Neurology Oral Boards

[nycdoc22]

A few questions about the adult neuro orals coming up..:

On the patient encounter - what kind of neuro exam should be done ... ie a focused one (including fundoscopy) or "complete". ie. should i be checking webber and rinne on everyone? Should i be prepared to test CN I, taste, etc.

Also how complete should the fundoscopy be? I am comfortable looking at the disc, but i'm no expert at assessing all the vessel abnormalities, etc.

Some where i read that we should use 'sterile safety pins'. Short of lighting a match over one, i have no clue how to get those.

Also do we do a general physical exam? Vitals? look for skin lesions (in adults..peds - definately).

ON the history portion: how much of a medical history do we need (beyond whats clearly relavent? (do i have to review all 18 systems, etc. )

After the H & P - do we discuss the case with the patient. (ie, do we counsel them, etc...)


thanks for your help.

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[neurologist]

A few questions about the adult neuro orals coming up..:

On the patient encounter - what kind of neuro exam should be done ... ie a focused one (including fundoscopy) or "complete". ie. should i be checking webber and rinne on everyone? Should i be prepared to test CN I, taste, etc.

Also how complete should the fundoscopy be? I am comfortable looking at the disc, but i'm no expert at assessing all the vessel abnormalities, etc.

Some where i read that we should use 'sterile safety pins'. Short of lighting a match over one, i have no clue how to get those.

Also do we do a general physical exam? Vitals? look for skin lesions (in adults..peds - definately).

ON the history portion: how much of a medical history do we need (beyond whats clearly relavent? (do i have to review all 18 systems, etc. )

After the H & P - do we discuss the case with the patient. (ie, do we counsel them, etc...)


thanks for your help.

Gosh, doesn't your program do "mock orals" ?

You should absolutely do a COMPRHENSIVE but not necessarily "complete" neuro exam. Focus on things relevant to the primary complaint, but also run through the whole Mental status/cranial nerves/motor/sensory/coordination/reflexes/gait thing. You should be able to do it within 5 minutes or so. I would bring some stuff to test taste on the (very, very) unlikely chance that will be the patient's main complaint. Otherwise, don't bother. Weber and Rinne can be done pretty quickly, so I'd do it but be prepared to discuss and decide "how relevant" if it comes up abnormal. As for the fundus, If you can recognize the disk, that's probably good enough. I would focus any review of systems to things that may be relevant to the presenting complaint (cardiovascular for stroke, skin lesions/past head trauma or infection for seizures, etc).

If you have time, you can discuss/counsel, but I'd focus more on getting the hx and doing a good exam. That'll probably use up the whole time as it is. The examiners will likely ask you "what would you" do, so do be prepared to discuss it.

As for general medical exam, do what you think may be relevant: if you think it's a stroke, listen for bruits and murmurs. If you think it's neurofibromatosis or tuberous sclerosis, at least mention to the supervisor that you would look for lesions. They may or may not want you to actually do it.

"Sterile pins" can be purchased (they're not really safety pins, but a disposable sharpish thing with a removable cap over the tip.) You can ask in your school's neuro, neurosurg or PM&R dept if they have any they could spare. Or you can bring some actual safety pins and some alcohol wipes to "sterilize" them prior to use. On a related topic, BE ABSOLUTELY SURE TO WASH YOUR HANDS in the presence of the patient and examiner before and after the exam. I've seen people get dinged for not doing this!

Good luck!

 

[ChildNeuro]

Isn't there a neuro-opthalmology rotation during neurology residency so that you can identify a large majority of eye pathologies? Do any neurologists use the pan-opthalmoscope either? Any significant advantage?

 

[nycdoc22]

"Isn't there a neuro-opthalmology rotation during neurology residency so that you can identify a large majority of eye pathologies? "
- that was real helpful. Thanks.


"Do any neurologists use the pan-opthalmoscope either? " Yes

"Any significant advantage?" yes. maybe you should try looking up pan-opthalmoscope on the net. You'll find lots of info.

 

[ChildNeuro]

"Isn't there a neuro-opthalmology rotation during neurology residency so that you can identify a large majority of eye pathologies? "
- that was real helpful. Thanks.

Sorry I just thought that most neurology residents got like 2 months doing a neuro-opthalmology rotation given the importance of maintaing our patients vision. It would be interesting to know about the various training parameters at various programs, maybe some residency focus in certain things over the expense of other things.

 

[neurodoc]

Isn't there a neuro-opthalmology rotation during neurology residency so that you can identify a large majority of eye pathologies? Do any neurologists use the pan-opthalmoscope either? Any significant advantage?

Good questions. First, there is no general requirement for neuro residents to rotate in ophthalmology, but the opportunity is there. I decided on Neuro in my third year of med school and chose a 6 week elective in and another 4 week elective in my neuro residency. My main goal was to learn to become proficient in ocular examination, specifically direct and indirect (both momcocular ahnd binocular) ophthalmoscopy and the use of the biomicroscope (slit lamp). I think that I learned these techniques, and that they have helped me to become a better clinician.

For bedside examination I use both direct ophthamoscopy (DO) with the standard ophthalmoscope and monocular indirect ophthalmoscopy (MIO) with the excellent Welch-Allen "Panoptic" monocular indirect scope. The former is great for high-magnification views of the fundus. The latter gives a broader, less magnified, view of the fundus. Both excel at different things, and being able to use both extends your "diagnostic armamentarium." But the real benefit of my ophtho rotations was learning to is the binocular indirect ophthalmoscope (BIO) and the slitlamp.

Nick