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  • Neuroscience
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BRAIN AND BEHAVIOUR: Neuroscience

Index

• General Outcomes for Neurosciences
• Cerebrovascular Disease (Stroke and TIA)
• Delirium and Dementia (see Psychiatry)
• Stupor, Coma and the Unconscious patient
• Organic Brain Syndromes
• Head Injury
• Spinal Cord Disorders and Injury
• Seizure Disorders
• De-Myelinating Diseases
• Migraine and Headaches
• Parkinson's Disease and Neuro-degenerative Disorders
• Neuromuscular disorders
• Dizzyness and Vertigo
• Tumours
• CNS Infections
• Neuropathies
• Chronic Pain
• Neurogenetic Disorders

• General Outcomes for Neurosciences
  • Medical knowledge: ANATOMY
    • Skull, Mandible and Facial Bones
      1. Know the main functions of the skull (BB2)
      2. Review the main anatomical features of the skull (BB2)
      3. Be able to identify skull landmarks and explain their significance (BB2)
      4. Be able to describe the development of the skull and the common developmental abnormalities (BB2)
    • Nasal Cavity and Sinuses
      1. Be able to identify the paranasal sinuses (BB2)
    • The Cranial Cavity and Meninges
      1. Describe the arrangement of the dura mater, arachnoid mater and pia mater in the cranial cavity and outline their functions. (GEP/BB)
      2. Explain the functions of the falx cerebri and the tentorium cerebelli in stabilising the brain during movement (GEP/BB)
    • Autonomic Nervous System
      1. Describe the anatomy of the sympathetic nervous system and explain the main differences between it and the somatic nervous system. (GEP/M&P)
      2. Explain how the anatomy of the parasympathetic nervous system differs from that of the sympathetic. (GEP/M&P)
    • Cerebral Cortex
      1. Name the main sulci and fissures of the cerebral cortex and the main lobes of the cerebral hemispheres (including the limbic lobe) (BB1, GEP/BB)
      2. Define projection fibres, association fibres, commissural fibres and name an example of each (BB1, GEP/BB)
      3. Define the terms primary cortex and association cortex, locate their relative positions on the brain surface and state the functional relationship between them (BB1, GEP/BB)
      4. Explain the significance of the homunculi associated with the pre- and post-central gyrus (BB1, GEP/BB)
      5. Define the concept of columnar organisation of the cortex (eg SI) and its relationship to somatotopic organisation in creating body maps (eg, creation of parallel maps for modality specific stimuli) (BB1, GEP/BB)
    • Hypothalamus
      1. Describe the functional organisation of the hypothalamus (BB1)
      2. Name the principal hypothalamic nuclei (BB1)
      3. Describe the principal afferent and efferent connections of the hypothalamus (BB1)
      4. Describe the hypothalamic autonomic and endocrine projections (BB1)
      5. Describe the hypophyseal portal system (BB1)
      6. Describe the hypothalamo-hypophyseal tract (BB1)
      7. Describe the principal fibre tracts linking the hypothalamus with the brain stem reticular formation (BB1)
    • Circulation System of the Brain
      1. Describe the principal arteries of the brain, thalamus and spinal cord (BB1, GEP/BB)
      2. Explain the possibilities for collateral circulation through the Circle of Willis (BB1, GEP/BB)
      3. Describe the relationship of the blood supply to major functional areas of the brain (BB1, GEP/BB)
      4. Describe the venous drainage of the brain and spinal cord (BB1, GEP/BB)
      5. Describe the major vascular disorders with regard to the blood supply to the CNS (BB1, GEP/BB)
    • Neural Pathways
      1. Draw a cross section of the spinal cord showing grey and white matter, dorsal and ventral horns; different laminae and zones of termination of the different types of primary afferent fibres; show the location of flexor and extensor motorneuron cell bodies (BB1, GEP/BB, GEP/M&P)
      2. Describe the anatomy of the spinal canal and the organisation of the dorsal and ventral roots. Describe the trajectory of the roots, the numbers of cervical, thoracic, lumbar and sacral roots and their relationship to the sympathetic ganglia. (GEP/M&P)
      3. Describe the functional neuro-anatomy underlying patterns of sensory loss including peripheral neuropathy, hemianaesthesia, sensory level and Brown-Séquard syndrome (NEURO4)
      4. Draw a cross-section of the cord to show the principal ascending and descending tracts located within the white matter. (GEP/BB, GEP/M&P)
      5. Describe the functional neuro-anatomy underlying patterns of motor loss including monoparesis, hemiparesis, quadraparesis, paraparesis and the differences between upper and lower motor neuron weakness (NEURO4)
    • Central Nervous System
      1. Describe the functional neuro-anatomy underlying coma (NEURO4)
