Review Flashcards
(148 cards)
1
Q
Which anesthetic agent may precipitate electric seizure activity?
A
Enflurane & Brevital may also cause seizures
2
Q
What does the transcranial doppler measure?
A
Cerebral Blood Flow
3
Q
At what rate of CBF dose the EEG slow?
A
Increase
4
Q
What is the resting membrane potential of a neuron?
A
-70mv
5
Q
Name two bloodborne pathogens
A
Hepatitis B
HIV
6
Q
When passing a person who is sterile:
A
The person who is sterile should pass with his/her back toward you.
7
Q
Name one airborne pathogen:
A
TB
8
Q
Name the most common disease process which is resistant to decontamination and sterilization?
A
CJD
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
10
Q
What part of the surgical attire are sterile?
A
-In front waste up to neckline
-Elbows down
11
Q
When is “baseline” recording taken?
A
Post incision, balanced anesthesia
12
Q
What additional surgical gear is necessary when working with TB patients?
A
HEPA respirator
13
Q
Horizontal resolution defines which aspect of the EEG?
A
Frequency
14
Q
Vertical resolution defines which aspect of the EEG
A
Amplitude
15
Q
Which feature on the EEG or EP equipment affect horizontal resolution?
A
Frequency
16
Q
What is Nyquest Frequency?
A
The sampling rate should be at least twice the frequency being recorded.
17
Q
What is Aliasing?
A
Result in inadequate sampling rate.
18
Q
What is the calculation of sampling rate?
A
of sampling points
______________________ = sampling rate
Analysis Time
19
Q
What is Inter-Sampling Interval or Dwell time?
A
Space “between” data points
20
Q
Which feature on the EEG or the EP equipment affects vertical resolution?
A
Sensitivity
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
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.
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
24
Q
Should the electrode impedance of the amplifier be high or low compared with that of the recording electrodes?
A
High
25
Does the LFF introduce a Phase lead or Phase lag
.1Hz-------\__/-----
.3Hz------\__/----
1Hz-----\__/------ (shortens)
Phase lead
26
Does the HFF introduce a Phase lead or Phase lag
~~~~~\ 3000 Hz
~~~~~~\ 2000Hz
~~~~~~~\ 1000 Hz (prolong)
Phase lag
27
What is the most common cause of 60 cycle artifact?
Uneven or unbalanced electrodes
28
Calculate the number of oscillations representing 60 Hz artifact for each epoch
AEP 10ms ______
SEP 100ms ______
SEP 50ms _______
Multiply by .06
AEP=0.6
SEP= 6
SEP=3
29
What type of artifact is 16.66ms ?
60 cycle
30
What is Pre-Stimulus Delay (negative) and its function?
-Includes a period of time before recording
-Estimate noise environment
31
What is Post Stimulus Delay (positive) and its function?
-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.
32
What is the function of artifact rejection?
-Excludes activity outside a predetermined range
33
What type of monitoring validates the function of the Circle Of Willis?
EEG
34
What two main types of EEG abnormalities are noted with a patient needing a shunt in endarterectomy surgery?
-Decrease in amplitude unilateral (ipsilateral) to the surgical site
-Increase in slow waves
“ After clamp is released”
35
What is the difference between EEG Monitoring and EEG Testing in the OR?
-Monitoring is provided by a technologist and gives descriptions only.
-Testing is performed by the surgeon
36
What are the recommended setting for EEG in the OR?
Sensitivity______
HLF _____
60 Hz ______
LLF ______
paper speed_____
Sensitivity=3uv/mm
HLF = 70Hz
60Hz= In
LLF=0.3sec
Paper speed=15mm/sec
37
CSA is defined as?
-Compressed spectral array
-Y-Axis: power amp 2/2
-X-Axis: Frequency
38
DSA is defined as?
-Density Spectral Array
-Color representation or gray scale
-Represents EEG power at each frequency in each epoch
39
Spectral Edge frequency?
-Highest signal frequency present in the recorded EEG spectrum for each epoch
-Usually set to 90-97%
40
Where is the lumbar potential (LP) generated and is it a stationary or propagated potential?
