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SSEP

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Certificate Practice Quizzes Quiz on SSEP, created by eds neuro on 15/03/2016.
eds neuro
Quiz by eds neuro, updated more than 1 year ago
eds neuro
Created by eds neuro almost 10 years ago
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Resource summary

Question 1

Question
Peak N13 is recorded from the:
Answer
  • cuneate nucleus
  • medial lemniscus

Question 2

Question
Peaks to identify pre and post central gyrus respectively are:
Answer
  • N20, P25
  • P22, N20

Question 3

Question
What is the analysis time for median SSEPs?
Answer
  • 50 msec
  • 100 msec

Question 4

Question
What is the best recording montage for P31?
Answer
  • Cv5-Fpz
  • Cv5-hand

Question 5

Question
What is asynchronous stimulation?
Answer
  • stimulation with delay
  • stimulating two different nerves

Question 6

Question
When doing asynchronous stimulation for intra-operative SSEPs, it is:
Answer
  • difficult to differentiate between left and right side responses
  • easy to differentiate between left and right side responses

Question 7

Question
According to the guidelines, P37 is a:
Answer
  • near field response
  • far field response

Question 8

Question
When performing a C5-C6 vertebral body fusion, what SSEP montages give the most information?
Answer
  • Ulnar- median
  • Posterior tibial -median

Question 9

Question
P14 is defined as a far-field response from the:
Answer
  • Caudal medial lemniscus
  • brainstem

Question 10

Question
If you are missing Erb's point and N20 responses during your median nerve SSEP recordings, what could be the cause?
Answer
  • increasing of inhalational agents
  • peripheral stimulation problem

Question 11

Question
Where do you place the active popliteal-fossa electrode?
Answer
  • lateral to the crease behind the knee
  • distal to crease behind the knee

Question 12

Question
When stimulating the posterior tibial nerve at the ankle, where do you monitor for TOF?
Answer
  • tibialis anterior
  • abductor hallucis

Question 13

Question
During an anterior cervical discectomy, a loss of N20 but preservation of N13 is consistent with:
Answer
  • spinal cord damage
  • compression of carotid

Question 14

Question
During a L4 vertebral body fusion what modalities are the most informative?
Answer
  • triggered EMG -post tibial SSEP
  • median SSEP- post tibial SSEP

Question 15

Question
Which of the following montages would be good for using a multiply time base?
Answer
  • median and Ulnar SSEPs
  • BAER and median

Question 16

Question
If you need to monitor the C7 vertebrae, what nerve would be most appropriate?
Answer
  • median
  • Ulnar

Question 17

Question
Which of the following conditions would most likely affect tibial nerve SSEPs?
Answer
  • ataxia
  • diabetes

Question 18

Question
If you have changes in the right ulnar SSEP response, and the surgery is thoracic, what could be happening?
Answer
  • positioning effect
  • thoracic spine manipulation

Question 19

Question
When doing language mapping on the cortex, what's the most common way it's done?
Answer
  • direct cortical stimulation with an awake patient
  • direct cortical stimulation with a patient under general anesthesia

Question 20

Question
What waveforms are recorded off the pre-central and post-central gyrus respectively?
Answer
  • P22 and N20
  • N20 and P25

Question 21

Question
What could be the problem with synchronous stimulation?
Answer
  • unable to detect unilateral changes
  • painful for the patient

Question 22

Question
What is the optimal stimulating rate for SSEPs?
Answer
  • 3.7
  • 15.1

Question 23

Question
If cortical responses are lost, what will you do next?
Answer
  • look at the second cortical
  • check stimulation electrodes

Question 24

Question
What will be a false positive data?
Answer
  • abnormal changes is your data
  • changes in data, but no deficits post-operatively

Question 25

Question
What will be a false negative data?
Answer
  • no changes in data but patient has post-operative deficits.
  • changes in data but no deficits post-operatively

Question 26

Question
Positioning changes in SSEP will be represented by:
Answer
  • loss of contralateral erb's, cervical, and cortical responses
  • loss of ipsilateral erb's, contralateral cervical and cortical responses

Question 27

Question
Somatosensory evoked potentials are most likely to be highly variable and less reliable in patients with
Answer
  • a tethered spinal cord
  • neuromuscular disease

