Mastering the cognitive knowledge within a field such as neurology is a formidable task. It is even more difficult to draw on that knowledge, procure and filter through the clinical and laboratory data, develop a differential diagnosis, and finally to form a rational treatment plan. To gain these skills, the student often learns best at the bedside, guided and instructed by experienced teachers, and inspired toward self-directed, diligent reading. Clearly, there is no replacement for education at the bedside. Unfortunately, clinical situations usually do not encompass the breadth of the specialty. Perhaps the best alternative is a carefully crafted patient case designed to simulate the clinical approach and decision making. In an attempt to achieve that goal, we have constructed a collection of clinical vignettes to teach diagnostic or therapeutic approaches relevant to the discipline of neurology. Most importantly, the explanations for the cases emphasize the mechanisms and underlying principles, rather than merely rote questions and answers.
This book is organized for versatility: it allows the student “in a rush” to go quickly through the scenarios and check the corresponding answers, as well as the student with more time to have thought-provoking explanations. The answers are arranged from simple to complex: a summary of the pertinent points, the bare answers, an analysis of the case, an approach to the topic, a comprehension test at the end for reinforcement and emphasis, and a list of resources for further reading. The clinical vignettes are purposely placed in random order to simulate the way that real patients present to the practitioner. A listing of cases is included in Section III to aid the student who desires to test his or her knowledge of a certain area, or to review a topic including basic definitions. Finally, we intentionally did not primarily use a multiple-choice question (MCQ) format because clues (or distractions) are not available in the real world. Nevertheless, several MCQs are included at the end of each scenario to reinforce concepts or introduce related topics.
HOW TO GET THE MOST OUT OF THIS BOOK
Each case is designed to simulate a patient encounter with open-ended questions. At times, the patient’s complaint is different from the most concerning issue, and sometimes extraneous information is given. The answers are organized with four different parts:
1. Summary—The salient aspects of the case are identified, filtering out the extraneous information. The student should formulate his or her summary from the case before looking at the answers. A comparison to the summation in the answer will help to improve one’s ability to focus on the important data, while appropriately discarding the irrelevant information, a fundamental skill in clinical problem solving.
2. A straightforward Answer is given to each open-ended question.
3. The Analysis of the Case, which is comprised of two parts:
a. Objectives of the Case—A listing of the two or three main principles that are crucial for a practitioner to manage the patient. Again, the student is challenged to make educated “guesses” about the objectives of the case on initial review of the case scenario, which help to sharpen his or her clinical and analytical skills.
b. Considerations—A discussion of the relevant points and brief approach to the specific patient.
Approach to the Disease Process—This has two distinct parts:
a. Definitions or Neurophysiology—Terminology or neuroanatomy correlates pertinent to the disease process.
b. Clinical Approach—A discussion of the approach to the clinical problem in general, including tables, figures, and algorithms.
Comprehension Questions—Each case contains several multiple-choice questions that reinforce the material, or introduce new and related concepts. Questions about material not found in the text will have explanations in the answers.
Clinical Pearls—A listing of several clinically important points are reiterated as a summation of the text and allow for easy review such as before an examination.