You have to monitor a CPA tumor with left retrosigmoid approach. What modalities do you want to monitor?

upper and lower SEP, BAER, EEG, Facial EMG, triggered EMG

All are true about sensorineural deafness except?

impacted ear wax causes wave I delay

subcortical, far field, perhaps thalamus, rostral

Inspire device cuff is surgically placed around

the medial fibres to stimulate protrusion of the tongue

With Radiculopathy, all are true except:

involves 2 or more paraspinal muscles

In which of the situations below would you alert the surgeon for a change in MEP response?

only if the response is lost in a muscle

Having the OR bed unplugged can cause:

it to act like a giant antennae & pick up more interference

When the right ulnar responses are decreased in amplitude and the pt appears light on EEG, what's the cause?

peripheral TIVA IV line infiltration

Which is untrue about MEPs?

MEPs are more reliable than SEPs, especially with inhalational anesthetics

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IONM Jeopardy

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Questions 99

Answers

1
The latency of a stationary response stays the same with electrode movement, (N13), but amplitude can change
False
True
2
What is the meningeal layer that is named after spiders?
M3
sub-arachnoid
middle meningeal
widow maker
3
The Tibial Nerve is a Component of the Sciatic Nerve
False
True
4
Which is not an upper extremity muscle group?
FCR
ADM
AHB
APB
5
The thick layer that divides the cerebral hemispheres is called
Formina of Luschka
Falx cerebri
Choroid plexus
Foramina of Magendi
6
What electrode placement on the head corresponds to the right foot?
T3
Pz
C2
Cz
7
Sound is made up of
all of the above
volume
frequency
envelope, onset/offset
8
Sustained EMG trains of repetitive, synchronous potentials may represent neuro insult, traction, compression
False
True
9
In an ABR with 100usec duration, stim 100db, Is this safe?
False
True
10
You have to monitor a CPA tumor with left retrosigmoid approach. What modalities do you want to monitor?
upper and lower SEP, BAER, EEG, Facial EMG, triggered EMG
upper SEP, BAER, 1x4 strip, RLN, Traps
upper SEP, BAER, EEG, Facial EMG
UE /LE SEP, BAER, EEG, Facial EMG, tEMG, Facial MEP
11
Burst EMG is brief, nonrepetitive, asynchronous, rarely indicative of neuro insult, correlates with tugging, displacing
True
False
12
All are true about sensorineural deafness except?
disease can be in the cochlea
high frequency loss, deterioration of the organ of corti
disease in the neural pathway from the cochlea to the brain
impacted ear wax causes wave I delay
13
The latency of a propagated response changes with electrode placement, such as Erbs point.
False
True
14
What changes can SSEPs detect?
detect ischemic events from posterior spinal artery
detect events from poor patient positioning
all of the above
posterior cord compression from surgical manipulation
15
N18
subcortical, far field, perhaps thalamus, rostral
stationary, non propogated, cervical potential
subcortical, far field, caudal medial lemniscus
propogated volley central cord
16
Inspire device cuff is surgically placed around
the lateral hypoglossal fibres leading to retraction of the tongue
the medial fibres to stimulate protrusion of the tongue
the medial fibres to innervate the retraction muscles
both lateral and medial fibres for bilateral tongue protrution
17
Which cranial nerves are not part of the brainstem?
12
10, 11, 12
I
I, II
18
Which of the following is a source of IOM physiological artifact:
EKG
ERG
blood warmer
cell saver
19
Ulnar stimulation causes:
extension of the 5th digit
flexion of the 5th digit
adduction of the 5th digit
abduction of the 5th digit
20
With Radiculopathy, all are true except:
cause irritation or injury to nerve root
commonly caused by bulging disk
involves 2 or more paraspinal muscles
symptoms of weakness or numbness
21
A screw well positioned within the pedicle will have a high impedance to electrical stimulation of higher intensities
True
Depends on the length
False
Depends on the diameter
22
In which of the situations below would you alert the surgeon for a change in MEP response?
loss of muscle response requiring increased voltage stim
only if the response is lost in a muscle
50% drop in amplitude
polyphasic waves change to biphasic waves
23
At what level of current is the pedicle screw considered breached when placing during an open procedure?
6mA
10mA
<15mA
12mA
24
If a patient demonstrates foot drop post operatively, what levels were affected during surgery?
L3-4
L4-5
L5-S2
L4-S1
25
Where would you expect to see changes if an aneurysm ruptures in the anterior circulation?
both SSEP, BAER
upper ssep
EEG only
LE- tibials
26
What is the caudal portion of the brainstem?
pons
medulla oblongata
thalamus
midbrain
27
In IONM, EMG monitoring cannot pick up ishemic changes
True
False
28
Having the OR bed unplugged can cause:
be a safety concern if cautery is used
it to act like a giant antennae & pick up more interference
a double ground risk
disrupt the earth ground to your equipment
29
What is the most rostral portion of the brainstem
pons
