ABRET CAP Certification for Autonomic Professionals

Before beginning autonomic testing, which step is most critical for patient safety and test validity?

• AVerifying patient identity using at least two unique identifiers
• BEnsuring the testing room is at exactly 25°C
• CCalibrating the sudomotor capsules
• DReviewing the patient's insurance coverage

A patient scheduled for QSART testing reports taking oxybutynin for overactive bladder. What is the appropriate action?

• AProceed with testing since oxybutynin only affects the bladder
• BNotify the ordering physician because anticholinergic medications can suppress sweat resp…
• CIncrease the acetylcholine concentration to overcome the medication effect
• DReschedule the test for the following day

The autonomic nervous system is divided into which two primary divisions?

• ASympathetic and parasympathetic
• BAfferent and efferent
• CSomatic and visceral
• DCentral and peripheral

Which preganglionic neurotransmitter is shared by both the sympathetic and parasympathetic divisions of the autonomic nervous system?

• ANorepinephrine
• BEpinephrine
• CAcetylcholine
• DDopamine

A patient presents with progressive orthostatic hypotension, anhidrosis, and urinary retention. Which condition is most consistent with this presentation?

• APostural orthostatic tachycardia syndrome (POTS)
• BVasovagal syncope
• CMultiple system atrophy (MSA)
• DIsolated cardiovagal dysfunction

Under HIPAA regulations, which action is permissible when handling a patient's autonomic test results?

• ADiscussing results with a colleague in the hospital cafeteria if no names are used
• BSharing results with the referring physician who ordered the test
• CEmailing unencrypted results to the patient's family member upon their verbal request
• DPosting anonymized test tracings on social media for educational purposes without patient…

Which term describes the inability to sweat?

• AHyperhidrosis
• BDiaphoresis
• CAnhidrosis
• DHypohidrosis

A patient with a known latex allergy is scheduled for autonomic testing. Which precaution is most important?

• ACancel all autonomic testing until the allergy resolves
• BEnsure all equipment, electrodes, and supplies used are latex-free
• CAdminister prophylactic antihistamines before testing
• DPerform testing only in the emergency department

Which cranial nerve carries the majority of parasympathetic outflow from the central nervous system?

• ATrigeminal nerve (CN V)
• BFacial nerve (CN VII)
• CVagus nerve (CN X)
• DHypoglossal nerve (CN XII)

A patient's history reveals they are taking a beta-blocker. Which autonomic test result is most likely to be directly affected?

• AQSART sweat volumes
• BThermoregulatory sweat distribution pattern
• CHeart rate response during deep breathing and Valsalva maneuver
• DResting skin temperature

According to ABRET professional standards, a CAP technologist discovers a calculation error in a previously reported autonomic test. What is the correct course of action?

• AIgnore the error if the overall clinical interpretation would not change
• BImmediately report the error to the supervising physician and follow institutional proced…
• CCorrect the report without notifying anyone to avoid creating liability
• DWait until the patient's next visit to address the discrepancy

Which of the following is a contraindication to performing a head-up tilt table test?

• AHistory of vasovagal syncope
• BSevere aortic stenosis
• CMild peripheral neuropathy
• DUse of compression stockings

Diabetic autonomic neuropathy most commonly affects which autonomic function first?

• ASudomotor function in the feet
• BPupillary constriction
• CBronchial smooth muscle tone
• DGastrointestinal motility in the esophagus

Before performing autonomic testing, the technologist should verify that testing equipment has undergone routine maintenance and calibration. What is the primary reason?

• ATo satisfy insurance reimbursement requirements
• BTo ensure accurate and reproducible test results
• CTo extend the warranty on the equipment
• DTo reduce the time needed for each test

A patient presents for autonomic testing with a history of pure autonomic failure (PAF). Which combination of test findings would you expect?

• ANormal QSART, normal tilt, and normal Valsalva responses
• BReduced QSART volumes distally, orthostatic hypotension on tilt, and absent late phase II…
• CExcessive QSART volumes, tachycardia on tilt without hypotension, and exaggerated Valsalv…
• DNormal QSART but absent heart rate variability during deep breathing only

What is the recommended room temperature range for the autonomic testing laboratory to ensure accurate baseline measurements?

• A18-20°C (64-68°F)
• B22-24°C (72-75°F)
• C28-30°C (82-86°F)
• D32-34°C (90-93°F)

When preparing a patient for QSART, what is the purpose of cleaning the skin at the test sites with alcohol?

