Neurology: Top Topic Updates for Primary Care

Day 1

The Neurological Examination.

Upon completion of this session, the participant should be able to: ^COMP

1. Organize the disparate parts of the neurologic examination into a personally relevant, manageable and reproducible diagnostic tool.
2. Perform a concise screening neurologic exam for asymptomatic patients.
3. Perform a problem-tailored neurologic exam for patients with neurologic complaints.
4. Obtain maximum yield from the examination of a patient with an altered mental status.

Multiple Sclerosis.

Upon completion of this session, the participant should be able to: ^COMP

1. Recognize the typical clinical features of multiple sclerosis.
2. Initiate an appropriate series of diagnostic investigations.
3. Formulate an approach to abortive and prophylactic therapy of multiple sclerosis.
4. Anticipate common medical complications of multiple sclerosis.

Stroke, Part I – An Evidence-Based Review of Risk Factors and Prevention.

Upon completion of this session, the participant should be able to: ^{EBM, GL, COMP}

1. Identify risk factors and apply prevention strategies.
2. Apply the CHA₂DS₂-VASc Score to assess risk of stroke with Atrial Fibrillation and guide treatment plan.
3. Plan when to refer patients for carotid endarterectomy.
4. Determine use of aspirin, clopidogrel, dipyridamole, warfarin and novel anticoagulants, carotid endarterectomy and stenting.

Stroke, Part II – TIA and Acute Stroke.

Upon completion of this session, the participant should be able to: ^{GL, COMP}

1. Apply risk stratification to TIA.
2. Employ a protocol for evaluation and treatment of TIA and stroke.
3. Apply inclusion criteria and vascular imaging for thrombolysis and interventional clot retrieval.
4. Review 2018 Guidelines for wake up stroke.

Day 2

Seizures and Epilepsy – Diagnosis.

Upon completion of this session, the participant should be able to: ^COMP

1. Differentiate among the major types of seizures.
2. Apply epidemiologic aspects to the diagnosis of epilepsy.
3. Distinguish seizures from syncope.
4. Formulate a plan for diagnostic investigation.

Seizures and Epilepsy – Management.

Upon completion of this session, the participant should be able to: ^COMP

1. Determine when treatment with anticonvulsant medication is warranted.
2. Choose among the many available anticonvulsant medications.
3. Manage problems confronted by women with epilepsy.
4. Counsel patients regarding their driving privileges. 

An Approach to the Dizzy Patient.

Upon completion of this session, the participant should be able to: ^COMP

1. Detect common presentations of dizziness.
2. Assess the pathophysiology of vertigo and nystagmus.
3. Apply bedside techniques to distinguish dizziness subtypes and identify dangerous causes.
4. Utilize potentially curative treatment for benign positional vertigo.

Syncope and Autonomic Dysfunction.

Upon completion of this session, the participant should be able to: ^COMP

1. Discuss the causes and natural history of syncope and Postural Orthostatic Tachycardia Syndrome (POTS).
2. Apply bedside tilt and tilt table testing.

Define treatment strategies for orthostatic hypotension.

Day 3

Sleep Disorders – Insomnia and Obstructive Sleep Apnea.

Upon completion of this session, the participant should be able to: ^COMP

1. Appraise the normal structure and function of stages of sleep.
2. Formulate a diagnostic and therapeutic approach to insomnia.
3. Detect clinical features and initiate management of sleep apnea.
4. Evaluate patients for comorbidities of obstructive sleep apnea.

Sleep Disorders – Restless Legs Syndrome, Narcolepsy and Others

Upon completion of this session, the participant should be able to: ^COMP

1. Diagnose restless legs syndrome in under a minute.

2. Manage restless legs syndrome.
3. Diagnose and treat narcolepsy.
4. Determine the prognosis of, and treat, REM-sleep behavior disorder.

Migraine and Chronic Daily Headache.

Upon completion of this session, the participant should be able to: ^COMP

1. Differentiate between the five sub-types of chronic daily headaches.
2. Appraise the pathophysiology of headache and migraine.
3. Develop a plan for appropriate medication for intractable headache.
4. Assess the prevalence of medication overuse headaches in daily practice.

Peripheral Neuropathy and Neuropathic Pain Management.

Upon completion of this session, the participant should be able to: ^COMP

1. Define the spectrum of neuropathic signs, symptoms, and causes.
2. Develop an approach to bedside examination.
3. Discuss the mechanism of neuropathic pain.
4. Apply effective therapies.

Day 4

Dementia.

Upon completion of this session, the participant should be able to: ^COMP

1. Evaluate patients with mild cognitive impairment or dementia.
2. Diagnose the major syndromes associated with common causes of dementia.
3. Distinguish the conditions that frequently mimic dementia.
4. Manage major complications of dementia.

Parkinson’s Disease and Essential Tremor.

Upon completion of this session, the participant should be able to: ^COMP

1. Assess the clinical features of the syndrome of parkinsonism.
2. Evaluate other important typical features of Parkinson’s disease.
3. Select treatment options for management of Parkinson’s disease.
4. Distinguish among common types of tremor and devise a therapeutic plan for a patient with essential tremor.

Confessions of a Mostly Happy Doctor – Strategies for Reducing Physician Burnout.

Upon completion of this session, the participant should be able to: ^COMP

1. Review current literature re: physician burnout.
2. Incorporate strategies to reduce clerical burdens of EMR.
3. Adopt strategies for successful patient experience surveys.
4. Apply techniques for managing functional symptoms in the office.

Libby Zion’s Lesson: Serotonin Syndrome and P450 Drug Interactions.

Upon completion of this session, the participant should be able to: ^COMP

1. Define the clinical features of common drug interactions.
2. List the features of serotonin syndrome and distinguish from other Neurologic drug toxicities.
3. Recognize potential drug interactions and determine how to predict them.
4. Apply a simple clinical algorithm for anticipating and avoiding drug interactions.

Day 5

Cobalamin (B-12) Deficiency and Other Neurologic Disorders of Gastrointestinal Function.

Upon completion of this session, the participant should be able to: ^COMP

1. Define recent advances in B-12 deficiency, Post-Gastroplasty Neuropathy, and Copper deficiency.
2. Examine the changing clinical presentation of this illness.
3. Apply newer laboratory techniques to the diagnosis.
4. Apply an algorithm for the diagnosis and treatment of B-12 deficiency.

Concussion and Sports: A Guide for Primary Care

Upon completion of this session, using Cochrane EBM sources and guidelines from the 3rd International Symposium on Concussion in Sports, the participant should be able to: ^{EBM, GL, COMP}

1. Describe the pathophysiology and, using evidence-based medicine, review the emergency treatment of concussion.
2. Apply an evidence-based medicine approach to decisions regarding imaging after minor head trauma.
3. Demonstrate use of currently recommended management approaches for assessment, follow up, and return to play.

Spasticity, Ataxia, and Gait Disorders.

Upon completion of this session, the participant should be able to: ^COMP

1. Detect the major clinical features of spasticity.
2. Institute a diagnostic investigation of cervical spondylosis.
3. Assess ataxia and the other major clinical features of cerebellar dysfunction.
4. Evaluate different types of gait disorders.

Psychogenic Neurologic Disorders.

Upon completion of this session, the participant should be able to: ^COMP

1. Evaluate common neurologic manifestations of psychogenic disorders.
2. Distinguish among malingering, factitious disorders and conversion disorders.
3. Conduct an interview of a patient with a suspected psychogenic disorder.
4. Formulate a plan for management of a psychogenic illness.