterior fossa surgery, wave V of the BAEPs may increase in latency due
to?
,1. Spinal drainage
2. warming of the nerve
3. retraction of the cerebellum
4. use of neuromuscular blocking agent - ✔✔3. retraction of the cerebellum
✔✔Which of the following nerve injuries usually does NOT produce spontaneous EMG
activity during intraoperative monitoring?
1. Heat
2. Pressure
3. Ischemia
4. Irrigation - ✔✔3. Ischemia
✔✔Which of the following is the method for monitoring the facial nerve?
1. BAEPs
2. Blink reflex
3. Free run EMG
4. Visual observation of facial movement - ✔✔3. Free run EMG
✔✔When monitoring facial nerve EMG, which of the following is an indicator of potential
nerve damage?
1. Ocassional burst of fibrillation potentials
2. Continuous train of neurotonic discharges
3. CMAP to direct stimulation
4. Ocassional muscle faciculations - ✔✔2. Continuous train of neurotonic discharges
✔✔What is the recommended bandpass setting for facial nerve compound muscle
action potential recording?
1. 1-250 to 1500hz
2. 5-30 to 3000hz
3. 10-30 to 16,000hz
4. 100-200 to 1000hz - ✔✔1. 1-250 to 1500hz
✔✔Neuromuscular blocking agents should NOT be used when recording which of the
following evoked responses?
1. BAEPs
2. Peroneal SSEPs
3. Facial nerve EMG
4. ECochG - ✔✔3. Facial nerve EMG
, ✔✔What is the most likely effect of isoflurane at MAC 1.5 on tibialis anterior CMAP
amplitude in response to spinal stimulation?
1. Marked increase
2. Marked decrease
3. Minimal decrease
4. Minimal increase - ✔✔2. Marked decrease
✔✔It is most important for intraoperative monitoring records to include notions of?
1. Surgical events
2. periodic impedance checks
3. serial changes in hematocrit
4. changes in anesthesia personnel - ✔✔1. Surgical events
✔✔Which of the following is a critical surgical event?
1. Drilling of burr hole in skull
2. Decortication of vertebral elements
3. Placing of muscle plug in the internal auditory canal
4. Resecting of tumor fragments during acoustic neuroma resection - ✔✔4. Resecting of
tumor fragments during acoustic neuroma resection
✔✔Which of the following should be reported to the surgeon?
1. Loss of response
2. Change in time base
3. Switch to backup electrodes
4. increase in stimulus intensity - ✔✔1. loss of response
✔✔D waves are recorded from which of the following electrodes?
1. Epidural electrodes over the spinal cord
2. Subdural electrodes over the motor strip
3. Surface electrodes over peripheral nerves
4. Needle electrodes in distal extremity muscles - ✔✔1. Epidural electrodes over the
spinal cord
✔✔An objective measure of meaningful change to use to warn the surgeon is the ?
1. latency decrease
2. 50% amplitude decrease
3. IPL decrease
4. 10% amplitude decrease - ✔✔2. 50% amplitude decrease
