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Certification-Board NCC : Certified in NeuroCritical Care (ABEM) Exam

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Exam Number : NCC
Exam Name : Certified in NeuroCritical Care (ABEM)
Vendor Name : Certification-Board
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NCC test Format | NCC Course Contents | NCC Course Outline | NCC test Syllabus | NCC test 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
B.Neurotrauma
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
• ALS
• 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
E.Encephalopathies
1. Eclampsia, including HELLP Syndrome
2. Hypertensive encephalopathy
3. Hepatic encephalopathy
4. Uremic encephalopathy
5. Hypoxic-ischemic and anoxic encephalopathy
6. MELAS
F.Clinical syndromes
1.Coma
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
H.Pharmacotherapeutics
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)
Disorders
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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Certification-Board NeuroCritical test Questions

important Care medication Fellowship | NCC Practice Test and Real test Questions

The essential Care medicine fellowship software at Saint Louis school school of medicine offers a one- or two-12 months ACGME permitted critical care fellowship to graduates of approved residency or fellowship courses.  

The Saint Louis institution school of drugs essential care and pulmonary crucial care fellowships run in parallel strengthening each classes with the aid of sharing college, rotations and tutorial experiences.  

because 1979, more than 200 fellows have graduated from the critical care fellowship and are at the moment training crucial care medicine nationally and internationally, including two past presidents of the Society of critical Care medicine. The fellowship makes a speciality of a powerful scientific adventure to supply extraordinary intensivists.  

all over the fellowship, trainees function the following methods: valuable venous catheter, renal replacement catheter, arterial catheter, intracranial force monitor (Camino Catheter), intubation, tube thoracostomy, percutaneous dilational tracheostomy, thoracentesis, paracentesis and lumbar puncture.       

The fellowship is supported with each day lectures, month-to-month journal golf equipment, weekly grand rounds, monthly ultrasound video conferences, quarterly chest conferences, and three every year symposia overlaying extra corporeal membrane oxygenation (ECMO), important care ultrasound, the elaborate airway and mechanical ventilation. The fellows are additionally assisted via crucial care board intensivists and important care advanced practitioners in-condominium 24 hours a day. The advanced practitioners can be found to help help the guy’s group with rounding, assessing sufferers and, if imperative, performing methods.  

Curriculum

The fellows are offered a special 12- or 24-month adventure rotating between Saint Louis college and Mercy St. Louis hospitals with exposure to quite a lot of intensive care unit populations including scientific, surgical, trauma, neurological, neurosurgical, cardiac and vascular sufferers.  

Rotations clinical/Surgical Intensive Care Unit

The Mercy clinic St. Louis medical/surgical intensive care unit rotation exposes the fellows to scientific and surgical pathophysiology. The intensive care unit crew comprises a fellow, resident, pupil and demanding care faculty member answerable for the day by day multidisciplinary instructing rounds. The group is answerable for the care of complicated scientific and surgical sufferers including the efficiency of a number of invasive methods. The evening coverage is provided through the night float group that contains fellows, health professional extenders and lower back up supervision through the in-condo telemedicine important care school member.

Neuro-Trauma Intensive Care Unit

The Mercy clinic St. Louis neuro-trauma intensive care unit gives care to sufferers sustaining assorted trauma, tense mind damage, acute stroke, subarachnoid hemorrhage, spinal twine damage, put up operative mind and backbone surgical procedure and neurologic disorders requiring respiratory support. Working intently with the trauma surgeons and neurosurgeons, the neurointensivists provide bedside care of these sufferers together with placement of intra-cranial drive screens.  Mercy health facility St. Louis is a finished stroke middle and a degree I trauma core. the majority of essential care attending college have completed the neurocritical care subspecialty certification from the United Council for Neurologic Subspecialties.    

medical Intensive Care Unit

The Saint Louis tuition clinical Intensive Care Unit (MICU) rotation offers comprehensive care to patients with lifestyles-threatening or probably life-threatening scientific ailments of all foremost organ methods. the two fellows assigned to pulmonary disorder/important care drugs or critical care medication are the group leaders for the month-to-month rotation block-assigned scientific residents. along with the MICU attending health care provider, fellows actively participate in patient care including efficiency and supervision of all ICU-linked invasive strategies.

Telemedicine

The Mercy sanatorium St. Louis digital Care middle helps one of the largest telemedicine classes within the nation. The vital care and pulmonary critical care fellows study ICU telemedicine competencies all the way through this rotation, masking a few intensive care gadgets alongside the crucial care attending college and nursing group of workers. The fellows develop abilities navigating electronic medical facts, bedside monitoring methods and the video capabilities of virtual care. The fellows gain knowledge of the benefits and obstacles of crucial care telemedicine.

Cardiovascular Intensive Care Unit (CVICU)

all over the CVICU rotation, the fellows look after patients with ischemic coronary syndromes, challenging arrhythmias, vascular surgical procedure, cardiogenic shock and publish-cardiac arrest hypothermia. in addition, sufferers requiring extracorporeal membrane oxygenation (ECMO) are managed within the CVICU in collaboration with the ECMO group. This crew comprises an ECMO intensivist, cardiovascular perfusionist, cardiothoracic surgeon, really good intensive care unit nurses and respiratory practitioners.  

