Lecture Notes on CNIM Mock Exam and Neurologic Examination

Initial Expectations and Purpose of the Mock Exam

• Expectations: Most to score under 50 the first time.
  • Scoring 30-40 is satisfactory.
  • Some people may score better based on experience or prior studying.
  • Scores below 20 are not terrible.
• Purpose:
  • Diagnostic tool to assess current knowledge level.
  • Helps identify areas that need improvement or study.
  • Used to assess progress over time.
• Instructions for Mock Exam:
  • Allocate four hours to complete the 250-question mock exam.
  • Read and understand every question and answer option.
  • Focus on keywords and categorize questions (anatomy, guidelines, etc.).
  • Avoid answering questions you completely don’t know to prevent skewed results.

Study Techniques and Further Preparation

• Study Techniques:
  • In second semester, practice understanding why answers are correct or incorrect.
  • Review central nervous system pathology lecture.
• Exam Re-take:
  • Repeat exam in second semester.
  • Expect exponential improvement on second attempt.

Neurologic Examination Overview

• Importance of Neurologic Exam:
  • Overlooked in education and training.
  • Prevents false negatives in intraoperative neuromonitoring.
  • Helps in assessing preoperative and intraoperative status.

Components of the Neurologic Exam

1. Mental Status:
   • Observation of patient's orientation and mental clarity.
2. Cranial Nerves:
   • Assessment of cranial nerve function (focus on CN 3-12).
3. Motor Exam:
   • Inspection, palpation, muscle tone, functional and strength testing.
   • Use MRC strength scale to determine muscle strength.
4. Reflexes:
   • Deep tendon reflexes (DTRs), Babinski, Hoffman sign.
5. Coordination and Gait Testing:
   • Not commonly done in pre-op, but important to understand.
6. Sensory Exam:
   • Testing for sensation in dermatomes and myotomes.

Distinguishing Between Lesion Types

• Upper vs Lower Motor Neuron Lesions:
  • Upper: Hyperreflexia, hypertonia.
  • Lower: Atrophy, hyporeflexia, fasciculations.
• Reflexes:
  • Hyperreflexia can indicate upper motor neuron lesion.

Neurologic Examination in Clinical Practice

• Focus on specific structures at risk during procedures.
• Use patient history and symptoms to guide examination.
• Utilize functional understanding of anatomy to assess risk.

Conclusion

• Emphasized the importance of understanding and practicing the neurologic exam.
• Prepare for further interactive session to demonstrate neurological assessment techniques.