-Spinal cord
-Stationary
41
Where is the lumbar potential (LP) maximal along the spinal column?
T12
42
What type of montage best displays the P31 & N34?
Fz-C5
43
In the Fz-C5s channel,the active electrode which lies above the generator for P31 and N34 is?
Fz
44
Which obligate peak of the lower SEP is an analog of the median nerve P14 response?
P31
45
Which obligate peak of the lower SEP is an analog of the median nerve N18 response?
N34
46
What effect dose inhaled halogenated anesthetic gases have on the P31 & N34 responses?
None
47
What affect do inhalation agents have on the P37?
-Decreased amplitude
-Increased latencies
48
Utilizing a rate of 18/sec for lower SEP will affect which of the following:
-Latency by 20%
-Amplitude by 80%
-Latency and Amplitude
Latency & Amplitude
49
What effect does a fast rate have on spinal responses?
None
50
What effect does halogenated agent have on spinal responses?
-Increase in latency
-Decrease in amplitude
51
What is the recommended placement of the spinal electrodes?
-Under the Lamina Arch on the Dura
52
What is the recommended metal composition of the epidural electrode?
-Platinum
53
Why is platinum used for epidural spinal electrodes placed in the field when used for stimulation?
Because other metals can become toxic when current is applied
54
Which of the following tracts is not affected by Desflurane:
a) Pyramidal Tracts
b) Ventral Tracts
Pyramidal Tracts
55
Which of the following peaks is most affected by Propofol?
a) P31
b) EP
c) P37
d) N18
d) N18
56
Where does the ascending responses decussate?
At the medulla
57
Which of the following pathways is associated with motor function?
a) Dorsal
b) Pyramidal
c) Anterior columns
b) Anterior Column
58
Upper motor neuron extend from:
a) Ventral Horn to Peripheral neurons
b) Precentral gyrus to ventral horn
c) Post central gyrus to dorsal column
b) Precentral gyrus to ventral horn
59
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) Ventral Horn to Peripheral neurons
60
Upper motor neuron injury results in:
a) Flaccidity
b) Spasticity
c) Paralysis
d) Paresis
b) Spasticity
61
Lower motor neuron injury result in:
a) Flaccidity
b) Spasticity
c) Paralysis
d) Paresis
a) Flaccidity, Atrophy
62
SSEP assess function of:
a) Ventral Columns
b) Dorsal Columns
c) Descending Columns
d) Pyramidal Tracts
b) Dorsal Columns
63
CMAPs represent waveforms elicited by:
a) Cortex
b) Nerve
c) Muscle
d) Subcortex
c) Muscle
64
CNAPs represent waveform elicited by:
a) Cortex
b) Nerve
c) Muscle
d) Subcortex
b) Nerves
65
TceMeps are best elicited using:
a) Versed, Fentanyl, Desflurane
b) Propofol, Fentanyl, Isoflurane
c) Desflurane, Fentanyl, Nitrous
d) Etomidate, Fentanyl, Nitrous
d) Etomidate, Fentanyl, Nitrous
66
TceMeps are best elicited using:
a) NMB-Partial
b) NMB-0/4 twitches
c) No NMB
c) No NMB
67
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
d) 50% amp decrease & 10% latency increase
68
TceMeps contraindications consist of:
a) Seizure disorder
b) Cardiac History
c) Vagal nerve stimulator, cardiac history,& seizures
d) Pacemaker, skull opening, seizures
d) pacemaker, skull opening,& seizures
69
Which scalp electrode functions as the cathode in TceMep stimulation?
-Ipsilateral to limb recorded
-Deletis Cz(anode) Fz(cathode)
70
What muscle groups are most often used for TceMep recorded for surgeries involving the lumbar region?
-Quads, TA, Hallucis
-Some may use TA, MG, Hallucis
71
What electrode do we use to recorded the D-Wave and I Wave in the TceMep recordings?
Epidural
72
What is the origin of the D-Wave to TceMep stimulation?
Represent ‘Direct” excitation of the corticospinal tract neurons
73
What is the origin of the I-Wave to TceMep stimulation?
