Written Blueprint
Introduction
This is an exam blueprint, also referred to as, exam specification for American
Chiropractic Neurology Board’s certification exam in functional neurology.
The skills and knowledge certified by this examination represent a postdoctoral
chiropractic level of expertise where a certified individual can:
1. Examine individuals with a thorough functional neurological examination
2. Diagnose neurological and associated problems after examination
3. Treat through chiropractic methodologies neurological and associated problems
4. Treat through functional and environmental modalities neurological and associated
problems
5. Educate patients with respect to minimizing chronic neurologically related
problems
Exam Purpose
This examination is based upon the most critical job activities a Chiropractic
Neurologist performs. The skills and knowledge certified by this examination
represent entry level into the postdoctoral chiropractic neurological professional
level of expertise for a certified individual. The critical job activities
derived from the 2002 job analysis of Chiropractic Neurologists include the
following patient care areas:
1. Examination
2. Diagnosis
3. Treatment
4. Follow-up
Additionally, ethics and techniques were identified by our Subject Matter
Expert (SME) Panel as important components not included on the 2002 job analysis.
Questions asked of the Board by the public and Diplomates were also brought
to the SME panel and this data supported the inclusion of ethics and techniques
on the exam. The panel divided the neuraxis into the twelve domains sited below
and identified as critical in the job analysis.
Background and Experience
The test is intended to address the knowledge and skill areas that demonstrate
proficiency as a Chiropractic Neurologist. Eligibility requirements are:
1. The applicant must hold the degree of Doctor of Chiropractic from a CCE
accredited college (USA) or its equivalent.
2. The applicant must show evidence of having successfully completed a post
doctoral program in neurology of three hundred (300) credit hours from a chiropractic
college, university, institution, foundation or agency whose program is approved
by the continuing education committee of the Commission for the Accreditation
of Graduate Education in Neurology (CAGEN). The Chiropractic College, organization,
institution, foundation, or agency from which the applicant has completed his/her
course of study must certify to the Board that the applicant has satisfactorily
completed three hundred (300) credit hours of postdoctoral instruction in neurology.
3. The applicant must possess a license or registration to practice chiropractic
and be in good standing with the respective licensing/registration agency.
The skills and knowledge measured by this examination are derived from current
course content and from an understanding of the jobs of current Chiropractic
Neurologists. A team of highly qualified Chiropractic Neurologists defined
the test content and determined the categories for case submission for the
exam.
Exam Structure
The knowledge domains measured by this examination are shown in the table
below along with the percentages of the exam that are applied to each domain. This
is in accord with the job analysis update from the Subject Matter Experts performed
in 2007.
Domains
|
Percentage of Exam
|
Brain and Its Environment
|
5.78%
|
Lobes of the Brain
|
6.44%
|
Brain Stem & Cranial Nerves
|
8.44%
|
Spinal Cord
|
7.56%
|
Peripheral Nerves
|
13.44%
|
Autonomic Nervous System
|
5.11%
|
Cerebellum & Vestibular System
|
14.44%
|
Basal Ganglia & Limbic System
|
7.33%
|
Muscles / NMJ and Receptor Disease
|
8.00%
|
Sensory
|
7.78%
|
Neuro Endocrine
|
7.33%
|
| Neuro Anatomy & Physiology |
7.56%
|
Ethics
|
1.11%
|
Objectives:
The objectives for the examination as determined from the job analysis and
its update are as follows:
Objectives
|
Percentage of Exam
|
General Knowledge
|
5.11%
|
Pathways
|
12.00%
|
Diagnosis (Clinical, Level of Lesion & Functional)
|
30.44 %
|
Differential Diagnosis
|
15.11%
|
Treatment (Adjustment and other treatments)
|
13.33%
|
Rehabilitation
|
4.44%
|
Follow-up
|
0.44%
|
Metabolic Rate
|
1.78%
|
Risk Factors
|
4.22%
|
Referral
|
3.78%
|
Special Studies
|
7.56%
|
Techniques
|
0.67%
|
Ethics
|
1.11%
|
According to the job analysis update, diagnosis and differential diagnosis
are the most significant portions of the job of the chiropractic neurologist. Treatment,
of course, follows those. The reason that diagnosis is weighed so heavily
is because each patient receives three types of diagnosis: clinical/medical,
level of the lesion, and functional. In this way, the chiropractic neurologist
differs from other diagnostic professions because the level of the lesion and
the functional diagnoses are the ones that dictate the treatment and rehabilitation
modalities and the mechanisms for measuring success of treatment.
