Neurology Midterm Over!

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Finished part of neurology, the midterm was worth 30% the final will be worth 70% of the grade. The course is split up between lecture, lab, and discussion (electrophysiology). The lecture portion of the course only started a few weeks ago, but we’ve already covered several hundred pages, between 1500-2000 slides (120-180 new slides per day), and several hundred more pages out of the text if you found time to do that as well — I should note that of the 120-180 slides you’ll probably only receive 1-3 questions, so you study everything in the hopes that you might understand it and hopefully see that concept on the test. In lab we dissect the brain we dissected out from gross anatomy, it’s a good break from lecture and requires less brain power than participating in electrophysiology discussion. So, you might be curious what learning neuroscience/anatomy is like. Well, the easiest way to understand it is the example below:


In the ball above, imagine your were given the task to find out where each rubber band was going. This also means knowing where each rubber band was crossing another band. Now, imagine each rubber band has a function, so you’ll need to know that too. And now, imagine you weren’t allowed to take the rubber bands apart, you’re forced to make a 3D map in your head instead. That’s medical neuroanatomy.

So, medical neurology/anatomy comes in several flavors. Some questions give you an amorphous blob and you’re expected to make sense of it:

There are not many first order questions in medical school.
There are not many first order questions in medical school.

A typical medical school question in neuroanatomy is a second or perhaps third order question, they’re doing you a favor if they ever ask you a first order question. For example, it’s rare that you’ll be asked ,”What is structure L?”, instead it’s more normal to ask “Where do the axons that originate in location L?”, or, “What symptoms would manifest in a lesion of structure labeled L?”

From the lecture material we receive many vignette style questions, also known as mock board exam style. If you’re not familiar with a vignette, it’s just a short story that leads into a question. Some of the story will be useless some of it will be useful, it’s your job to figure out which is which — it’s not far off from how real cases tend to be. A typical style question for neurology is:

Screenshot from the program Brain Voyager
Screenshot from the program Brain Voyager

“A 53 year old right handed bartender comes in after insistence from his wife because he’s been tripping more than usual lately. His pupil reflexes are intact, and he’s orientated in time and place. The neurological exam was unremarkable, except that his reflexes were exaggerated in his left leg. You also notice that he stumbles to his left when you ask him to walk with his eyes closed, this only happens when his eyes are closed. In general, what lesion would explain his symptoms?”

A. upper motor neuron lesion, right posterior spinocerebullar

B. upper motor neuron lesion, left posterior spinocerebullar

C. lower motor neuron lesion, right posterior spinocerebullar

D. upper motor neuron lesion, left rostral spinocerebullar

E. upper motor neuron lesion, left ventral spinocerebullar

On the upside, the questions are interesting and you start to feel all doctorey! Now, I feel a lot more prepared to attempt to understand when a patient comes into their appointment with a constellation of symptoms not easily explained away. Presumably, now that I just learned a bit of neurology I’ll think every patient that comes in has a neurological problem — I also assume I’ll think the same way for each system that I learn about. I suppose it may even sound a little silly, but it’s funny how the symptoms you learned just but a day or two before become relevant when that patient walks in the room. Sure, you won’t see that 1/100,000 diagnosis, but you will see stroke survivors and those with lifestyles that all but summon an impending cerebral accident. So, neurology is tough, but it’ll be the first time in medical school medical students will start to think like physicians.




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