Question 28

Question
Which of the following evoked potential test would have the highest rate of abnormalities in patients with MS?
Answer
  • BAEP
  • SEP of the lower extremity

Question 29

Question
What is the application of the 10-20 system most appropriate for?
Answer
  • landmarks for electrodes
  • placement of Queens Square electrode array

Question 30

Question
Which of the following evoked potentials has the most critical electrode placement?
Answer
  • post tibial SSEP
  • cognitive EP

Question 31

Question
Where would you record P37?
Answer
  • Cpz
  • Cpc

Question 32

Question
Using a recording montage of Fpz to a non-cephalic reference, what is the best description of N14?
Answer
  • near-field potential
  • propagated potential

Question 33

Question
If you have a pre-stimulus "negative" delay of 15 ms and a time base of 45 ms, 15 ms will be displayed:
Answer
  • before the stimulus and 30 ms after.
  • after the stimulus and 30 ms after.

Question 34

Question
Which one of the following is most likely to cause a false negative for a thoracolumbar fusion?
Answer
  • bilateral synchronous stimulation of posterior tibial nerve.
  • bilateral asynchronous stimulation of peroneal nerve at the knee.

Question 35

Question
What is an advantage of synchronous stimulation?
Answer
  • maximal response
  • easy setup

Question 36

Question
If you lose EP and N20 in median SSEP, what is the first thing you should check?
Answer
  • arm position
  • increase in anesthesia

Question 37

Question
If you lose EP in median SSEP, what is the first thing you should check?
Answer
  • integrity of stimulation and recording electrodes
  • recent surgical manipulations

Question 38

Question
If, while monitoring a thoracolumbar procedure, over the past three hours, there is a steady decrease in bilateral P37 with stable P31 , what should you do?
Answer
  • continue to monitor P31
  • increase stimulation intensity

Question 39

Question
If you are unable to acquire a motor twitch, what is the preferred method of assuring maximal stimulation?
Answer
  • increase stimulation to maximum
  • increase stimulation until Erb's point potential is at a maximum

Question 40

Question
If your cortical SSEP is small in amplitude, what is the preferred method to increase the response?
Answer
  • increase rep rate
  • increase intensity

Question 41

Question
What is the purpose of an SSEP epidural electrode placed caudal to the surgical site?
Answer
  • to verify the adequacy of stimulation
  • to record a motor action potential

Question 42

Question
What is the purpose of pre-operative SSEP data?
Answer
  • to detect abnormalities
  • to use for intra-operative comparison

Question 43

Question
During a C5-7 ACDF, what are optimal SSEP stimulation sites?
Answer
  • ulnar and posterior tibial
  • median and peroneal at the knee

Question 44

Question
Posterior tibial nerve SSEP would be used over median nerve SSEP for an aneurysm of which artery?
Answer
  • middle cerebral
  • anterior cerebral

Question 45

Question
SSEPs would be best used for which of the following?
Answer
  • scoliosis correction
  • trans sphenoidal resection of adenoma

Question 46

Question
When recording scalp SSEP, the signal is transmitted primarily through the:
Answer
  • dorsal column ipsilateral to stimulation
  • spinothalamic pathway contralateral to stimulation

Question 47

Question
Which of the following EPs is a combination of near-field and far-field potentials?
Answer
  • SSEPs
  • half-field pattern reversal

Question 48

Question
When setting up stimulation electrodes for posterior tibial nerve SSEP, it is important to:
Answer
  • never wrap tape all the way around the ankle or limb
  • avoid using stress loops

Question 49

Question
What obligatory peak is missing?
Image:
7dcfcfea-0c95-46cd-8434-450dd615760c (image/jpeg)
Answer
  • N20
  • N13

Question 50

Question
What is the most likely cause for the missing peak?
Image:
b1255312-01b8-41fb-acb2-fb2c0bbc0c38 (image/jpeg)
Answer
  • right parietal lesion
  • brachial plexopathy

Question 51

Question
What peak falls at 46.67?
Image:
f7874cc5-1dd7-4860-96b9-f7d372c240c4 (image/jpeg)
Answer
  • P37
  • N20