All questions on the written examination are multiple-choice. Some are
complex or multiple-multiple choice questions. A Scantron sheet is used
for the recording of answers.
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Case Topics - 2010
Acoustic Neuroma
Acromegaly (Growth Hormone Related Problems)
Acute Transverse Myelitis
Addiction
Addison's disease
AIDS
Alcohol Induced Neuropathy
Alcoholic polyneuropathy
Allodynia
Amyloid Neuropathy
Amyotrophic Lateral Sclerosis
Ankylosing Spondylitis
Anorexia nervosa
Anterior Cerebral Artery Stroke
Anterior Interosseous Entrapment
Anterior Spinal Artery Syndrome
Anxiety
Anxiety / Panic Attacks
Appendicitis
Arnold-Chiari malformation and secondary syrinx formation
Arthritic related neuropathy (Rheumatoid Arthritis)
Athetosis
Auditory Processing for Language (Different Aphasia's)
Autism
Autoimmune Related Neuropathy (Sulfatide / MAG / GM1 / Gallop)
Autonomic Disfunction lesions
Autonomous Bladder (subsacral Lesion)
Barotrauma
Basal Ganglionic lesions
Basal skull fracture
Basilar Ischemia
Bell's Palsy
Benedikt's Syndrome
Benign fasciculation syndrome
Benign Positional Vertigo
Berger's Disease
Berry Aneurism
Bilateral Cerebellar disease
Botulism
Brachial Plexus Avulsion
Brain cancer
Brainstem infarction
Brainstem Ischemia (TIA)
Brainstem Vascular Infarct
Broca's Aphasia
Brodmann's areas
Brown-Séquard syndrome
Bulimia
C6 Radiculopathy (Due to neural foraminal stenosis, disc)
Capsular CVA
Carcinomatous invasion of the sphenoid bone
Cardiac Arythmias/rate anomalies
Carotid Artery Occlusion
Carpal tunnel in Type 2 Diabetic - mechanisms
Cauda Equiina Syndrome
Caudication of the Cauda Equina
Cavernous Sinus Thrombosis
Cavernous sinus vasculitis
Central cord tumor
Cerebellar Ataxia
Cerebellar Atrophy/malacia
Cerebellar Pons lesion
Cerebellar Tumor
Cerebral Palsy
Cervical Canal Stenosis
Cervical Discopathy
Cervical posterior cord compression secondary to degenerative changes
Cervical radiculitis with concomitant right cerebellar and right cortical concomitants
Cervical Spondylosis
Cervical sprain/strain injury with concomitants
Cervical Stenosis
Cervical myelopathy
Cervicogenic Vertigo
Charcot Marie Tooth Disease
Cholesteatoma
Chromic Fatigue Syndrome
Chronic Adrenal
Chronic Inflammatory Demyelination Process
CIDP (Chronic inflammatory demyelinating polyneuroradiculopathy)
Cluster headache
Cochlear nerve lesion
Colon Cancer
Coma
Complex Partial Seizures
Complex Regional Pain Syndrome
Conduction Aphasia
Crohn’s disease
Cubital Tunnel
Cupulolithiasis
Cushing's disease
CVA to the dominant or the non-dominant hemisphere
Decreased adenohypophysis production
Decreased movement of tympanic membrane
Dentate Cerebellar lesion
Depression
Diabetes
Diabetes insipidus
Diabetic lumbar (ischemic) plexopathy
Diabetic Neuropathy (Stocking glove, sensory > motor)
Diabetic polyneuropathy
Diplopia & Ptosis
Distal muscular dystrophy
Duchenne’s Muscular Dystrophy
Dysarthria
Dysautonomia
Dysphagia
Dysphasic Confusion
Eating Disorders (Anorexia Nervosa / Bulemia / Obesity)
Emery-Dreifuss dystrophy
Encephalitis
Entrapment at the site of the ligament of Struthers
Entrapment Syndrome-anywhere
Epidural Hematoma
Erb's Palsy
Erectile Dysfunction
Excess Mesencephalic Depolarization
Exotropia
Expressive Aphasia
Facet Syndrome
Facial Paresis
Facioscapulohumeral Dsytrophy
Familial Spastic Paraplegia
Fibromyalgia
Fistula
Focal dystonia
Focal seizure
Foville's/Parinaud's syndrome
Friedrich's ataxia
