Neurology
🧠 🧠 Neurology is a high-yield topic for USMLE Step 2 CK, with questions focusing on localization of lesions, stroke types, seizure management, movement disorders, and neuromuscular diseases.
Many neurology-related cases on Step 2 CK test clinical decision-making skills, requiring you to differentiate between conditions based on history, exam findings, and imaging.In this quick review, we’ll cover the most commonly tested neurology topics to help you maximize your score.
1. Stroke: Ischemic vs. Hemorrhagic
🔹 Ischemic Stroke (Most Common – 85%)
🧠 Causes:
Thrombotic Stroke – Due to atherosclerosis (e.g., carotid stenosis)
Embolic Stroke – Due to AFib, carotid plaque, endocarditis
Lacunar Stroke – Due to hypertension affecting small penetrating arteries
📌 Diagnosis:
Non-contrast CT (rule out hemorrhage)
📌 Treatment:
✔ If within 4.5 hours: tPA (Alteplase)
✔ If outside 4.5 hours: Aspirin + Statin
✔ AFib-related stroke? Start anticoagulation (warfarin, DOACs)
🔹 Hemorrhagic Stroke (15%)
🧠 Causes:
Hypertensive Hemorrhage (basal ganglia, pons, cerebellum)
Subarachnoid Hemorrhage (SAH) – Due to ruptured aneurysm
Amyloid Angiopathy – Common in elderly, affects lobes
📌 Diagnosis:
Non-contrast CT (bright blood signal)
📌 Treatment:
✔ BP control with labetalol, nicardipine
✔ Reverse anticoagulation (if on warfarin, use Vitamin K + PCC)
✔ For SAH: Nimodipine (prevents vasospasm)
2. Seizures and Epilepsy
🔹 Types of Seizures
1️⃣ Focal Seizures (Partial Seizures)
✔ Simple Partial – No loss of consciousness
✔ Complex Partial – Loss of awareness, automatisms (lip smacking)
✔ Secondary Generalized – Spreads to both hemispheres
2️⃣ Generalized Seizures
✔ Tonic-Clonic (Grand Mal) – Loss of consciousness, muscle rigidity, jerking
✔ Absence Seizure – Staring spells, 3-Hz spike & wave on EEG
✔ Myoclonic Seizure – Sudden jerky movements
📌 First-Line Treatment:
✔ Focal Seizures → Carbamazepine, Lamotrigine
✔ Generalized Seizures → Valproic Acid, Levetiracetam
✔ Absence Seizures → Ethosuximide
🔹 Status Epilepticus (Seizure >5 Minutes or Recurrent Seizures Without Recovery)
📌 Management:
1️⃣ First-line: IV Lorazepam
2️⃣ If persistent: IV Phenytoin or Fosphenytoin
3️⃣ If refractory: Intubation + IV Midazolam/Propofol
🚨 Always check glucose in seizure patients!
3. Parkinson’s Disease vs. Essential Tremor
📌 Parkinson’s first-line treatment: Levodopa/Carbidopa
📌 Essential Tremor first-line treatment: Propranolol
4. Multiple Sclerosis (MS)
🧠 Chronic CNS demyelinating disorder affecting young women (20–40 years old).
🔹 Key Features
✔ Optic Neuritis – Painful vision loss, afferent pupillary defect
✔ Internuclear Ophthalmoplegia (INO) – Weak adduction of eye
✔ Lhermitte’s Sign – Electric shock sensation down the spine with neck flexion
✔ Uhthoff’s Phenomenon – Symptoms worsen with heat
📌 Diagnosis:
✔ MRI Brain & Spine – Multiple white matter plaques
✔ CSF Analysis – Oligoclonal bands
📌 Treatment:
✔ Acute Flare: IV Methylprednisolone
✔ Chronic Management: Beta-interferons, Natalizumab, Ocrelizumab
5. Myasthenia Gravis vs. Lambert-Eaton Syndrome
✅ Myasthenic Crisis: Treat with Plasmapheresis or IVIG
6. Headaches: Migraine vs. Cluster vs. Tension
✅ Prophylaxis for Migraines: Beta-blockers, Topiramate, AmitriptylineKey
Takeaways for Step 2 CK
✔ Know stroke types and acute management (tPA vs. BP control).
✔ Differentiate seizure types and first-line treatments.
✔ Understand movement disorders (Parkinson’s vs. Essential Tremor).
✔ Recognize MS presentations and MRI findings.
✔ Differentiate between Myasthenia Gravis & Lambert-Eaton Syndrome.
How IMG Rotations Can Help You Prepare for your residency match
At IMG Rotations, we provide:
✔ Hands-on U.S. Clinical Experience (USCE) in Neurology & Internal Medicine
✔ Exposure to stroke management, seizures, and neurological exams
✔ Expert mentorship from U.S.-based physicians
✔ Research opportunities to boost your residency application