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CNIM - ABRET PRACTICE EXAM
QUESTIONS WITH CORRECT
ANSWERS 2025 GRADED A+
Cavities inside the skull correct answers >> Anterior/middle/posterior fossa Cranial bones correct answers >> Frontal, occipital, sphenoid, ethmoid (unpaired). Parietal & temporal (paired). Mental protuberance correct answers >> chin bone MCA supply of the cerebral cortex correct answers >> Hand + face/mouth/auditory Cranial nerves correct answers >> -12 pairs (Mixed fibers: sensory/motor/both). -Emerge @ irregular intervals from the brain.
-Nuclei displacement: Motor = medial Sensory = lateral Meckle's Cave correct answers >> Depression in the medial middle fossa where CN V ganglion sits Low frequency sounds correct answers >> @ apex of cochlea Area of spine w/ small pedicles, long spinous process, large inter-vertebral foramen correct answers >> Thoracic Neuroforamen correct answers >> Opening w/in the spinal canal for nerve roots to enter the SC Firm outer layer of the disc correct answers >> Annulus fibrosis Syrinx correct answers >> Fluid-filled cavity @ center of the SC
Synaptic transmission, and/or Δ's in thalamocortical projections, produce correct answers >> Cortical potentials Peripheral nerve sensitivity correct answers >> Least sensitive to injury (more sensitive = SC grey/white mater, cortical grey matter) Cavernous angiomas correct answers >> Multi-lobulated lesions containing hemorrhage Geriatric population: prevalence of temporal bone hyperostosis correct answers >> 10-15% Presbycusis correct answers >> High freq hearing loss; gradually occurs in older individuals Most commonly injured CN correct answers >> Facial nerve (VII) Burst fracture correct answers >> -Break in the vertebra -Failure of anterior & middle vertebral columns
-Caused by violent compressive event (fall, MVA) Excessive neck flexion in sitting position correct answers >> Quadraparesis (due to ischemia in upper T-spine) Lhermittes Sign correct answers >> Shocking sensation that occurs throughout the body during neck flexion Central Cord Syndrome (CCS) correct answers >> -Sacral sparing -Loss of sensory/motor fx @ level of injury -Disruption of grey matter (+) Babinski Sign could indicate correct answers >> -severe [UMN] SC trauma -abnml PTN SSEPs Hoffman's Reflex (1918) correct answers >> Palmar flexion of the thumb when the distal phalanx of the middle finger (of the same hand) is rapidly stroked
Sevo/Des/N2O correct answers >> DO NOT act on the same neuronal receptors On an equi-MAC basis (w/ equivalent doses of anes), which has the greatest effect on MEPs of recorded mm's? correct answers >> N2O N2O correct answers >> -synergistic IONM effects when mixed w/ Iso --> depressed IONM -weak anesthetic agent -causes ~75% DEC in SSEP amplitudes Desflurane correct answers >> -affects NMJ --> enhances effect of NMBs -no effect on MEP CMAPs -eliminates most rapidly Isoflurane 1.7% correct answers >> may result in burst suppression TIVA MoA on pt mvmnt correct answers >> Glycine receptor blocking in the SC
Which is not a major MoA of the usual anesthetic agents that affect IONM? correct answers >> Inhibition of nerve conduction velocity EP modality most affected by propofol correct answers >> Mid-latency auditory response Ketamine correct answers >> (NMDA antagonist) -does NOT act @ GABA synapse -desirable for peds <6-10 y/o + TCeMEP monitoring -agent that least depresses SSEPs -SSEP/MEP = INC amp -EEG = INC beta Propofol correct answers >> (GABA agonist) -SSEP/BAER = INC latency -EEG = slowing Etomidate correct answers >> (GABA agonist) -SSEP/MEP: INC amp
Monitoring mm relaxation is done via TOF. How is relaxation measured? correct answers >> By counting the # of mm responses to 4 stimuli @ 2 Hz Barbiturate effect on EEG correct answers >> burst suppression phenytoin (Dilantin) correct answers >> anticonvulsant (NaV channel blocker) -should be excluded before ECoG for inter-ictal discharges Advantages of general anesthesia during CEA correct answers >> -prevents pt mvmnt; provides brain protection & rapid BP control -does NOT provide measurement of brain activity Anesthesia optimal BIS range correct answers >> 40- Which least affects the neurogenic response to SC stimulation? correct answers >> Anesthetic agents > NMBs, hardware insertion, current shunting from irrigation