Geniculate neuralgia
Generalized seizure
Glaucoma
Glutathione and Degenerative Neurological Disease
Guillain Barre Syndrome
Headache-all types
Heavy Metal Exposure
Hemiballismus
Hemsiphericity
Hereditary motor and sensory neuropathy
HMSN type 1
Horner's
Huntington’s chorea
Hyperalgesia
Hyperkalemia
Hypertension
Hyperthyroidism and neurological symptoms
Hypertonicity (Spastic Gait) UMN lesion
Hypocalcemia (carpal pedal spasms due to kidney disease
Hypokalemia
Hyponatremia
Hypothalamic lesion
Hypothyroidism
Hypothyroidism and neurological symptoms
Hysterical blindness
Inclusion body myositis
Increased intracranial pressure
Increased sinus pressure
Infectious meningitis
Inner Ear Compromise
INO
Insomnia
Intention Tremor
Irritable Bowel Syndrome
IVth ventricle tumor -Bell's palsy & lat rectus palsy
Klumpke palsy
L5 radiculopathy -denervation mechanism (Acute verses Chronic)
Labyrinthitis
Lambert Eaton Syndrome
Lateral Rectus Palsy
Lead / Arsenic Induced Neuropathies
Lesion in the organ of Corti
Lesioned arcuate fasciculus
Limb Girdle Dystrophy
Lipoma
LMN lesion vs. UMN lesion
Locked In Syndrome
Loss of nerve impulses through the VIII cranial nerve
Lower Brachial Plexopathy
Lumbar disc hernation at T12 affecting the conus from within T12
Lumbar radiculopathy
Lupus (SLE)
Manic Depression
Mechanism of manipulation
Medial plexus injury
Medication Induced Physiological Tremor
Meniere's Disease
Meningitis
Mental illness
Mesencephalic lesion
Middle Cerebral Artery stroke (lenticulostriate branch)
Middle Cerebral Artery stroke (Main trunk occlusion)
Middle Ear Infection
Middle Ear Tumor (Glomus Tumor)
Migrainous Event
Mild dementia 2o to hip fracture
Millard-Gubler Syndrome
Motor Neuron Disease
Multifocal Motor Neuropathy
Multiple Sclerosis
Muscular Dystrophy
Myesthenia Gravis
Myopathy
Myotonia Congenita
Myotonic Dystrophy
Narcolepsy
Neuralgic Amyotrophy
Neurofibromatosis Type I
Neuromuscular Junction Disorder
Nocturnal Enuresis
Nothnagel's Syndrome
OCD
Optic neuritis
Orbital cellulitis
Otosclerosis
Oxidative Stress
Pancoast Tumor
Panhyperpituitarism
Panhypopituitarism
Panic Disorder
Parasagittal Meningioma
Parathyroid Disease
Parinaud’s syndrome
Parkinson’s disease
Partial complex seizure
Pathology in the utricle
Peripheral Nerve Pathology due to Vasculitis
Peripheral Vestibular Neuronitis
Pernicious anemia
Pituitary adenoma
Pituitary macroadenoma
PMS
Poliomyelitis
Polymyalgia rheumatica
Polymyositis
Polyneuropathy
Polyneuropathy associated with multiple myeloma
Pontomedullary degeneration i.e. AICA Syndrome
Post comm art aneurysm-III nrv palsy
Posterior Cerebral Artery Stroke
Post-traumatic Syringomyelia
Postural Hypotension
Postural orthostatic tachycardia syndrome
Presbycusis
Primary Myopathy
Progressive cervical myelopathy
Progressive muscular atrophy
Pronator Teres Entrapment
Pseudo Bulbar palsy
Pseudotumor Cerebrii
Radial Nerve Entrapment
Radiculopathy-any level
Ramsey Hunt Syndrome
Raynauds
Receptive aphasia
Recurrent thenar motor branch entrapment
Regional Complex Pain Syndrome
Right Cerebellar lesion or Left Cerebellar lesion
Sat night palsy
Schizophrenia
Sciatic Nerve lesion due to Injection
Scotoma
Senile Dementia / Alzheimer's
Sensory Radiculopathy
Skew Deviation
Sleep disorders (Sleep apnea) (Pineal and Melatonin)
Slow stretch verses fast stretch
Sprain / Strain Injury
Stress Incontinence
Stroke-any artery
Subacute Combined Degeneration
Subluxation
Supranuclear Palsy
Sydenham's Chorea