• ATo anesthetize the skin before electrode placement
• BTo remove oils, lotions, and debris that could impede acetylcholine iontophoresis and swe…
• CTo sterilize the area for an invasive procedure
• DTo cool the skin to prevent spontaneous sweating

Prior to performing a head-up tilt test, the patient should rest supine for a minimum of how many minutes to establish a stable baseline?

• A2 minutes
• B5 minutes
• C20 minutes
• D60 minutes

When setting up continuous beat-to-beat blood pressure monitoring, which of the following is essential for accurate readings?

• AThe finger cuff must be placed on the index or middle finger with proper sizing to mainta…
• BThe blood pressure cuff should be placed over the patient's clothing for comfort
• CThe monitoring device only needs calibration once per year
• DThe patient's arm should be elevated above heart level throughout testing

What is the primary purpose of a system warm-up period for autonomic testing equipment?

• ATo allow electronic components to reach stable operating temperatures for consistent and…
• BTo charge the battery backup system
• CTo synchronize the clock with the hospital network
• DTo run an automatic software update

When attaching ECG electrodes for autonomic testing, which lead placement is most commonly used for continuous heart rate monitoring during the Valsalva maneuver and deep breathing tests?

• AStandard 12-lead ECG configuration
• BA modified lead II or similar configuration that provides clear R-wave detection for accu…
• CA single precordial lead (V1) only
• DLimb leads only without any chest electrodes

What information should the technologist provide to a patient before beginning a Valsalva maneuver test?

• AOnly the duration of the test
• BA clear explanation of how to perform forced expiration against a closed airway at the ta…
• CThat the test is painful and they should take analgesics beforehand
• DThat they should hold their breath as long as possible without additional instructions

Which electrical safety measure is most important when using iontophoresis during QSART?

• AUsing the highest available current to minimize test duration
• BEnsuring the current is limited to the prescribed level to prevent skin burns and that th…
• CApplying iontophoresis only to calloused areas of skin
• DHaving the patient remove all clothing before testing

What is the correct patient position for the baseline (pre-tilt) phase of a head-up tilt table test?

• ASeated upright in a chair
• BSupine on the tilt table with safety straps secured
• CStanding for 5 minutes before lying down
• DProne on the tilt table

When preparing supplies for thermoregulatory sweat testing (TST), what is the function of the indicator powder applied to the patient's body?

• AIt absorbs excess moisture to keep the patient dry
• BIt changes color upon contact with sweat, providing a visual map of sweat distribution
• CIt acts as a thermal insulator to prevent heat loss
• DIt reduces skin friction during positioning

Which infection prevention measure is required between patients when using reusable QSART capsules?

• ARinsing with tap water only
• BThorough cleaning and disinfection according to manufacturer and institutional protocols
• CAir drying without cleaning is sufficient since skin contact is minimal
• DWiping with a dry cloth

During setup for autonomic testing, the technologist notices the beat-to-beat blood pressure device is displaying erratic waveforms. What is the most appropriate first troubleshooting step?

• ABegin testing and note the issue in the report
• BCheck the finger cuff size, placement, and ensure the hand is at heart level
• CReplace the entire monitoring system
• DSwitch to intermittent manual blood pressure readings for all tests

When positioning skin temperature probes for autonomic testing, where should they typically be placed?

• AOnly on the forehead
• BOn the dorsum of the hand or foot and at another reference site to monitor skin temperatu…
• CInside the patient's mouth for core temperature measurement
• DOn the anterior chest wall directly over the heart

What is the standard expiratory pressure target during the Valsalva maneuver in autonomic testing?

• A10 mmHg for 10 seconds
• B40 mmHg for 15 seconds
• C80 mmHg for 30 seconds
• D20 mmHg for 5 seconds

During QSART, acetylcholine is delivered to the skin via iontophoresis. Which standard test sites are used?

• ABoth palms and both soles
• BForearm, proximal leg, distal leg, and foot
• CForehead, chest, abdomen, and thigh
• DBilateral axillae and bilateral groin

What angle is the patient tilted to during a standard head-up tilt table test?

• A30 degrees
• B45 degrees
• C70 degrees
• D90 degrees

During heart rate deep breathing (HRDB), what is the standard breathing rate used for the test?

