Clinical Decision Making – year 4 students

Hi Everyone.

What with COVID19 circulating, and hackers hacking, we thought it might be helpful to have a backup resource for the Neurology part of the CDM course. This is mostly a “remote” course to make sure you can still access it from your lockdown bunkers.

We’ve tried to make it as interactive as possible. Lectures are broken up a bit with questions and there are seminars, worked cases, interactive sessions, mystery videos and quizzes.

Basically, the purose of the course is to equip you with a bit more knowledge about the sorts of neurological disorders you might encounter in your exams and, more importantly, your clinical practice. At least 10% of the acute medical take is “neurological” and so it is more than just a niche specialty full of odd people (and I do mean the doctors here!).

We are focusing on 4-5 key disorders that allow us to explore the anatomy, physiology and pathophysiology in a way that, hopefully, doesn’t make you comatose. We also want to give you some examination tools that help you to identify where a problem might be, just by using your clinical common sense and a bit of helpful neuro knowledge.

We’ve chosen to largely ignore the brain for this bit, in a radical departure from the norm. Aside from the Movement disorders section, we are going to spent more time on the spinal cord and the motor system beyond that (nerve, NMJ, muscle). In a moment of madness, I thought we should cover “dizziness”, not because I was in a dark place that day, but because if you can figure out what dizziness is, you are nailing it.

We have been asked by the medical school to incorporate some other key clinical skills – the use of guidelines, safe prescribing practices – as well as piquing your interest about future therapies, hot topics research wise and use the use of technologies.

Lastly, we want to introduce you to the fact that medicine in general, and neurology specifically, can be challenging, confusing, ethically taxing and, quite frankly, a bit “messy”. This is the real world you will be practising in and patients, and diseases, don’t usually read textbooks (or websites).

Welcome to the world of “realistic medicine”.

Hope you enjoy the CDM Neurology course.


We’ll be covering a number of different conditions in this course. In order to do so, you will find these lectures useful (I hope).

The anatomy lecture introduces you to important features of the spinal cord and peripheral nervous system. The session on investigations will help you to develop a structure for working up a patient.

The other lectures will take you on a tour of basal ganglia, spinal cord and peripheral nervous system and introduce you to some key disorders that a) illustrate the structure and function of nervous system and b) are common in clinical practice (or exams!).

Neuroanatomy – useful stuff to know

Neurological investigations – how to do it

Neuromuscular weakness – how to spot it; how to treat it

Motor Neurone Disease – jargon busting towards better understanding

Human movement – how it works and why it doesn’t

Parkinson’s disease – how to assess and manage it


The tutorials will be on the MLE for you but we have hosted them externally as well – just in case.

These should compliment the lectures and take you a little deeper – should you wish to go there. They will allow you to go at your own pace and, hopefully, help you to appreciate the impact of some of the conditions on patients and families. We also wanted to showcase some newer treatments and how these have been informed by a knowledge of basic anatomy, pathology and physiology.

Living with PD and the future

Hyperkinesia and Huntington’s genetics

Future therapies – antisense oligonucleotides

“A bit dizzy doc” – how to not lose hope when assessing dizziness


MS – now and in the future


These cases are a clinical puzzle for you to solve. Approach these towards the end of the week and see how much you have learned. If you can crack these, you are doing well.

Worked case – Brian

Worked case – Jane

Worked case – Michael


The seminar will cover some crucial issues that face all clinicans, regardless of specialty. Obviously we will be focusing on neurology but there are common features to take with you from this session. We reckon you can apply these in other fields too.

Specifically, we will work our way through two cases – one of Huntington’s disease and the impact a postive gene test might have on the family. The second takes us through the course of a patient with MND, highlighting how we might talk about advanced care needs and interventions such as non-invasive ventilation, PEG feeding and end of life care.

Tricky issues – ethics of gene testing, non-invasive ventilation and PEG feeding; talking about dying


No week of neurological teaching would be complete without the torture of a quiz. We’ll try to make it as clinically relevant as possible – honest.

Clinical scenarios, diagnosis, investigations

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