No Laughing Matter

Exam Stress Busters

Now that everyone’s settled into the new year, I’m sure that you’re all counting down the five months and three days until the 2016 RITE exam! Joy. If it makes you feel any better, I’m in a similar boat, with my ten year re-certification coming up next spring.

I wanted to pass along a couple of board review recommendations. The first is Laughing Your Way to Passing the Neurology Boards! by Drs. Amy McGregor and David Z. Rose. (As an aside, I recently interviewed Dr. Rose for a Neurology podcast about his forthcoming paper, “Hemorrhagic Stroke Following Use of the Synthetic Marijuana ‘Spice'”. The paper is online now and the podcast comes out on 9/29).

Laughing Your Way weighs in at close to 800 pages, but the material is presented in an easy-to-digest format. There are 21 chapters covering neuroanatomy, movement, epilepsy, vascular, etc. Each condition within those chapters is presented in a kind of bullet point format except that instead of plain bullets, there are a variety of “guideposts”–Definitions, Perils, Mnemonics, Buzz Words, and a few others. I found most of these to be quite useful. The definitions are concise, e.g. “Autoimmune myasthenia gravis is due to a decrease in the number of functioning acetylcholine receptors at the neuromuscular junction due to antibodies . . . .” The “Hot Tips” are clinically meaningful, e.g. “Inversion of the foot by the tibialis posterior should be tested while the foot is plantar flexed, to eliminate the action of the tibialis anterior”. An example of a “Peril” is “. . . [Lambert-Eaton myasthenic syndrome] may be due to an underlying malignancy such as small cell lung cancer.”

I found the mnemonics to be a mixed bag. Some are short and memorable, such as “The entorhinal cortex is how information enters the hippocampus.” Or, “In Capgras’ syndrome, patients believe people around them have been captured and replaced with impostors.” Others are more derivative, such as this one for West syndrome (characterized by Hypsarrhythmia, Infantile spasms, and Developmental delay): “In the old West, when an infant seized, people yelled, ‘ACTH!’ and they HID.” There are far more of these than I could ever remember, but perhaps the point isn’t to memorize them all (after all, the reader will likely know at least some of this information already), but rather to help one remember information that one doesn’t already know.

Other nice features of Laughing Your Way include very simple, clear tables and diagrams. I also appreciated the “List of Mosts” at the end of each chapter, e.g.

  • Essential tremor is the most common tremor.
  • Sydenham chorea is the most common cause of acquired chorea in childhood.
  • SCA 3 (Machado-Joseph disease) is the most common autosomal dominantly inherited ataxia in the US.

Finally, there are a few multiple choice questions at the end of each chapter, and these seemed to be in line with my recollection of RITE and board exam questions. Overall, I think the authors accomplished something very difficult–canvassing the basics of neurology in a way that is at the same time comprehensive, readable, and memorable. I wasn’t falling off my chair laughing, but the material does (dare I go here?) go down smoothly.

The other book that came into my possession recently is the McGraw-Hill Specialty Board Review book Neurology, by Dr. Nizar Souayah (second edition). This one, like most such books, is also organized into a bunch of chapters covering the various sub-disciplines within neurology. It is composed entirely of multiple choice questions and answers–over 1200 of them. As with the RITE, some of the questions are hard and not of every day relevance to the practicing adult neurologist–especially some of those in the anatomy, pediatrics, neurogenetics, and neurochemistry chapters. For example, “Which of the following types of episodic ataxia (EA) causes the longest-lasting attacks? EA type 1, 2, 3, 4, or 7?” Or, “The abnormal gene coding for Ataxin 3 is located on chromosome 12, X, 19, 4, or 14?”

On the other hand, there are many clinically relevant questions in this book, and where it really shines is in the answers. The thrust of this book isn’t in the questions themselves, but in the often lengthy explanations of why some answers are correct and the others aren’t. Some of these explanations run half a page or even longer. Once in a while, I found an answer that I’m pretty sure is incorrect but I think that’s going to be true for any book. Like the RITE, some of the questions are based on radiographic images, photomicrographs, etc. and there’s a color insert pertaining to many of these questions.

So in a very different way than Laughing Your Way, Neurology also covers a lot of neurology, but organized around questions and narrative explanations rather than bullet points, mnemonics, and the like. For the extremely ambitious, one could contemplate using Laughing Your Way as a quicker overview and then Neurology as a test question bank. More likely, some will find one way of learning to be more natural and some the other. For my own board preparation, I’ve been using Continuum, reading most carefully through the pediatric neurology and other topics that I’m weakest in–I find it very clinically-oriented with good questions and answers. However, Continuum doesn’t cover basic neurological science nearly as well as the two books reviewed above. For the RITE and initial certification, something like the books above will provide better test preparation.

About Justin A. Sattin

I'm a vascular neurologist and residency program director. I created this blog in order to share some thoughts with my resident and other colleagues, and to foster my own learning as well.
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2 Responses to No Laughing Matter

  1. Clio rubinos says:

    Thanks for this post! I just had a baby and since I have “newborn encephalopathy” I was looking for a book that gives the information in a succinct way and easy to read. What is your thought about clínical neurology book by Cheng-Ching?

    • Justin A. Sattin says:

      I don’t have that one, but it looks pretty good on Amazon. I like the way the questions are arranged in groups of 3-4, with one extended answer for the group. The bottom line is that, for RITE exam / board preparation, you need to answer lots of these multiple choice questions. It doesn’t comport with real life, but it’s necessary to pass the exams. Good luck!

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