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Prep (CNIM) > Review > Flashcards

Review Flashcards

1
Q

Which anesthetic agent may precipitate electric seizure activity?

A

Enflurane & Brevital may also cause seizures

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2
Q

What does the transcranial doppler measure?

A

Cerebral Blood Flow

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3
Q

At what rate of CBF dose the EEG slow?

A

Increase

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4
Q

What is the resting membrane potential of a neuron?

A

-70mv

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5
Q

Name two bloodborne pathogens

A

Hepatitis B
HIV

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6
Q

When passing a person who is sterile:

A

The person who is sterile should pass with his/her back toward you.

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7
Q

Name one airborne pathogen:

A

TB

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8
Q

Name the most common disease process which is resistant to decontamination and sterilization?

A

CJD

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9
Q

Match the following:
High-Level Disinfection_____
Intermediate-Level Disinfection______
Low Level Disinfection_____

a) Critical Items
b) Semi Critical Items
c) Non Critical Items

A

A
B
C

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10
Q

What part of the surgical attire are sterile?

A

-In front waste up to neckline
-Elbows down

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11
Q

When is “baseline” recording taken?

A

Post incision, balanced anesthesia

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12
Q

What additional surgical gear is necessary when working with TB patients?

A

HEPA respirator

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13
Q

Horizontal resolution defines which aspect of the EEG?

A

Frequency

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14
Q

Vertical resolution defines which aspect of the EEG

A

Amplitude

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15
Q

Which feature on the EEG or EP equipment affect horizontal resolution?

A

Frequency

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16
Q

What is Nyquest Frequency?

A

The sampling rate should be at least twice the frequency being recorded.

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17
Q

What is Aliasing?

A

Result in inadequate sampling rate.

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18
Q

What is the calculation of sampling rate?

A

of sampling points
______________________ = sampling rate
Analysis Time

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19
Q

What is Inter-Sampling Interval or Dwell time?

A

Space “between” data points

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20
Q

Which feature on the EEG or the EP equipment affects vertical resolution?

A

Sensitivity

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21
Q

What is the function of common mode rejection?

A

It reject external interference averages above the preset value that is common in both amplifiers

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22
Q

What does the term Cancellation mean in differential amplification

A

Occurs when both electrodes in the pair are equal or near equal amplitude resulting in “flat line” output.

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23
Q

What does the term Summation mean in differential amplification?

A

Are when two outputs of the opposite polarity are subtracted during the differential amplification

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24
Q

Should the electrode impedance of the amplifier be high or low compared with that of the recording electrodes?

A

High

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25
Q

Does the LFF introduce a Phase lead or Phase lag

.1Hz——-\_/—–
.3Hz——\_/—-
1Hz—–\__/—— (shortens)

