This is just a quick guide for students (of osteopathy) on how to pass, and if you have the background knowledge, get a good mark in a undergraduate clinical neurology exam.
I got this strategy from Massud Wassel. At the begining I didn’t understand a word of what he was saying but after reviewing for his final exam in the 3rd year of the master in osteopathy; I got the grip on what he expected.
The first and essential thing to do –in any practical exam– is to introduce yourself properly to the examiner and model. Make sure you talk slowly and clearly, throughout the whole process. You may know what you are talking about, but with the stress of an exam, that message may not be transmited appropriately.
Second explain clearly the outline of your routine. This is: a neurological examination of a patient should include 6 categories:
1. Assessment of mental status
2. Observation of posture, gait, balance, and muscle tone (cerebellar testing)
3. Cranial nerve testing
4. Deep tendon reflexes (DTR)
Depending on the case you are given you may want to re-order or cut down (for time or exam purposes) your routine. But make sure you clearly explain why. This will allow you to take the lead of your examination. It will show your examiner that you have a structured approach to a neurological examination of a patient
Third explain in detail to your examiner each test you would do in each category. For example, in cranial nerve testing explain what test you would do, and why you would do it in the frame of your case.
Fourth explain to your examiner what would you expect to find in each test. What does it mean if the test is negative, what does it mean if the test is positive. From here clearly develop your differential thinking relating it to your case. This is not giving a diagnosis, but interpreting your potential findings. This section is where you can stand out if you have background knowledge. Here you can add specific clinical considerations and specific tests to backup your argument.
For example when performing DTR you are looking for signs of upper motor neuron lesions (UMNL) vs. signs of lower motor neuron lesions (LMNL). It is easy to mistake and say: I am looking for UMNL signs or LMNL signs. You are not looking for those signs; you test and your findings will give you the answer. Then, if you suspect or consider UMNL; you can add specific tests such as Babinski sign (Plantar reflex), Chaddocks tests, etc.
If you don’t have a structure this section is when it can all go wrong. As you will be asked questions that will make you loose your time. But if you have a structure and you blank out in a specific point, as you have initially given your outline, your examiner may leed you onto the next question. If he doesn’t, ask if you can move to the next point. Your routine will guide you even under stress.
Fifth is your examination on a model/patient. Make sure you introduce yourself if you haven’t done it before. Then make sure you explain each test to the patient as clearly as possible; while explaining to your examiner what you are doing in relation to the case you have been given.