medulla oblongata
midbrain
thalamus
30
If constant current stim=40mA, skin resistance= 10Kohms, what happens to current if resistance increases
current increases
current decreases
current stays the same
risk of macroshock
31
The 2 lateral ventricles are connected via the
foramin of luschka
the aqueduct of sylvian
foramin of monroe
foramin of Magendie
32
When the right ulnar responses are decreased in amplitude and the pt appears light on EEG, what's the cause?
peripheral TIVA IV line infiltration
Artery of Adamkiewicz thrombus
systemic hypotension
increase in sevo >1.5 mac
33
In spinal cord stimulator placement, dorsal columns are stimulated:
False
True
34
D wave and Spinal Cord Motor Mapping are not the same
True
False
35
What action during surgery would cause axonal excitability resulting in cranial motor neuron discharge?
irrigation fluids can cause a transient discharge of the motor unit
temperature causes marked changes in excitability
axonal conducting velocity varies with temperature
all of the above
36
What electrode on the head corresponds to the right hand?
CP3
C1
P3
C3
37
90% of deceased prostate cancer patients had metastatic spinal lesions
True
False
38
Pulse Width Has no Effect on Eliciting an H-reflex
True
False
39
What is the common number of stimulations in a train of stims for TcMEPs?
3-7
5-9
1.0-1.2
1-7
40
Which is untrue about MEPs?
MEPs are more reliable than SEPs, especially with inhalational anesthetics
weak muscles may not produce a response, yet are the most at risk
With more cortical representation, upper extremities have larger responses
Patients with 3/5 lower extremity strength have weak or absent MEPs
41
In contrast to analog filtering, digital filters typically don't cause temporal distortion of EPs.
True
False
42
The Following are All Cranial Nerves Except
Facial
Hypoglossal
Axillary
Olfactory
43
Tongue Deviation s/p CEA Surgery may be Due To
Excessive Retraction at the Angle of the Jaw
All of the Above
CN XII Compression from Bleeding or Drainage Pressure
Mechanical Injury to CN XII
44
With median nerve stim, the area where the phase reversal happens directly identifies what area of cortex
somatosensory cortex
motor strip
parietal-occipital
cingulate gyrus
45
Using a ball tip probe the surgeon wants to stim the cortical area around the tumour so you set your equipment for:
Anodal stimulation
Cathodal stimulation
Transcortical LQP
Hemispheric stimulation
46
Sustained EMG trains of repetitive, synchronous potentials may represent:
could be from cold irrigation
all of the above
could mean patient is getting light
could be from metal hitting metal artifact
47
Which of the following is a common complication of microvascular decompression of cranial nerve VIII?
lower extremity weakness
hearing loss
visual loss
upper extremity weakness
48
For pedicle screw stimulation the best placement for the return electrode to minimize stim artifact is:
between the shoulder blades
sterile needle in the wound bed
on the hip
just above the incision
49
During IONM, electrodes in the tongue monitor which cranial nerve?
CNXII - Hypoglossal
CN10- sensory Vagus
CNXI - Spinal accessory
CN IX - Glossopharyngeal
50
Volatile Inhalation Agents Impact Which of The following the Most?
MEP
TOF
N9
Impedance
51
Which is a depolarizing muscle relaxant that blocks at post junctional membrane?
Propofol
Remifentanyl
Rocuronium
Succinylcholine
52
Tibial stimulation causes:
plantar eversion of foot
Babinski response
efferent volley to the popliteal fossa
plantar flexion of toes
53
What separates the precentral motor gyrus and the sensory post-central gyrus
central sulcus
transverse gyrus
sylvian fissure
superior frontal gyrus
54
Cortical Blindness can occur after a watershed stroke with a lesion in
temporal radiations
occipital lobe
the eyes
all of the above
55
When to alert the surgeon
all of the above
wave V latency approaches 1.0 msec and amp decrement approaches 50%
wave V latency increases more than 1.0msec and amp decrement >50%
loss of wave V
56
Stretchng of a Peripheral Nerve Will Increase Conduction Velocity.
True
False
57
The best outcome with Inspire cuff placement causes bilateral tongue protrusion
True
False
58
Criteria for BAER Interpretation
all of the above
interpeak latency I-V
absolute latency
amplitude (wave V should be bigger than wave I amplitude)
59
Stimulation Electrodes for the H-Reflex are Located in
Posterior Tibial Nerve
Sural Nerve
The Anterior Horn of the Spinal Cord at L2
Popliteal Fossa
60
Humans react with motion to music that is unique.
False
True
61
When doing MEPs, it is important to test the TOF. If we have 4 out of 4 twitches with fade, what % is the pt relaxed?
0-75%
none of the above
100%
0%
62
Your patient has 2/4 twitches on TOF. What percentage are they blocked?
75% blocked/relaxed
90% blocked/relaxed
50% blocked/relaxed
80% blocked/relaxed
63
What is the maximum allowable chassis leakage current?
100 u amps
50u amps
10u amps
500 u amps
64
To optimize EMG response, all are true except:
needle placement 7-10cm apart is ideal
use standardized bipolar needles 2cm apart
avoid the innervation zone (in belly of muscle)
