Neuro Block 2

Hello MedHatters!

I am posting this months after this course ended, but I did initially start writing for this block while it was occurring. Although I still have very strong feelings about this course, (and so do a lot of my fellow classmates), take what I say with a grain of salt. 

Or a lot of grains of salt. Because I was definitely very salty during this course. So without further ado…

Okay.

I’m definitely burnt out and not giving a flying kahuna lately about school. Or anything really. But, this is probably the first time in a few months where I’ve felt like I don’t need to be super rushed with learning everything. It still stinks the way that they scheduled things this year, that hasn’t changed. But in general, my class rallied together to get several things moved/changed on our schedules so it doesn’t interfere with both this upcoming Neuro exam and our final exam in a few weeks. Go class!

For this section, you are learning basically tracts. You start learning actual neuroanatomy (not the head and neck stuff like on last test). And the big thing you learn include the somatosensory and motor tracts.

Yikes!

Now, if you are anything like me, you are or will be freaking out when you see this. It looks like a foreign language. I know. Just do me a favor and take in a big deep breath.

Now let it out.

Good.

ExamS:

I’m going to lump both exam 2 and 3 here just because the third exam was more of the same strugglebus as this one.

Exam 2:

• 38 anatomy questions
• 6 embryology questions
• 4 histology questions
• 32 physiology questions.

Total: 80 questions.

Exam 3:

• 47 Anatomy
• 4 Histo
• 33 Physiology

Total: 80 questions

*They are going to ask you A LOT on lesions on the tracts. Know those tracts forward, backward, and inside out. Know what symptoms you would experience when you remove part of a tract. A sizable chunk of our 2nd exam questions were based on this. There were actually some questions on our 3rd exam that went over 2nd exam material. And honestly, that was a low blow to do. But, there were also similar style questions on the 3rd exam tracts. Looking back they were very very heavy on the tract questions during the second exam though. 

Practical:

Just like the rest of your practicals, it will be 60 questions. And because we didn’t have a practical on the same day as our second exam, everything from the second and third exam was fair game for the last practical.

Not all of our brains were viable either. (I mean our cadaver brains, but I guess you could say the same thing about med student brains here…) Because of that, there were less real brains we could use to learn with, they were harder to handle just because picking them up often ended up melting the myelin (it is fat based), and most of our brains were sliced.

On the practical you will see slices (both paper and real slices), tags on actual brain tissue, models, pictures, all of it. Everything was pretty much fair game, and there were unfortunately a wide range of things they could pull to test us on. I think they gave us a 12 page list or something ridiculous like that.

In general, my class did not have a good time with this practical. Our labs were not structured and they didn’t teach anything this time around. We basically showed up and had to try to find all of the structures on our own. Most students didn’t bother going to lab because we had no direction and it was incredibly anxiety inducing. I was one of them. Why bother wasting my time trying to find something if I can’t even tell if its right? When I could go learn a lecture, and try to get a base understanding of a lecture? I’m really really hoping that the fellows next year are more hands on with teaching this topic, and the course directors structure lab differently so it facilitates learning.

I suggest you go to anatomy tutoring for this. One of the second years who was a head tutor, single handedly taught us all neuro. If it wasn’t for him, none of us would have gotten the scores we did on that practical. I’m not sure how they will go about doing it this year. I’m not sure if the anatomy fellows for this next year will help with this or if one of the tutors will be taking this on. Either way, our head tutor was the only reason both our class and the class of 2021 got any sort of a decent score on our practicals.

This was the site he recommended by the way: http://courses.biology.utah.edu/nielsen/5315_lecturepresentations.html

This website works best in internet explorer. If you don’t have it, you can download a similar version of internet explore through an app on your iPad. This was recommended by our tutor to help pick out some structures. I can’t remember which lecture specifically it was but I’m sure you can play around on the website and find it. If not, I’m sure there are other websites similar to this you can use.

There is also an Anki deck link lower down in this post of just brain slices. The 2021 class only needed this to do fantastic on their final practical. Ours was not that easy or straightforward. BUT, it can help you learn where some structures are for both lab and lecture.

How I studied:

1. The biggest thing that is going to help here is learning the anatomy first. You don’t need to go crazy in-depth right away. But get oriented. Know a few big structures at first and you can zoom in a little at a time. As of right now, you do not need to know every single tiny minute anatomy structure. But having an idea of the order and where things are relative to one another will help.
2.  Then learn the tracts. Draw, draw, draw. If you can draw them and explain where they cross and what areas they are going to and what synapses where, you are golden.
3. Once you are fairly comfortable with the above, you can start going through and figuring out if there is a lesion here and what happens. Or better yet, they are going to give you symptoms and a timeline and ask you where the lesion is. This is how they are going to test you on this knowledge. I know, not fair, but this is apparently what they ask on boards as well.

Start on the smaller chunks of things, and then you can go back in and add in more detail based on the slides.

Honestly, I used a similar approach for blood vessels as well. I drew out the Circle of Willis first. I then went in and added where the cranial nerves were at/what was sandwiched or ran with what blood vessels. You are going to want to know that if blood supply on one vessel gets knocked out, what cranial nerve(s) may get affected. The same thing goes for parts of the brain. But truthfully, if you are comfortable with general anatomy, you can either go back in and fill in the details or be able to generally guess.

Then I went back and learned how each of the branches off the Circle of Willis worked. And how knocking out certain areas will affect what parts of the brain.

