The Board feels strongly that two examinations are essential to evaluate the knowledge and skills required for certification because of the varied academic backgrounds of applicants and the paucity of certified training programs in IONM. A written exam is used to identify an adequate knowledge base, followed by an oral exam to identify adequate judgment skills. The Board believes that the extra burden of an oral examination insures that individuals who are certified have the ability to meet the dynamic challenges of data interpretation and supervision that occur in the operating room. The Board spent a substantial amount of time developing the written exam to insure that it represents a wide cross-section of material and does not represent any one group’s viewpoint. Not unexpectedly, the questions for the examination are in constant evolution as the knowledge base shifts and new questions replace older questions. In order to insure a comprehensive evaluation of the knowledge base, a content outline was developed to indicate the material to be covered by the examination. Further, in order to clarify the relative importance of these aspects, category weightings were developed. These weightings are used to distribute the questions on the examination are shown below.

I. BASIC NEUROSCIENCE… 27.6%
II. SIGNAL ACQUISITION AND PROCESSING…4.8%
III. ELECTROENCEPHALOGRAPHY (EEG)…9.6%
IV. SENSORY EVOKED POTENTIALS… 23.6%
V. MOTOR POTENTIALS …24.4%
VI. EFFECTS OF ANESTHESIA …10.0%

Thus the basic neuroscience section is weighted 28% and will have 28% of the questions on the examination (since some questions may overlap sections, each question was designated to the section of primary importance for the question). It should be noted that the content outline is a working document and evolves each year representing the evolving spectrum and importance of the knowledge base important to the field. Hence, the outline and weightings shown above represent the content and weightings at the time of this writing. The questions for the current examination were derived by current and former ABNM Directors. All current questions were contributed from ABNM Directors who designed questions to insure adequate coverage of the outline. After ensuring accuracy, the questions were then evaluated for psychometric factors by the testing agency. Finally, the initial Board conducted focus groups (including practicing individuals and non-Board members) in several locations around the country to study accuracy, timeliness and regional variations in opinion and practice. The question set used for the examination is regularly updated, reviewed and selected by the Board from the question set to adequately cover the outline. The Board has chosen to maintain the DABNM as a comprehensive certification in IONM and not to certify in specific modalities in recognition that the qualities of supervision and judgment transcend the boundaries between modalities. The ABNM Part I-Written examination for Certification will contain 250 multiple choice questions. The passing score will be determined by the ABNM and PTC for every version of the ABNM examination form that is used for the ABNM written examination. The ABNM Part I-Written examination will be administered on the dates published on the ABNM website. There is one correct answer for each of the 250 questions. All are of the A type (pick the one best answer from the 4 or 5 possible answers) and there are no “K” type questions (answer (a) if 1, 2, 3 are correct, (b) if 1, 3, etc). Some questions are simple recognition of knowledge and others are scenario based (i.e. questions revolving around a short case presentation). As noted above, each question is allocated to the content outline in one area and the question distribution reflects the percentages of weighting in the outline. 

Example Written Examination Questions:

1. What is the most prominent EEG characteristic of isoflurane at low-moderate concentrations?
a. Isoelectricity
b. Selective delta loss
c. Burst-suppression activity
d. Power peaks within the 8-12 Hz band (correct)

2. The ascending fibers of the cuneate nucleus and gracilis nucleus cross over in the medulla to form what structure?
a. Internal capsule
b. Lateral lemniscus
c. Medial lemniscus (Correct)
d. Superior colliculus

3. Which of the following anesthetic agents can increase SEP amplitudes?
a. Etomidate (Correct)
b. Isoflurane
c. Midazolam
d. Nitrous oxide

4. When stimulating the median nerve, an electrode placed at Erb’s point will record activity generated from
a. cauda equina
b. lumbar plexus
c. brachial plexus (Correct)
d. thalamocortical radiations

5. Quantitization error resulting in the failure to resolve the true primary complex of the evoked response is due to
a. sampling too slow a rate
b. using too narrow a bandwidth
c. using too low a gain for the system’s A-to-D input (Correct)
d. using too high a gain for the system’s A-to-D input

6. What is the proposed generator of Wave I of the BAEP?
a. Superior olive
b. Inferior colliculi
c. Auditory cortex
d. Distal auditory nerve (correct)

7. The facial nerve is being monitored during an operation for an acoustic tumor by recording EMG potentials from electrodes on the face placed at long distance from each other. The surgeon is probing the surgical field with a monopolar handheld stimulating electrode. Clear responses are observed from one location and a clear response from another but no response from other locations of the surgical field. The latency of the EMG response is different, short when one location is stimulated and long when the other location is stimulated. From where do these responses most likely come?
a. Both responses from the facial nerves
b. Both responses from the trigeminal nerve
c. The response with the long latency from the facial nerve and the response with the short latency from the trigeminal nerve (correct)
d. The response with the short latency from the facial nerve and the response with the long latency from the trigeminal nerve

8. The P100 from the visual evoked potential stimuli is generated by the
a. retina.
b. optic nerve.
c. optic chiasm.
d. occipital cortex. (Correct)