Certified in NeuroCritical Care (ABEM) Exam Dumps

NCC Exam Format | Course Contents | Course Outline | Exam Syllabus | Exam Objectives

The following are specific diseases, conditions, and clinical syndromes commonly managed by a neurointensivist:
A. Cerebrovascular Diseases
1. Infarction and ischemia
• Massive hemispheric infarction
• Basilar artery occlusion and stenosis
• Carotid artery occlusion and stenosis
• Crescendo TIAs
• Occlusive vasculopathies (Moya-Moya, sickle cell)
• Spinal cord infarction
2. Intracerebral hemorrhage
• Supratentorial
• Cerebellar
• Brainstem
• Intraventricular
3. Subarachnoid hemorrhage - aneurysmal and other Vascular malformations
• Arteriovenous malformations
• AV fistulas
• Cavernous malformations
• Developmental venous anomalies
4. Dural sinus thrombosis
5. Carotid-cavernous fistulae
6. Cervical and cerebral arterial dissections
1. Traumatic brain injury
• "Diffuse axonal injury"
• Epidural hematoma
• Subdural hematoma
• Skull fracture
• Contusions and lacerations
• Penetrating craniocerebral injuries
• Traumatic subarachnoid hemorrhage
2. Spinal cord injury
• Traumatic injury (transection, contusion, concussion)
• Vertebral fracture and ligamentous instability
C. Disorders, Diseases, Seizures, and Epilepsy
1 . Seizures and epilepsy
• Status epilepticus (SE) Convulsive
Non-convulsive (partial-complex and "subtle" secondarily generalized SE) Myoclonic
2. Neuromuscular diseases
• Myasthenia gravis
• Guillain-Barre syndrome
• Rhabdomyolysis and toxic myopathies
• Critical illness myopathy and neuropathy
3. Infections
• Encephalitis (viral, bacterial, parasitic)
• Meningitis (viral, bacterial, parasitic)
• Brain and spinal epidural abscess
4. Toxic-metabolic disorders
• Neuroleptic malignant syndrome/malignant hyperthermia
• Serotonin syndrome
• Drug overdose and withdrawal (e.g., barbiturates, narcotics, alcohol, cocaine, acetaminophen).
• Temperature related injuries (hyperthermia, hypothermia)
5. Inflammatory and demyelinating diseases
• Multiple sclerosis (Marburg variant, transverse myelitis)
• Neurosarcoidosis
• Acute disseminated encephalomyelitis (ADEM)
• CNS vasculitis
• Chemical or sterile meningitis (i.e. posterior fossa syndrome, NSAID induced)
• Central pontine myelinolysis
• Others
6. Neuroendocrine disorders
• Pituitary apoplexy
• Diabetes insipidus (including triple phase response)
• Panhypopituitarism
• Thyroid storm and coma
• Myxedema coma
• Addisonian crisis
D. Neuro-oncology
1 . Brain tumors and metastases
2. Spinal cord tumors and metastases
3. Carcinomatous meningitis
4. Paraneoplastic syndromes
1. Eclampsia, including HELLP Syndrome
2. Hypertensive encephalopathy
3. Hepatic encephalopathy
4. Uremic encephalopathy
5. Hypoxic-ischemic and anoxic encephalopathy
F.Clinical syndromes
2. Herniation syndromes with monitoring & ICP
3. Elevated intracranial pressure and Intracranial hypotension/hypovolemia
4. Hydrocephalus detection & treatment
5. Cord compression
6. Death by neurologic criteria, end of life issues, and organ donation
7. Vegetative state
8. Dysautonomia (cardiovascular instability, central fever, hyperventilation)
9. Reversible posterior leukoencephalopathy
10. Psychiatric emergencies (psychosis)
G. Perioperative Neurosurgical Care
II. General Critical Care: Pathology, Pathophysiology, and Therapy
A. Cardiovascular Physiology, Pathology, Pathophysiology, and Therapy
1. Shock (hypotension) and its complications (vasodilatory and cardiogenic)
2. Myocardial infarction and unstable coronary syndromes
3. Neurogenic cardiac disturbances (ECG changes, stunned myocardium)
4. Cardiac rhythm and conduction disturbances; use of antiarrhythmic medications; indications for and types of pacemakers
5. Pulmonary embolism
