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Test Number : NCC
Test Name : Certified in NeuroCritical Care (ABEM)
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NCC exam Format | NCC Course Contents | NCC Course Outline | NCC exam Syllabus | NCC 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
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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LO Jobs; Valuation items; agency/Investor changes; loan-COVID-Video; Powell Sees extended challenging times | NCC PDF obtain and exam Questions

LO Jobs; Valuation items; company/Investor changes; personal loan-COVID-Video; Powell Sees prolonged tough times

As they race toward the Memorial Day break on the twenty fifth, for the first time in history they are able to keep the human race via laying in front of the tv and doing nothing. Let's not screw it up! Zillow laid out its make money working from home (WFH) plan: the leisure of 2020. Microsoft? October on the earliest. fb & Google for the rest of 2020. Who cares what politicians say? owners asking americans to return to an office could be faced with antibody checking out, temperature monitoring, and social distancing. The coronavirus pandemic might trigger lasting damage to economies and people by leaving corporations harassed with debt and by means of leaving households concerned about economic security. financial institution of England Chief Economist Andy Haldane: "All crises leave scars, and this disaster assuredly might be no exception." no matter if it is very nearly every government on earth, or billions of individuals, there is loads of borrowing happening. On a private degree, Truist’s Michele Perrin shared this video of an interview along with her husband Chuck who was hit swiftly with the virus and is now, fortuitously, on the gradual highway to recovery although his lungs were broken and may take as an awful lot as a yr to recuperate.

Lender products and capabilities

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consequences of a latest examine on COVID-19 communications showed that loan is barely 20% among all of the other monetary functions which are competing for consumer eyes. no longer to mention, personal loan is additionally up towards different industries backyard of finance. With all of this noise going out to the client, how do you know you’re accomplishing the audience you desire? And if you're attaining the appropriate individuals, how can you be certain your messaging is impactful ample to get them to act. In these days’s environment, it’s in no way been greater essential to attain the right viewers with the right message. click on here to see the survey outcomes from Informative analysis and learn how your message can stand out from all the noise!

Take the guesswork out of appraisal alternate options all through this difficult time with Connexions’ all-new clever Valuation Portal (IVP). It immediately identifies the absolute best appraisal classification in response to GSE necessities by using analyzing client, personal loan, and property facts to make the greatest product selections for your company. IVP’s choice-tree know-how analyzes customer, mortgage, and property records to make the optimum product selections on your enterprise, while guaranteeing each appraisal ordered is compliant, low in cost, and situationally acceptable. And with Connexions’ new digital inspection device, CNX360, appraisers can safely and securely assemble property tips and footage from the householders with a click on of a button. Connexions has great event within the appraisal business and presents a premier Appraisal management platform that promises premier-in-category expertise options, allowing you to convey the very best quality real property appraisals to your purchasers. interested in Connexions’ IVP or CNX360? Contact them today!

As Chase, Wells Fargo and others step away from HELOC lending because of present financial disruption, many borrowers want a lender to help them access their (frequently appreciable) domestic equity reserves. ReverseVision President Joe Langner says this creates probability for lenders providing the home equity Conversion mortgage (HECM). as a result of HECMs in fact bring in a down market, senior householders are turning to the bendy HECM line of credit score as a substitute for usual HELOCs. That’s as a result of unlike HELOCs, HECMs can not be canceled, recast or frozen. HECMs additionally deliver debtors flexibility in making month-to-month personal loan funds. if you’d want to learn more about how this moneymaking, widely underutilized lending application can advantage your senior borrowers and your bottom line, contact Wendy Peel for a free check with or demo of ReverseVision.

Investor/Lender changes

The FHFA became busy yesterday. Fannie Mae issued Lender Letter LL-2020-07, COVID-19 fee Deferral. “Servicers will use this new exercising solution to help owners impacted by way of COVID-19 economic hardships return their mortgage to present reputation after as much as one year of neglected funds. Designed to be elementary and effective for each servicers and borrowers, this solution strikes the volume of the ignored payments to the conclusion of the mortgage.”

Freddie Mac, also overseen by means of the FHFA, introduced “a solution for homeowners once they have resolved their COVID-19-connected difficulty that can at once convey their mortgages present and put them returned on target.”

