Transcription

1 1. What are the 2 types of nervous tissue? 2. What are types of neuroglia? 3. What are the 3 main parts of a neuron? 4. What are afferent and efferent messages in the nervous system? 5. What s the difference b/t white and grey matter? 6. What s ortho- vs. antidromic 7. Why are receptors called selective transducers? 8. Memorize conduction speed with receptors. a. What does myelin have to do with conduction speed? 9. At rest, what is the intra- and extracellular makeup of sodium and potassium? a. What is resting membrane potential? b. What happens with a strong depolarization? 10. What are the steps from a cell at rest through hyperpolarization? 11. How is an action potential conducted in a neuron? 12. What s the all-or-none law when talking about AP s? a. What is the purpose of refractory period? b. What s the difference between absolute and relative refractory period? 13. What s the difference between contiguous conduction and saltatory conduction? 14. What happens in action potentials when we stimulate at 110% threshold? a. How is this different in receptors? 15. Explain movement through a graded potential. 16. What s the difference b/t graded and action potentials? 17. How do graded responses affection action potentials? 18. Why should we stimulate at supramax intensity? 19. What are the general function of glutamate, GABA and Ach in the nervous system? 20. Review how a neuron goes from quiet to active. 21. Describe synaptic transmission. 22. What s the difference b/t spatial and temporal summation? 23. Example 24. Describe saltatory conduction 25. Describe how myelin speeds up conduction.

2 26. Describe how myelin lowers resistance to increase conduction velocity. 27. Example of continuous vs. saltatory a. What is the conduction speed of the PNS vs. the auditory system? 28. What electrodes are needed to record a potential? 29. How is an electrode like ½ a battery? a. What metals are good to use for recording? 30. Why do you need to use the same electrodes for recording? 31. What s the purpose of an electrode? a. Why is Ag-AgCl a good choice as an electrode b. What direction does current and electrons flow? 32. How should the anode and cathode be placed for SSEP? a. What is the relationship of electrode surface area and impedance? b. If threshold of a nerve fiber is reached, why might there be an increase in amplitude if you increase the stim intensity? 33. What is anodal blocking? 34. Where should MN and UN electrodes be placed? 35. What are some alternative places? 36. What are the abbreviations of the system? a. What side has odd # s? b. What does the 10 and 20 of the system stand for? 37. What s the difference b/t a bipolar and referential setup? 38. Example 39. List the 5 different ways waves are recorded in SSEP from generator points. 40. What s the difference b/t a traveling and a stationary wave? 41. Is each generator point from 1 source? 42. How Is A Potential Is Recorded That Causes Polarity Change In A Near-Field Response In White Matter? 43. What s the difference b/t near and far-field? 44. Example 45. Are there any differences in near and far-field potentials in white and gray matter?

3 46. Describe a negative and positive peak. 47. What are the UE SSEP generator points? 48. What are the obligate peaks? 49. Erb s point 50. Cervical response 51. P14 response 52. What does different electrode positions do to the P14 response? 53. N N P Can there be recording issues in people with phantom limb pain, aside from part of the limb missing to stimulate? 57. Summarize UE SSEP pathway. 58. Summarize UE SSEP stimulation from nerve to recording in the cortex. 59. What s the alarm criterion for a significant change in UE SSEP? 60. What are some parts of the ACDF that might be problematic for the nervous system? 61. What do SSEP look like in pts with severe sensory neuropathies? a. Why does this happen? 62. Examples of lesions and SSEP recordings 63. How does conduction velocity change as we age? 64. How does temperature affect SSEP? 65. Example 66. When would you consider MEP or EMG for ACDF cases? 67. MEPs and ACDF 68. Describe the setup for dermatonal SSEPs 69. What is the stimulating and recording parameter for DSSEP? a. Should we use these more often? b. Are they reliable? 70. For LE SSEP, what is the # of trials, analysis time, pulse width, stim rate, stim intensity, impedance, and bandpass? 71. Where should you stimulate the posterior tibial nerve for LE SSEP?

