CNIM ASAP Exam with Complete Solutions

White matter consists of what type of fiber tracts? - ANSWER-Axon of nerve fibers In the visual pathway, fibers anterior to the optic chiasm are called - ANSWER-Optic Nerves If a neurologist suspects nerve damage in a PTs neurological exam, he may order - ANSWER-Nerve conduction/EMG excitatory neurotransmitter - ANSWER-Glutamate The trigeminal nerve can be monitored from which muscle? - ANSWER-Masseter Damage to which structure would most likely result in motor deficits - ANSWER-Lateral cortical spinal tract When removing a pituitary tumor via the nasal passage, the surgeon must produce a hole in - ANSWER-Sphenoid What cranial nerve allows turning the head and lift the shoulders? - ANSWER-Accessory Which of the following is not part of the Circle of Willis? - ANSWER-Superior Cerebellar Artery This cranial nerve's function is to transfer visual information from the retina to the brain - ANSWER-Optic The dorsal column pathways synapse at which location on their way to the sensory cortex? - ANSWER-Nucleus cuneatus and thalamus Which type of action potentials contribute to the popliteal fossa response - ANSWER-orthodromic and antidromic Upper extremity SSEPs are transmitted through which spinal cord tract? - ANSWER-Fasciculus cuneatus The Zygomatic branch of CN 7 innervates which muscle? - ANSWER-Orbucularis Oculi Which cranial nerve travels above cerebellopontine space? - ANSWER-Trigeminal What type of glial cells make up the myelin sheath of the peripheral nervous system? - ANSWER-Schwann ions are involved in a neuronal action potential - ANSWER-Potassium and Sodium The Artery of Adamkiewicz originates between: - ANSWER-T8-L1 resting membrane potential of a neuron - ANSWER--70mV What type of glial cells make up the myelin sheath of the central nervous system - ANSWER-Oligidendrocytes C7 nerve route emerges from the inter-vertebral foramen between - ANSWER-C6 and C7 vertebrae C8 nerve root exits the spinal cord - ANSWER-Above T1 The anterior spinothalamic tract carries sensory modalities of - ANSWER-Crude touch During a CEA, collateral perfusion is maintained by - ANSWER-Circle of Willis The blood supply to the spinal cord is predominantly provided by - ANSWER-ASA The two vertebral arteries pass through foramen magnum and unite to form - ANSWER-The basilar artery not one of the branches of the facial nerve - ANSWER-maxillary What is the segmental motor innervation of the peroneus longus? - ANSWER-L4, L5, S1 Where is the central relay station for sensory information that is located between the cerebrum and spinal cord? - ANSWER-Thalamus Upper extremity SSEPs are primarily transmitted through - ANSWER-Fasciculus Cuneatus Conus medullaris is located at which level in adults? - ANSWER-L1 and L2 The thalamus and hypothalamus make up the - ANSWER-Diencephalon Cranial Nerve 6 - ANSWER-Abducens Resection of skull base tumors in the cerebellopontine angle may reduce the blood flow to which of the following vessels? - ANSWER-AICA What neurotransmitter is released at the neuronal end of the neuromuscular junction? - ANSWER-Acetylcholine The 3rd ventricle is connected to the 4th ventricle by the - ANSWER-Aqueduct of Sylvius Which of the following cranial nerve innervates the extraocular muscles? - ANSWER-Abducens What section of the spinal cord is considered the watershed zone? - ANSWER-Thoracic Which cranial nerves function focuses on facial touch, temperature, sensation, an mastication? - ANSWER-Trigeminal What does the T stand for in TLIF? - ANSWER-Transforaminal Blood is supplied to the spinal cord by? - ANSWER-One ASA and two PSA Which of the following areas of the spinal cord is most likely to have the poorest blood supply? - ANSWER-Thoracic What vertebral levels do the fasciculus gracillis carry information from? - ANSWER-T7 and below Lower motor neurons primarily exit the spinal cord through: - ANSWER-Ventral nerve roots Which spinal artery is responsible for 1/3 of the spinal cords perfusion? - ANSWER-PSA What abnormality can defect in lower motor neurons cause? - ANSWER-Flaccid Paralysis The flexion of the 4th and 5th digits of the hand would represent stimulation of the following nerve: - ANSWER-Ulnar Nerve A loss of balance upon closing