Occur at periodic intervals: reflect “indirect” depolarization of the same axons
74
List the recommended amp and stim settings for TceMep:
Sensitivity_____
BandPass_______
Analysis time______
Pulse_____
Inter-stim Interval_______
-Sensitivity: 10-200uv/div
-Bandpass :100-1000Hz
-Analysis time: 100ms
-Pulses: 1
-ISI:2-4ms
75
What is the maximum stim intensity recommended for TceMep?
500V
76
What does Deletis define as the interpretive value of a retention of at least 50% of the amplitude of the D-Wave?
-He warns at 30%
-Signs of descending spinal cord tract injury
77
What is the criteria for alarm established by Calancie for TceMep?
If you need 100 volts or more than what the threshold is its considered an abnormality
78
Cranial Nerves
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
Which Cranial Nerves are sensory only?
I,II,VIII, Total #3
-Olfactory
-Optic
-Vestibulocochlear
80
Which Cranial Nerves are motors only?
III,IV,VI,XI,XII Total #5
-Oculomotor
-Trochlear
-Abducens
-Accessory
-Hypoglossal
81
Which Cranial nerves are both sensory and motor?
V,VII,IX,X Total #4
-Trigeminal
-Facial
-Glossopharyngeal
-Vagus
82
Which Cranial Nerves originate at the midbrain?
-III, and IV
-Oculomotor and Trochlear Nerves
83
Which Cranial Nerves originate at the Pons?
-V, VI, and VII
-Trigeminal, Abducens, and Facial Nerves
84
Which Cranial Nerves originate at the medulla?
-VIII, IX, X, XI, and XII
Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, and Hypoglossal
85
What is the function of (CN I) Olfactory nerve?
Smell (anosmia)
86
What is the function of (CN II) Optic nerve?
Vision ( anopsia)
87
Which cranial nerves control eye movement?
III, IV, VI
88
Which Cranial Nerve destination is the “Lateral Rectus Muscle”, and function is “affected eyeball cannot move laterally beyond midpoint”?
(CN VI) Abducens
89
Which Cranial Nerve destination is “Muscles of Mastication” with functions of chewing and sensations for touch , pain, and temperature?
(CN V) Trigeminal
90
Which of the following Cranial nerves has muscles of the tongue and function is swallowing, with movement of the tongue?
(CN XII) Hypoglossal
91
Which of the following Cranial Nerves control the superior oblique muscle and function is movement of the eyeball (strabismus & diplopia)
(CN IV) Trochlear
92
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?
(CN VII) Facial
93
The stenocleidomastoid and trapezius muscles are destinations of which cranial nerve and also have functions of swallowing and head movement?
(CN XI) Accessory
94
The superior rectus, medial rectus, inferior rectus, and inferior oblique muscles innervate which cranial nerve and function is movement of eyelid and eyeball?
(CN III) Oculomotor
95
Damage of smooth muscle function that would interfere with speaking, swallowing, and the digestive system is caused by which cranial nerve?
(CN X) Vagus
96
Which cranial nerve is routed through the internal auditory meatus and controls hearing and equilibrium?
(CN XIII) Vestibulocochlear
97
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?
(CN IX) Glossopharyngeal
98
ABR Montage
- Cz-Ai
- CZ-Ac
99
What wave of ABR can be absent in normal patients?
Wave II
100
What are the obligate peaks for ABR?
-I, III, and V
-2-2-4
101
What is the active electrode and polarity of Wave I in the montage of the ABR?
Ai-negative
102
What is the generator and artery which controls Wave I of the ABR?
-Distal Auditory Nerve
-Internal Auditory Artery
103
What is the active electrode and polarity of Wave III of the ABR?
Cz-Positive
104
Wave V of the ABR active electrode is___with a _____ polarity
Cz-Positive
105
What is the generator and artery which controls Wave III of the ABR?
-Superior Olivary Complex
-Vertebral Artery (VBA)
106
What is the generator and artery which controls Wave V of the ABR?
-Inferior Colliculus
-Vertebral Artery
107
Excessive filtering can cause?