Question 52

Question
What peak falls at 39.71?
Image:
aa5580fb-d4cd-4cd8-a40b-a2d6d65304d2 (image/jpeg)
Answer
  • P31
  • N14

Question 53

Question
What channel gives you the best recording of the peak at 30.04?
Image:
7af62d0f-ad0a-4c94-b990-3dd148dc364f (image/jpeg)
Answer
  • scalp-neck
  • scalp-scalp

Question 54

Question
What are the inactive channels?
Image:
a0d0e712-7846-4876-b663-ee306e45e21e (image/jpeg)
Answer
  • Cz' - Cv5
  • Fpz- REP

Question 55

Question
Where is the phase reversal?
Image:
54eb1324-fa22-4a50-aea7-41d035566992 (image/jpeg)
Answer
  • 4E and 4D
  • 4D and 4C

Question 56

Question
What channel represents the primary sensory cortex?
Image:
cc27c62b-7011-4599-ba66-e433d9a349d9 (image/jpeg)
Answer
  • 4C
  • 4D

Question 57

Question
What area are 4D and 4E over?
Image:
30e3686b-ef21-46f4-9509-add49d754c3d (image/jpeg)
Answer
  • pre-central gyrus
  • somatosensory cortex

Question 58

Question
What is the maximal recommended stimulation duration for lower SSEPs?
Answer
  • 300 us
  • 600 us

Question 59

Question
Stimulation of the median nerve and direct cortical recording for phase reversal is used to locate the:
Answer
  • sensorimotor cortex
  • central Sulcus

Question 60

Question
What is the interval time between P14 and N20?
Answer
  • CCT
  • dwell

Question 61

Question
The initial negative activity appearing at the scalp (between 16-19 ms) from the stimulation of the upper extremity is thought to be generated by the:
Answer
  • thalamus
  • precentral gyrus

Question 62

Question
Synaptic transmission and/or changes in the thalamocortical projections are believed to produce:
Answer
  • cortical potentials
  • the P100 potential

Question 63

Question
Stimulation of the median nerve at the wrist in a normal adult will elicit:
Answer
  • a primary cortical response at about 20 msec
  • an Erb's point response at about 15 msec

Question 64

Question
Generator sites are typically deep within anatomic structures. Most EPs are considered to be:
Answer
  • far-field responses
  • steady state potentials

Question 65

Question
SSEP recordings are thought to be generated by which of the following sensory tracts?
Answer
  • posterior columns and medical lemniscus
  • lateral geniculate

Question 66

Question
When recording a posterior tibial nerve SSEP, the Fpz-C5s channel records:
Answer
  • sub cortical far-field potentials
  • sub cortical near-field potentials

Question 67

Question
When recording from LP-IC, the latency of the peak is:
Answer
  • 12 ms
  • 22 ms

Question 68

Question
An advantage of referential recordings as opposed to bipolar recording of spinal cord somatosensory evoked potentials is:
Answer
  • less invasion of the surgical field
  • avoiding cancellation of the potentials

Question 69

Question
The median nerve SSEP can also be helpful as a measure of:
Answer
  • cerebral blood flow
  • lower spinal cord function

Question 70

Question
A patient is admitted to the operating room diagnosed with a burst fracture of the L1 vertebra. The most appropriate nerve(s) to monitor would be the:
Answer
  • posterior tibial and ulnar nerves
  • posterior tibial and peroneal nerves

Question 71

Question
During micro vascular decompression (MVD) of the trigeminal nerve, the monitoring of median nerve SSEPS will demonstrate the:
Answer
  • effect of retractor placement on the cochlear and vestibular nerves
  • integrity of the somatosensory system traversing brainstem structure

Question 72

Question
The intensity of stimulation should be adjusted to:
Answer
  • sensation level
  • produce a minimal movement at the joint involved

Question 73

Question
The filter settings optimal for recording a median nerve somatosensory evoked potential is:
Answer
  • 5-1000
  • 20-3000

Question 74

Question
When you experience 60 Hz noise on one of your channels due to a loose electrode, whose position is blocked by the sterile field , what should you do?
Answer
  • remove that channel from further recordings
  • switch to your backup electrode