A

Phase lead

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26
Q

Does the HFF introduce a Phase lead or Phase lag

~~~~~\ 3000 Hz
~~~~~~\ 2000Hz
~~~~~~~\ 1000 Hz (prolong)

A

Phase lag

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27
Q

What is the most common cause of 60 cycle artifact?

A

Uneven or unbalanced electrodes

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28
Q

Calculate the number of oscillations representing 60 Hz artifact for each epoch

AEP 10ms ______
SEP 100ms ______
SEP 50ms _______

A

Multiply by .06

AEP=0.6
SEP= 6
SEP=3

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29
Q

What type of artifact is 16.66ms ?

A

60 cycle

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30
Q

What is Pre-Stimulus Delay (negative) and its function?

A

-Includes a period of time before recording

-Estimate noise environment

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31
Q

What is Post Stimulus Delay (positive) and its function?

A

-Eliminates from the waveform period before the stim onset and response. Stimulus delivered prior to presentation of the Y-Axis.

-Usually gets rid of a period before contaminated by stim artifact.

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32
Q

What is the function of artifact rejection?

A

-Excludes activity outside a predetermined range

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33
Q

What type of monitoring validates the function of the Circle Of Willis?

A

EEG

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34
Q

What two main types of EEG abnormalities are noted with a patient needing a shunt in endarterectomy surgery?

A

-Decrease in amplitude unilateral (ipsilateral) to the surgical site
-Increase in slow waves
“ After clamp is released”

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35
Q

What is the difference between EEG Monitoring and EEG Testing in the OR?

A

-Monitoring is provided by a technologist and gives descriptions only.

-Testing is performed by the surgeon

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36
Q

What are the recommended setting for EEG in the OR?

Sensitivity______
HLF _____
60 Hz ______
LLF ______
paper speed_____

A

Sensitivity=3uv/mm
HLF = 70Hz
60Hz= In
LLF=0.3sec
Paper speed=15mm/sec

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37
Q

CSA is defined as?

A

-Compressed spectral array
-Y-Axis: power amp 2/2
-X-Axis: Frequency

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38
Q

DSA is defined as?

A

-Density Spectral Array
-Color representation or gray scale
-Represents EEG power at each frequency in each epoch

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39
Q

Spectral Edge frequency?

A

-Highest signal frequency present in the recorded EEG spectrum for each epoch
-Usually set to 90-97%

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40
Q

Where is the lumbar potential (LP) generated and is it a stationary or propagated potential?

A

-Spinal cord
-Stationary

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41
Q

Where is the lumbar potential (LP) maximal along the spinal column?

A

T12

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42
Q

What type of montage best displays the P31 & N34?

A

Fz-C5

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43
Q

In the Fz-C5s channel,the active electrode which lies above the generator for P31 and N34 is?

A

Fz

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44
Q

Which obligate peak of the lower SEP is an analog of the median nerve P14 response?

A

P31

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45
Q

Which obligate peak of the lower SEP is an analog of the median nerve N18 response?

A

N34

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46
Q

What effect dose inhaled halogenated anesthetic gases have on the P31 & N34 responses?

A

None

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47
Q

What affect do inhalation agents have on the P37?

A

-Decreased amplitude
-Increased latencies

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48
Q

Utilizing a rate of 18/sec for lower SEP will affect which of the following:

-Latency by 20%
-Amplitude by 80%
-Latency and Amplitude

A

Latency & Amplitude

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49
Q

What effect does a fast rate have on spinal responses?

A

None

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50
Q

What effect does halogenated agent have on spinal responses?

A

-Increase in latency
-Decrease in amplitude

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51
Q

