Neurology Shelf Poll - Study Materials

[Betsy]

List your major source of prep for the Neuro shelf exam. Please elaborate below with any additional advice.

[hnaggarmd]

I used PreTest, First Aid for Step II and Blueprints for Neurology. I felt that Blueprints and 1st Aid were enough for the shelf exam (although I am still waiting for my grade). I really didn't feel that PreTest benefited, but it is always good to do practice questions. Dr. Pruitt recommends Clinical Neurology text. It is a great reference book, but too long to get through during the rotation. The test had very long vignettes with many choices so you have to read quickly through the questions in order to finish on time.

Know how to diagnose and manage epidural, subdural, subarachnoid hemorrhages, signs and symptoms of acute intermittent porphyria, organophosphate poisoning. Know side effects of seizure meds (just review 1st Aid for Step 1). Know how to treat/diagnose migraine/cluster/tension HA. There were a few eye questions related to MLF and PPRF. Know about thiamine deficiency, Wernickes, Broca's. Know when to get a CT/MRI/XR. That's all that I can remember for now.

[Betsy]

This was posted by khullmd from the Class of 2006 Forum.

Books/Studying: I liked the Lange text and PreTest, in combination. I found that Oklahoma notes was too outliney in format and didn't provide the depth of explanation that I was looking for. The Lange text is totally manageable if you spread it out over the rotation; it's only a couple hundred pages and provides the detail you need. Be sure to get all the way through PreTest at least once - the questions are shorter than on the real thing, but it will give you a sense of topics and format.

Shelf Board:
Strokes - anatomy, distribution, physical S/S, differential, treatment plan*
Headaches - migraine, cluster, tension, treatment
Seizures - know all the different types/presenations, dx, treatment, side effects of drugs
Imaging - which studies are appropriate under which conditions
Neuro emergencies
Meningitides - know presentation, etiology (viral, bacterial, fungal, etc.), CSF numbers, differential, which agents are most common at which ages, treatment (esp antibiotic coverage)
Movement disorders - Parkinson's, Huntington's, etc.
Degenerative - Alzheimer's, MS, etc.
Plexus vs. root vs. peripheral nerve
Sensory deficits - causes of visual field cuts, vertigo, loss of other special senses, changes in sensation/pain
Motor deficits
Nutritional disorders
Infectious processes - encephalitis, Lyme disease, etc.

*Be sure you know the next step in management for all of the above!

[Betsy]

Better practice your speed-reading skills, because this exam had some incredibly long vignettes! I agree with what the two people above posted about the exam.

I bounced around and couldnt decide what book to read. In hindsight, I would recommend reading Clinical Neurology starting at the beginning of the rotation. Its only like 300 pages, and it reads pretty well (the first chapter is hard to get through, but persevere). I started with Oklahoma Notes, and also found them to be too outliney. You really need to understand the basics of neuro before jumping into this book. (Some people liked High Yield Neuro). Pre-test is also pretty good practice. Oklahoma Notes are good, but dont have everything you need to know for the shelf. It is definately a great review right before taking the exam. I didnt have a chance to finish Lange because I jumped around at the beginning of the rotation. Since its only 4 weeks, there isnt alot of time to do that.

Good things to pick up on when taking the shelf that will help you narrow down your DDx quickly....pick up on the age of the patient and the duration of symptoms. Ex: 2 year hx of progressive dementia (Alzheimers) vs 3 months (CJD). Also, make sure you know your UMN vs LMN signs. This will also help you figure out what is going on with the patient. Remember the obvious thats easy to forget when you are under pressure during the test.....like if you are thinking the answer may be ALS or polio, make sure the patient does not have sensory deficits, or that cant be the right answer.

One more thing, make sure to read what the question is asking (duh, I know). There is alot of "what is the best INITIAL test" and what is the "best test to confirm the dx", etc, and this can make a big difference in your answer. Overall, its not too painful. Any other questions, feel free to ask! Good luck!

[Eileen]

I used clinical neurology. I actually got through it--though it's detailed at times and to really get everything you basically would have to read it twice. I didn't think it had "everything you need to know for the test". But I doubt anything does.

A few things about the test:

It's the longest of any shelf I've taken... If you think you might run out of time, it may be wise to do the last 10 questions earlier because they have a dozen answer choices and bubbling 'C' on those probably isn't going to get you very far.

Know genetics (disease inheritance), phenytoin--indications for use and side effects, headaches--diagnosis and treatment, everything about the eye--the eye is involved in a ton of different disorders, psych disorders, motor--root vs. plexus vs. peripheral, median vs. radial vs. ulnar nerve, gait problems came up a ton just like eye, vertigo--causes/treatments, CSF interpretation and treatment for different types of meningitis, lead poisoning, childhood viruses leading to seizures/encephalitis, and everything else everyone else said. Review First Aid for Step 1 and everything in it related to neuro.

Good luck...

[giannucci]

I used Clinical Neurology and PreTest. There really is a good bit of down time in all of the clinics and you tend to get to go home fairly early so it is doable to get through both of these books. While the material on the tests varies, I didn't notice very much in the way of neuro anatomy. For the most part if they were asking about a stroke, the only localization necessary was whether it was anterior, middle, or posterior - so I would advise not to spend a lot of time trying to remember how to differentiate an inferior division MCA stroke from a superior division MCA stroke (for example). Eileen's tip on brushing up on toxins and their acute treatment is a good one. As has been the case on the other shelf exams, there seems to be a fair number of questions based on acute managment...which we typically aren't exposed to on rotations, so it would be good to try to familiarize yourself with that.

[lindachambers]

I used clinical neuro and pretest as well. Ditto on everyone elses advise on specifics but take the time thing seriously.. I always finish tests early and ended up furiously filling in A bubbles at the end just so something would be on there.. but there are 10% of free pts if you watch the lectures and get all your SPEL in so if you meet all expectations all you need is a 59 on your shelf to get a B so its not so bad

[Peggy Sue]

I used Clinical Neurology and Pretest. I would definately recommend Clinical Neurology for chapters on the biggies: exam, movement disorders, seizure, etc. I read it a lot in downtime in clinic.
And no joke about time being an issue for the shelf. I always finish tests early, and I only had ~2 min to spare at the end of this one (and that was after speeding up about halfway through). No one left early. The test itself isn't so bad except for the time issue. Most questions about drugs were asking which drug to use after a certain clinical picture. More CNS infections than I expected.

[bobo]

I dont know what you are all talking about, but the neuro clerkship sucked, its sucked for years, there was no time to study at MCG and that test was ugly, lots of medicine, so if you take it as a 1st rotation get ready. I read pretest and oklahoma notes and still got rocked. Its no wonder more people fail the neuro shelf than any other one, b/c like many other experiences at MCG it comes down to 'teach yourself medicine'!

[raped]

OMG that test is sooo hard, advice to any 2nd years: take neuro later in the year, rotations 1-3 before you had medicine makes the test much more difficult, ie you could fail. The 2 failures in one early rotation were partners, did the neuro dept see that as a red flag? Become concerned? Look at the history of early failures? or ask why? NO, because students have been failing those early rotations for years, but MCG refuses to fix the problem...duh, maybe teach some neuro or require a lower low shelf score score in early rotations so students arent screwed, of I agree with Bobo above, you get what you pay for and no one cares or is willing to take action.