Sympathetic Hypertonia
Syphilis
Tabes Dorsalis
Tardive dyskinesia
Tarsal Tunnel Syndrome
Temporal arteritis
Temporal Lobe Automatism
Temporal lobe seizure
Temporal Mandibular Joint Syndrome
Tension Headache
Testicular dysfunction
Thoracic Outlet Syndrome
Thyroid Related Peripheral Neuropathy
Tick Paralysis
TND Cerebellum
Torsional Dystonia
Tourette's Syndrome
Transcortical Aphasia
Transient Compressive Nerve Injury
Transverse myelitis
Trauma to the Cochlea
Traumatic Head Injury
Tremors
Trigeminal Neuralgia
Ulcerative colitis
Ulnar Nerve lesion at Guyons Canal
Uninhibited Bladder
Upper Brachial Plexus (Erbs palsy)
Vasovagal Response
Ventral Cord Pathology
Ventral horn cell disease
Vertebral Artery Syndrome
Vertigo/anosmia 2o to basal skull Fracture
Vestibular epilepsy
Visual Pathways: Visual Field losses and lesions responsible
Wallenberg Syndrome
Weber's syndrome
Wernicke’s Aphasia
Wernicke’s encephalopathy
Whiplash
Wilson's Disease (Copper induced athetosis)
Zoster
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Tools and Modalities
Tools used in Examination |
Special Test |
Risk Factors |
Treatment Tools |
Nutrition and
Supplements |
Pen Light
Pin Wheel
Reflex Hammer
Optokenetic Tape
Ophthalmoscope
Otoscope
Sphymomanometer
Stethoscope
Thermometer
Blind Spot
Tuning fork
SPO2
Measuring Tape
Novel Face Recognition
Height/Weight Chart
Cotton Balls
Scales |
X-Ray
MRI
CT Scans
Sereology
Electrolytes
Blood Chemistries
UA
Glucose Tolerance
NVC
EMG
Real Eyes
VNG
Spirometry |
Osteoporosis
Unstable vertebral segments
Fragile metabolic rate
Diabetic
Compression fx
Demyelinating disease
Chronic illness
Coronary or carotid artery
Blockage
Prescription med side effects |
Hemi-field glasses
Optokenetic Tape
Jucussi
Resistance exercise
bands
Arm Cables
Spin chair
Spin video
Interferential TENS
Caloric-warm/cold
Traction
G-five
Exercise Equipment
Puzzles
Music
Ultrasound
Metronome
Hemifield tape |
Co-Q-10
Vit C
Vit E
Calcium
Potassium
Omega 3 Fatty Acids
Glucosamine
Chondroiton
Heavy Water
Antioxidants
Probiotics
Detox products
Chealation |
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Written Exam Case Template
HISTORY:
Chief Complaint/Present Illness:
Pain History:
Family History:
Social History:
Past Medical History/Review of Systems:
PHYSICAL EXAM:
General Appearance:
Vitals:
Height/WT; Temp; HR & Rhythm; Respiratory; B/P L and R. Ausculatory
Exam: (Bruits, Lung Sounds, Abdominal Sounds); Pulses: (Brachial,
radial, femoral, popliteal, dorsalis pedis); Rib Excursion:
Mental Status:
Cranial Nerves:
Sensation:
Motor:
Tone: Strength: Reflexes:
Coordination/Balance:
Imaging/Special Studies:
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References
The following is a list of references used in preparation of the examination
and to determine model answers.
- Adams, R.D. and Victor, M. (Latest edition) Principles of Neurology. New York:
McGraw-Hill Book Co.
- Annals of Neurology, (Journal). Little Brown & Company
- Barr, M.L. and Keirnan, J. A. The Human Nervous System: An Anatomical Viewpoint
(Latest edition). Philadelphia: Harper & Row, Publishers.
- Beatty, J. (1995) Principles of Behavioral Neuroscience. Time Mirror.
- Blume, Warren T. (1994) Atlas of Adult Electroencephalography. Raven Press
- Carpenter, M.B. Core Text of Neuroanatomy (Latest edition). Baltimore: Williams & Wilkins,
Co.
- Chiappa. Evoked Potentials in Clinical Medicine
- Conn, P. Michael (1994) Neuroscience in Medicine. J.B. Lippincott.