6. Pulmonary edema: cardiogenic versus noncardiogenic (including neurogenic)
7. Acute aortic and peripheral vascular disorders (dissection, pseudoaneurysm)
8. Recognition, evaluation and management of hypertensive emergencies and urgencies
9. Calculation of derived cardiovascular parameters, including systemic and pulmonary vascular resistance, alveolararterial gradients, oxygen transport and consumption
B.Respiratory Physiology, Pathology, Pathophysiology and Therapy
1.Acute respiratory failure
• Hypoxemic respiratory failure (including ARDS)
• Hypercapnic respiratory failure
• Neuromuscular respiratory failure
2. Aspiration
3. Bronchopulmonary infections
4. Upper airway obstruction
5. COPD and status asthmaticus, including bronchodilator therapy
6. Neurogenic breathing patterns (central hyperventilation, Cheyne-Stokes respirations)
7. Mechanical ventilation
• Positive pressure ventilation (BIPAP)
• PEEP, CPAP, inverse ratio ventilation, pressure support ventilation, pressure control, and non- invasive ventilation
• Negative pressure ventilation
• Barotrauma, airway pressures (including permissive hypercapnia)
• Criteria for weaning and weaning techniques
8. Pleural Diseases
• Empyema
• Massive effusion
• Pneumothorax
9. Pulmonary hemorrhage and massive hemoptysis
10. Chest X-ray interpretation
11. End tidal C02 monitoring
12. Sleep apnea
13. Control of breathing
C. Renal Physiology,Pathology, Pathophysiology and Therapy
1.Renal regulation of fluid and water balance and electrolytes
2.Renal failure: Prerenal, renal, and postrenal
3.Derangements secondary to alterations in osmolality and electrolytes
4. Acid-base disorders and their management
5.Principles of renal replacement therapy
6. Evaluation of oliguria and polyuria
7.Drug dosing in renal failure
8. Management of rhabdomyolysis
9. Neurogenic disorders of sodium and water regulation (cerebral salt wasting and SIADH).
D. Metabolic and Endocrine Effects of Critical Illness
1. Enteral and parenteral nutrition
2. Endocrinology
• Disorders of thyroid function (thyroid storm, myxedema coma, sick euthyroid syndrome)
• Adrenal crisis
• Diabetes mellitus
Ketotic and hyperglycemic hyperosmolar coma Hypoglycemia
3. Disorders of calcium and magnesium balance
4. Systemic Inflammatory Response Syndrome (SIRS)
5. Fever, thermoregulation, and cooling techniques
E.Infectious Disease Physiology, Pathology, Pathophysiology and Therapy
1. Antibiotics
• Antibacterial agents
• Antifungal agents
• Antituberculosis agents
• Antiviral agents
• Antiparasitic agents
2. Infection control for special care units
• Development of antibiotic resistance
• Universal precautions
• Isolation and reverse isolation
3. Tetanus and botulism
4. Hospital acquired and opportunistic infections in the critically ill
5. Acquired Immune Deficiency Syndrome (AIDS)
6. Evaluation of fever in the ICU patient
7. Central fever
8. Interpretation of antibiotic concentrations, sensitivities
F.Physiology, Pathology, Pathophysiology and therapy of Acute Hematologic Disorders
1 . Acute defects in hemostasis
• Thrombocytopenia, thrombocytopathy
• Disseminated intravascular coagulation
• Acute hemorrhage (GI hemorrhage, retroperitoneal hematoma)
• Iatrogenic coagulopathies (warfarin and heparin induced)
2. Anticoagulation and fibrinolytic therapy
3. Principles of blood component therapy (blood, platelets, FFP)
4. Hemostatic therapy (vitamin K, aminocaproic acid, protamine, factor VIla)
5. Prophylaxis against thromboembolic disease
6. Prothrombotic states
G. Physiology, Pathology, Pathophysiology and Therapy of Acute Gastrointestinal (GI) and Genitourinary (GU)
1. Upper and lower gastrointestinal bleeding
2. Acute and fulminant hepatic failure (including drug dosing)
3. Ileus and toxic megacolon
4. Acute perforations of the gastrointestinal tract