      2. Describe the functional neuro-anatomy underlying Cauda Equina syndrome (NEURO4)
      3. Understand the concept of dermatomes and their clinical significance (GEP/M&P)
    • The Cerebellum
      1. Describe the main gross anatomical features of the cerebellum, including its input and output pathways and its lobular arrangement. (BB2, GEP/BB)
      2. Describe the microanatomical arrangement of the cerebellum including the cortical morphology and connections of the deep nuclei. (BB2, GEP/BB)
      3. Describe the functional subdivisions of the cerebellum and the effect of injury in different regions. (BB2, GEP/BB)
      4. Describe the functional significance of the cerebellar connections to the vestibular system (BB2, GEP/BB)
    • The Limbic System
      1. Be able to describe limbic structures - the hippocampus, the amygdaloid and the septal nuclei (BB2)
      2. Be able to explain the principal connections between the foregoing limbic structures and the hypothalamus, anterior and dorso-medial thalamic nuclei, prefrontal cortex and midbrain reticular formation. (BB2)
      3. Be able to describe the effects of lesions in the amygdala and fornix (BB2)
      4. Discuss the theories of prefrontal cortex function based on clinical evidence (BB2)
      5. Discuss the theories of temporal lobe function based on clinical evidence (BB2)
    • Vision
      1. Describe the functional neuro-anatomy underlying the visual field defects; homonymous hemianopia, bitemporal hemianopia (NEURO4)
      2. Describe the functional neuro-anatomy underlying a relative afferent pupillary defect (NEURO4)
      3. Describe the functional neuro-anatomy underlying eye movement defects; oculomotor, trochlear and abducens palsies and internuclear ophthalmoplegia (GEP/BB, NEURO4)
    • Cranial Nerves
      1. Describe the functional neuro-anatomy underlying defects of facial expression including forehead sparing upper motor neuron facial palsy (NEURO4)
      2. Describe the functional neuro-anatomy underlying a bulbar palsy including dysphonia, dysphagia and aspiration (NEURO4)
    • Surface Anatomy of the Back and Spine
      1. Be able to make the positon of the end of the spinal cord in the vertebral canal
    • The Spinal Cord
      1. Describe the functional organisation of the grey matter (BB1, GEP/BB)
      2. Define the term receptive field and describe the different types of cells in the dorsal horn (BB1, GEP/BB)
      3. Draw a cross section of the spinal cord to show the location of the main ascending and descending tracts within the white matter and how information is transmitted to the brain (BB1)
      4. Describe the organisation of the spinal cord in the vertebral column and the arrangement of dorsal and ventral roots (BB1)
    • Dermatomes
      1. Define the terms dermatome and myotome and show the distribution of cutaneous dermatomes on the body (BB1)
    • Surface Anatomy - General
      1. Be able to identify the different dermatomes on the limbs to assess somatosensation
  • Medical knowledge: PHYSIOLOGY
    • The Vestibular System
      1. Be able to list the functional roles of the vestibular system (BB2)
      2. Describe how the vestibular system detects angular and linear acceleration (BB2)
      3. Describe the vestibule-ocular reflexes and how they are tested. Define nystagmus and vertigo. (BB2, GEP/BB)
      4. Be able to describe the central pathways of the vestibular system (BB2)
      5. Be able to list the clinical signs of vestibular system dysfunction (BB2)
      6. Be able to describe tests for balance disorders (BB2)
    • General Outcomes for Nervous System Physiology
      1. to obtain quantitative data on the 2-point discrimination thresholds on different parts of the body (GEP/M&P)
      2. Describe the basic organisation of the peripheral and central nervous system (BB1, GEP/BB)
      3. Describe the main types of peripheral sensory receptors (BB1)
      4. Be able to describe the essential differences between afferent and efferent nerves. (GEP/M&P)
      5. State the main neurotransmitters employed by sensory afferents and in CNS neurons and their associated receptors (BB1)
      6. Define the term neurotrophic factor and explain the neurotrophic hypothesis (BB1, GEP/BB)
      7. To understand the basis of the resting membrane potential (GEP/BB)
      8. Explain the role of growth factors in the developing and mature nervous system (BB1, GEP/BB)
      9. Name and identify the major parts of the adult nervous system and describe their primary functions (BB1, GEP/BB)
      10. Describe the types of peripheral axons and sensory nerve fibres and their conduction velocities (including ANS fibres) (BB1)
      11. Define the term neuromodulator and give examples of such (BB1)