one's eyes while standing upright indicates a positive: - ANSWER-Romberg's sign What is a chronic autoimmune disease that affects the myelin sheath of the central nervous system? - ANSWER-Multiple Sclerosis Bell's Palsy - ANSWER-Facial Nerve Brown Sequard Syndrome - ANSWER-Spinal Cord Compression A dystonic condition which causes the neck to twist to one head and the head to tilt - ANSWER-Torticollis Myelopathy - ANSWER-Spinal cord compression Positive Babinski sign - ANSWER-Fanning of toes clinical indication of a lower motor neuron lesion - ANSWER-Fasciculation What is an autosomal recessive inherited disease that affects the spinocerebellar tracts, posterior columns and dorsal root ganglion resulting in ataxia, muscle weakness, loss of coordination, speech impairment, and curvature of spine? - ANSWER-Friedreich's Ataxia Which motor and sensory finds are consistent with Brown Sequard Syndrome? - ANSWER-Contralateral loss of pain and temperature sensation, ipsilateral loss of motor function A 67-year-old patient with long standing history of diabetes mellitus type 2, is scheduled for surgery with IONM. He also has a left foot drop. Which nerve compression is responsible for foot drop? - ANSWER-Common peroneal nerve radiculopathy - ANSWER-Nerve roots Shortened sternocleidomastoid muscle - ANSWER-Torticollis What is likely to result from a positional compression of the brachial plexus? - ANSWER-Thoracic Outlet Syndrome Spondylosis - ANSWER-Degenerative Spine Disease Compression of which nerve root would cause a shoulder abduction? - ANSWER-C5 What is a slow growing tumor that can directly affect balance and hearing? - ANSWER-Acoustic Neuroma Receptive aphasia is associated with damage to which neural structure? - ANSWER-Posterior part of the superior temporal gyrus What spinal disorder causes a forward displacement of the vertebra that is commonly seen in the 5th lumbar vertebra? - ANSWER-Spondylolisthesis Which TcMEP wave is most affected by a bolus of 30mg rocuronium? - ANSWER-I Wave During a neurological exam, which of the following cranial nerves would be included for evaluating extra ocular movements? - ANSWER-3, 4, 6 What is indicated by the presence of unilateral Babinski Signs? - ANSWER-Pyramidal tract dysfunction What is indicated by inability to stand without swaying with eyes closed? - ANSWER-Positive Romberg Elements of a neurologic exam - ANSWER-motor strength, cranial nerves, sensory deficits What is the neurological deficit related to the compression of the spinal cord? - ANSWER-Myelopathy Sensory evaluation of the ophthalmic, maxillary, and mandibular branches is used during the neurological exam of what cranial nerve? - ANSWER-Trigeminal Snellen Chart - ANSWER-Visual acuity A patient who presents with a foot drop is most likely to have nerve root compression at what level? - ANSWER-L5 A Babinski sign in an adult: - ANSWER-Indicates an upper motor neuron lesion Documentation of all Evoked Potentials should include but not limited to: - ANSWER-All are correct - date of exam, PT name/identifying number/age/gender, tech name or initials When visiting a patient in the pre op holding area prior to their surgery, what would the tech inquire about and document prior to providing SEP and MEP IONM for their surgery? - ANSWER-Sensory or motor deficits, history of seizures, any loose teeth or denture When interviewing a patient, she states she has bilateral lower extremity pain. When inquiring the duration of the pain, the PT appears confused. What is another phrase to clarify the PT understands the durations meaning? - ANSWER-How long does the condition last? Which of the following risks described to the PT prior to IONM is most common? - ANSWER-Bite injuries A pre-op IONM PT evaluation, including a review of medical records, history taking, focused examination and description of IONM is the responsibility of: - ANSWER-Intraoperative Neuro Monitoring Supervising professional with contributions from the intraoperative monitoring tech When communicating with the PT and their family prior to surgery, the IONM tech should: - ANSWER-Introduce themselves, explain what type of monitoring will be performed Forward displacement of a vertebra which may cause moderate to severe