The industry is watching moves by means of AmeriHome and PennyMac, two colossal non-bank correspondent buyers. the day past it turned into PennyMac’s flip. “PennyMac will make updates to the govt LLPAs effective for all choicest Effort commitments taken on or after Friday, may additionally 15: update values on the executive ‘FICO price changes’ Grid.” A demo of the up-to-date price sheet(s) was posted closing evening to the PennyMac Portal. “sample expense sheet(s) might be purchasable for obtain shortly after the normal fee sheet email notification is sent from ‘PennyMac seller Pricing.’”

Gateway First bank, Correspondent Lending, is amending its can also fifth, 2020 announcement titled update to company LLPAs: temporary promoting requirements regarding COVID-19. “valuable automatically, company buy or no money-out refinance transactions getting into a forbearance length (as described via Fannie Mae and Freddie Mac) after buy by Gateway however previous to the loans being sold to an company, usually are not assessed here LLPAs: 500 basis facets (5.000%) for first-time domestic consumers, or 700 groundwork facets (7.000%) for all different transactions. Loans which are at the moment in forbearance are not eligible for buy by way of Gateway. company money-out refinances that enter into forbearance after purchase by Gateway and in advance of being federally backed can result in a repurchase. purchase and no cash-out refinance transactions that enter right into a forbearance duration (as described by way of Fannie Mae and Freddie Mac) after purchase by Gateway, stay eligible in accordance with company salability and customers mortgage purchase and sale contract.”

be aware that Fannie Mae issued LL-2020-04 extending the temporary appraisal flexibilities unless June 30.

USDA issued suggestions on SFH Direct loan and supply courses. Fiscal year 2020 profits limits for the single family Direct loan and grant courses were posted on may additionally four, 2020 through a different technique be aware. The salary limits have been updated within the impacted web sites and systems (e.g. UniFi and the area 502’s Eligibility assessment tool). right here computerized worksheets have been also up-to-date, and different adjustments as referred to beneath were made. part 502 - Worksheet for Computing salary and highest personal loan Calculator (as found on the one household Housing Direct domestic Loans and Direct personal loan software Packagers pages). section 504 - automated Worksheet (as found on the single family unit Housing restoration Loans & promises page).

FHA, USDA, and VA have aligned to provide the housing finance business and consumers with advice that outlines their responses to forbearance and loss mitigation alternatives purchasable under the Coronavirus aid, relief, and economic protection (CARES) Act. The Interagency COVID-19 Forbearance reality Sheet for Servicers offers information to assist debtors looking for forbearance on their personal loan loans that are insured or assured by these agencies. A separate Interagency COVID-19 Forbearance fact Sheet for buyers is additionally purchasable.

This reality sheet outlines the steps borrowers need to take to request forbearance for his or her FHA-insured or USDA- or VA-guaranteed mortgages because of the COVID-19 countrywide Emergency.

today at 2PM ET, Metro-West Appraisal and Appraisal Buzz will host a free city hall-trend webinar to talk about safety, business instructions and the abruptly altering outcomes of the pandemic. Appraisers and leaders from Metro-West Appraisal, Genworth personal loan assurance, the Texas Appraiser Licensing and Certification Board and Collateral Analytics will participate in a reside mp;A. click on right here to register.

On the business personal loan front, World enterprise Lenders’ COVID-19 reduction personal loan application offers financing as much as $2,000,000 to groups impacted by the pandemic, qualifying groups through reviewing their pre-coronavirus revenues as a part of its eligibility standards; groups can still qualify regardless of having little or no latest money movement. All loans are secured with enough fairness in essentially any kind of precise property and WBL will take a junior lien position. the two-year loan application is intended to make available to a struggling company the capital indispensable to climate the economic storm by means of offering no payments except month four, activity best funds for the primary year (first three months collected at closing), and loan structures with other flexible charge alternatives. Contact Phil Grossfield.