      12. Be able to describe the different kinds of sensory receptors found in the skin and other organs, and their relationship to the different diameters of sensory nerve fibres.the essential differences between afferent and efferent nerves. (GEP/M&P)
      13. Outline the pathway of, and name the enzymes involved in, the synthesis of noradrenaline and adrenaline. (GEP/M&P)
      14. Describe the synthesis, storage and release of acetylcholine. (GEP/M&P)
      15. To explain the simple action potential & saltatory conduction (GEP/BB)
      16. Describe the role of glial cells in the nervous system (BB1, GEP/BB)
      17. Explain how noradrenaline and adrenaline are released from sympathetic nerves, how they act, and how they are inactivated. (GEP/M&P)
      18. Describe how epsps and ipsps are generated at excitatory and inhibitory synapses within the CNS (BB1)
      19. Differentiate nicotinic from muscarinic effects. (GEP/M&P)
      20. Describe the control of muscle length and tension involving muscle spindles and tendon organs. (GEP/M&P)
      21. Describe the process of nerve regeneration and state the criteria for determining its success (BB1, GEP/BB)
      22. Describe the role of polysynaptic reflexes in the spinal cord (GEP/M&P)
      23. Describe the distribution of α- and ß-adrenoceptors and how different tissues/organs respond to adrenoceptor stimulation. (GEP/M&P)
      24. Explain the importance of termination of transmitter action, and give two different examples of how this is achieved (BB1)
      25. Briefly explain why regeneration in the CNS fails to occur (BB1, GEP/BB)
      26. Review how action potentials are propagated along axons and explain reasons for failure (BB1)
      27. Give examples of drugs (agonists / antagonists) selective for α- and ß-adrenoceptors, and for subtypes of these receptors. Discuss the therapeutic uses of these drugs. (GEP/M&P)
      28. Briefly describe how nerve conduction studies and electromyography are performed and how they can detect peripheral nerve abnormalities (BB1)
      29. Describe and explain the effects of anti-cholinesterase drugs (neostigmine, pyridostigmine) (GEP/M&P)
    • Consciousness, Coma and Persistent Vegetative States
      1. Define what consciousness is and its components. (BB2)
      2. Define the terms consciousness, coma and sleep (BB2)
      3. Describe how consciousness is measured using the Glasgow coma scale (BB2)
      4. Describe the anatomical correlates of consciousness. (BB2)
      5. Describe the neuroanatomical systems (reticular formation) which govern arousal
      6. Give a classification of unconscious states. (BB2)
      7. To understand the mechanism of action of general anaesthesia (GEP/BB)
      8. Describe the neurophysiological processes behind sleep and consciousness (BB2)
      9. Define the terminology used for vegetative states. (BB2)
      10. Appreciate the effect of pathological processes of this system on conscious level (BB2)
      11. Explain the difference between conditions closely related to the vegetative state such as minimally conscious state and akinetic mutism. (BB2)
      12. Explain the prognosis and outcome of the vegetative state. (BB2)
    • The Physiology of Pain
      1. Be able to define the following terms: pain, nociceptor, allodynia, hyperalgesia, spontaneous pain and referred pain. (BB2, GEP/BB)
      2. Be able to state the four main components involved in pain transmission & perception (BB2, GEP/BB)
      3. Be able to describe the biological significance of acute, prolonged and chronic pain. (BB2, GEP/BB)
      4. Be able to describe how tissue damage leads to altered activation of nociceptors and cells in the spinal cord. (BB2, GEP/BB)
      5. Be able to describe the chemical anatomy of nociceptors. (BB2, GEP/BB)
      6. Describe the main mechanisms whereby nociceptive transmission can be blocked or modulated. (BB2, GEP/BB)
      7. To understand the mechanism of action of local anaesthesia (GEP/BB)
      8. Review the ascending pathways by which fast and slow pain is transmitted from the periphery to the cortex. (BB2, GEP/BB)
      9. Be able to discuss the role of cells in the substantia gelatinosa in the gating of nociceptive transmission and comment on its clinical importance. (BB2, GEP/BB)
      10. Be able to summarise the functions of different brain areas in pain processing (BB2, GEP/BB)
      11. Be able to explain the concepts of peripheral and central sensitisation. (BB2, GEP/BB)
    • Motor Systems
      1. Be able to describe the regions of the cortex involved in motor control (BB2)
      2. Describe the anatomy and physiology of muscle spindle and Golgi tendon organs. (GEP/M&P)
      3. Be able to describe the functional characteristics of the major motor tracts (pyramidal, reticulospinal and vestibulospinal) and their origins (BB2, GEP/BB)