Anesthesia is started & pt is intubated. No MEP responses for 15-20 min after induction. Which muscle relaxant was used? correct answers >> Succinylcholine Latency Δ's are caused by effects on correct answers >> Na+ channel receptors Etomidate/ketamine/methohexital are used in low doses to elicit/enhance: correct answers >> seizure foci during EcoG DEC HCT correct answers >> INC RBC velocity Nitroprusside correct answers >> (breaks down to NO --> vasodilator) DEC's BP Unstable BP effects on cortical SSEPs correct answers >> fluctuating amplitudes Glucose is monitored & treated during surgery bc: correct answers >> -high/low BG levels = associated w/ worsened neurological injury
30 Hz = INC lat + DEC amp BAER troubleshooting: pt w/ conductive hearing loss correct answers >> INC stim intensity First 3 possible waveform components @ onset of BAERs correct answers >> cochlear microphonics, summating potential, AP of CN VIII BAER waves III-V are generated at correct answers >> Midbrain-pons area III = cochlear nucleus-SOC IV = SOC-decussation-LL V = IC Propofol effects on BAERs: correct answers >> -latencies: INC I/III/V -no Δ in amplitudes AICA vasospasm: effects on BAER correct answers >> complete loss of all waves EXCEPT cochlear microphonics
BAERs: 0.9 ms INC latency of both L & R wave V in a 10 min period most likely indicates: correct answers >> Temperature effects (hypothermia) BAER wave V - latency INC rate from temperature correct answers >> 0.2 ms per 1 deg C If the pt's threshold is 25 dB & the stimulator is set to 85 dB, the intensity is: correct answers >> 60 dB SL Masking level for eliminating crossover response correct answers >> 60 dB pe SPL BAER sound stimulus intensity @ the TM depends on the: correct answers >> acoustic coupling btwn the sound stimulus generator and the ear Advantage of direct CN VIII recordings correct answers >> diminishes need for averaging BAER latency abnormalities - vascular causes correct answers >> vascular malformations in the posterior fossa (associated w/ hemi-facial spasms & facial paresis)
Localizing sign (in a bipolar EEG montage) correct answers
phase reversal btwn adjacent channels w/ a common electrode frontal intermittent rhythmic delta activity (FIRDA) correct answers >> produced only as a response to anesthesia Spectral Edge correct answers >> Fx of: power/freq vs. time DEC power of Spectral Edge indicates: correct answers >> a greater proportion of EEG power @ lower freq's CSA & CDSA correct answers >> processed EEG displays Cardiac activity on the CSA/CDSA appears as correct answers >> delta activity Fast Fourier Transformation (FFT) correct answers >> Mathematical transformation: complex waveform --> simpler, uniform waves
EEG will most likely disappear at what temp? correct answers >> 16 deg C What EEG Δ's would you expect after intra-carotid injection of sodium amytal? correct answers >> Ipsi DEC in high freq waves EEG filter, time-base, and sensitivity for monitoring cortical ischemia during a CEA: correct answers >> 0.3-70 Hz, 15 mm/s, 3 uV/mm Most strokes associated w/ a CEA occur: correct answers >> after cross-clamping is released Methods to monitor brain perfusion during CEA: correct answers >> -intra-op: doppler, angiography -measuring residual "stump" (ICA) pressure CEA surgery: 80% of clamp-related EEG Δ's occur w/in: correct answers >> first 1 min Maximum time to expect EEG Δ's following carotid cross- clamping? correct answers >> 2 min
Problems w/ AD's correct answers >> -Thresholds (may be elevated in areas w/ structural damage; may vary from place- to-place & time-to-time) -AD's may arise from places w/ no significant spontaneous seizure activity -AD's may lead to seizures that, if occur during mapping --> pt can't continue w/ mapping When pt cooperation is lacking and mapping cannot be done w/ the pt awake: correct answers >> -Mapping can be done w/ pt asleep -Surgical staff can watch the pt under the drapes for evidence of motor responses (facial twitches, hand mvmnt) TCD transducer frequencies correct answers >> 2.0 MHz TCD: nml waveforms correct answers >> have a brisk upstroke TCD: primary quantitative value correct answers >> velocity
TCD: micro-embolic signals correct answers >> have a short duration of < .1 s sEMG: nerve root patterns correct answers >> -Irritation = soft, intermittent flutter (indicative of working near nerve/nucleus) -Injury = continuous, non-accelerating tapping (indicative of permanent injury) -Accelerated firing = pattern --> nerve injury What differentiates an sEMG train from a burst? correct answers >> synchronicity & repetitiveness sEMG trains correct answers >> -reflect sustained nerve traction or compression -suggestive of some degree of neural insult sEMG response similar to burst; occurs in the "cross sword" phenomena when metal touches metal: correct answers >> due to capacitive discharge from the metal
