Lippincott’s Illustrated Q&A Review of Neuroscience

Book Preface

Neuroscience is not only an enormously interesting topic on its own but is one that permeates most aspects of modern medicine: central lesions, peripheral nerve disease, trauma, such as nerve root avulsion, and many others.

In this respect, an understanding of nervous system structure coupled with knowledge of the corresponding clinical correlates are, simply put, two sides of the same coin. For example, understanding the corticospinal tract is enhanced by the knowledge of its function, and recognizing clinical defi cits of this same system requires knowledge of its structure.

The nervous system is a challenging and engaging puzzle, the clinical and anatomical pieces of which interlockto create a clear and successful diagnosis of the impaired patient.

Lippincott’s Illustrated Q&A Review of Neuroscience offers well-designed questions, the majority of which are clini cally oriented and presented in the patient vignette style used by the National Board of Medical Examiners (NBME). These questions cover a wide range of basic science topics, while stressing their use and relevance in a clinical context.

This style of question offers several distinct advantages. First, it allows the users to preview questions and test themselves in a format generally consistent with what they will see on the USMLE Step1. Second, it allows the users to review/test their knowledge of CNS structure and function in a format that mimics what may be seen in the clinical setting. Third, these questions provide excellent practice for any course taught in a professional school, whether it has a distinct clinical leaning or approach.

These questions do not follow one particular book, or source, but refl ect content that is most generally addressed in clinically oriented neuroscience/neurobiology courses. While there are what one could call general knowledge questions in a clinical format, there are also challenging questions that will both test and extend the users’ knowledge base.

The following general approaches, or innovations, have guided this project: Many questions are in a patient vignette style generally refl ecting that used by the NBME. As much as is reasonably possible, information on relevant history/cause, tests/imaging, and essential elements of the examination are used in the stem. The answers are listed in alphabetical order.

Every effort has been made to design brief questions that will test the users’ ability to interpret, recall, apply, and integrate information.

Recognizing that most users will be viewing images of the CNS in a clinical orientation or environment (viewer’s left is patient’s right; viewer’s right is patient’s left), all images, including line drawings, stained sections, brain slices, and brain specimens, are placed in an orientation that refl ects how that particular brain part is viewed in MRI and/or CT in the clinical environment. This method automatically imparts to these images the same features that are seen in MRI or CT: the image (line drawing, stained section, brain slice) has right and left sides and the topography of tracts within the image matches exactly that seen in MRI and CT. On the other hand, MRI and CT, by their very nature, have intrinsic direction and laterality. This provides maximum opportunity for the users to practice the essential skill of determining the correlation between side of lesion and laterality of defi cit(s), mandatory for the clinical environment. While this is a departure from other question/review books, it refl ects an absolute clinical reality: This reality being that when students view the brain in MRI or CT, their right is the patient’s left and their left is the patient’s right, and the anatomy in the brainstem is reversed top-to bottom: the anterior/ventral aspect of the brainstem is up in these images and its posterior/dorsal aspect is down. Mastering these relationships is absolutely essential to successful evaluation, diagnosis, and treatment of the neurologically impaired patient, a skill that should be developed early in the career of all users.

The correct answer is explained, the incorrect answers are also explained, and relevant additional points may be included in the answer.

There are a wide variety of structures within the nervous system that simply need to be learned, remembered, and recalled as part of any diagnostic effort. Chapter 23 provides an opportunity to practice identifying structures, spaces, or clinical defects that may be routinely encountered. While these examples are not designed to be al inclusive, they do provide broad-based samples. In most of the questions in this chapter, the images are of normal brains; three show clinical conditions. The clinical situations posed in all questions are meant to stimulate one’s thinking as to what structures may relate to the defi cits in the example. The items labeled in the image include one or more structures, damage to which would correlate with defi cits described in the example. This allows a functional correlation and, at the same time, an opportunity to identify central nervous system structures in a variety of images.

The study of neuroscience is a great adventure with many exciting and interesting twists and turns. In the end, the successful diagnosis brings great satisfaction to the physician and great peace of mind to the patient. It is the goal of this book to impart some of this excitement to the user.

Duane E. Haines
Jackson, MS