- Creutzfeldt, O. et.al. (1995) Cortex Cerebri: Performance, structural and functional
organization of the cortex.
- DeArmond, S.J., Fusco, M.M. and Dewey, M.M. Structure of the Human Brain. Structure
of the Human Brain: A Photographic Atlas. (Latest edition). New York: Oxford
University Press.
- Dejong, R.N. The Neurologic Examination (Latest edition). Hagerston (MD): Harper
and Row, Publishers.
- Dyck, Peripheral Neuropathy.
- Guyton. Textbook of Medical Physiology (Latest edition).
- Haines, D. Neuroanatomy: An Atlas of Structures, Sections and Systems. (Latest
edition). Baltimore: Urban & Schwarzenberg.
- Heimer, L. The Human Brain and Spinal Cord: Functional Neuroanatomy and Dissection
- Guide (Latest edition). New York: Springer-Verlag.
- Jennes, Lothar, et.al. (1994) Atlas of the Brain, with medical correlations.
Lippincott.
- Joynt. Clinical Neurology. Lippincott: updated yearly.
- Leigh, John R. & Zee, David S., 1999. Neurology of Eye Movements
(Contemporary). New York: Oxford University Press.
- Kandel, E.R., Schwartz, J.H. and Jessell, T.M. Principles of Neural Science
(Latest edition). New York: Elsevier Science Publishing Col, Inc.
- Kimura. Electrodiagnosis
- Langman, J. Medical Embryology. (Latest edition). Baltimore: Williams & Wilkins.
- Michaels (1994) The Cognitive Neurosciences. Gazzaniga (ed). MIT Press
- Mosenthal, W.T. (1994) A Textbook of Neuroanatomy with Atlas and discussion
guide. Parthenon.
- Pryce-Phillips, William (1995) A Companion to Clinical Neurology. Little, Brown & Co.
- Segev, Idan (ed), et.al. (1995) The theoretical foundation of Dendritic Function:
selected papers of Wilfrid Rall with commentaries. MIT Press.
- Theodore, William (ed) et.al. (1995) Epilepsy: 100 elementary principles. (3rd
Edition) W.B. Saunders.
- Yatsu, Frank M., et.al. (1994) Stroke (100 Maxims in Neurology Series). Hodder & Stoughton.
Recent Additions:
Author Book/Article/Presentation ISBN/Journal
Blume, Warren T.
Atlas
of Adult Electroencephalography 3-936817-15-4
Brock, JB
Board
Review Presentation
(found
in Carrick Course Companion)
Carrick
Clinical
Neuroscience Course Companion
Guide I & II
DeMyer
Technique
of the Neurologic Examination, 5th Ed.
71405682
Kandel, Schwartz & Jessel.
Principles
of Neural Science, 4th Ed 838577016
Nolte
The
Human Brain 323013201
(An Introduction to It's Functional
Anatomy) 5th Ed.
Patten Neurological
Differential Diagnosis, 2nd Ed. 3540199373
Preston & Shapiro Electromyography & Neuromuscular 075067492X
Disorders, 2nd Ed.
Theodore, William Epilepsy:
100 elementary principles. (3rd Ed.) 702018139
(ed) et.al.
Yatsu, Frank M., Stroke
(100 Maxims in Neurology Series) BMJ
et. al. 1995;311:69
(1 July)
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Practical Blueprint
Introduction:
This is an exam specification for the Practical Exam in Chiropractic
Neurology. The
skills and knowledge and abilities certified by this examination represent
a professional level of expertise where the certified individual can:
- Demonstrate the interview and psychomotor skills necessary in history
taking and patient examination
- Identify normal and abnormal findings from a physical/neurological examination
Exam Purpose:
This examination is based upon the most crucial job analysis
activities a chiropractic neurologist performs. The psychomotor skills,
knowledge and abilities certified by this examination represent a professional
level of expertise for a certified individual. The critical job activities
of a chiropractic neurologist are:
- Demonstrate the capability of taking a patient history through the use
of interview techniques
- Demonstrate the psychomotor skills of performing a physical/neurological
examination on a patient
- Demonstrate the ability to accurately identify the findings of a physical/neurological
examination through the use of video clips of examination results
Background and Experience:
The test is intended to address the knowledge and skill areas that demonstrate
proficiency as a Chiropractic Neurologist. Eligibility requirements
are:
- The applicant must hold the degree of Doctor of Chiropractic from a CCE
accredited college (USA) or its equivalent.