• A12 breaths per minute
• B6 breaths per minute
• C3 breaths per minute
• D20 breaths per minute

The Valsalva ratio is calculated as:

• AMinimum heart rate during strain divided by maximum heart rate after strain release
• BMaximum heart rate during strain divided by minimum heart rate after strain release
• CMean arterial pressure during strain divided by mean arterial pressure at rest
• DSystolic blood pressure at rest divided by systolic blood pressure during tilt

During the Valsalva maneuver, what happens to blood pressure during early phase II (strain phase)?

• ABlood pressure increases sharply
• BBlood pressure decreases due to reduced venous return and decreased cardiac output
• CBlood pressure remains unchanged
• DBlood pressure oscillates rapidly between high and low values

What does QSART specifically evaluate?

• APreganglionic sympathetic sudomotor pathway integrity
• BPostganglionic sympathetic sudomotor (axon reflex) function
• CThermoregulatory sweat center activity in the hypothalamus
• DParasympathetic innervation of sweat glands

During a head-up tilt test, a patient develops a heart rate increase from 72 to 108 bpm within 8 minutes of tilting, with blood pressure remaining stable at 118/74 mmHg. What does this pattern suggest?

• AOrthostatic hypotension
• BPostural orthostatic tachycardia syndrome (POTS)
• CVasovagal syncope
• DNormal orthostatic response

In the thermoregulatory sweat test (TST), what temperature must the patient's oral temperature reach to ensure adequate thermal stimulus?

• A36.5°C (97.7°F)
• B37.0°C (98.6°F)
• CAn increase of at least 1.0°C above baseline or 38.0°C (100.4°F), whichever is higher
• D40.0°C (104.0°F)

Which phase of the Valsalva maneuver reflects sympathetic adrenergic vasoconstrictor function?

• APhase I (onset of strain)
• BLate phase II (blood pressure recovery during strain) and phase IV (overshoot after strai…
• CPhase III (release of strain)
• DThe resting period before the maneuver

A patient undergoing QSART has normal sweat volumes at the forearm and proximal leg but absent sweat response at the distal leg and foot. What does this pattern suggest?

• AGeneralized autonomic failure
• BA length-dependent postganglionic sudomotor neuropathy
• CA central thermoregulatory defect
• DEquipment malfunction at the distal sites

What defines orthostatic hypotension according to consensus criteria?

• AA heart rate increase of more than 30 bpm upon standing
• BA sustained decrease in systolic blood pressure of at least 20 mmHg or diastolic blood pr…
• CAny drop in blood pressure within the first 30 seconds of standing
• DA systolic blood pressure below 90 mmHg regardless of positional change

During the thermoregulatory sweat test, a patient shows an absent sweat response over the entire right lower extremity while the left side sweats normally. Which level of lesion is most likely?

• ABilateral postganglionic peripheral neuropathy
• BUnilateral preganglionic or central lesion affecting the right sympathetic pathway
• CHypothalamic dysfunction
• DBilateral small fiber neuropathy

The cardiovagal function assessed by the heart rate deep breathing test and Valsalva ratio is mediated by which nerve?

• APhrenic nerve
• BVagus nerve
• CSympathetic chain
• DRecurrent laryngeal nerve

During QSART, which mechanism produces the sweat response at the recording capsule?

• ADirect stimulation of sweat glands by iontophoresed acetylcholine
• BThe axon reflex: acetylcholine activates postganglionic sudomotor nerve terminals, the im…
• CSystemic absorption of acetylcholine stimulating the hypothalamic sweat center
• DLocal heating of the skin by the iontophoresis current

Which test provides a quantitative measure of resting sweat output without pharmacological stimulation?

• AQSART
• BResting sweat output measurement
• CThermoregulatory sweat test
• DSympathetic skin response

During a head-up tilt test, a patient suddenly develops bradycardia (HR drops from 82 to 38 bpm) and hypotension (BP drops from 120/80 to 68/40 mmHg) with nausea and pallor. What is the most likely diagnosis?

• APostural orthostatic tachycardia syndrome
• BNeurogenic orthostatic hypotension
• CVasovagal (neurocardiogenic) syncope
• DCardiac arrhythmia

Which autonomic test is most sensitive for detecting early cardiovagal dysfunction?

• AHead-up tilt table test
• BHeart rate response to deep breathing (HRDB)
• CThermoregulatory sweat test
• DQSART