Must know topics prior to starting Neurology

[Chocolateagar04]

Hey,

Going to be starting Neurology in 3 weeks. I wanted to make a list of ABSOLUTE MUST KNOWS before starting. I want to, at the very least, read up on the following topics so that I know them cold or at least know the relevant information from Lange's Clinical Neurology 8th edition text:

1. Neuro Exam
2. Manage acute CVA
3. Manage Acute Seizure
4. Hypo/Hyper natremia
5. Reading EKGs (Brush up on Dubins)
6. ACLS/BLS
7. Meningitis
8. Pain Control

Anything that I'm missing? I know Neuro anatomy is important and I am reading it, however I'm really trying to figure out stuff I need to know while on call by myself admitting and covering patients possibly in the middle of the night so I don't seem dumb always asking for help.

Thanks.

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[bbake87]

Treatment of status and basic anti-convulsant pharmacology. Go over the basics of MRI Brain/Spine and CTOH with a senior resident. Read Blumenfeld.

 

[soulofmpatel]

Don't worry too much about ACLS/BLS, meningitis, pain control, and sodium. Try to improve your skills in reading a non contrast head CT for early infarct signs and maybe some basics for CT angiography of the head and neck.

Memorize a simple algorithm for status management:

i.e.

1) ativan 2mg IV X 4
2) dilantin 20mg/kg or keppra 1g IV
3) phenobarbital IV 20mg/kg
4) versed titrate to stop seizures
5) propofol titrate to stop seizrues

Try to do a few spinal taps if you get the chance

review some basic neuroanatomy and localization principles and peripheral nerve anatomy

 

[95439]

Don't worry too much about ACLS/BLS, meningitis, pain control, and sodium. Try to improve your skills in reading a non contrast head CT for early infarct signs and maybe some basics for CT angiography of the head and neck.

Memorize a simple algorithm for status management:

i.e.

1) ativan 2mg IV X 4
2) dilantin 20mg/kg or keppra 1g IV
3) phenobarbital IV 20mg/kg
4) versed titrate to stop seizures
5) propofol titrate to stop seizrues

Try to do a few spinal taps if you get the chance

review some basic neuroanatomy and localization principles and peripheral nerve anatomy

Shouldn't that be Ativan 2mg, then again (wihle loading with AED #1), then possibly again, then loading AED#2 (i.e. Keppra or Depakote; not phenobarb, that's for when 2 AEDs fail?).

I agree that the most important things to learn are emergencies. You can read about NMDA encephalitis quick enough that the patient won't deteriorate. But know how to manage stroke codes. The AHA has recently updated guidelines, and you're going to see a LOT of strokes.
Also know how to diagnose and treat GBS and other potential neuromuscular emergencies. Empiric antibiotics for meningitis are helpful to learn now because that's also something that should be treated rapidly. Spinal taps have horrible reimbursement. May have to do a bunch in residency but most attendings I know don't perform them. My two cents take it with a grain of salt.

 

[typhoonegator]

The majority of things you'll get yelled at about in your early training are acute neurology, and acute neurology for a junior resident can be learned in a single evening. SE, acute stroke, ICH, r/o SAH, cooling after cardiac arrest, ED evaluation for MS, and workup of the acutely dizzy are all in fair play. I would also suggest you learn about basilar/brainstem symptoms because those cases will make your attendings uneasy and the more you know the more competent you will appear. Maybe learn the first few agents for management of status migrainosus as well.

We all know you will be green in July. I'm already banking sleep. As long as you don't try to be a Rambo, you will be fine. Your senior residents, fellows, and attendings will all expect you to be semi-useless, and I mean that in the nicest way possible.