4 72. How can you stimulate the peroneal nerve? 73. What s the blood supply to the lumbosacral plexus? 74. What supplies blood to the cauda equina? 75. What s the first, second and third order neuron in the SSEP pathway? 76. What is the orientation of the LE DCML compared to the UE DCML? 77. What are the generator points of the LE SSEP? 78. What is the montage recommended for LE SSEP? 79. PF 80. LP 81. P N P31 and N34 vs. P14 and N18? 84. Where are MEPs produced? a. Where does anesthesia affect MEPs? 85. Describe the difference b/t D-waves and I-waves. 86. Does anes affect D or I-waves? 87. Does Sevo affect MEP at the neuromuscular junction? 88. What meds can cause changes to SSEP and MEP 89. If you can t use Prop/Remi TIVA what else might work? 90. Should you use Dex with tcmep? 91. Where does tcmep start after stimulation? 92. How many neurons fire with tcmep? 93. What is the blood supply to the lobes of the brain? 94. What is the pathway of the corticospinal tract? 95. What s the blood supply to the internal capsule? 96. Where does the DCML and LCST decussate in relation to each other? 97. Describe the supply of blood to the spinal cord in a as a whole a. What is the major feed of the lower 2/3 of the cord? 98. Describe the blood supply within the spinal cord. 99. Where are the watershed zones in the spinal cord? 100. How does the motor output from the LCST go from the white tract in the cord to the muscle? 101. Describe a muscle from bundle to myofibril.

5 102. Describe the patient presentation with motor lesions to the cortex, internal capsule, midbrain, pons, medulla, cervical cord, thoracic cord Where is the synapsing site from stimulation of the cortex with tcmep and recording with epidural electrodes? 104. What are the volleys following D-wave? a. Why is it later than D-wave? 105. How do I-waves assist in CMAP production with tcmep? 106. For tcmep, what is the electrode position, head lead locations, number of trains used, inter-pulse interval, pulse duration, max stimulation intensity, impedance of stimulating and recording electrodes, bandpass and analysis time? 107. Do you stimulate with cathode or anode for cortical tcmep. a. What about subcortical? 108. What are the different head lead setups and when would you consider using or not using each one? 109. How many trains till I-waves? 110. What inter-pulse interval allows for complete recovery of D-wave amplitude? 111. What inter-pulse interval may not elicit a response in the LE? 112. What are the latencies in the UE and LE, and what are the typical amplitudes of tcmep? 113. What s the problem with longer pulse durations? 114. What does an increase in intensity mean for areas stimulated under the anode? 115. What causes only a small fraction of current to actually stimulate the brain matter? 116. If you stimulate one cortex, can you get recordings on both sides? 117. How does impedance relate to intensity needed to stimulate the cortex? 118. What history is needed before deciding to perform tcmep? 119. What are the alarm criteria for tcmep? 120. What is fade?

6 121. Why is all-or-none a popular alarm criteria in the OR? 122. How can temperature affect tcmep? 123. What are some things you can do to get better tcmep recordings? 124. What s the youngest you can record a tcmep on? 125. What muscle strength do you need in order to get reliable tcmep? 126. Are tcmep predictive of a LMNL? 127. Are tcmep good for cord ischemia 128. What are some weaknesses of tcmep? 129. Is TMS reliable in the OR? 130. Is neurogenic MEP reliable for monitoring the motor system? 131. What is a common finding in BAER with acoustic neuroma testing? 132. What s the difference b/t weber s and rinne s test? 133. When would a surgeon choose a retrosigmoid, translabyrinthine, or medial fossa approach for an acoustic neuroma? 134. What anesthesia works with BAER? 135. What portion of the BAER is peripheral? a. What cases are intraoperative BAER used for? 136. What sound is used in the OR for BAER? 137. What structure first absorbs sounds vibrations? 138. How is an ear like a microphone? 139. Describe the difference in amplitude of sound and frequency of sound What is loudness? a. How is it measure? 141. How many bels in 1 db? 142. What s the audible range of humans? 143. How does hearing change with age? 144. What are the 3 small bones in the ear, and what purpose do they serve? 145. That muscles of the ear affect hearing, and what innervates them? 146. What s the difference in the oval vs. round window?

