Neurology Shelf

[ItsAboutThePatient]

Hey guys I just bombed a test that is practice for the neuro shelf. I know similar threads were removed for copyright violations. Maybe you can help me understand some topics I still don't understand?

How do you distinguish between occlusion of PICA and vertebral for wallenburg syndrome? This would be in a 70 year old at the ED 3 hours after acute onset of dizziness. Difficulty swallowing. Left ptosis. Left pupil 2 mm, right is 5 mm, both reactive. Nystagmus on lateral gaze. Loss of pain over the left side of face and right side of body.

If you were in your 70s with memory loss and confusion for the past 18 months and minor forgetfulness for 4-5 years with dramatic worsening in the last few months, and you had an S4 gallop and a right carotid bruit, decreased peripheral pulses, and babinski on the left, what drug would you use and why? Aspirin? Clopidogrel? Anticoagulation? I think the answer is aspirin but I don't know why.

Thanks guys and gals

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[byaaaaaaah23]

Hey guys I just bombed a test that is practice for the neuro shelf. I know similar threads were removed for copyright violations. Maybe you can help me understand some topics I still don't understand?

How do you distinguish between occlusion of PICA and vertebral for wallenburg syndrome? This would be in a 70 year old at the ED 3 hours after acute onset of dizziness. Difficulty swallowing. Left ptosis. Left pupil 2 mm, right is 5 mm, both reactive. Nystagmus on lateral gaze. Loss of pain over the left side of face and right side of body.

If you were in your 70s with memory loss and confusion for the past 18 months and minor forgetfulness for 4-5 years with dramatic worsening in the last few months, and you had an S4 gallop and a right carotid bruit, decreased peripheral pulses, and babinski on the left, what drug would you use and why? Aspirin? Clopidogrel? Anticoagulation? I think the answer is aspirin but I don't know why.

Thanks guys and gals

Def thought those were the hardest questions on that NBME. I actually asked my senior resident about the first one, he basically said vertebral stroke would probably have some altered mental status/level of consciousness in addition to that while PICA would more commonly cause just that set of sx. Not very satisfying, I know.

For the second, I also think the answer is aspirin but can't really give you a good reason why. I put warfarin which was wrong, for whatever that's worth.

 

[ItsAboutThePatient]

Is it just me or was that NBME really hard in general? I got like 68 on it and I got 90 on the first one :/