Phase shifts
108
ABR Filter settings
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
MN-PTN SSEP Montage
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
What is the obligate peak, active electrode and polarity for Cpc-Fz
-N20
-Cpc
-negative
111
N20 is what type of response that is generated from what part of the brain?
-Near-field
-Primary Sensory Cortex (post central gyrus)
112
Which artery supplies N20?
Middle cerebral artery (MCA)
113
Which is the obligate peak, active electrode, and polarity of Cpi-Epc
-P14-Cpi-Positive
-N18-Cpi-Negative
114
N18 is a far-field response generated at the?
Brainstem/Thalamic
114
What type of response is P14 and where is it generated?
-Far-field
-Caudal Medial Lemniscus
115
P14 and N18 are supplied by which artery?
Vertebral Artery(VBA)
116
What is the obligate peak, active electrode, and polarity of montage C5s-Epc?
-N13
-C5s
-Negative
117
The generator for N13 is? And supplied by which vascular branch?
-Near-field, stationary response
-Spinal Cord
-Artery of Adamkewicz
118
What is the obligate peak, active electrode, and polarity for montage Epi-Epc?
-N9
-Epi
-Negative
119
What is the generator site for the N9 response? And what is the artery that supplies this response?
-Near-field propagated response
-Brachial plexus
-None
120
What is the obligate peak, active electrode, and polarity for this montage in the lower SSEP, Cpz-Fpz?
-P37
-Cpz
-Positive
121
What is the generator for P37 in the lower SSEP and is also supplied by which artery?
-Near-field, Primary Sensory Cortex
(post central gyrus)
Anterior Cerebral Artery
122
What is the obligate peak, active electrode and polarity for montage Cpi-Fpz?
-P37
-Cpi
-Positive
123
What is the obligate peak, active electrode, and polarity of montage Fpz-C5s in the lower SSEP?
-N34
-Fpz
-Negative
124
N34 is a far-field response generated in the ________ and blood supplied from which artery?
Brainstem/Thalamic
Vertebral Artery (VBA)
125
What is the Lumbar potential (LP) response active electrode, polarity and obligate peak?
-T12
-Negative
-N22
126
What is the generator and vascular branch for the LP(T12) response?
-Near-field Stationary response
-Spinal Cord
-Artery of Adamkewicz
127
What is the obligate peak, active electrode and polarity for montage PFd-PFp?
-N11
-PFd
-Negative
128
What is the generator site and artery that supplies the N11 response?
-Near-field propagated response
-Posterior Tibial Nerve
-None
129
Median Nerve -stimulators are placed?
-Between tendons of the palmaris longus/flexor radialis muscles.
-Stimulation causes thumb twitch (abduction)
130
Ulnar Nerve –stimulators are placed?
Lateral to the flexor carpi radialis tendon
Stimulation causes (pinky twitch)
131
Posterior Tibial nerve is located?
-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
Peroneal nerve is located?
-Above the Fibular head
-Stimulation causes foot eversion(foot waving)
133
Cathode: is negative and placed?
2cm Proximal to the anode
134
Anode: is positive and placed?
2-3cm distal to cathode
135
Facial Nerve stimulation is?
Cathode to anode
136
With Sensitivity a larger number will result in?
A Smaller waveform
137
With Gain a larger number will result in?
A Larger waveform
138
What is the most common cause of unequal electrode impedance?
60Hz
139
Pre-stimulus delay is?
Negative
140
Post stimulus delay is
Positive
141
What are the two main vascular branches that supply blood to the brain?
-Middle Cerebral Artery
-Anterior Cerebral artery
142
What are the normal curves of the spine?
-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
What are the two major roots of the spinal cord?
-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
What is the blood supply for the spinal cord?
-Anterior spinal artery supplies (ventral) 2/3 of the cord
-Two Posterior spinal arteries (dorsal) supplies 1/3 of the cord
145
The greater concentration outside of a cell membrane?
Na+ (Sodium Ions)
146
The greater concentration on the inside of a nerve cell is?
K+ (Potassium)
147
Which afferent spinal pathway terminates at the thalamus?
Dorsal lateral (spinothalamic)