7 147. What s does vibration of the basilar membrane cause? 148. What s the purpose of the hair cells? 149. What part of the cochlea does fast frequency sounds go? 150. What membranes separate the cochlea? 151. How is mechanical energy of sound transformed into electrical signals? 152. What are the major relay structures in the auditory pathway? 153. What s the difference in conductive and sensorineural hearing loss? 154. Example audiograms 155. What are the following settings for BAER: stimulator, sound type, duration, polarity, delivery, rep rate, intensity, masking, filters, analysis time, sensitivity, head leads, notch filter? 156. What kind of clicks are used? a. What time is added for the tube connected to the ear bud inserts? 157. What s the difference b/t condensation and rarefaction? 158. What is alternating clicks and is it of benefit? 159. How are the clicks delivered? 160. What range of rep rate is best, and what should you stay below? 161. When is damage to hearing begin with ear bud stimulation? a. What s the difference in db pe SPL and db HL? 162. Filter settings? 163. What is the latency of wave V, and what is the analysis time? 164. Are BAER waves large or smaller waves? 165. What does size of the wave mean for the # of sweeps needed? 166. Why do BAER have a poor signal-to-noise? 167. Why does averaging work? 168. Which BAER is a negative wave? a. What causes post-auricular muscle artifact? 169. What is the anatomical areas for the generator points in BAER?

8 170. What is the blood supply to the inner ear? 171. What is the blood supply to the cochlear nerve? 172. What are the more upstream blood vessels seen around the brainstem? 173. What artery supplies the cochlear nucleus? 174. What artery supplies the superior olivary nucleus and lateral lemniscus? 175. What artery supplies the inferior colliculus? 176. What artery supplies the medial geniculate body? 177. How are the electrodes set up on the head? 178. How is wave I different from the way wave III and V are generated? 179. What is volume conduction and how does that assist BAER potentials? 180. What 3 rules does conduction through the body follow? 181. Wave I? 182. Wave II? 183. Wave III? 184. Wave IV? 185. Wave V? 186. Wave V? 187. Wave VI and VII? 188. What s measured in BAER? 189. Alarm criteria for BAER? 190. What can temperature change, blood pressure change, conductive loss, drilling the skull, and opening dura do to BAER recordings What are known causes of artifact in BAER? 192. Which wave is the last to disappear with decreased intensity? 193. What procedures are BAER better for, which is not as sensitive? 194. What makes up that atom? 195. How does an atom have a charge, and what s its measurement? a. What s the difference b/t resistors and conductors? 196. What is Coulomb s Law? a. What s a current of 1 coulomb per second?

9 197. How is electromotive force similar to a hydraulic system? 198. What is resistance of current? a. What s it measured in? 199. What is Ohm s Law? a. What happens to the current if the resistance is double? 200. What does an ohmmeter, ammeter and voltmeter measure? 201. What s the difference b/t direct and alternating current? 202. What does electroencephalography measure? 203. What causes the cortical activity monitored? 204. How does volume conductance enable EEG recordings? 205. A radial dipole has what orientation, while a tangential has what orientation? 206. What does the frequency of the waveforms indicate about the cortical activity? 207. Image 208. How does background electrical fields contaminate the recordings/ 209. What are the positions the patient may be placed in? a. What are the name of the tables? 210. What in the OR gives off noise at 60 Hz? 211. What are the sizes of the amplitudes of our recordings vs. noise? 212. What s the difference b/t physiological and non-physiological artifact? 213. What are things you can do to fight noise? 214. What s the appropriate way to apply head electrodes and keep noise in the lead to a minimum? 215. You can affect the resistance of the skull, but you can affect what to keep recordings optimal? 216. Why are twisted electrodes better? 217. What is parasitic capacitive coupling? 218. Where should you place the ground? a. How does it help reduce noise? 219. What does a signal go through before it pops up on your screen?

