CNIM Final Study Guide (Questions on actual exam) | Complete Solutions (Verified)

CNIM Final Study Guide (Questions on actual exam) | Complete Solutions (Verified) An increase in stimulation intensity causes a linear increase of which of the following SSEP components? 1. N20 2. N45 3. P31 4. P37 Epidural electrodes are made of platinum because 1. It is the most durable metal 2. It is the lowest impedance metal 3. The chance of allergic reaction is eliminated 4. Other metals may become toxic when currents are applied During a median nerve preoperative study, a patient has discomfort at the wrist. Stimulation electrodes are 10 mm gold disk, stimulus intensity is 20 mA, and stimulus duration is 100 usec. Which of the following would most likely reduce the patients discomfort while maintaining adequate stimulation? 1. Increase stimulus duration 2. Use larger stimulating electrode 3. Use smaller stimulating electrode 4. Decrease stimulus intensity below motor threshold Which of the following would enhance wave I of the BAEP? 1. Increase the rate 2. Increase the intensity 3. Decrease the analysis time 4. Decrease the number of repetitions In BAEPs, wave I can most easily be differentiated from cochlear microphonics based upon 1. Amplitude 2. Morphology 3. Click polarity 4. Absence in contralateral recording What is the interstimulus interval of a 50 Hz click stimulus? 1. 0.02 msec 2. 0.20 msec 3. 0.50 msec 4. 20.00 msec Contralateral masking should be used during BAEPs to 1. Help the patient relax 2. Enhance wave I amplitude 3. Separate the IV/V complex 4. Prevent crossover responses The complete absence of a BAEP is most likely the result of 1. Sedation 2. Multiple sclerosis 3. Severe hearing loss 4. A normal age variant Identification of wave V of the BAEP may require 1. Tympanic electrodes 2. Bilateral stimulation 3. Decreasing stimulus intensity 4. Use of a noncephalic reference In spinal surgery, the primary purpose of the popliteal fossa recording electrode is to 1. Verify adequacy of stimulus 2. Limit current spread 3. Confirm amplifier integrity 4. Provide evidence of a muscle twitch While performing a posterior tibial SSEP, hypothermia of the lower extremities is most likely to cause 1. Increased L3-P37 latency 2. Increased T12-P37 latency 3. Slowed peripheral conduction velocity 4. Abnormal prolongation of the P37-N45 complex Which of the following peaks in tibial nerve SSEPs is most analogous to P14 of median nerve SSEP? 1. N20 2. N34 3. P31 4. P37 Which of the following devices measures electrode resistance? 1. Ammeter 2. Ohmmeter 3. Voltmeter 4. Photometer If an evoked potential has a voltage of 10 uV and the associated noise has a voltage of 50 uV, what is the signal-to-noise ratio after 100 averaged responses? 1. 1:1 2. 1:2 3. 2:1 4. 5:1 To display median nerve SSEP response as an upward deflection, which of the following must be known? 1. Waveform polarity and latency of the response 2. Waveform polarity and polarity convention of the amplifier inputs 3. Polarity convention of amplifier inputs and amplitude of the response 4. Latency of the response and polarity convention of the amplifier inputs If an amplifier is rated as having 120 dB common mode rejection ratio, which of the following ratios of in-phase to out-of-phase signals would be expected? 1. 10,000:1 2. 100,000:1 3. 500,000:1 4. 1,000,000:1 Which of the following cranial nerves innervated the extraocular muscles? 1. Optic 2. Facial 3. Abducens 4. Trigeminal Which of the following is an example of an SSEP far-field subcortical potential? 1. N20 2. N34 3. Erbs point 4. Popliteal fossa Which of the following opposes any change in current? 1. Capacitance 2. Impedance 3. Inductance 4. Resistance Which of the following electrode materials has little electrode potential drift and a long time constant? 1. Tin 2. Gold 3. Silver 4. Stainless steel Where should epidural electrodes be placed? 1. On the dura 2. In the spinal cord 3. Within the dural memebrane 4. Between the dura and the spinal cord With referential recording, maximal amplitude cortical evoked potentials following stimulation of the left posterior tibial nerve usually would be found between 1. C3 and Cz 2. C4 and P4 3. Fz and Cz 4. C4 and Cz For preoperative posterior tibial somatosensory evoked potentials, which of the following would be the best ipsilateral location for the ground electrode? 1. Arm 2. Calf 3. Mastoid 4. Sole of the foot To record the afferent volley after posterior tibial nerve stimulation, an electrode should be placed on the 1. Patella 2. Metatarsal 3. Popliteal fossa 4. Medial malleolus Impedances of applied electrodes should be 1. Balanced and below 5,000 ohms 2. Balanced and above 5,000 ohms 3. Unbalanced and below 5,000 ohms 4. Unbalanced and above 5,000 ohms During posterior fossa surgery, when BAEPs are used for monitoring brainstem function, it is most important to 1. Record cranial nerve VII action potentials 2. Monitor cranial nerve V function ipsilaterally 3. Stimulate and record from the operative side only 4. Stimulate and record from the contralateral side Which of the following cranial nerves is most appropriate to monitor during resection of a 4 cm vestibular schwannoma? 