- The applicant must show evidence of having successfully completed a post
doctoral program in neurology of three hundred (300) credit hours from
a chiropractic college, university, institution, foundation or agency whose
program is approved by the continuing education committee of the Commission
for the Accreditation of Graduate Education in Neurology (CAGEN). The Chiropractic
College, university, organization, institution, foundation, or agency from
which the applicant has completed his/her course of study must certify
to the Board that the applicant has satisfactorily completed three hundred
(300) credit hours of postdoctoral instruction in neurology.
- The applicant must possess a license or registration to practice chiropractic
and be in good standing with the respective licensing/registration agency.
The skills and knowledge measured by this examination are derived from current
course content and from an understanding of the jobs of current Chiropractic
Neurologists. A team of highly qualified Chiropractic Neurologists
defined the test content and determined the categories and videoed examination
findings for the video clips for the exam.
Exam Structure:
The knowledge domains measured by this examination are shown in the table
below.
| Domains |
| History |
| Physical/Neurological Examination |
| Examination Finding |
Within the domains, the following table identifies the test objectives. Test
items will relate to a specific objective within a domain.
| History |
Percentage |
| Onset, Timing, Site Involved, Radiation,
Quality/Characteristics, Palliative/Aggravating Factors (OPQRST) |
10% |
| Past HX; Trauma, Surgeries, etc. |
5% |
| Social HX |
5% |
| Family HX |
5% |
| Review of Systems |
5% |
| Examination |
|
| Vital Signs: |
5% |
| Cranial Nerves |
6% |
| Sensory |
6% |
| Motor |
7% |
| Cerebellar/Balance |
6% |
| Cardiovascular/Provocative Maneuvers |
10% |
| Simulation Findings |
|
| Reflexes |
2% |
| Gait |
2% |
| Eye Movements |
2% |
| Provocative Tests |
2% |
| Cerebellar tests- dysdiadochokinesis-dysmetria,
etc. |
2% |
| Motor/Strength Tests |
2% |
| Tone (ptosis, facial paresis, etc) |
2% |
| Pupil responses |
2% |
| Palatal Paresis, Gag Reflex |
2% |
| Posture & angulation & tongue deviation |
2% |
| Spontaneity of movement |
2% |
| Observation (atrophy, sweating, edema,
color, atrophic skin changes) |
2% |
| Recognition/sequencing tests |
2% |
| Parietal Drift |
2% |
| Percussion Myotonia, clonus |
2% |
The answers to the questions on the video simulations are oral. The candidate
will hear and read the questions, then respond orally. This section
is also videotaped.
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ACNB Practical Examination Case Template
The candidate must be able to conduct a thorough history:
OPQRST
Past History-thorough
Social History
Family History-1st and 2nd degree relatives
ROS-Every System
The candidate must be able to demonstrate the psychomotor skills and the
knowledge to perform a complete head-to-toe Neurological Physical Examination:
Vital Signs: Ht/wt, Temperature, Pulse, Respirations, Blood Pressures
(Bilateral)
Cranial Nerves: ALL and all aspects of testing each one
Sensory: Pain & Temperature, Vibration and Light Touch, Joint
Position Sense of ALL extremities
Motor: Reflexes, Tone, All extremities
Coordination/Balance: Romberg, Finger-Nose, Rapid alternating movements,
pronation/supination, Gait & Tandem, Heel-Shin test. Be certain
to perform all tests correctly and safely.
Heart/Lung: Auscultation of all heart sounds and areas, auscultation
for bruits, auscultation of six (6) lung fields and apex, Palpation of pulses-upper
and lower extremities
Abdomen: Auscultation of each quadrant and abdominal aorta; percussion
of each quadrant, palpation of each quadrant (in this order)
Correctly perform special neurological and orthopedic tests such as: Optokinetics,
Eply’s, Hall Pike, Homan, Lhermitte’s, Hoffman’s, Tromner’s,
TOS, Mill’s, Cozen’s, S.I. Joint ortho tests, A.C. joint pathology,
ACL, Hip capsule, Tinel’s, Kemp’s, O’Donohues, and others. This
is NOT an exhaustive list.
Video Clips:
The candidate must be able to view a series of video clips of a neurological
examination section (very short) and identify what he/she is seeing and what
it means, including the nerves involved. The candidate will be asked
two questions about each of the 15 clips. The questions are in an oral
and written presentation format. Each clip may be viewed a maximum of
two (2) times.