10 220. What inputs come into the amplifier that it has to sort out? 221. How does a differential amplifier work? 222. What is common mode rejection? 223. How do you figure out the CMRR in decibels? 224. What is the formula for the amplifier gain? a. What s a common amplification of signals after 225. What is the difference b/t analog and digital processing? 226. What does a digital converter do? 227. What happens if the digitizing rate is set too slow? 228. What is epoch/analysis period/sweep length? a. What is dwell time/bin width/intersample interval? b. What is the relationship of dwell time to sampling rate? c. How many points per channel is recommended? 229. A decrease in dwell time with a constant analysis time does what to the resolution? 230. How many points are needed for the dwell time to sufficiently resolve the highest frequency collected? a. What s that called? 231. What is the least sample required during collection of EEGs? 232. Shortening the dwell time does what to the # of addresses? 233. What s it called if sampling is done too infrequently? 234. What does vertical resolution define? a. What is a bit? b. What s the minimum bits required for IOM? c. How do you find the resolution when the amount of bits is given? 235. Given the range and resolution, how do you find the smallest voltage detected (precision)? 236. How many bits of resolution is recommended? 237. Why is that many bits recommended? 238. What is quantization errors?

11 239. How does resolution and range relate to quantization errors? 240. What s the purpose of an isolation box? 241. Analog filters are made up of what? a. What advantages does digital filters have over analog filters? 242. For LFF, how are capacitors and resistors aligned? a. For HFF, how are capacitors and resistors aligned? 243. Memorize 244. What are the electrical quantities associated with circuits? 245. What is voltage? 246. What is amperage? 247. What is resistance? 248. What is conductance? 249. What is power? 250. What is inductance? 251. Describe a circuit in series and a circuit in parallels What is the difference in high pass and low pass filters output potential? 253. What is the reciprocal of resistance? 254. How does Ohm s law apply to resistors? 255. What is the equation to find the power dissipated by the resistor? 256. What are inductors? 257. Inductors behave like what? 258. What does a transistor do? 259. What frequencies is a notch filter around? 260. What does smoothing do to your plotted data? 261. Signal averaging review 262. What reject levels should you be set at? 263. What is Amaurosis fugax? 264. How does EEG progress with inhalational agents? 265. What are the 7 stages of EEG during anesthesia (assuming it makes it all the way)? 266. What is WAR and FIRDA patterns? 267. What is AIS and WPS patterns?

12 268. What EEG is present in moderate anesthesia? 269. How do barbiturates differ from opioids in EEG suppression? 270. In EEG, what is the head lead setup, impedance, bandpass, paper speed, and sensitivity? 271. How do you find CP3, M1 and M3 in the system? What s the difference in a referential setup vs. bipolar? a. Which is recommended for the OR? 274. Which is more likely to pick up artifact? 275. How many channels should you use for IOM CEA? 276. What are the frequencies of EEG monitored? 277. How are the waves classified? 278. What frequencies dominate the frontal and occipital regions a. What frequencies are more prominent during sleep? 279. What does awake EEG look like? a. What artifact is common? 280. What does a sedated patient s EEG look like? 281. What is burst suppression? 282. What is the goal of anesthesia for CEA? a. What is the goal of anesthesia during an aneurysm clipping? 283. What should the filter settings be for EEG? 284. What areas should the EEG cover? 285. What are the watershed zones of the cortex? 286. What alarm criteria is recommended for EEG on CEA? 287. Tips on looking at EEG on the test 288. Explain how the Circle Of Willis is a big shunt 289. How does the posterior circulation help during clamping? 290. Image 291. When should you see sleep spindles in a patient under anesthesia? 292. How do resting EEG differ from awake EEG? 293. When are changes in EEG seen during CEA?

13 294. What are recommended practices when watching EEG during CEA? 295. When should signals return after shunt placement? a. What are gradual changes vs. abrupt changes attributed to? 296. What is ischemic penumbra? 297. What is penlucida? 298. How long can the brain go without blood flow? 299. What blood flow levels are the critical levels needed to maintain adequate blood flow? 300. What level of BF is consistent with ischemia? 301. What is the Fast Fourier Transform? 302. What s the difference b/t CSA and DSA? 303. What are peak power frequency and spectral edge frequency? 304. What happens if the power spectral edge shift to the left? 305. What is burst suppression ratio and what is it used for? 306. What is the alarm criteria for CEA using SSEP? 307. What are weaknesses of EEG? 308. Which will go first, SSEP or EEG? 309. Why doesn t stimulation of the MN SSEP alter the EEG recordings? 310. Which is better for EEG for CEA, SSEP or EEG? 311.