The books:

Okay. So. When it comes to resources they give you a ton. A TON PEOPLE. You do not need to use all of them. In fact, they give you so many, or at least recommend so many, that it frankly is very overwhelming.

The first one: “Neuroanatomy in clinical context” by Haines. The very first time, and honestly probably a few times after that too when you open this book, you will get overwhelmed. There is a lot of brain anatomy and imaging here. And not a lot of supportive text. Quite frankly, it feels like they only added text to call it a textbook instead of one giant picture book…

The way I handled this was first learning a bit of the anatomy off the slides or from a secondary resource. One that I knew I could easily follow so I didn’t feel entirely lost. I partially used my powerpoint from class (although they flew through a lot of information as well) and youtube for this section. Get your feet wet a bit with where you are at.

Then I went back to look at specific brain slices, etc in this book. If it is easier for you to understand/orient yourself, look at more of the hand-drawn figures. Again, orient yourself. If you are feeling overwhelmed step away from this book and consult the good ol’ internet with a source you feel you can comfortably learn more from. Then get back to this. They will test you based off of images and slices in this book.

Note: They don’t give brain slices on the written exams. Just on the practicals. However, you do have to have a good base understanding of where certain structures lie in different areas of the brain to know where the tracts are running through or to/from.

When you feel like you know the anatomy better or can orient yourself to be able to tell what slice of brain you are in, start looking at the actual slices and imaging they have. They take a chunk of images out of this book and slap it into their lecture slides. But there are WAY more images in the textbook that they could pull from on the test or in your future anatomy lab practical. They also had an extra book that they kept in the lab that had a ton of photos. It couldn’t leave the lab, but I’m assuming they also took some slides from that book as well.

In the future, you can use this knowledge to look at real brain slices in the lab.

I have an Anki deck that was handed down from previous years that is just brain slices. This was all a previous year needed to know to pass the final neuroanatomy practical, but I found it helpful in me just learning structures for this section. Our practical was way harder than what these slices had.

Brain Slices Anki Deck: Download From Here

Physio books:

Well. I didn’t really use any physiology books this time around. The recommended one was “Neuroscience” by Purves. We have it at home, I just didn’t pick it up much. I attempted to use it for one of the exams, but there is a lot of text. I didn’t personally get a ton of useful information out of it. But I sure as hell tried.

Dr. Karius will also have her iBooks for some of her lectures on blackboard. Her iBooks repeat what she says in lecture basically. If you prefer the text, use her iBook. If you prefer to just listen to her lecture and dissect that, then use that.

Also, Dr. Karius loves her compare/contrast tables. She would briefly show us the filled in tables during lecture but leave them blank for you to fill in. If you are watching the lectures, you can just pause and take a photo or write the information down. If you are in lecture, I suggest you take a picture then.

Why?

You’ll need it to help you quick study. But it’ll also help you know what she wanted after you attempt to fill in the charts yourself and want to compare it to what she had.

Helpful recommended sources for tracts:

– If you like a general overview I first started with Handwritten tutorials on youtube. On their actual website they have PDF’s drawn out for you. If you want to add those to your iPad and draw all over them/follow along, this is helpful. It isn’t quite the in-depth that you will need for the test, but it is a start. You may need to actually go to their website and click on the ‘videos’ header to pull up this information (specifically for tracts) because sometimes their youtube page won’t have all of the videos.

-I then jumped into Ninja Nerd Science’s videos. They were way, WAY more in-depth. In fact, probably more in-depth than you actually need for certain aspects. But close to what you need for others. He talks about specific pain fibers in a lot of these pathways, but his videos are longer. If you are already getting a good gist of how the tract is running then great! It is sticking. If you find his videos too long, then no big deal.

*Protip: On Youtube you can increase the speed. So just bump up the speed if you don’t have time to sit and watch 30-60 minutes of his video. Or you are just used to increased speed due to watching med school lectures.*

-Another channel that I have used for some information and some of my classmates have used: Armando Hasudungan. Personally, some of his videos are really helpful. Other times I felt his information wasn’t up to par since it was slightly different from what we were taught. Which I was concerned might screw me up. But if you like the way he teaches, he’s pretty in-depth too. Also, he’s great artist.

-Dirty USMLE. LOVE this channel. Pretty high yield stuff as well.

-You could also use USMLE STEP 1. They might be able to concisely teach you some high yield topics. But they will not go into detail.

-Neuroscientifically challenged is another great neuroscience channel. His are very brief, so it is a good place to get an overview of/review for boards. I think all of the videos are 2 minutes or less. Which means not great for in-depth understanding, but a good place to start and then go back and build.

Notecard material:

I’m currently using Quizlet as I can download the same app onto my phone after I make the notecards on my computer. That way, I can pull it up while I’m in line at the grocery store or waiting for food or whatever and not feel guilty.

There are some Anki cards that former second years have made. I do have the Brain Slice one (up earlier in the post) that was posted on the classes facebook page (I don’t have a facebook so someone will kindly send them to me). Again, I use Anki on my computer because it is free that way. There may have been other decks that I simply didn’t get access to.

I will notecard material such as herniations, lesions, and most of the physiology lecture material. That way, I can quickly get in the information that is more high yield for testing. I have tried note-carding other material, but honestly I couldn’t figure out a good way to notecard some of it. Oh well.

I hope some of this helps ya’ll in neuro. This was not a good course for our class and we hoped we expressed this enough to our professors and administration about changing it for years to come.

Good luck. Cheers!