      4. Describe the pathophysiologic mechanisms of spasticity, clonus, hyperreflexia and decorticate and decerebrate postures. (BB2, GEP/BB)
      5. Describe the concept of lower motoneurone and upper motoneurone lesions, muscle tone & spasticity. (GEP/M&P)
      6. Describe the acute and chronic deficits arising from lesioning of individual motor tracts and the acute and chronic deficits arising from lesioning the motor cortex; be able to compare with lesions of the lower motorneurone. (BB2)
      7. Name cholinergic agonists and antagonists; describe their receptor selectivity and possible therapeutic uses. (GEP/M&P)
      8. Explain the mechanisms of action of different kinds of neuromuscular blocking agents. (GEP/M&P)
    • Spinal Reflexes
      1. Define the terms motor unit, upper and lower motoneurons (BB1)
      2. Describe how the force of muscle contraction is controlled by impulse frequency and by recruitment of motor units (BB1)
      3. Define muscle tone, spasticity and flaccidity (BB1)
      4. Describe the effects on muscles and reflexes of upper and lower motoneuron damage (BB1)
    • Brainstem and Cranial Nerves
      1. Define the main sub-regions of the brainstem, their associated functions and state which cranial nerves are associated with each region (BB1, GEP/BB)
      2. List the symptoms associated with damage to cranial nerves (BB1, GEP/BB)
      3. Describe the course and exit foraminae of the cranial nerves from the skull vault especially cranial nerves V, VII, IX, X and XII (BB1, GEP/BB)
      4. Briefly describe the organisation of the cranial nerve nuclei and main ascending and descending pathways in the brainstem (BB1, GEP/BB)
      5. Explain the consequences of vascular or physical lesions to the different areas of the brainstem in terms of clinical signs (BB1, GEP/BB)
      6. Explain the consequences of raised pressure in the posterior cranial fossa (BB1, GEP/BB)
      7. Describe the main peripheral targets in the head innervated by cranial nerves V, VII, IX, X and XII (BB1, GEP/BB)
      8. Briefly state the main functions of the reticular formation (BB1, GEP/BB)
    • Blood Brain Barrier and CSF
      1. Describe the structure and function of the meninges and the blood-brain barrier (BB1)
      2. Describe how different classes of compound cross the blood-brain barrier and why this is a problem in therapeutics (BB1)
      3. Describe how cerebro spinal fluid (CSF) is formed and how it circulates in the brain (BB1)
      4. Describe how breakdown of the blood-brain barrier is a serious problem (BB1)
    • Basal Ganglia
      1. Describe the morphology and blood supply of the caudate and lentiform nuclei and the associated internal capsule (BB2, GEP/BB)
      2. Describe the principal afferent and efferent connections of the caudate nucleus and putamen (striatum). (BB2, GEP/BB)
      3. Describe the connections of the globus pallidus & subthalamic nucleus. (BB2, GEP/BB)
      4. Explain the circuitry of the substantia nigra and its association with Parkinson's disease. (BB2)
      5. Describe the role of the basal ganglia in motor control and discuss how their damage can lead to Parkinson’s disease, Huntington’s chorea, ballismus and athetosis. (BB2)
    • Somatosensory Pathways
      1. Describe the pathways to the brain for touch receptors; describe the clinical manifestations of lesions in these pathways (BB1, GEP/BB)
      2. Describe the pathways to the brain for proprioceptive receptors; describe the clinical manifestations of lesions in these pathways (BB1, GEP/BB)
      3. Describe the pathways to the brain for pain receptors; describe the clinical manifestations of lesions in these pathways (BB1, GEP/BB)
      4. To produce a clear description of the changes in sensory perception in a subject with circulation occluded in one arm. Discuss the neurophysiological processes in the arm that are responsible for these perceptual changes. (GEP/M&P)
      5. Describe the organisation of somatosensory (VP) thalamus (BB1, GEP/BB)
      6. List the differences that may be encountered when a lesion is located at the peripheral, spinal, posterior fossa (brainstem), or supra-tentorial (thalamus/cortex) levels (BB1, GEP/BB)
      7. to discuss the concept of somatosensory receptive fields on the body surface, how density and size of these fields may affect the localisation of touch stimuli (GEP/M&P)
    • Cerebral Function
      1. Explain the term cerebral dominance, how it may be demonstrated, and describe the lateralisation of functions associated with language, and how it is related to left or right handedness (BB1, GEP/BB)
      2. Describe the functions of the non-dominant hemisphere (BB1, GEP/BB)
      3. Define the terms agnosia, apraxia and aphasia (BB1, GEP/BB)
      4. Describe the main effects of lesions of the occipital, parietal, temporal and frontal cortices (BB1, GEP/BB)