Capital Markets

there have been two main headlines moving the bond market the day prior to this, as U.S. Treasuries exhibited some curve-pulling down motion in rallying for the second day in a row. the first was Fed Chairman Powell urging the White house and Congress to spend more money to make sure their preliminary response to the coronavirus-brought on economic downturn is not for naught. additionally, he pointed out that he expects most effective a gradual financial recuperation and he repeated his opposition to a negative activity fee policy within the U.S. all through his prepared remarks. In ordinary, his outlook turned into fairly bleak. “there's a transforming into feel that the healing may also come greater slowly than they wish…and that may also mean that it’s indispensable for us to do more,” he noted.

On the shiny side, the Chairman appears to be a firm believer that the Fed at the moment has enough equipment in its toolkit to address the crisis, saying that negative rates aren't currently below consideration. for my part, it’s worth noting that the Chairman said that “further fiscal aid could be expensive, but price it,” to Congress when the equal argument may well be used about negative rates if the Fed really desires to achieve its mandate of attaining highest employment and strong expenses. Easing monetary coverage is more straightforward when inflation is low. The other headline impacting the bond market changed into the concerns over a 2d wave of coronavirus infections, which weighed on possibility tolerance.

Some housekeeping notes. The U.S. Treasury $22 billion 30-year bond public sale was met with lukewarm demand. The Producer expense Index for ultimate demand missed expectations because it marked its greatest lower considering the fact that information begun in December 2009. Most of that decline was attributed to a drop in expenses for remaining demand items. Core PPI, which excludes food and power, a little overlooked expectations as neatly. The figures will actually keep the consumed the course on the lessen certain.

nowadays’s leading financial releases are already out: Weekly initial Claims for the week ending may additionally 9 (2.ninety eight million!), April Export expenditures (-three.3 p.c), April Import prices (-2.6 %, ex-oil -2.5). There are three scheduled Fed presidents speaking nowadays: Minneapolis’ Kashkari, adopted through Atlanta’s Bostic and Dallas’s Kaplan. The big apple Fed will habits two FedTrade buy operations totaling as much as $4.875 billion beginning with $1.625 billion UMBS15 2 % and a pair of.5 percent, followed by $3.25 billion UMBS30 2 % via 3 p.c. The Desk will also file on MBS purchases for the week ending may additionally 13 this afternoon. moreover, today marks the category B forty eight-hour notification. They begin the day with agency MBS fees more suitable/up just about .a hundred twenty five and the ten-yr yielding .sixty two % after closing the day before today at 0.sixty five percent.

Employment and Transitions

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“At castle & Cooke mortgage we’re working complicated to sustain with their continual growth. There are worse problems, correct? but you tend to grow rapidly for those who’re a personal loan business within the Goldilocks Zone: Small ample to provide clients a personalized adventure however massive ample to provide loan officers all the equipment and support they need. Their ‘simply correct dimension’ is the leading intent Dave Purdy lately joined us as a Regional supervisor. under Dave, we’ve already opened three new branches in New Mexico and Texas whereas attempting to find opportunities in Oklahoma, Kansas, and Missouri. We’re additionally excited to welcome trade veteran Steve combine to the family unit. With over 20 years of consumer Direct management, Steve will head up and build out their new customer Direct office in the Dallas/ft. price enviornment. if you’re trying to find a great career at a corporation that’s just correct for you, contact Christi Fullerton these days.”

“Altisource is continuing to develop in El Paso! Two strategic leaders are mandatory to support us proceed to bring world-type customer and consumer experiences. If system innovation, leadership in talent construction and tenure within the personal loan business are a part of your DNA, Altisource would want to meet you! try our job posting hyperlink. Please reach out to Ashley Crawford with any questions.”

“Carrington loan functions continues to extend its Non-Delegated Correspondent channel. because of this, we've openings for FHA and VA Underwriters with both a FHA DE or VA SAR Authority. The positions include an aggressive compensation kit including a sign-on bonus and can work remotely from home. Resumes/questions should be sent to John Cervantes, Director of talent Acquisition.”

Plaza home loan, Inc. introduced that Kelley Tillinghast has joined the business as SVP, Chief Underwriter and will oversee all underwriting in Plaza’s three channels (Wholesale, Correspondent, and Reverse), taking part in a key position in surroundings company underwriting guidelines and requirements.

NewDay u . s . a . hired Pooja Bansal as SVP of Human elements and Communications, and promoted Eugene Mizin as SVP of Operations and Finance.

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