Conferences

Fellows are required to attend conferences and grand rounds constantly.

  • ICU daily Didactic ConferencesEssential core ICU subjects are introduced.Weekdays: 1 p.m.
  • ICU Grand RoundsTopic reviews and research displays presented by means of critical care school, subspecialty school, crucial care fellows and invited guest audio system.Tuesday: 12 p.m.
  • Chest ConferenceCase presentations and interactive dialogue offered by the Mercy sanatorium St. Louis pulmonary attending instructing staffQuarterly
  • Symposia

    important care docs offer extra courses for fellows interested in particular clinical concerns and applied sciences. 

    critical Care Ultrasound direction

    This formal ultrasound path includes didactic and useful classes presented and directed via the vital care branch together with Dr. Jan Kasal, who co-chaired the Society of crucial Care medicine ultrasound path, and Dr. Chakradhar Venkata, each certified by the country wide Board of Echocardiography (Testamur). The route comprises echocardiography, DVT assessment, lung and chest ultrasound, and abdominal fast examination. The 3D programs Ultrasound Mentor provides an ultrasound simulation ambiance for the fellows to sharpen and examine their competencies.

    intricate Airway direction

    This formal airway direction offered with a multidisciplinary approach including illustration from essential care medicine, pulmonary drugs, emergency drugs, trauma surgical procedure, pharmacy and anesthesia. The course provides didactics, purposeful classes, and an comparison of the existing airway device. The SimMan 3G used during this course offers energetic interactive and tutorial simulation periods.

    Mechanical air flow path

    The mechanical ventilation course is a mix of didactic lectures and a palms-on functional evaluation of mechanical ventilators with test lungs. Case scenarios are introduced and discussed at several getting to know stations. The direction focuses on utilized pulmonary physiology within the surroundings of mechanical air flow.

    ECMO education path

    The ECMO education direction gives the fellows and group of workers with the groundwork for the medical follow of ECMO. This course contains didactic lectures and practical classes with a useful ECMO circuit introduced via cardiovascular perfusionists, ECMO intensivists and ECMO consultants.

    month-to-month presentations

    Fellows present and attend conferences, meetings and textbook reports on a monthly basis. 

    Journal club

    Fellows current journal articles following the facts-primarily based drugs strategy. The crucial care school liable for journal club shows completed the EBM workshop subsidized through Duke school clinical middle.

    Video Ultrasound conference

    here's a combined Mercy clinic St. Louis and Saint Louis university hospital video ultrasound conference that gives a platform for the fellows to current and talk about ultrasound cases with the pulmonary and critical care attendings. focused ultrasound subject matters are introduced and reviewed.

    Fellows/Director assembly

    here is a monthly meeting between the fellows and the application director to talk about any points of the fellowship.

    QI convention

    The vital Care QI convention is administered by way of the fellows to address nice and security considerations bearing on the ICU. The APACHE outcomes database gives physiologic and effect information on all ICU admissions and is introduced all over this meeting for evaluate and to determine for tendencies of care.

    critical Care Textbook overview

    each and every month, the fellows are expected to examine a section of a particular critical care textbook and then reply questions that the attendings have written for that analyzing. The questions are presented and discussed all over the convention. The goal of the assessment is to finished a critical care textbook every two years in preparation for the crucial care ABIM certifying examination.

    research

    medical research is conducted at Saint Louis institution health facility and Mercy health facility St. Louis. The essential care fellows are encouraged and mentored to Excellerate a scientific research thought together with the Institutional review Board submission and presentation of their analysis findings at local or countrywide conferences. annually, the department sponsors the Robert W. Taylor, M.D., Mercy analysis Colloquium that provides a local venue for presentation of research initiatives from the fellows, residents and attendings. The department additionally participates in trade and govt-sponsored research.

    requirements

    The important care fellowship application doesn't participate within the national Resident Matching software (NRMP). applications are accredited each year beginning in the spring.  application substances may still be scanned and emailed to  kayla.carns@mercy.web and interviews are performed in late summer and early fall.  

    application materials
  • software form
  • Two letters of advice (one from the application director or present branch chair)
  • scientific school transcript
  • personal observation
  • contemporary picture (at least two inches squared)
  • UMSLE transcript or COMLEX transcript MSPE
  • school 

    Our school work in important care medicine, inside medicine, pulmonology and sleep medicine.

  • Zerihun Bunaye, M.D. 
  • Michael Cox, M.D.
  • Dayton Dmello, M.D.
  • Muhammad Ali Javed, M.D.
  • Anup Kaytal, M.D. 
  • Michael Plisco, M.D. 
  • Farid Sadaka, M.D. 
  • Joan Shaffer, M.D. 
  • Barry Stoll, D.O. 
  • David Tannehill, D.O.
  • Steven Trottier, M.D. 
  • Javad Vaziri, D.O.
  • Chakradhar Venkata, M.D. 



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