5. Acute vascular disorders of the intestine, including mesenteric infarction
6. Acute intestinal obstruction, volvulus
7. Pancreatitis
8. Obstructive uropathy, acute urinary retention
9. Urinary tract bleeding
H. Immunology and Transplantation
1. Principles of transplantation (brain death, organ donation, procurement, maintenance of organ donors, implantation)
2. Immunosuppression, especially the neurotoxicity of these agents
I. General Trauma and Burns
1. Initial approach to the management of multisystem trauma
2. Skeletal trauma including the spine and pelvis
3. Chest and abdominal trauma - blunt and penetrating
4. Burns and electrical injury
J. Monitoring
1. Neuromonitoring
2. Prognostic, disease severity and therapeutic intervention scores
3. Principles of electrocardiographic monitoring
4. Invasive hemodynamic monitoring
5. Noninvasive hemodynamic monitoring
6. Respiratory monitoring (airway pressure, intrathoracic pressure, tidal volume, pulse oximetry, dead space, compliance, resistance, capnography)
7. Metabolic monitoring (oxygen consumption, carbon dioxide production, respiratory quotient)
8. Use of computers in critical care units for multimodality monitoring
K. Administrative and Management Principles and Techniques
1. Organization and staffing of critical care units
2. Collaborative practice principles, including multidisciplinary rounds and management
3. Emergency medical systems in prehospital care
4. Performance improvement, principles and practices
5. Principles of triage and resource allocation, bed management
6. Medical economics: health care reimbursement, budget development
L. Ethical and Legal Aspects of Critical Care Medicine
1. Death and dying
2. Forgoing life-sustaining treatment and orders not to resuscitate
3. Rights of patients, the right to refuse treatment
4. Living wills, advance directives; durable power of attorney
5. Terminal extubation and palliative care
6. Rationing and cost containment
7. Emotional management of patients, families and caregivers
8. Futility of care and the family in denial
M. Principles of Research in Critical Care
1. Study design
2. Biostatistics
3. Grant funding and protocol writing
4. Manuscript preparation
5. Presentation preparation and skills
6. Institutional Review Boards and HIPAA
Ill. Procedural Skills
A. General Neuro-Critical Care
1 . Central venous catheter placement; dialysis catheter placement
2. Pulmonary artery catheterization
3. Management of mechanical ventilation, including CPAP/BiPAP ventilation
4. Administration of vasoactive medications (hemodynamic augmentation and hypertension lysis)
5. Maintenance airway and ventilation in nonintubated, unconscious patients
6. Interpretation and performance of bedside pulmonary function tests
7. Direct laryngoscopy
8. Endotracheal intubation
9. Shunt and ventricular drain tap for CSF sampling
10. Performance and interpretation of transcranial Doppler
11. Administration of analgosedative medications, including conscious sedation and barbiturate anesthesia
12. Interpretation of continuous EEG monitoring
13. Interpretation and management of ICP and CPP data
14. Jugular venous bulb catheterization
15. Interpretation of Sjv02 and Pbt02 data
16. Management of external ventricular drains
I 7. Management of plasmapheresis and IVIG
18. Administration of intravenous and intraventricular thrombolysis
19. Interpretation of CT and MR standard neuroimaging and perfusion studies and biplane contrast neuraxial angiography
20. Perioperative and postoperative clinical evaluation of neurosurgical and interventional neuroradiology patients
21. Performance of lumbar puncture and interpretation of cerebrospinal fluid results
22. Induction and maintenance of therapeutic coma and hypothermia

