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In-Training Exam High Yield Topics Neurology

In-Training Exam High Yield Topics Neurology. Emergency Medicine Foundations Curriculum. In-training Exam (ITE) Content:. Written to level of EM3 Predicts performance on EM Boards 225 MC questions Given 4.5 hrs to take +/- 25 are visual stimuli – pictures/ ekg/xrays

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In-Training Exam High Yield Topics Neurology

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  1. In-Training ExamHigh Yield Topics Neurology Emergency Medicine Foundations Curriculum

  2. In-training Exam (ITE) Content: • Written to level of EM3 • Predicts performance on EM Boards • 225 MC questions • Given 4.5 hrs to take • +/- 25 are visual stimuli – pictures/ekg/xrays • Highest yield topics • Cardiovascular ~ 10% • Trauma ~ 10% • Abd/GI ~ 8% • Thoracic/Respiratory ~ 8% • Procedures/Skills ~8% • Note that Geriatrics makes up at least 6% of these and Pediatrics at least 8%

  3. Foundations Challenge Overview • Rapid Review of High-Yield Test Topics • Visual Diagnosis • Clinical Concepts • Rapid Fire • Work in 2-4 different teams • Answer challenge questions for points • Point value per challenge varies by difficulty • Win test prep and pride

  4. Foundations Challenge Rules • Create a Team Name • Best Team Name starts the Challenge (as arbitrarily determined by your Instructor) • Your team must answer the entire question correctly to win points • If you team answers incorrectly, the Challenge Question points can be stolen by the next team • If they answer correctly, they get your points AND a chance to answer the next question • If they answer incorrectly, the turn passes again to the next team in line

  5. Neurology

  6. 31 yo m p/w inability to move R face x 2 hours 1pt Foundations Challenge Visual Diagnosis Dx and Tx?

  7. 1pt 31 yo m p/w inability to move R face x 2 hours Foundations Challenge Visual Diagnosis Dx: Bell’s palsy Tx: steroids, artificial tears

  8. Bell’s palsy Foundations Challenge Knowledge Bomb

  9. 35 yof p/w headache x1 week and blurry vision 1pt Foundations Challenge Visual Diagnosis Dx and Tx?

  10. 1pt 35 yof p/w headache x1 week and blurry vision Foundations Challenge Visual Diagnosis Dx: Idiopathic Intracranial HTN Tx: Lumbar puncture

  11. Idiopathic intracranial hypertension (pseudotumorcerebri) Foundations Challenge Knowledge Bomb

  12. 26 yoasian man with atraumatic BLE paralysis 2 pts Foundations Challenge Clinical Concepts Labs to check? Treatment?

  13. 26 yoasian man with atraumatic BLE paralysis 2 pts Foundations Challenge Clinical Concepts Labs to check? TSH, free T4, K Treatment? Gentle oral K repletion, beta blockers

  14. periodic paralysis Foundations Challenge Knowledge Bomb

  15. Where is the lesion? 3 pts Foundations Challenge Clinical Concepts 83 yom p/w two hours of … RLE weakness/numbness Aphasia + R facial and RUE weakness/numbness Binocular vision changes

  16. Where is the lesion? 3pts Foundations Challenge Clinical Concepts 83 yom p/w two hours of … RLE weakness/numbness ACA Aphasia + R facial and RUE weakness/numbness L MCA Binocular vision changes PCA

  17. Large vessel occlusion syndromes Foundations Challenge Knowledge Bomb

  18. Large vessel occlusion syndromes Foundations Challenge Knowledge Bomb

  19. Other important cva syndromes Foundations Challenge Knowledge Bomb

  20. Indications for tpa? (need all 4) 4 pts Foundations Challenge Clinical Concepts 1. 2. 3. 4.

  21. Indications for tpa? (need all 4) 4 pts Foundations Challenge Clinical Concepts 1. Adult patient (>18 yo) 2. No ICH on CT 3. Symptom onset <4.5 hours 4. No other clear reversible cause

  22. Absolute contraIndications for tpa? 3 pts Foundations Challenge Clinical Concepts Name 3

  23. Absolute contraIndications for tpa? (name 3) 3 pts Foundations Challenge Clinical Concepts • Within 3 mos: ischemic stroke, neurosurgery, or head trauma • Current or previous ICH • Major surgery within 2 weeks • BP >185/110 after attempted reduction • Possible SAH • Known intracranial tumor, aneurysm, or AVM • Possible reversible cause • Recent bleeding or coagulopathy (PT >15s, INR > 1.7, platelets <100k

  24. Name the difference between: 2 pts Foundations Challenge Clinical Concepts Myasthenia Gravis AND Lambert-Eaton MyasthenicSyndrome

  25. Name the difference between: 2 pts Foundations Challenge Clinical Concepts Myasthenia Gravis Antibody vs. post-synaptic acetylcholine receptors Worsens with repetitive movement Lambert-Eaton Myasthenic Syndrome Antibody vs. pre-synaptic voltage-gated calcium channels Improves with repetitive movement Usually paraneoplastic (esp. small cell lung cancer)

  26. Myasthenia gravis vs.lambert-eaton syndrome Foundations Challenge Knowledge Bomb

  27. Name a disease that typically causes… 2 pts Foundations Challenge Clinical Concepts Ascending Paralysis? Descending Paralysis?

  28. Name a disease that typically causes… 2 pts Foundations Challenge Clinical Concepts Ascending Paralysis? Descending Paralysis? Guillain-Barré Syndrome Tick Paralysis Botulism Miller Fisher variant GBS Myasthenia Gravis Lambert-Eaton Myasthenic Syndrome

  29. 2 pts Foundations Challenge RAPID FIRE Diplopia with lateral gaze Dx? Bilateral Bell’s palsy Dx?

  30. 2 pts Foundations Challenge RAPID FIRE Diplopia with lateral gaze Internuclearophthalmoplegia (associated with MS) Bilateral Bell’s palsy Lyme disease

  31. 3 pts Foundations Challenge RAPID FIRE HOW DO YOU TREAT SEIZURES RELATED TO… Eclampsia? Isoniazid overdose? Status epilepticus?

  32. 3 pts Foundations Challenge RAPID FIRE HOW DO YOU TREAT SEIZURES RELATED TO… Eclampsia? Magnesium sulfate Isoniazid overdose? Pyridoxine (Vit B6) Status epilepticus? 1. Benzos 2. Phenytoin/Fosphenytoin 3. Phenobarbital

  33. 3 pts Foundations Challenge RAPID FIRE WHAT IS THE TREATMENT FOR … CVA in a sickle cell patient? Tick paralysis? Healthcare worker exposed to Neisseria meningitis patient?

  34. 3 pts Foundations Challenge RAPID FIRE WHAT IS THE TREATMENT FOR … CVA in a sickle cell patient? Exchange transfusion Tick paralysis? Remove the tick Healthcare worker exposed to Neisseria meningitis patient? Rifampin 600mg BID x2d OR Cipro 500mg PO x1 OR Ceftriaxone 250mg IM x1

  35. Good Luck!!! www.emergencymedicinefoundations.com

  36. References Foundations Teaching Content: Dr. Andrew Ketterer, MD, MA Medical Education Fellow, Beth Israel Deaconess Dr. Kristen Grabow Moore, MD, MEd Assistant Professor, Emory University References: • Life in the Fast Lane • HippoEM Board Review • Rivers Written Board Review • Medscapeemedicine • Northwestern EM Chief Residents

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