CNIM Final Exam Questions With Verified
Answers.
Platinum electrodes are ideal under what circumstances?
A)when high voltage stimulation is applied
B)when stimulating through the cranium
C)in guarding against neurotoxicity for direct stimulation or recording
D)in guarding against artifact for...
Platinum electrodes are ideal under what circumstances?
A)when high voltage stimulation is applied
B)when stimulating through the cranium
C)in guarding against neurotoxicity for direct stimulation or recording
D)in guarding against artifact for cortical recordings - answer✔C)in guarding against
neurotoxicity for direct stimulation or recording
In this image, the P31 brainstem potential is recorded by what electrode(s)?
A)Cv6
B)A2
C)Pz
D)Pz and Fz - answer✔D)Pz and Fz
The recording electrode is the first one in the montage (input I). Montage for P31: FPZ-C5s (far
field, Caudal Medial Lemniscus. Basilar Artery)
Where is the motor cortex?
In phase reversal, you look for the N20 as reference. This peak should point upwards if placed in
the somatosensory cortex, if it's downward (P20), then it is in the motor cortex.
Which of the following is NOT a bipolar SSEP recording montage?
A)Cpz-Fz
B)Cp3-Cp4
C)Cp3-Fpz
D)Fpz-Cs5 - answer✔D)Fpz-Cs5
Bipolar montage means both electrodes are on the scalp. If one of them is not on the scalp, then
it's a referential montage.
To eliminate crossover, ACNS guidelines suggest masking noise be set to ____.
A)60 db HL
B)60 dB SPL
C)75 dB HL
D)75 dB nHL - answer✔B)60 dB SPL
Or 30-35dBHL would have also being the correct answer.
When stimulating TES-MEPs from C3-C4, responses are mostly present on the patient's right
sided muscles. Where is the cathode?
TcMEP (TES-MEP) uses anodal stimulation, so anode at C3 (Left) = MEPs MOSTLY on the
RIGHT side of the body. Cathode would be on the opposite side at C4.
D waves:
A)Stimulated epidurally
B)More sensitive to ischemia than TcMEPs
C)Unaffected by muscle relaxant
D)Differentiate between Left and Right corticospinal tracts - answer✔C)Unaffected by muscle
relaxant
D waves are "direct" waves elicited by stimulation of the pyramidal neurons in the corticospinal
pathway. Conversely, I waves are "indirect" waves elicited by stimulation of interneurons in the
cortex which then synapse with pyramidal neurons and result in depolarization of the
corticospinal pathway in the spinal cord. D and I waves are recorded over the epidural space of
the spinal cord and are therefore unaffected by muscle relaxant and cannot clearly distinguish left
and right. D waves are also less sensitive to ischemia than muscle MEPs.
What modalities should you run for a MVD (Microvascular Decompression)?
A)BAER and CN EMG
B)SSEP and EEG
C)MEP and EEG
D)SSEP and MEP - answer✔A)BAER and CN EMG
These surgeries are performed to alleviate pressure on a cranial nerve from an offending vessel.
You should perform EMG from that cranial nerve. You also need to monitor the brainstem so
BAERs are great for that.
Which of the following techniques would be the most useful in IONM of a Left ACA aneurysm?
Don't be fooled on the pathway though and remember where the axons land in the longitudinal
fissure on the OPPOSITE side of stimulation. The are just best recorded ipsilateral to the side of
stim.
Which nerve innervates the Abductor Pollicis Brevis Muscle?
A)Radial
B)Median
C)Ulnar
D)Sural - answer✔B)Median
Which derivation is optimal for isolating brainstem potentials following median nerve
stimulation?
A)CS5 - FPZ
B)CPi - EPc
C)CS5 - EPc
D)CPc - EPi - answer✔B)CPi - EPc
To isolate cortical it would be CPc-CPi
With a signal to noise ratio of 1:2, averaging 64 responses will:
A)Reduce the noise by 50%
B)Not change the ratio
C)Improve the ratio to 8:1
D)Improve the ratio to 4:1 - answer✔D)Improve the ratio to 4:1
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