What is the recommended placement of the spinal electrodes?

A

-Under the Lamina Arch on the Dura

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52
Q

What is the recommended metal composition of the epidural electrode?

A

-Platinum

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53
Q

Why is platinum used for epidural spinal electrodes placed in the field when used for stimulation?

A

Because other metals can become toxic when current is applied

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54
Q

Which of the following tracts is not affected by Desflurane:

a) Pyramidal Tracts
b) Ventral Tracts

A

Pyramidal Tracts

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55
Q

Which of the following peaks is most affected by Propofol?

a) P31
b) EP
c) P37
d) N18

A

d) N18

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56
Q

Where does the ascending responses decussate?

A

At the medulla

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57
Q

Which of the following pathways is associated with motor function?

a) Dorsal
b) Pyramidal
c) Anterior columns

A

b) Anterior Column

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58
Q

Upper motor neuron extend from:

a) Ventral Horn to Peripheral neurons
b) Precentral gyrus to ventral horn
c) Post central gyrus to dorsal column

A

b) Precentral gyrus to ventral horn

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59
Q

Lower motor neurons extend from:

a) Ventral Horn to Peripheral neurons
b) Precentral gyrus to ventral horn
c) Post central gyrus to dorsal column

A

a) Ventral Horn to Peripheral neurons

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60
Q

Upper motor neuron injury results in:

a) Flaccidity
b) Spasticity
c) Paralysis
d) Paresis

A

b) Spasticity

61
Q

Lower motor neuron injury result in:

a) Flaccidity
b) Spasticity
c) Paralysis
d) Paresis

A

a) Flaccidity, Atrophy

62
Q

SSEP assess function of:

a) Ventral Columns
b) Dorsal Columns
c) Descending Columns
d) Pyramidal Tracts

A

b) Dorsal Columns

63
Q

CMAPs represent waveforms elicited by:

a) Cortex
b) Nerve
c) Muscle
d) Subcortex

A

c) Muscle

64
Q

CNAPs represent waveform elicited by:

a) Cortex
b) Nerve
c) Muscle
d) Subcortex

A

b) Nerves

65
Q

TceMeps are best elicited using:

a) Versed, Fentanyl, Desflurane
b) Propofol, Fentanyl, Isoflurane
c) Desflurane, Fentanyl, Nitrous
d) Etomidate, Fentanyl, Nitrous

A

d) Etomidate, Fentanyl, Nitrous

66
Q

TceMeps are best elicited using:

a) NMB-Partial
b) NMB-0/4 twitches
c) No NMB

A

c) No NMB

67
Q

TceMeps significant changes consist of :

a) 10% Increase in peak latency
b) Amplitude reduction or loss of responses
c) Absence of response only
d) 50% amp decrease & 10% latency increase

A

d) 50% amp decrease & 10% latency increase

68
Q

TceMeps contraindications consist of:

a) Seizure disorder
b) Cardiac History
c) Vagal nerve stimulator, cardiac history,& seizures
d) Pacemaker, skull opening, seizures

A

d) pacemaker, skull opening,& seizures

69
Q

Which scalp electrode functions as the cathode in TceMep stimulation?

A

-Ipsilateral to limb recorded

-Deletis Cz(anode) Fz(cathode)

70
Q

What muscle groups are most often used for TceMep recorded for surgeries involving the lumbar region?

A

-Quads, TA, Hallucis

-Some may use TA, MG, Hallucis

71
Q

What electrode do we use to recorded the D-Wave and I Wave in the TceMep recordings?

A

Epidural

72
Q

What is the origin of the D-Wave to TceMep stimulation?

A

Represent ‘Direct” excitation of the corticospinal tract neurons

73
Q

What is the origin of the I-Wave to TceMep stimulation?

A

Occur at periodic intervals: reflect “indirect” depolarization of the same axons

74
Q

List the recommended amp and stim settings for TceMep:

Sensitivity_____
BandPass_______
Analysis time______
Pulse_____
Inter-stim Interval_______

A

-Sensitivity: 10-200uv/div
-Bandpass :100-1000Hz
-Analysis time: 100ms
-Pulses: 1
-ISI:2-4ms

75
Q

What is the maximum stim intensity recommended for TceMep?

A

500V

76
Q

What does Deletis define as the interpretive value of a retention of at least 50% of the amplitude of the D-Wave?

A

-He warns at 30%
-Signs of descending spinal cord tract injury

77
Q

What is the criteria for alarm established by Calancie for TceMep?

A

If you need 100 volts or more than what the threshold is its considered an abnormality

78
Q

Cranial Nerves

A

Olfactory (CN I)
Optic (CN II )
Oculomotor (CN III)
Trochlear (CN IV)
Trigeminal (CN V)
Abducens (CN VI)
Facial (CN VII)
Vestibulochochelar (CN VIII)
Glossopharyngeal (CN IX)
Vegus (CN X)
Accessory (CN XI)