back pain: - ANSWER-Spondylolisthesis Which of the following medical terms means on top or upon? - ANSWER-Epi Narrowing of the spinal canal or foramen - ANSWER-Stenosis When is the latest acceptable time during a surgery to begin monitoring? - ANSWER-Before any surgical manipulations which place neural structures at risk Lateral curvature of the spine - ANSWER-Scoliosis surgical operation that refers to removal of something - ANSWER--ectomy 1. What part of the spinal cord is most at risk for ischemia? - ANSWER-Thoracic 1. When consenting a PT for IONM who is 16 years old, who must sign the consent form? - ANSWER-PTs parents The triceps and extensor capri ulnaris muscles can be good locations to monitor EMG when the surgery is close to - ANSWER-C7 nerve root Due to the relative inexcitability of the motor cortex in the pediatric population, direct cortical stimulation may not be suitable in PT less than - ANSWER-5 years old A PT with a history of diabetes is likely to also have - ANSWER-decreased lower SSEP amplitudes, increased lower SSEP latencies, peripheral neuropathy When evaluating for special considerations/contradiction for MEP monitoring, what is the most appropriate step to take when identifying a patient with a previous medical history of seizures that have been well controlled with medication? - ANSWER-Discuss the risk with the surgeon and anesthesia team and proceed as they wish contradiction for the use of TCEMEPs - ANSWER-Epilepsy Which element in a PT medical history may cause the SEP stimulation to fail? - ANSWER-Peripheral neuropathy The surgical site for a posterior fossa tumor surgery requires adjustment of the standard SSEP recording electrodes. Which adjustments should be made? - ANSWER-Move C5s lateral special considerations/contradictions for MEP monitoring - ANSWER-Neurotransmitter, aneurysm clip, cochlear implants A selective dorsal rhizotomy is associated with - ANSWER-Cerebral palsy and the severing of posterior rootlets Which modality is a contradiction when a PT has a cochlear implant - ANSWER-TcMEP When monitoring a C6-C7 ACDF on a PT with an amputated left wrist, which of the following is the most appropriate stimulation site for the left upper extremity? - ANSWER-Ulnar notch During the pre op evaluation on a PT, the mother informs you the PT has seizures and is currently on meds. This history implies: - ANSWER-A contradiction to TcMEP While reviewing the PT history, the MRI report states "there is tethering of the spinal cord caudal to the conus medullaris". Which of the following statements would be a significant change during monitoring when considering this history? - ANSWER-Loss of unilateral vas lat TcMEP During carotid endarterectomy, which SSEP modality is recommended for monitoring cerebral function? - ANSWER-Median Which of the following muscles would be most appropriate monitor for a C5 foraminotomy? - ANSWER-Deltoid What modalities are ideal to run on a Chiari malformation decompression? - ANSWER-TceMEPs, Baeps, SSEP IONM modalities would be most appropriate for an MVD - ANSWER-EMG and BAEP What nerve should be monitored if the surgeon is concerned about foot drop? - ANSWER-L5 and peroneal Monitoring the posterior tibial nerve SSEPs is most appropriate in cerebrovascular procedures involving which of the following arteries? - ANSWER-Anterior Cerebral Upper extremity SSEPs are monitored during lumbar surgeries to evaluate - ANSWER-Positioning and anesthetic effects IONM modalities would be most appropriate for a C5-C6 ACDF - ANSWER-MEP, SSEP, EMG Which cranial nerves should be monitored during a MVD for trigeminal neuralgia? - ANSWER-5 and 7 The most effective method to monitor spinal motor pathway during surgery is - ANSWER-Multi pulse transcranial electric stimuli with recording from lower extremity muscles What modalities should you monitor for a CEA surgery? - ANSWER-Ipsilateral EEG, Contralateral SSEP What modalities should you monitor for a vestibular neurectomy procedure? - ANSWER-Ipsilateral BAEP and facial nerve EMG During the resection of a vestibular schwannoma, what modalities are important to run? - ANSWER-BAEPs and CN 7 Translabyrinthine approach - ANSWER-CPA Tumor To monitor the integrity of the facial nerve during