      5. Describe the consequences of severing the corpus callosum - split brain syndrome (BB1, GEP/BB)
    • The Neural Control of Movement
      1. Review the main functions of non-neuronal cells in the PNS and CNS in health and disease (BB2)
      2. Draw a diagram of the connections of the major components of the motor system (motor cortex, basal ganglia, cerebellum, brainstem, spinal cord and a-motoneurons) (BB1, GEP/BB, GEP/BB)
      3. Outline the main fuction of each part of the motor system (BB1, GEP/BB)
      4. Review the main neurotransmitters used by the nervous system (BB2)
      5. Define the area of the brain occupied by the motor cortex, its major inputs and outputs and its topographic arrangement (in terms of the distorted motor homunculus representation) (BB1, GEP/BB)
      6. Review the main pathways by which the sensory modalities of touch, pain and proprioception are transmitted from the periphery to the brain, where they decussate, the basic tests used to assess their integrity and the clinical signs associated with damage (BB2)
      7. Define the main functions of the motor association cortex (BB1, GEP/BB)
      8. Know the main components of the motor system with particular emphasis on the monosynaptic reflex and the corticospinal (pyramidal) tract, their clinical significance, how to test reflexes and how to recognise damage to the motor system (BB2)
      9. Review the organisation and functions of the cranial nerves, the basic tests used to assess their integrity and the clinical signs associated with their damage (BB2)
      10. Name the pathways that comprise the pyramidal and extra-pyramidal systems and describe their main functions (BB1, GEP/BB)
      11. Review the functional organisation of the cerebral hemispheres, including higher mental functions and tests associated with them (BB2)
      12. Describe the basic neurological sequence involved in executing a voluntary movement (BB1, GEP/BB)
      13. Know the distribution of the principal arteries of the brain and spinal cord and the main functional areas of the brain and spinal cord that they cover (BB2)
    • Neuropharmacology
      1. Review the circuitry of the basal ganglia, its main neurotransmitters and its pathological modifications in Parkinson’s disease and Huntington’s disease (BB2, GEP/BB)
      2. Define drug targets within a typical chemical synapse in the nervous system (BB1)
      3. Explain the importance of the blood-brain barrier as a determinant of efficacy (BB1)
      4. Appreciate the importance of drug delivery systems in neurology. (BB2)
      5. Describe how different classes of compound cross the blood-brain barrier and why this is a problem in therapeutics (BB1)
      6. Describe the mechanisms of action, pharmacokinetics, adverse effects and limitations of drugs used in the treatment of Parkinson’s disease (e.g. L-DOPA, dopaminergic agonists, cholinergic antagonists, MAOB inhibitors). (BB2, GEP/BB)
      7. Give examples of side-effects fo drugs used in neuropharmacology and describe their impact on disease management (BB1)
      8. Describe the treatment of Huntington’s disease. (BB2)
      9. Define the concept of treatment-resistance, and give examples of causes underlying this phenomenon (BB1)
      10. Briefly review future directions in the management of Parkinson’s disease and Huntington’s disease. (BB2)
    • Physiology of Memory and Learning
      1. Define learning, and describe the conditions under which it occurs. (BB2)
      2. State the differences between classical conditioning and operant conditioning (BB2)
      3. Define short- and long-term memory, and consolidation. (BB2)
      4. Define anterograde and retrograde amnesia, and state some of the major causes of these. (BB2)
      5. Describe the possible synaptic mechanisms underlying memory formation (BB2)
      6. State the role of the hippocampus and the amygdala in memory. (BB2)
      7. Briefly outline the effects of frontal and temporal lobe lesions on memory. (BB2)
    • Control of Behaviour
      1. Describe the neural circuits involved in the control of feeding (BB1)
      2. Describe the neural circuits involved in the control of thirst (BB1)
      3. Describe the neural circuits involved in the control of reproduction (BB1)
      4. Describe the neural circuits involved in the control of micturition (BB1)
      5. Describe how hypothalamic lesions or genetic variations can modify motivated behaviour (BB1)
    • The Peripheral Nervous System
      1. List the changes that occur after nerve injury - distal to the injury; in the dorsal root ganglion; proximal to the injury (BB1, GEP/BB)
  • Medical knowledge: PATHOLOGY
    • Hydrocephalus
      1. Describe the pathology, presentation, investigation and management of hydrocephalus (NEURO4)
    • General topics