Hypoglossal (CN XII)

79
Q

Which Cranial Nerves are sensory only?

A

I,II,VIII, Total #3

-Olfactory
-Optic
-Vestibulocochlear

80
Q

Which Cranial Nerves are motors only?

A

III,IV,VI,XI,XII Total #5

-Oculomotor
-Trochlear
-Abducens
-Accessory
-Hypoglossal

81
Q

Which Cranial nerves are both sensory and motor?

A

V,VII,IX,X Total #4

-Trigeminal
-Facial
-Glossopharyngeal
-Vagus

82
Q

Which Cranial Nerves originate at the midbrain?

A

-III, and IV

-Oculomotor and Trochlear Nerves

83
Q

Which Cranial Nerves originate at the Pons?

A

-V, VI, and VII

-Trigeminal, Abducens, and Facial Nerves

84
Q

Which Cranial Nerves originate at the medulla?

A

-VIII, IX, X, XI, and XII

Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, and Hypoglossal

85
Q

What is the function of (CN I) Olfactory nerve?

A

Smell (anosmia)

86
Q

What is the function of (CN II) Optic nerve?

A

Vision ( anopsia)

87
Q

Which cranial nerves control eye movement?

A

III, IV, VI

88
Q

Which Cranial Nerve destination is the “Lateral Rectus Muscle”, and function is “affected eyeball cannot move laterally beyond midpoint”?

A

(CN VI) Abducens

89
Q

Which Cranial Nerve destination is “Muscles of Mastication” with functions of chewing and sensations for touch , pain, and temperature?

A

(CN V) Trigeminal

90
Q

Which of the following Cranial nerves has muscles of the tongue and function is swallowing, with movement of the tongue?

A

(CN XII) Hypoglossal

91
Q

Which of the following Cranial Nerves control the superior oblique muscle and function is movement of the eyeball (strabismus & diplopia)

A

(CN IV) Trochlear

92
Q

Which Cranial Nerve have muscles Obicularis Oculi, and Obicularis Oris with functions that control facial expressions, secretion of saliva and tears. Also with taste buds sensory of 2/3 anterior of the tongue?

A

(CN VII) Facial

93
Q

The stenocleidomastoid and trapezius muscles are destinations of which cranial nerve and also have functions of swallowing and head movement?

A

(CN XI) Accessory

94
Q

The superior rectus, medial rectus, inferior rectus, and inferior oblique muscles innervate which cranial nerve and function is movement of eyelid and eyeball?

A

(CN III) Oculomotor

95
Q

Damage of smooth muscle function that would interfere with speaking, swallowing, and the digestive system is caused by which cranial nerve?

A

(CN X) Vagus

96
Q

Which cranial nerve is routed through the internal auditory meatus and controls hearing and equilibrium?

A

(CN XIII) Vestibulocochlear

97
Q

The stylopharyngeus muscle is controls by which cranial nerve that function salivation, and the taste buds 1/3 posterior of the tongue, Also regulation of blood pressure?

A

(CN IX) Glossopharyngeal

98
Q

ABR Montage

A
  • Cz-Ai
  • CZ-Ac
99
Q

What wave of ABR can be absent in normal patients?

A

Wave II

100
Q

What are the obligate peaks for ABR?

A

-I, III, and V
-2-2-4

101
Q

What is the active electrode and polarity of Wave I in the montage of the ABR?

A

Ai-negative

102
Q

What is the generator and artery which controls Wave I of the ABR?

A

-Distal Auditory Nerve
-Internal Auditory Artery

103
Q

What is the active electrode and polarity of Wave III of the ABR?

A

Cz-Positive

104
Q

Wave V of the ABR active electrode is___with a _____ polarity

A

Cz-Positive

105
Q

What is the generator and artery which controls Wave III of the ABR?

A

-Superior Olivary Complex
-Vertebral Artery (VBA)

106
Q

What is the generator and artery which controls Wave V of the ABR?

A

-Inferior Colliculus
-Vertebral Artery

107
Q

Excessive filtering can cause?

A

Phase shifts

108
Q

ABR Filter settings

A

Filters for ABR=
HFF:2500-3000 Hz
LFF:10-30 Hz
Sweeps 1000-4000
Analysis time 10-15ms
60 cycle out
Artifact reject enabled

109
Q

MN-PTN SSEP Montage

A

Cpc-Fz bipolar (cortical)
Cpi-Epc referential (sub-cortical)(Scalp to Noncephalic)
C5s-Epc referential (cervical)
Epi-Epc referential (Erb’s Point)

Cpz-Fpz bipolar (cortical)
Cpi-Fpz bipolar (cortical)
Fpz-C5s referential (sub-cortical)( scalp to Noncephalic)
LP (T12) referential (spinal)
Pfd-Pfp referential (popliteal fossa)

110
Q

What is the obligate peak, active electrode and polarity for Cpc-Fz

A

-N20
-Cpc
-negative

111
Q

N20 is what type of response that is generated from what part of the brain?

A

-Near-field
-Primary Sensory Cortex (post central gyrus)

112
Q

Which artery supplies N20?

A

Middle cerebral artery (MCA)

113
Q

Which is the obligate peak, active electrode, and polarity of Cpi-Epc

A

-P14-Cpi-Positive
-N18-Cpi-Negative

114
Q

N18 is a far-field response generated at the?