a parotidectomy: - ANSWER-Stimulate proximally and record distally Which modalities should you monitor for a C7 fracture? - ANSWER-Ulnar and PTN Which acoustic neuroma approach results in scarified ipsilateral hearing in virtually all patients? - ANSWER-Translabyrinthine The use of intraoperative monitoring during scoliosis surgery may replace the: - ANSWER-Stagnara test Which is the best monitoring strategy during posterior myelotomy procedure? - ANSWER-SSEP, EMG, TcMEP Which modality is used as a diagnostic tool for multiple sclerosis? - ANSWER-SSEP During the untethering of a tethered cord, what is severed? - ANSWER-Filum terminale Which of the following cranial nerves is most appropriate to monitor during a resection of a 4cm vestibular schwannoma? - ANSWER-Facial Which nerve innervates the adductor pollicis muscle? - ANSWER-Ulnar Which of the following muscles would be most appropriate to monitor for a L4-L5 Posterior Lumbar Interbody Fusion? - ANSWER-Vas Lat, TA, Peroneus Longus What is the minimum CMRR required for EP amplifiers? - ANSWER-80dB WADA testing primarily assesses - ANSWER-Language function Which of the following frequencies is attenuated by a HFF of 70 HZ? - ANSWER-80 HZ In a microvolt signal inside 50 microvolts of noise averaged for 100 traces, the final signal to noise ratio will be - ANSWER-2:1 An analysis time of 5msec is appropriate for monitoring: - ANSWER-ECochG What is the required vertical resolution of an EP system? - ANSWER-16 Bits Brief, fine, irregular twitches seen under the skin on a motor exam are known as: - ANSWER-Fassiculations Plain radiographs are required for PT with - ANSWER-Scoliosis On a neurological exam, what does 4/5 strength indicate? - ANSWER-Movement against resistance but less than normal Which of the following is a test that uses ionizing radiation to create detailed images of bone and soft tissue? - ANSWER-CT A typical SSEP stimulus has a PW between: - ANSWER-100-300 microseconds What is the recommended analysis time for TcMEP recording? - ANSWER-100msec What are HFF composed of? - ANSWER-Capacitors in parallel, resistors in series The character of a differential amplifier by which the identical signals applied to both input channels of the amplifier are cancelled, is known as: - ANSWER-CMRR Which of the following best describes the expected EEG changes during an intracarotid amobarbital (WADA) procedure? - ANSWER-Slow activity in the hemisphere ipsilateral to the injection An acceptable band pass used to record SSEPs from the upper and lower limbs is usually between: - ANSWER-30-3000HZ 1. Which of the following is a test that uses magnetic field and pulses of radio wave energy to create detailed images of soft tissue? - ANSWER-MRI According to the 10-20 system of measuring, CP3 is located halfway between: - ANSWER-C3 and P3 According to the 10-20 system of measuring, for a head measurement of 35 from inion to nasion, what would be the measurement from Cz to the nasion? - ANSWER-17.5 Scalp to noncephalic reference - ANSWER-Fz-C5S According to ACNS guidelines, facial nerve monitoring electrodes should be placed in which of the following muscles? - ANSWER-Orbicularis oculi and orbicularis oris What would be the most appropriate muscle to use when asked to monitor CN 3? - ANSWER-Inferior rectus The pop fossa distal and proximal electrodes should be placed midline of the pop fossa, and what is the distance that they should be from the popliteal crease? - ANSWER-2cm and 5cm respectively In spinal surgery, the primary purpose of the pop fossa recording electrode is to: - ANSWER-Verify adequacy of stimulus For a posterior L5-S1 decompression and fusion, which muscles should be monitored? - ANSWER-Gastroc, TA, AH Recording of median nerve SSEP during carotid endarterectomy is a useful adjunct to EEG for detecting: - ANSWER-Ischemia is in the MCA What is the most appropriate location for a non cephalic reference electrode for upper extremity SSEP? - ANSWER-Contralateral Erbs point Subdermal needles placed by the epidural space should be placed by: - ANSWER-Surgeon In which type of EP is the scalp position of recording electrodes most critical? - ANSWER-Lower SSEP When placing a stimulator probe on the ankle for intraoperative