CNIM - ABRET Practice Exam Questions and Answers 2022/2023 Cavities inside the skull - ANSWER-Anterior/middle/posterior fossa
Cranial bones - ANSWER-Frontal, occipital, sphenoid, ethmoid (unpaired). Parietal & temporal (paired).
Mental protuberance - ANSWER-chin bone
MCA supply of the cerebral cortex - ANSWER-Hand + face/mouth/auditory
Cranial nerves - ANSWER--12 pairs (Mixed fibers: sensory/motor/both).
-Emerge @ irregular intervals from the brain.
-Nuclei displacement:
Motor = medial Sensory = lateral
Meckle's Cave - ANSWER-Depression in the medial middle fossa where CN V ganglion sits
Low frequency sounds - ANSWER-@ apex of cochlea
Area of spine w/ small pedicles, long spinous process, large inter-vertebral foramen - ANSWER-Thoracic
Neuroforamen - ANSWER-Opening w/in the spinal canal for nerve roots to enter the SC
Firm outer layer of the disc - ANSWER-Annulus fibrosis
Syrinx - ANSWER-Fluid-filled cavity @ center of the SC
Spinal cord ends @ the level btwn: - ANSWER-L1-L2 vertebrae (Conus Medullaris)
Blood supply to the SC consists of: - ANSWER-1 ASA for both MEP tracts
Hydrostatic pressure - ANSWER-Depends on body position
Structural functional anatomy may be altered by: - ANSWER-Previous lesions, current, plasticity, pressure
Glia cell - ANSWER-Comes from the Greek word "glue"
Large diameter nerve fiber (vs. small diameter) - ANSWER--Recruited 1st w/ INC'd stim intensity -Higher conduction velocity
-More vulnerable to hypoxia & pressure Δ's
Synaptic transmission, and/or Δ's in thalamocortical projections, produce - ANSWER-
Cortical potentials
Peripheral nerve sensitivity - ANSWER-Least sensitive to injury (more sensitive = SC grey/white mater, cortical grey matter)
Cavernous angiomas - ANSWER-Multi-lobulated lesions containing hemorrhage
Geriatric population: prevalence of temporal bone hyperostosis - ANSWER-10-15%
Presbycusis - ANSWER-High freq hearing loss; gradually occurs in older individuals
Most commonly injured CN - ANSWER-Facial nerve (VII)
Burst fracture - ANSWER--Break in the vertebra
-Failure of anterior & middle vertebral columns
-Caused by violent compressive event (fall, MVA)
Excessive neck flexion in sitting position - ANSWER-Quadraparesis (due to ischemia in upper T-spine)
Lhermittes Sign - ANSWER-Shocking sensation that occurs throughout the body during neck flexion
Central Cord Syndrome (CCS) - ANSWER--Sacral sparing
-Loss of sensory/motor fx @ level of injury
-Disruption of grey matter
(+) Babinski Sign could indicate - ANSWER--severe [UMN] SC trauma
-abnml PTN SSEPs
Hoffman's Reflex (1918) - ANSWER-Palmar flexion of the thumb when the distal phalanx of the middle finger (of the same hand) is rapidly stroked
A nml curve of the lumbar spine taking place @ 1-2 y/o - ANSWER-Kyphosis
Scoliosis progression in peds - ANSWER-More likely in girls > boys
Apraxia - ANSWER-Difficulty w/ skilled mvmnts
Neurapraxia - ANSWER-PNS disorder: blockage of sensory + motor nerve conduction (w/o axonal damage) INC venous pressure leads to - ANSWER--venous congestion; DEC drainage of nml veins; chronic hypoxia
-NOT hypotension
common source of air embolism introduction into the blood supply - ANSWER-Superior sagittal sinus
MAC is approximated by the effect of anesthesia on - ANSWER-H-reflex (mvmnt when stimulated)
Sevo/Des/N2O - ANSWER-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? - ANSWER-N2O
N2O - ANSWER--synergistic IONM effects when mixed w/ Iso --> depressed IONM
-weak anesthetic agent
-causes ~75% DEC in SSEP amplitudes
Desflurane - ANSWER--affects NMJ --> enhances effect of NMBs
-no effect on MEP CMAPs
-eliminates most rapidly
Isoflurane 1.7% - ANSWER-may result in burst suppression
TIVA MoA on pt mvmnt - ANSWER-Glycine receptor blocking in the SC
Which is not a major MoA of the usual anesthetic agents that affect IONM? - ANSWER-
Inhibition of nerve conduction velocity
EP modality most affected by propofol - ANSWER-Mid-latency auditory response
Ketamine - ANSWER-(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 - ANSWER-(GABA agonist)
-SSEP/BAER = INC latency
-EEG = slowing
Etomidate - ANSWER-(GABA agonist)
-SSEP/MEP: INC amp
-EEG: slowing
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