A

Brainstem/Thalamic

114
Q

What type of response is P14 and where is it generated?

A

-Far-field
-Caudal Medial Lemniscus

115
Q

P14 and N18 are supplied by which artery?

A

Vertebral Artery(VBA)

116
Q

What is the obligate peak, active electrode, and polarity of montage C5s-Epc?

A

-N13
-C5s
-Negative

117
Q

The generator for N13 is? And supplied by which vascular branch?

A

-Near-field, stationary response
-Spinal Cord
-Artery of Adamkewicz

118
Q

What is the obligate peak, active electrode, and polarity for montage Epi-Epc?

A

-N9
-Epi
-Negative

119
Q

What is the generator site for the N9 response? And what is the artery that supplies this response?

A

-Near-field propagated response
-Brachial plexus
-None

120
Q

What is the obligate peak, active electrode, and polarity for this montage in the lower SSEP, Cpz-Fpz?

A

-P37
-Cpz
-Positive

121
Q

What is the generator for P37 in the lower SSEP and is also supplied by which artery?

A

-Near-field, Primary Sensory Cortex
(post central gyrus)

Anterior Cerebral Artery

122
Q

What is the obligate peak, active electrode and polarity for montage Cpi-Fpz?

A

-P37
-Cpi
-Positive

123
Q

What is the obligate peak, active electrode, and polarity of montage Fpz-C5s in the lower SSEP?

A

-N34
-Fpz
-Negative

124
Q

N34 is a far-field response generated in the ________ and blood supplied from which artery?

A

Brainstem/Thalamic
Vertebral Artery (VBA)

125
Q

What is the Lumbar potential (LP) response active electrode, polarity and obligate peak?

A

-T12
-Negative
-N22

126
Q

What is the generator and vascular branch for the LP(T12) response?

A

-Near-field Stationary response
-Spinal Cord
-Artery of Adamkewicz

127
Q

What is the obligate peak, active electrode and polarity for montage PFd-PFp?

A

-N11
-PFd
-Negative

128
Q

What is the generator site and artery that supplies the N11 response?

A

-Near-field propagated response
-Posterior Tibial Nerve
-None

129
Q

Median Nerve -stimulators are placed?

A

-Between tendons of the palmaris longus/flexor radialis muscles.

-Stimulation causes thumb twitch (abduction)

130
Q

Ulnar Nerve –stimulators are placed?

A

Lateral to the flexor carpi radialis tendon

Stimulation causes (pinky twitch)

131
Q

Posterior Tibial nerve is located?

A

-Halfway between the medial border of the achilles tendon and posterior border to the medial malleolus (ankle bone)

-Stimulation causes Plantar Flexion (twitch) of the toes

132
Q

Peroneal nerve is located?

A

-Above the Fibular head

-Stimulation causes foot eversion(foot waving)

133
Q

Cathode: is negative and placed?

A

2cm Proximal to the anode

134
Q

Anode: is positive and placed?

A

2-3cm distal to cathode

135
Q

Facial Nerve stimulation is?

A

Cathode to anode

136
Q

With Sensitivity a larger number will result in?

A

A Smaller waveform

137
Q

With Gain a larger number will result in?

A

A Larger waveform

138
Q

What is the most common cause of unequal electrode impedance?

A

60Hz

139
Q

Pre-stimulus delay is?

A

Negative

140
Q

Post stimulus delay is

A

Positive

141
Q

What are the two main vascular branches that supply blood to the brain?

A

-Middle Cerebral Artery
-Anterior Cerebral artery

142
Q

What are the normal curves of the spine?

A

-Cervical Lordosis 20 to 40 degrees
-Thoracic Kyphosis or Kphotic curve: concave anterior and convex posterior 20 to 40 degrees
-Lumbar Lordosis or Lordotic curve: convex anterior and concave posterior 40 to 60 degrees

143
Q

What are the two major roots of the spinal cord?

A

-Dorsal Root (posterior)
Sensory (afferent)
Ascending Spinal Tracts (spinalthalamic)
Faciculus gracilis(medial dorsal columns) LMN
contributed by sacral/lumbar levels
Faciculus cuneatus (lateral dorsal columns)UMN
contributed by thoracic/cervical levels
Cross at pontine medial lemniscus
Medial lemniscus terminates in thalamus

-Ventral Root (anterior)
Motor (efferent)
Descending Corticospinal tract
90% cross midline in the pyramidal decussation
Terminates in the intermediate gray matter and emerge out the ventral cord

144
Q

What is the blood supply for the spinal cord?

A

-Anterior spinal artery supplies (ventral) 2/3 of the cord

-Two Posterior spinal arteries (dorsal) supplies 1/3 of the cord

145
Q

The greater concentration outside of a cell membrane?

A

Na+ (Sodium Ions)

146
Q

The greater concentration on the inside of a nerve cell is?

A

K+ (Potassium)

147
Q

Which afferent spinal pathway terminates at the thalamus?

A

Dorsal lateral (spinothalamic)

Prep (CNIM) (1 decks)

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