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Why universities may still consider UGCโ€™s proposal to understand NCC

On April 15, the institution promises fee (UGC) forwarded for consideration to all vice-chancellors of universities throughout India a concept of the Directorate standard, countrywide Cadet Corps (NCC), aimed toward together with NCC as an optional field in curricula. If here's applied, NCC will become a part of the alternative-based credit score system (CBCS) estimated in the national schooling policy (NEP) 2020. it will enable college students enrolled as NCC cadets to receive tutorial credit for NCC working towards, and avail employment incentives offered below numerous crucial and state govt schemes.

NCC is the realmโ€™s biggest uniformed formative years volunteer service provider. With a footprint covering lots of academic associations across the nation, it has a stronger gender ratio than any other uniformed corporation within the nation with woman cadets accounting for one-third of the total. As in the Indian armed forces, the NCCโ€™s army wing dwarfs the navy and air force wings in terms of numbers.

recently, the principal Armed Police Forces (CAPFs) introduced entry schemes following a concerted effort through the Directorate normal NCC, apart from the preferential medication given to NCC cadets in recruitment to posts in state police departments, fireplace services, woodland departments, and others. The biggest incentive for the adolescence, however, is the satisfaction that stems from wearing a uniform, even though many state-stage NCC directorates are unluckily unable to supply that incentive as a result of paucity of money.

In thought, state governments are required to share the expenditure with the Ministry of Defence, and defray the costs on pay and allowances of the native personnel of the state NCC directorate, aside from featuring for workplace lodging, furniture, transportation for the local gadgets, and their officials. they're additionally purported to share the economic burden of working usual NCC camps for cadets in the state. In practice, very few states meet their full obligations, creating financial distress for native directorates despite the large help offered by means of the Centre. This hurts the core points of NCC training, the introduction of imperative infrastructure, and the monetary management of programmes.

NCC practising has a transformative effect, making cadets extra disciplined and committed. They learn to relate to standard americans including all over crises and empathise with better social and developmental motives. besides the fact that children, there is also a view that cadets should still now not be deployed randomly with the aid of the local administration as mascots at VIP events, for crowd and site visitors management at gala's, and for unrelated โ€œsocial serviceโ€ actions. Such actions may still no longer develop into an alternative choice to core practicing.

ironically, probably the most greatest impediments to creating the NCC greater alluring to the youth is the perspective of the defense force. An NCC posting is equated to being โ€œsidelinedโ€. instead of deploying their top of the line and brightest as position models, there's a tendency to depute people who are medically unfit or considered as โ€œdisgruntledโ€, often on their remaining posting. it's regular that a vast majority of first rate officers get superseded in the pyramid-like constitution of the defense force and some of them, both equipped and influenced, are additionally deployed with the NCC.

even though one may still evade making a vast generalisation, the truth is still that few officers on NCC assignments return to their provider. Some need to be reverted as a result of they fail to fulfill the requirements. Fewer nevertheless movement on to bigger ranks upon returning. in the case of Junior Commissioned Officers (JCOs) and other Ranks (OR) who're sent to the NCC as permanent teacher (PI) staff, many do return and get promoted.

The regularly occurring angle within the armed forces that the NCC is a few form of a dumping ground needs to trade. NCC tenures should influence in additional credit in promotions. this may be certain over time that the senior echelons of the defense force have satisfactory publicity to Indian society and its aspirations.

In expanding the NCC, the govt need to make certain that the states give enough infrastructure for practicing and administrative services in addition to logistical aid. additionally, the best of the native practising personnel such as the affiliate countrywide Cadet Corps Officers (ANOs), and their profession advancement need to even be assured. this is able to attract superior human components to the NCC programme.

Ninety-nine per cent of the inductees into the military from the NCC join as jawans. This may additionally now not be amazing given that a huge majority of NCC cadets come from pretty disadvantaged sections of society. They regard the practicing and exposure provided as a pathway to greater economic opportunities. Cadets from greater privileged sections of society do join the NCC however accomplish that mostly for the joy of donning a uniform, participating in adventure actions, and present process weapons training.

general, the NCC structure must evolve in a route during which the adolescence, regardless of socio-economic background, are drawn to it as a way of advancing both character and profession and rendering national service. a much better mix of cadets will promote brotherly love among the many formative years, peculiarly during the camaraderie experienced all over working towards camps. it might also outcome in more advantageous intake into the โ€œofficerโ€ flow of the militia and better administration in different sectors, both public and private.

The UGC has taken a pretty good step but no matter if the colleges will settle for the thought is not guaranteed. at least within the case of the universities the place it is on offer, the NCC must evolve from being a further-curricular pastime to an non-compulsory field with course credit. while it could actually smartly continue to be a voluntary pursuit, the NCC should be built-in into the national academic policy and made a proper a part of institution syllabi.

This column first appeared within the print version on might also 12, 2021 below the title โ€˜credit for cadetsโ€™. The author became a Senior under Officer in the military Wing-Infantry of the 3rd Gujarat Battalion Vadodara in 1977. he's at present DG of the Manohar Parrikar Institute for Defence experiences and Analyses. Views expressed are own


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