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Sample Case History Flow Chart
Patient Name:
_____________________________________________________
Home Address:
_____________________________________________________
Home Phone:
_____________________________________________________
Work Phone:
_____________________________________________________
Date of Birth:
_____________________________________________________
Age:
___________
Male: ___ Female: ___
Marital Status:
Single: ___ Married: ___ Separated: ___ Divorced: ___ Widowed:
___
Occupation:
_____________________________________________________
Referring Physician’s Name:
_____________________________________________________
Type of doctor who referred you:
_____________________________________________________
State your major problem/pain:
_____________________________________________________
Describe your symptoms in detail.
_____________________________________________________
How long have you had this condition?
_____________________________________________________
Have you had similar conditions in the past?
No: ___
Yes: ___ If Yes, please specify:
_____________________________________________________
What activities aggravate your condition?
_____________________________________________________
Is this condition interfering with:
Work: ___ Sleep: ___ Daily Routine: ___
Other: _____
Please specify:
_____________________________________________________
What other health care have you received for this problem, i.e. what other
doctors have treated this condition?
_____________________________________________________
Other complaints:
_____________________________________________________
Do you presently take any medication/over the counter/homeopathic or recreational
drugs?
No: ___ Yes: ___ If Yes, please specify:
_____________________________________________________
_____________________________________________________
List previous injuries/major illnesses/accidents
_____________________________________________________
_____________________________________________________
List fractures/dislocations/concussions past and present:
_____________________________________________________
_____________________________________________________
List previous surgeries/hospitalizations:
_____________________________________________________
_____________________________________________________
_____________________________________________________
Have you had changes in bowel/bladder/sexual function? If so, please specify.
_____________________________________________________
_____________________________________________________
Do you have any condition involving your heart/lungs/thyroid/or other internal
organs? If yes, please specify:
_____________________________________________________
_____________________________________________________
Are you a:
Non-smoker: ___
Smoker: ___ (# of Packs per day _____ for ____
years)
Ex-smoker: ___ (for how long ____).
Regarding alcohol use, are you a:
Never Drank: ___
Drinker: ___
Ex-drinker:
___
If you drink alcohol, enter the average number of drinks per weeks:
Bottles of beer: ____
Mixed drinks: ______
Glasses of wine: ____
Shots of liquor: _____
How would you rate the amount of physical activity you perform?
Very little: ___ Little: ___ Moderate: ___ Active: ___ Very Active: ___
List activities in which you participate on the average of two times per
week:
_____________________________________________________
Please specify any conditions or illnesses in your family medical history
(i.e. diabetes, cancer, etc.) (parents, grandparents, siblings, and children)
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
Females Only:
Date your last menstrual period began:
_____________________________________________________
Number and ages of your children:
_____________________________________________________
Are you pregnant now? No: ___ Yes: ___ Not sure: ___
Date of last pelvic/breast (PAP test) examination:
_____________________________________________________
_____________________________________________________
Doctor’s Comments from the interview:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
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Practice Test
This Pretest is a sample of the format for testing that the ACNB
Diplomate exam uses. The following case has been retired from the previous
tests. The actual test is comprised of several cases in this format followed
case related questions. A section at the end of each test, approximately
the last 30 questions, will assess information from the Domains and Objectives
in the blueprint but will not be case related. See “Pretest Answers” to
check your knowledge on this particular Pretest case.
For questions 1-12 refer to the case below—
HISTORY:
Chief Complaint/Present Illness:
A 54-year-old Caucasian male presents with right arm weakness for the last
3 weeks.
Pain History:
Patient had onset of achiness and stiffness in his right neck and shoulder
and weakness of his right forearm, wrist, and fingers. He denied any
pain and stated the “problem was more achy than sharp pain”. He
stated the problem started after he feels asleep in his granddaughter’s
bed while holding her.
Family History: non-contributory.
Social History:
He reported he has 2-3 manhattan’s each evening, maybe an extra one
or two on the weekend. He stated he use to work out a lot, but has not been
very active for the last year or two. He is a retired Navy Chief.
Past Medical History/Review of Systems:
Non-contributory
PHYSICAL EXAM:
General Appearance:
Patient is a well groomed, healthy man.
