neurology clerkship learning objectives

Perform a neurological screening examination, with direct attending observation and evaluation of the student’s ability to test the cranial nerves, motor system, reflexes and sensory system.
Describe how to further localize neurological lesions responsible for seven common neurological conditions or syndromes (see Clinical Syndrome Approach, below):
- focal weakness or numbness
- visual changes or impairment
- dementia, delirium, language, memory or cognitive loss
- dizziness, abnormal balance or gait
- headache or regional pain
- impaired consciousness or sleep disorder
- seizures or involuntary movements
Describe the basic pathophysiology, usual clinical manifestations, and appropriate treatment of common neurological disorders, including:
- cerebrovascular disease (transient ischemic attacks, infarction and hemorrhage)
- epilepsy (partial and generalized seizures, status epilepticus)
- infections affecting the central nervous system (meningitis, encephalitis)
- central nervous system tumors (primary, metastatic)
- multiple sclerosis
- headaches (migraine, tension headache, secondary headache)
- dementia (especially Alzheimer’s disease, vascular dementia)
- neuromuscular disorders (neuropathies, myopathies, neuromuscular junction disorders, motor neuron diseases, radiculopathies)
- movement disorders (especially Parkinson’s disease, essential tremor)
- sleep disorders (especially sleep apnea)
Describe the proper dosing, indications, risks, benefits and common side-effects of medicines used to treat neurological disorders, including:
- anticonvulsants
- levodopa and dopamine agonists
- cholinesterase inhibitors, central and peripheral
- corticosteroids
- immunomodulatory agents, such as beta-interferon, gamma globulin
- anticoagulant and platelet inhibitory drugs
- triptans, beta-blockers, tricyclic antidepressants (migraine therapy)
- anticholinergics, beta-blockers, dopamine antagonists (treatment of hyperkinetic movement disorders)
Describe the indications, complications and contraindications of neurological diagnostic procedures, including:
- neuroimaging (CT, MRI, angiography, myelography) (see Neuroradiology Learning Objectives, below)
- nerve, muscle or brain biopsy
- electroencephalography (EEG)
- electromyography (EMG)
- lumbar puncture (with a simulation-based workshop, see below)
Describe the diagnosis and treatment of neurological emergencies, including:
- acute stroke syndrome
- status epilepticus
- coma
- increased intracranial pressure
- meningitis or encephalitis
- acute paralytic conditions (spinal cord compression, myasthenic crisis, Guillain-Barré syndrome)
Discuss the therapeutic options for relieving pain in patients with neurological disorders, such as:
- migraine and other headache syndromes
- neuralgic conditions
- radicular pain (zoster, “sciatica”)
Discuss the neurological criteria for brain death and poor prognostic clinical signs for patients in a persistent vegetative state. Describe the use of assistive devices and supportive care in chronic or incurable neurological disorders, as well as decisions to forego life-sustaining measures.
Display expected competency in communication skills, professionalism, patient care, practice-based & lifelong learning, and social & community context of healthcare.