Introduction to the

RITE 2015-2016

The R

ITE

- Date: February 20 and 21st

The R

ITE

- 425 Questions- Anatomy 10%- Behavioral/Psych 10%- Clinical adult 20%- Clinical pediatrics 10%

- Contemporary issues

3%- Neuroimaging 13%- Pathology 10%- Physiology 14%

The R

ITE - 3 Sections- 1st and 3 rd – multiple

choice- 2nd – imaging section

Anatomy Brainstem/cerebellum

Cortex and connections **

Embryology Clinical adult Critical care/stroke *

Demyelinating disease

Epilepsy * Infectious disease * Neuro-ophthalmology/neuro-otology

Clinical pediatrics Develop, Learn, Lang, Behav, Psych

disorders Epilepsy * Movement disorders *

Neonatal * Vascular and inflammatory

disorders *

Contemporary Issues Driving Ethics/professionalism *

Evidence-based medicine

Neuroimaging Critical care/stroke Dementia * Developmental/neurogenetic disorders

Epilepsy * Infection Multiple sclerosis/Autoimmune disorders

Pathology Developmental Epilepsy * Neurodegenerative disease *

Pharmacology/chemistry

Aging, degenerative diseases *

Cerebrovascular disease

Other pain syndromes *

Sleep disorders

Subject 2011 2012 2013 2014 2015

Anatomy 66 73 58 56 62

Behavior/Psychiatry 79 72 90 63 71

Clinical Adult 92 81 86 65 87

Clinical Pediatric 65 49 67 56 50

Contemporary Issues 81 88 60 59 63

Neuroimaging 80 45 45 53 42

Pathology 77 46 65 39 59

Pharmacology/Chemistry 89 80 60 67 69

Physiology 93 92 82 76 84

TOTAL 87 78 76 65 76

Imagin

g S

ect

ion - Pathology- CT, MRI- EEG- EMG

Reso

urc

es - N Drive- Wiki- Old answers- Old images

Oth

er

- Recordings- Picture days

Practice

NEURO-OTOLOGY/OPHTHY

Symptoms of Perilymph Fistula?

Recurrent vestibulopathy

Precipitated by coughing, sneezing, straining, exercising

Symptoms of 4th nerve palsy?

Vertical Diplopia

Head tilt to opposite shoulder

Head turn downward with chin depressed, eyes up

Face turn to opposite side

NEURO-OTOLOGY/OPHTHYSwollen, painless optic nerve?

Anterior ischemic optic neuropathy

NEURO-OTOLOGY/OPHTHY

Swollen, painful optic nerve? Optic Neuritis

NEURO-OTOLOGY/OPHTHY

Eye disease associated with cat scratch fever?

NeuroretinitisBartonella henselae is now called

Rochalimaea henselae

NEURO-OTOLOGY/OPHTHY

Diffuse pallor of retina? Central retinal artery occlusion

Note macular "cherry red spot" and retinal pallor between macula and disc. The retinal veins appear normal size, but the arteries are barely visible and attenuated

Neuro-toxicologyCiguatera poisoning comes from…

Consuming large reef fish (grouper, barracuda, red snapper) – actually produced by micro-organisms that then is passed up food chain

Toxin is Ciguatoxin

Ciguatoxin causes…. Depolarization of nerves in nodes of Ranvier by opening voltage gated sodium channels.

Symptoms…. Sensory symptoms, usually paradoxical (hot feels cold)

Neuromuscular disordersBacterial infection associated with small fiber neuropathy…?

Mycobacterium leprae, aka LEPROSY!

Sensory loss pattern…? Preservation of vibratory sense/ reflexes

Includes sensory loss on ears and nose

A FLUTIST WITH TREMOR

• A 22 year old flutist was seen for slowly progressive tremor. She had to leave Julliard. She also seemed to have substantial performance anxiety and some rather obsessive delusional thinking. The patient described a tremor that was worse the longer she held her flute, and occasional involuntary flexion of her fingers. She c/o dysphagia.

• On examination she had a postural tremor and mild hypokinetic dysarthria. Reflexes were brisk but symmetric.

• Her blood work was nl except mildly elevated AST. MRI showed mild diffuse increased signal intensity in the upper midbrain, reduced signlal in the BG.

WILSON’S DISEASE

• AR on Chromosome 13 ATP 7B gene - ATPase Cu transport

• Presents in early adulthood with tremor, hepato-spenomegaly, liver or renal abnormalities, 50% neuro: tremor, dystonia, dysarthria/phagia

• Kaiser Fleisher rings in cornea and Face of the giant panda MRI T2

• Dx ceruloplasmin/Ur 24h Cu• Treat with zinc, trientine or TetraThioMol (PCM toxic)