Vitals:
B/P 128/80 bilaterally; 98.6 o F (37 o C) ear temperatures bilaterally; Ht.:
5’ 11” (180 cm); Wt.: 190 lbs. (83.4kg). Auscultation
Exam: Bruits are absent, heart sounds, lung sounds,
and abdominal sounds are all normal. Pulses:
Brachial, radial, femoral, popliteal, dorsalis pedis are normal.
Mental: Oriented x 3
Cranial Nerves: Normal.
Sensation: no change in sensations were found
on the skin of the right arm, forearm, or hand.
Motor: At
rest the patient’s right wrist and fingers are flexed slightly. He had
a slight weakness of elbow flexion, especially when tested in neutral pronated/supinated
position. No weakness was found when testing elbow flexion in the palm
up position. There was weakness of flexion of the proximal phalanges
on the metacarpals, and weakness of thumb abduction.
Left triceps 5/5 Right triceps 5/5
Left
pronation 5/5, right pronation 5/5
Left
wrist extension 5/5, right wrist extension 4/5
Left
finger flexors 5/5, right finger flexors 4/5
Left
finger extensors 5/5, right finger extensors 4/5
Reflexes: Left triceps 2/5. Right triceps
2/5
Left Brachioradialis 2/5. Right Brachioradialis
1/5
Left biceps 2/5. Right biceps 2/5
Lower extremity MSR’s 2/5
bilaterally.
Plantar responses were absent bilaterally
and he had no clonus.
Coordination/Balance:
Left Finger to Nose testing WNL
Right Finger to Nose testing was accurate and without tremor, but patient
was much slower doing the test on this side.
Labs: HgbA1C- 5, Fasting Blood glucose=98mg/dl.
Imaging/Special Studies:
Plain radiographs, moderate DJD at C5-6, and C6-7 with no mention of IVF
involvement.
QUESTIONS:
1. What peripheral nerve entrapment is the most likely cause
of this lesion?
Use the following as choices of answer(s) for #15.
1. anterior
interosseous
2. axillary
3. deep
radial
4. median
5. musculocutaneous
6. radial
7. superficial
radial
8. ulnar
a. 3
b. 6
c. 3, 6, & 7
d. 3 & 5
2. The
most likely diagnosis in this case is?
a. Cubital
tunnel syndrome
b.Klumpke
palsy
c. Anterior
Interosseous Syndrome
d. Saturday
Night Palsy
e. Erb’s
palsy
3. What
physiological process is responsible for this patient’s symptoms?
a. demyelination
secondary to compression
b. traction
axonopathy
c. Pancoast
tumor compressing the brachial plexus
d. ischemic
compression
4. The
most likely site of this nerve entrapment is?
a. supinator
muscle
b. axilla
c. spiral
groove of humerus
d. adhesions
from radial-humeral joint capsule
5. EMG
study with respect to this case should be ordered:
a. Immediately
b. 4-6
weeks post injury
c. 1 week
d. Contraindicated
in this case
6. Injury of the posterior cord would cause the most weakness in which
of the following muscles.
a. Brachioradialis
b. teres
minor
c. teres
major
d. supraspinatus
7. Which nerve injury is most likely in this case?
a. Grade
1 neuropraxia
b. Grade
2 neuropraxia
c. Grade
1 axonotmesis
d. Grade
1 neurotmesis
e. Grade
2 neurotmesis
8. Which of the following condition should be on your differential
in this case?
a. arsenic
intoxication
b. diabetes
c. lead
intoxication
d. polymyositis
9. With respect to this case, if an EMG study does not reveal any
abnormality in this muscle group, a root lesion can be ruled out as the cause
of this lesion.
a. paraspinal
b. flexor
digitorum profundus
c. pronator
teres
d. serratus
anterior
10. The main risk factor causing this patients dysfunction is?
a. diabetes
b. malnutrition
c. hereditary
d. alcoholism
11. After peripheral nerve injury, the nerve regenerates at a rate
of:
a. 1 cm/day
b. 1 inch/day
c. 1 millimeter/day
d. 1 meter/day
12. Utilizing
the concepts of Functional Neurology, what treatment is the most appropriate
for this patient?
a. Slow
stretch of the forearm and finger extensors on the right
b. Fast
stretch of the forearm flexors on the right
c. Slow
stretch of the shoulder protractors on the right
d. Fast
stretch of the elbow flexors on the right.
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Practice Answers
1. b.
2. d.
3. d.
4. c.
5. a.
6. c.
7. a.
8. c.
9. a.
10. d.
11. c.
12. a.
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