SSEP monitoring of the lower extremities for an ACDF, which of the following is most appropriate? - ANSWER-Never wrap tape or band completely around ankle When performing IOM for an intraoperative MRI case, use of electrodes that are not MRI conditional may result in - ANSWER-Thermal burns When placing subdermal needle electrodes, the tech should: - ANSWER-Secure the needles in place with tape If the electrolyte from one stimulating electrode spreads to the other electrode, which of the following occurs - ANSWER-Current shunting High current density - ANSWER-needle Epidural electrodes are made of platinum because: - ANSWER-Other metals may become toxic when currents are applied Which of the following is a negatively charged electrode? - ANSWER-Cathode Which of the following is a positively charged electrode? - ANSWER-Anode MRI conditional electrodes are made from which of the following? - ANSWER-Nickel titanium What EEG rhythm is approximately 4-7 HZ? - ANSWER-Theta Prior to passing recording and stimulation devices over to the sterile field, the IOM tech should verify: - ANSWER-The seal has not been broken and is not yet expired What is the most frequent mode of infection transmission, which can be either direct or indirect? - ANSWER-Contact Gowned surgical personnel are considered sterile from the height of the sterile field up and from: - ANSWER-2 inches above the elbows to the hands Items that contact mucous membranes or non intact skin are semi critical and require what level of disinfection? - ANSWER-high level What is the main source of airborne bacteria in the operating room? - ANSWER-Exfoliated skin particles from the operating room staff When should hands be cleaned? - ANSWER-Before and after wearing gloves Penetration of the sterile field occurs when: - ANSWER-The surgeons arm brushes against the recording equipment Standard precautions are used to reduce the transmission of: - ANSWER-bloodborne pathogens Contact dermatitis, including both irritant and allergic responses, is a common clinical reaction associated with: - ANSWER-latex A PT has a known latex allergy. What should the tech be most cautious about in regards to providing IOM? - ANSWER-gloves used Which organization is responsible for overseeing accreditation and certification standards and sets initiatives for National Patient Safety Goals in the US? - ANSWER-TJC How often are National Patient Safety Goals released? - ANSWER-annually Impedance is the opposition to: - ANSWER-alternating current flow Current: - ANSWER-Amount of electrons flowing between two points Following SSEP stimulation of peripheral nerve, the pathway ascents through the: - ANSWER-Ipsilateral dorsal columns Ohms's Law - ANSWER-V=IR D Waves are recorded from which of the following electrodes? - ANSWER-Epidural electrodes over the spinal cord The ability to cancel in phase signals and record out of phase signals can be best described as: - ANSWER-CMRR A positive event occurring in the lead connected to the negative terminal, will results in a deflection: - ANSWER-downward If an amplifier is rated as having 120 dB CMRR, which of the following ratios of inphase to out of phase signals would be expected? - ANSWER-1,000,000:1 The ability to amplify the difference between two input voltages and the ability to cancel out any voltage common to the two inputs - ANSWER-Differential amplifier To display a tibial nerve SSEP response as a downward deflection, which of the following must be known? - ANSWER-Polarity of the response and polarity of the convention of amplifier inputs If an amplifier has a CMRR of 100:1, what is the corresponding DB? - ANSWER-40 The ability of an amplifier to accurately cancel voltages that are common to both inputs: - ANSWER-CMRR most affect the ability to record BAEPs - ANSWER-Coagulator Alternating current is used when checking electrode impedance to: - ANSWER-Avoid electrode polarization Balanced impedances allows you to: - ANSWER-Maximize common mode rejection Which of the following opposes any change in current? - ANSWER-inductance Evoked potential data are obliterated with: - ANSWER-Monopolar cautery Why should the impedances of stimulating electrodes be kept low and balanced? - ANSWER-To reduce stimulus artifact