needles in Innervation zone shows lower EMG amplitude
65
Although double grounding may not be good for signal integrity, it is not a safety issue
True
False
66
Myelin sheaths surround axons & aid in conduction in the peripheral(PNS) and central nervous systems (CNS)
myelin sheaths are produced by oliodendroglia cells in the PNS
myelin sheaths are produced by oliogendroglia cells in the PNS
myelin sheaths are produced by schwann cells in the PNS
myelin sheaths are produced by schwann cells in the CNS
67
80% of fibres from the cochlear nucleus cross to the contralateral side
False
True
68
The use of IOM during scoliosis surgery may replace:
Romberg Test
Babinski sign
Stagnara test
Hoffman sign
69
Where is the cell body located of the 1st neuron in the SSEP pathway?
cell body connects the reflex arch
dorsal root ganglion near the exit of the spinal cord
dorsal root ganglion near the entry of the spinal cord
cell body connects the fasiculus gracillis to the thalamus
70
Where would you expect to see changes if an aneurysm ruptures in the posterior fossa?
Upper SSEP
EEG only
both SSEP, BAER
LE- tibial SSEP
71
N20
subcortical, far field, perhaps thalamus, rostral
cortical far field
propagated valley passing under hand area
primary cortical, near field
72
With Myelopathy, what is untrue?
commonly caused by a bulging disk
symptoms can include stiffness, incoordination, weakness, numbness
it is a disease of the spinal cord
caused by irritation or injury to nerve roots
73
To Elicit an H-Reflex, EMG Pair Electrodes are Placed into
Both in the Gastrocnemius
Tibialis Anterior and EDB
Soleus and Adductor Hallucis
Gastrocnemius and Soleus Muscles
74
Vasospasm can arrest flow in the labrynthine artery and will show changes in the BAER
False
True
75
What is true about meningioma spinal cord tumours?
2-4% of all CNS tumours
80% arise in women
arise from the dura
full tesection is difficult
76
Sound travels from the organ of Corti of the inner ear carried by CN VIII to reach the primary auditory cortex.
True
False
77
Ideal candidates for successful treatment of sleep apnea with Inspire should have
BMI less than 35%
No other implanted devices
Nasal obstruction from deviated septum
Neck size greater than 19.5
78
Waves VI, VII that can be seen clinically is wiped out by general anesthesia
False
True
79
Deficiency of this vitamin can cause a peripheral neuropathy, seen in those on strict vegetarians diets
B6
B12
Vitamin K2
Vitamin K1
80
MEPs are more sensitive to compression, ischemia, blunt trauma and distraction of the spinal cord than SEPs
False
True
81
Document IOM vitals to include all except:
Blood Plasma Volume
Respiratory Rate
Heart rate
Blood Pressure
82
To best monitor anterior cerebral artery aneurysm surgery, which modality should be used
Double Banana EEG
VEP
lower SSEP
upper SSEP
83
Which of the Following are Correct Concerning the RLN
Contributor to the N9 SSEP Wave
A Branch of CN IX
The RLN Innervates the Cricothyroid Muscle
The Left RLN is Longer than the Right RLN
84
Primary spinal cord tumours seen are:
Extradural (rare)
All of the above
Intradural/Extramedullary (90%)
Intramedullary (8-10%)
85
With conductive hearing loss, what change would you see in the ABR?
increase in both I and V
increase in wave V
decrease in wave I
increase in I-V interpeak
86
The Inspire device to treat sleep apnea works to
Innervate tongue protrusion
cause tongue deviation
Inervate tongue retraction
curls the tongue to the roof of the mouth
87
Which of the following anesthetic agents may increase the amplitude of cortical potentials
Halothane
Nitrous oxide
Pentobarbital
Etomidate
88
Where should epidural electrodes be placed?
on the dura
in the spinal cord
within the dural membrane
between the dura & soinal cord
89
Median stimulation causes:
anodal blocking response
abduction of the thumb
flexion of the 5th digit
aduction of the thumb
90
What nerve would not be monitored in the OR for Parotid gland tumor or posterior fossa craniotomy?
X Vagus
IX Glossopharyngeal, motor impulses to parotid gland
XII Spinal Accessory
VII Facial
91
With MEP stimulation, what percentage of fibres cross at the pyramids (medulla)
75%
99-100%
50%
80-90%
92
Which is a non-depolarizing muscle relaxant that blocks acetylcholine at the neuromuscular junction.
Succinylcholine
Rocuronium
Remifentanyl
Propofol
93
In IONM, EMG monitoring may not pick up slow stretch or compression injury
False
True
94
Which of the following opposes any change in current?
resistance
Inductance
Impedance
capacitance
95
Peroneal stimulation causes:
plantar flexion of toes
efferent volley to the popliteal fossa
a negative babinski
plantar eversion of foot
96
Which is not a lower extremity muscle group?
TA
EDB
AH
FCR
97
What modality is most effective to use when trying to locate a specific nerve root?
Triggered EMG
H-Reflex
Prass Probe
Spontaneous EMG
98
N13
subcortical, far field, caudal medial lemniscus
primary cortical, near field
subcortical, far field, perhaps thalamus, rostral
stationary, nonpropagated, cervical potential, postsynaptic
99
Noise exposure can cause damage to hearing
False
True

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