      1. Demonstrate an awareness of the breadth of neurological pathology
  • Medical knowledge: CLINICAL FEATURES of DISEASE
    • Hydrocephalus
      1. Describe the pathology, presentation, investigation and management of hydrocephalus (NEURO4)
    • General Outcomes for Neurological Disorders
      1. Be able to describe the Kluver - Bucy syndrome, temporal lobe epilepsy and Wernicke-Korsakoff syndrome. (BB2)
  • Medical knowledge: THERAPEUTIC PRINCIPLES
    • 5-HT Transmission
      1. Describe the 5-HT pathways in the central nervous system. (BB2)
      2. List and characterise the main types of 5-HT receptors. (BB2)
      3. Describe the mechanism of action of drugs that act on 5-HT systems. (BB2)
    • Synaptic Transmission
      1. Describe the neuronal structures involved in synaptic transmission. (BB2)
      2. Describe the main steps involved in neurotransmission. (BB2)
      3. List and classify major types of neurotransmitters. (BB2)
      4. Describe the effects of neurotransmitters at postsynaptic level. (BB2)
      5. Review the basic mechanisms underlying neuronal excitability. (BB2)
    • Dopaminergic Systems
      1. Describe the dopaminergic pathways in the central nervous system. (BB2)
      2. List and characterise the main types of dopaminergic receptors. (BB2)
      3. Describe the mechanism of action of drugs that act on dopaminergic systems. (BB2)
      4. Review the main circuits involved in the control of movement. (BB2)
    • Drug Dependence and Addiction
      1. Explain mechanisms underlying pharmacodynamic and pharmacokinetic tolerance. (BB2)
      2. Give examples of major drugs that cause dependence and induce tolerance. (BB2)
  • Medical knowledge: PSYCHOLOGY
    • Drug Dependence
      1. Describe physical and psychological drug dependence. (BB2)
    • General Outcomes for Learning and Conditioning
      1. Distinguish different types of conditioning and learning. (BB2)
      2. Describe the role of learning in addictive behaviours. (BB2)
      3. Illustrate the relevance of learning principles in medicine. (BB2)
      4. Provide examples of psychological treatments based on theories of learning. (BB2)
  • Clinical skills: HISTORY and EXAMINATION
    • Examination of the Nervous System - General
      1. Perform and present an examination of the conscious level, the cranial nerves and the neurology of the upper and lower limbs (NEURO4)
      2. Appreciate the anatomical / physiological basis of the peripheral neurological examination (BB2)
      3. Appreciate the anatomical basis of the central neurological examination (BB2)
      4. Know how to gain consent to examine a person / patient's neurological system(s) (BB1, BB1)
      5. How to gain consent to examine a person / patient’s peripheral neurological system (BB2)
      6. Know how to correctly identify some simple abnormalities of the neurological system including signs of stroke disease (BB1, BB1)
      7. Know how to position a patient / person correctly prior to examining their peripheral neurological nervous system, gait and cerebellar system. (BB2)
      8. Be able to perform a cutaneous sensory examination (low threshold touch; pinprick; point position sensation; vibration; temperature) (GEP/M&P)
      9. Know how to identify the common clinical signs that show a patient has neurological deficit and / or the patient is unwell. (BB2)
      10. Be able to identify the common clinical signs that show a patient has neurological deficit and / or the patient is unwell. (BB2)
      11. Appreciate how to systematically observe a patient from the end of the bed using the 'feet to face' principle, identifying some common abnormalities of peripheral neurological disease. (BB2)
      12. Be able to perform a reflex tendon examination of the following reflexes: beceps, triceps, knee, ankle and plantar flexor (GEP/M&P)
      13. Know how to systematically observe a patient from the end of the bed using the 'feet to face' principle, identifying some common abnormalities of central neurological disease. (BB2)
      14. Be able to demonstrate the appropriate techniques required to perform a systematic examination of a patient’s peripheral neurological system including gait and cerebellar disorders. (BB2)
      15. Be able to perform an EMG (electromyography) of the muscles of the upper limb and interpret the data generated (GEP/M&P)
      16. Appreciate how to perform the associated clinical examination and investigations required to complete a neurological assessment. (BB2)
      17. Know how to perform the associated clinical examination and investigations required to complete a neurological assessment. (BB2)
      18. Be able to perform a sensory and motor examination of the hand to assess the functions of the main nerves that innervate the hand
      19. Appreciate how to complete the neurological assessment of a patient. (BB2)