1. Optic 2. Facial 3. Abducens 4. Oculomotor During carotid endarterectomy, what SSEP modality is recommended for monitoring cerebral function? 1. Femoral 2. Median 3. Posterior tibial 4. Common peroneal If the EEG is preserved during carotid endarterectomy surgery, it indicates 1. Inadequate level of anesthesia 2. Diffuse neuronal dysfunction 3. Accurate electrode placement 4. Adequate cortical perfusion and oxygenation SSEPs to posterior tibial nerve stimulation are most appropriate to monitor during surgery for 1. Scoliosis 2. Hemifacial spasm 3. Middle cerebral artery aneurysm 4. Cerebellar pontine angle tumor In recording electrocochleograms, it is best to stimulate using 1. Tone pips 2. Tone bursts 3. Alternating clicks 4. Rarefaction clicks and condensation A postincision baseline recording is used to 1. Evaluate homodynamic status 2. Determine long term prognosis 3. Establish a standard for the patient 4. Compare patient's values to laboratory normative data Which of the following would most likely be normal in the pre-operative baseline upper extremity SSEP of a patient with a lesion in the dorsal column? 1. N20 2. P22 3. Erbs point potential 4. Central conduction time Selection of the nerve to be stimulated for preoperative baseline SSEPs is determined by the 1. Patient age 2. Surgical procedure 3. Dermatomal innervation 4. ANesthesiologist The record the afferent volley during preoperative baseline studies after posterior tibial stimulation, an electrode should be placed on the 1. Patella 2. Metatarsal 3. Popliteal fossa 4. Medial malleolus Routine intraoperative electrophysiological monitoring documentation should include 1. Heart rate 2. Blood pressure 3. Respiratory rate 4. Blood plasma volume 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 In a bipolar montage, the key element in localization is the 1. Instrument phase reverse 2. Relative voltage in each channel 3. Common mode rejection of in-phase noise 4. Synchronization of discharges Scalp-to-noncephalic reference 1. Fz-C5S 2. Cpz-Fz 3. Epi-Epc 4. Cpc-Cpi According to the ACNS guidelines, system bandpass settings for monitoring facial nerve spontaneous muscle activity should be 1. 1-250 to 1500 Hz 2. 10-30 to Hz 3. 10-30 to 16,000 Hz 4. 100-200 to Hz 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 orbicularis oris Harrington instrumentation includes 1. Rods 2. Pedicle screws 3. Sublaminal wires 4. Segmental wires 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 During endolymphatic sac surgery, trending of which of the following waveform measures would be most helpful? 1. Wave V/I amplitude ratio 2. Wave i-III interpeak interval 3. Wave III-V interpeak interval 4. Summating potential/action potential amplitude ratio 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 Changes can be reported to the surgeon as quickly as possible when the surgeon is asked to 1. Alert the technologist when cautery is in use 2. Keep the field dry of fluids 3. Inform the technologist when critical structures are approached 4. Avoid monopolar cautery use Pedicle screws are used for 1. Spinal fixation 2. Correction of curve 3. Anterior fusion 4. Derotation of spine The purpose of interbody cages is often to 1. Employ multiple point fixation 2. Restore lost disc height 3. Restore sagittal contours 4. Prevent migration prior to fixation Transcranial motor evoked potentials are best elicited when using 1. A train of stimuli 2. Complete neuromuscular blockade 3. Halogenated agents 4. Stimulus rates above 20/ sec. In Compresed Density Spectral Array, frequency is depicted by 1. Y-axis 2. X-axis 3. Epoch 4. Data points Which of the following is used to best identify artifact and insure electrode integrity? 1. Acquiring averaged data 2. Performing calibration 3. Viewing live input 4. Measuring impedance During carotid endarterectomies Spectral Edge Frequency is usually set to 1. 60-67% 2. 70-77% 3. 80-87% 4. 90-97% Which of the following anesthetic agent will obliterate the transcranial electric motor evoked potential? 1. Propofol 2. Desflurane 3. Fentanyl 4. Nitrous Oxide Which of the following temperatures should be annotated as being hypothermic? 1. 34 degrees Celsius 2. 36 degrees Celsius 3. 38 degrees Celsius 4. 40 degrees Celsius Which of the following systolic blood pressures is most likely to attenuate the evoked potential? 1. 150 mm/Hg 2. 140 mm/Hg 3. 130 mm/Hg 4. 120 mm/Hg One contraindication of the use of transcranial electrical motor evoked potentials is 1. Epilepsy 2. Trigeminal neuralgia 3. Scoliosis 4. Cervical myelopathy 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 data 4. Laboratory normative data Which of the following anesthetic agents may increase the amplitude of cortical potentials? 1. Etomidate 2. Halothane 3. Pentobarbital 4. Nitrous Oxide Fentanyl 1. Narcotic agent 2. Volatile agent 3. Barbiturate agent 4. Neuromuscular blocking 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 During posterior fossa surgery, wave V of the BAEPs may increase in latency due to 1. Spinal drainage 2. Warming of the nerve