Question 75

Question
Why is braiding wires beneficial?
Answer
  • reduces ambient noise
  • decreases CMRR

Question 76

Question
Both SSEP and BAEP waveforms can be affected by structural manipulation using:
Answer
  • retractors
  • suction

Question 77

Question
During lumbar interbody fusion using cage modalities to monitor are:
Answer
  • upper and lower SSEPs
  • lower SSEPs and s-EMG

Question 78

Question
Peripheral conduction time is between:
Answer
  • N9-P14
  • N9-N20

Question 79

Question
Central conduction time for posterior tibial SSEP is:
Answer
  • LP- P37
  • P31-P37

Question 80

Question
Supra-maximal stimulation can be confirmed by the amplitude of:
Answer
  • peripheral responses
  • cortical responses

Question 81

Question
The peak labeled as 'A' is also known as:
Image:
9f42487a-45db-4fcc-80c1-92060ca018e4 (image/jpeg)
Answer
  • N20
  • N30

Question 82

Question
The peak labeled as 'B' is also known as:
Image:
b398d190-354c-415d-83cc-95ca6ed77ec9 (image/jpeg)
Answer
  • P30
  • N20

Question 83

Question
The peak labeled as 'C' is also known as:
Image:
31a6ef98-e473-4a2a-814a-5f33f7f1a5b6 (image/jpeg)
Answer
  • P31
  • P14

Question 84

Question
The peak labeled as 'D' is also known as:
Image:
1c33abb0-99e8-400b-844c-246f468e07d9 (image/jpeg)
Answer
  • N9
  • P10

Question 85

Question
The SSEP traces are recorded for the:
Image:
83b1ad3d-eef3-4d47-b7fa-30d72ab4948f (image/jpeg)
Answer
  • left median
  • left ulnar

Question 86

Question
The second trace in the recording is the:
Image:
6e5ca5e7-6af2-4201-838a-ebff5ae5624a (image/jpeg)
Answer
  • cortical response
  • transcortical response

Question 87

Question
What is the probable cause of changes in the data in the picture below?
Image:
d74bbb96-dd1e-4291-8490-e20c25ed535e (image/jpeg)
Answer
  • anesthesia
  • temperature

Question 88

Question
Peroneal nerve stimulation can be performed at the:
Answer
  • lateral malleolus
  • fibular head

Question 89

Question
Amplitude of the scalp SSEP responses is:
Answer
  • 0.1-10 uV
  • 10-100 uV

Question 90

Question
For peroneal nerve SSEP stimulation, the ground should be at the:
Answer
  • calf
  • thigh

Question 91

Question
During upper extremity SSEP recording the Erb's point electrode records the activity from the:
Answer
  • brachial plexus
  • lumbar plexus

Question 92

Question
During PTN stimulation, if there is a change in cz· -Fpz cortical response, which other montage should be used to confirm the change?
Answer
  • CPc- CPi
  • Cv5- Fpz

Question 93

Question
Monitoring only SSEP may fail to recognize the changes in:
Answer
  • ascending spinal cord tracts
  • anterior spinal cord function

Question 94

Question
A dermatome is a:
Answer
  • patch of skin that sends pain information via single nerve roots through the spinal cord
  • specific stimulus site for SSEP recordings

Question 95

Question
If the body temperature of a patient drops to 29 degree C it will cause:
Answer
  • decrease in latencies with a decrease in amplitude
  • increase in latencies with a decrease in amplitude

Question 96

Question
If there is a rapid loss of cortical responses with consistent subcortical responses, the cause will be:
Answer
  • anesthesia
  • blood loss

Question 97

Question
The rationale for monitoring popliteal fossa recording during a thoracic spine surgery is to:
Answer
  • limit chassis leakage
  • verification of adequacy of stimulation

Question 98

Question
Hypothermia of the lower extremities will result in:
Answer
  • increased P31 -P37 1atency
  • prolonged peripheral conduction time

Question 99

Question
Nerves to be used for SSEP monitoring intra-operatively depends upon the:
Answer
  • surgical procedure
  • surgeon

Question 100

Question
What should be reported to the surgeon during a surgical procedure?
Answer
  • Loss of responses
  • Change is electrode impedance
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