    • Examination of the PNS
      1. Appreciate the anatomical and physiological basis of the peripheral neurological examination (BB1)
      2. Know the correct techinque used to perform a limited motor and sensory examination of the upper and lower limbs (BB1)
    • Examination of the CNS inc. Cranial Nerves
      1. Appreciate the anatomical / physiological basis of the neurological examination including the cranial nerves and their functions and the supporting basic neuroanatomy (BB1)
      2. Know how to gain consent to examine a person / patient’s cranial nerves (BB2)
      3. Know how to position a patient / person correctly prior to examining their cranial nerves. (BB2)
      4. Be able to demonstrate the appropriate techniques required to perform a systematic examination of cranial nerves II, III, IV, V, VI, VII and XII. (BB2)
      5. Be able to perform clinical examination of cranial nerves III - VII and XI - XII
      6. Associate specific tests with cranial nerves, sensory modalities and ascending or descending pathways
      7. The student should know the principles of the examination with reference to the basic neuroanatomy and neurophysiology of the cranial nerves and pathways
    • Taking a History
      1. Take, record and present a neurological history, including a drug history (NEURO4)
  • Clinical skills: INVESTIGATION
    • Neurological Investigations
      1. Describe the pathology, presentation, investigation and management of hydrocephalus (NEURO4)
      2. Describe the role of clinical neurophysiology in the investigation of neurological disease (NEURO4)
      3. Interpret the following features of CSF – cell count, protein content, glucose content, xanthochromia, oligoclonal bands (NEURO4)
  • Clinical skills: IMAGING
    • Neurological Imaging
      1. Demonstrate an ability to distinguish between CT, T1 & T2 weighted images and recognise gross abnormalities (NEURO4)
      2. Describe the different types of neuro-imaging techniques available to investigate the nervous system (BB1, GEP/BB)
      3. Define the role of functional imaging in the vegetative state. (BB2)
  • Clinical skills: DIAGNOSIS and REASONING
    • General Outcomes for Neurological Diagnosis
      1. Interpret historical and examination findings in order to begin to formulate a differential diagnosis, suggest reasonable investigations and produce a management plan including pharmacological therapy where appropriate (NEURO4)
  • Clinical skills: PATIENT MANAGEMENT
    • Management of Neurological Disorders
      1. Describe the pathology, presentation, investigation and management of hydrocephalus (NEURO4)
    • Emergency Management
      1. Describe the resuscitation and immediate management of patients suffering from the following emergency conditions; coma, injury to the head and spine, meningitis, neuromuscular respiratory failure and status epilepticus (NEURO4)
  • Clinical skills: PHARMACOLOGICAL THERAPY
    • Pharmacological Therapy - Neurological Disorders (General)
      1. Demonstrate knowledge of therapeutics, pharmacokinetics, side effects and interactions for the following common medications used in neurological treatment; carbamazepine, phenytoin, valporate, carbidopa / levodopa (NEURO4, NEURO4)
  • Clinical skills: SURGERY and ANAESTHETICS
    • Deep Brain Stimulation
      1. Understand the principles underlying deep brain stimulation and appreciate the impact of this technique in neurology. (BB2)
  • Professional issues: ETHICS and LAW
    • End of Life (inc. Do Not Resuscitate Orders)
      1. Define ethical issues such as the end of life decision. (BB2)
• Cerebrovascular Disease (Stroke and TIA)
  • General Outcomes for Cerebrovascular Disease
  • Transient Ischaemic Attacks (TIAs)
  • Cerebrovascular Accident (CVA / Stroke)
    1. Describe the pathology, presentation, investigation and management of stroke (NEURO4)
    2. Describe the pathophysiology of stroke in relation to risk factors. (BB2)
    3. Recognise the common neurovascular syndromes and mechanisms of stroke. (BB2)
    4. Understand the role of thrombolysis in the treatment of acute ischaemic stroke. (BB2)
    5. Understand the principles of management of patients who have suffered a stroke. (BB2)
  • Cerebrovascular Disease in Older People (CVA & TIA)
    1. The common differential diagnoses of patents presenting with TIA or stroke like symptoms (HCOE4)
• Delirium and Dementia (see Psychiatry)
  • General Outcomes for Delirium and Dementia
    1. Be able to classify dementia (BB2)
    2. Be able to describe the pathogenesis of Alzheimer's disease. (BB2)
    3. Be able to describe alterations in cholinergic neurotransmission in Alzheimer's disease. (BB2)
    4. Be able to describe the main types of acetylcholinesterase inhibitors and their use in dementia. (BB2)
