• Set Yourself Up For Success Webinar

    October 6, 2021 at 2 PM Eastern/11 AM Pacific
    SDN and Osmosis are teaming up to help you get set up for success this school year! We'll be covering study tips, healthy habits, and meeting mentors.

    Register Now!

  • Funniest Story on the Job Contest Starts Now!

    Contest starts now and ends September 27th. Winner will receive a special user banner and $10 Amazon Gift card!

    JOIN NOW
  • Site Updates Coming Next Week

    Site updates are coming next week on Monday, Wednesday, and Friday. Click the button below to learn more!

    LEARN MORE

Psych resident reading recommendations

samac

Tinfoil hoarder
5+ Year Member
Dec 11, 2014
5,948
10,925
176
  1. Resident [Any Field]
Hello!
I’m starting my psych residency and am on neuro in August. We have a busy stroke service here and general neuro. Over the month we cover stroke, the unit, and overnight call.
I’m a DO and never had the opportunity to do a neuro rotation so I’m a little scared about it. Do you all have any simple references you’d recommend so I don’t look like a total idiot? I don’t have time to read through the entirety of a big reference book, but I didn’t know how good pocket neurology or something else may be?
I want to be the most helpful resident I can
 

DrSatan

Satan, M.D.
7+ Year Member
Apr 16, 2014
107
217
216
  1. Resident [Any Field]
No one will expect too much from you honestly. Just learn how to do a good neurologic exam (<-- link) & ask a lot of questions to patients so you can help your senior narrow the differential. Neurology is typically fairly boring with spurts of super interesting cases (as in any field).

Big things you'll see on stroke are altered mental status (usually no true localizing features on exam, typically due to an infection), functional neurologic/conversion disorder (give-way weakness, coachable strength, not localizing, young women), seizure with post-ictal Todd's paralysis, migrainous phenomena (young women, associated headache, positive symptoms like paresthesias, visual phenomena, olfactory hallucinations, light/sound sensitivity, nausea & vomiting, but keep cerebral venous sinus thrombosis on your differential [need CTV or MRV to rule out]), BPPV/peripheral neuritis/labyrinthitis (learn the HINTS+ exam to look like a boss), recrudescence (recurrence of prior stroke symptoms due to underlying infection or toxic/metabolic etiologies), alcohol intoxication (yes, ugh), & true occasionally real stroke (hemorrhagic or ischemic). There are others like like brain metastases, hemiplegic migraine, amyloid spells (cerebral amyloid angiopathy-related inflammation), PRES (basically hypertensive emergency, usually have seizures), RVCS (similar to the prior), CNS vasculitis, or CNS lymphoma.

Learn the NIHSS (<-- link); it's very easy & very gross. Learn the major tPA inclusion & exclusion criteria (or keep a card with you). Review the basics of CT, CTA, & CT perfusion imaging (<-- link) & understand what an ASPECTS score (<-- link) is (don't be expected to come up with the score). MRI for stroke is super easy, but sequences can be different depending where you go, so just ask your senior which ones to look at to diagnose stroke (it's EXTREMELY easy on MRI); typically you look for brightness on diffusion-weighted imaging (DWI) & darkness on apparent diffusion coefficient (ADC). Think DWI = White & ADC = Dark (means there is restriction of water in that area, which is typically due to stroke in these contexts). You typically start with a CT noncon to rule out hemorrhage to evaluate whether it's safe to give tPA (within 3-4.5 hours), this is usually coupled with a CTA to evaluate for a large vessel occlusion with perfusion studies to see how much penumbra is theoretically present to save with a mechanical thrombectomy via neurosurgery (24 hour window here).

Inpatient general is another whole beast. Expect lots of seizure & status epilepticus evaluations, altered mental status, numbness + weakness (usually more so peripheral neuropathies), multiple sclerosis, rapidly progressive dementia (it never is), myasthenia exacerbations, & placement for any decompensating "neuro" patient. I'd focus mainly on how to get a good H&P for epilepsy, such as seizure semiology (aura, what it looked like, how it spread, how long it lasted, tongue biting, urinary incontinence, frequency, stressors, alcohol use, sleep deprivation), current AEDs (& if taking regularly), prior AEDs, infectious symptoms, changes in medications (that may alter AED absorption), etc.

I honestly don't feel like continuing to add stuff as this was already probably overkill. Just do the full neurologic exam & trust what you find (only then will you find out if what you're doing is wrong). Try to localize as best you can (eg, muscles, NMJ, peripheral nerves, spine, brainstem, subcortical, or cortical brain). Read about the diseases you see on UpToDate to get a basic idea of what to ask, what to look for, diagnostic criteria (these are not hard & fast typically), & treatment options. Don't be afraid to ask questions.

Feel free to ask more questions if they come to you.
 
Last edited:
  • Like
  • Love
Reactions: 7 users
About the Ads

yugui

New Member
Jul 1, 2020
1
2
1
  1. Attending Physician
I love this book, its the best book to introduce yourself to the neurology field. 10/10

Aaron Berkowitz - Clinical Neurology and Neuroanatomy: a localización-based approach (Lange)

I would have loved to have It when I started my residency program. Its only 300 pages and everything is explained so clearly and easy.... of course if you want to get deep into a subject its not enought but as an introduction is perfect.
 
  • Like
Reactions: 1 users
About the Ads
This thread is more than 1 year old.

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.