    5. Be able to describe the use of memantine and its rationale. (BB2)
    6. Be able to discuss new therapeutic approaches in Alzheimer's disease. (BB2)
• Stupor, Coma and the Unconscious patient
  • General
  • The Collapsed patient in A & E
• Organic Brain Syndromes
  • General
• Head Injury
  • General Outcomes for Head Injury
    1. Describe the pathology, presentation, investigation and management of head injury (NEURO4)
    2. Review the anatomical features of the cranium relevant to head injury. (BB2)
    3. Understand the pathological changes which occur in the brain following head injury. (BB2)
    4. Be able to provide an overview of the types of intracranial injury which occur and the basic principles of their management after head injury. (BB2)
    5. Be able to list and show examples of different types of skull fractures (BB2)
  • Aphasia
  • Intra-cranial Haemorrhage
  • Sub-arachnoid Haemorrhage
    1. Describe the pathology, presentation, investigation and management of subarachnoid haemorrhage (NEURO4)
  • Raised Intracranial Pressure
• Spinal Cord Disorders and Injury
  • General Outcomes for Spinal Cord Disorders and Injuries
    1. Describe the pathology, presentation, investigation and management of spondylosis (NEURO4)
  • Myelopathy
  • Paraplegia
• Seizure Disorders
  • General Outcomes for Seizure Disorders
  • Epilepsy (General)
    1. Be able to describe the main types of epileptic seizure. (BB2)
    2. Describe the pathology, presentation, investigation and management of epilepsy (NEURO4)
    3. Describe the various mechanisms that may underlie epileptic seizures. (BB2)
• De-Myelinating Diseases
  • Multiple sclerosis
    1. Describe the neuroimmunological aspects of multiple sclerosis (BB2)
    2. Describe the pathology, presentation, investigation and management of multiple sclerosis (NEURO4)
    3. Be able to explain the symptoms, the progression of multiple sclerosis and its prognosis (BB2)
    4. Describe the present treatment of multiple sclerosis (BB2)
• Migraine and Headaches
  • General
    1. Understand the difference between primary and secondary headaches (BB2)
    2. Describe the pathology, presentation, investigation and management of headache (NEURO4)
    3. Can describe the pathophysiology, clinical symptoms and basic treatments of headache (BB2)
    4. Understand the distinguishing symptoms of the primary headaches (BB2)
    5. Understand the role of genetic and environmental factors in headache (thresholds and triggering / precipitating factors) (BB2)
    6. Review the central structures involved in primary headache Define the following terms: neurogenic inflammation, spreading excitation/depression, peripheral and central sensitization, central generator/modulation (BB2)
  • Pharmicological managment
  • Diagnosis
  • Acute headache
• Parkinson's Disease and Neuro-degenerative Disorders
  • General Outcomes for Neurodegenerative Disorders
    1. Describe Huntington’s chorea, ballismus and athetosis, and explain the deficits in basal ganglia function that lead to these syndromes. (GEP/BB)
  • Parkinson's Disease
    1. Can describe the pathophysiology, clinical symptoms and basic treatments of movement disorders (BB2, BB2, BB2, BB2, BB2)
    2. Describe the pathology, presentation, investigation and management of parkinson's disease (NEURO4)
    3. Describe the motor deficits seen in Parkinson’s disease and explain the theory of direct and indirect pathways used to explain the motor deficits (GEP/BB)
  • Motor Neurone disease
    1. Describe the pathology, presentation, investigation and management of motor neuron disease (NEURO4)
• Neuromuscular disorders
  • Myasthenia Gravis
    1. Describe the pathology, presentation, investigation and management of myasthenia gravis (NEURO4)
• Dizzyness and Vertigo
  • General
• Tumours
  • General Outcomes for Tumours
    1. Describe the pathology, presentation, investigation and management of brain tumours (NEURO4)
  • Meningioma
• CNS Infections
  • General
  • Meningitis
    1. Describe the pathology, presentation, investigation and management of infective meningitis (NEURO4, NEURO4)
    2. Meningitis: blind treatment, flow chart (CSP3)
• Neuropathies
  • General
    1. Describe the pathology, presentation, investigation and management of peripheral neuropathies (NEURO4)
  • Guillaine Barre Syndrome
• Chronic Pain
  • General
    1. Consider explanations for unusual pain phenomena. (BB2, GEP/BB)
    2. Be able to describe and evaluate the Gate theory of pain (BB2, GEP/BB)
    3. Be able to describe psychological methods of pain assessment. (BB2, GEP/BB)
    4. Be able to describe psychological pain management techniques and evaluate evidence of their efficacy (BB2, GEP/BB)
  • Opioids
  • Anaesthesia
  • Treatment
• Neurogenetic Disorders
  • General

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