Official Neurology Shelf Exam Discussion and Resource Thread

[Pox in a box]

Please post your advice for the neuro shelf as well as any particular books/resources you would recommend. After thoroughly searching, there is not a good consensus.

It seems Blueprints and PreTest are the frontrunners. It's also clear that most SDNers found the exam to be very difficult in comparison to other shelf exams.

TIA.

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[Anka]

Not anything you don't already know... but blueprints + PreTest. The thing that makes the test hard is that you really have to know the nitty gritty for the shelf, not so much that you need more than that. Manter & Gantz can also help a lot, but is hard to get through over the rotation.

Anka

 

[Pox in a box]

Not anything you don't already know... but blueprints + PreTest. The thing that makes the test hard is that you really have to know the nitty gritty for the shelf, not so much that you need more than that. Manter & Gantz can also help a lot, but is hard to get through over the rotation.

Anka

Which editions did you use of Blueprints and PreTest?

 

[Anka]

Second edition of blueprints and sixth of Pretest.

 

[TY06]

i heard this shelf is killer. i heard the passages are like one page long just for 1 question x 100!!!

 

[Anka]

i heard this shelf is killer. i heard the passages are like one page long just for 1 question x 100!!!

TY, you seem (judging by your previous posts) to get nervous about shelfs. I don't know whether it's because you enjoy being stressed out (after all, what better way to show what a bada$$ you are to all your premed buddies than to first tell them how hard it is, then to blast the thing), or because you are easily wrapped up in sensationalism yourself. In case it's the latter, here is your reality check every time someone tries to sell you a load like that one -- every medical student in the country is taking these things, so it's simply not possible they're unreasonable.

If you read regularly, get through some (any) book that everyone is using (Blueprints, pretest, casefiles was my formula for every rotation), you'll do okay.

Anka

 

[Pox in a box]

Have you used the Blueprints Clinical Cases in Neurology book?

Also, just to clarify, Case Files Neurology is not yet released.

 

[TY06]

TY, you seem (judging by your previous posts) to get nervous about shelfs. I don't know whether it's because you enjoy being stressed out (after all, what better way to show what a bada$$ you are to all your premed buddies than to first tell them how hard it is, then to blast the thing), or because you are easily wrapped up in sensationalism yourself. In case it's the latter, here is your reality check every time someone tries to sell you a load like that one -- every medical student in the country is taking these things, so it's simply not possible they're unreasonable.

If you read regularly, get through some (any) book that everyone is using (Blueprints, pretest, casefiles was my formula for every rotation), you'll do okay.

Anka

i do stress a lot, BUT everyone at my school says it was hard. several failed the neuro and psych shelves this year at my school. so im not making it up. i take it in 3 weeks...

 

[werd]

i think it mostly depends on if you've had a neuro course in your basic sciences. i've heard the shelf isn't that bad. taking it in a week.

 

[CM6565]

Case Files Neurology (just released) combined with the Neurology study questions from MKSAP 14 (about 100 total) will serve you quite well for the shelf! MKSAP 14 is expensive, but a lot of senior Internal Med residents at your hospital are likely to have a copy. If you have time, PreTest is a decent adjunct, but I wouldn't make it a high priority.

 

[winkleweizen]

Figured some people could benefit from this.

I did UW all the neuro and ophtho questions (baller-def do this).
The Neuro section of SUTM is also baller.
I also used pretest-ok

Also read up on back pain.

This combo allowed me to do really well.

 

[mmmcdowe]

Did well, used Uworld (A+) x 2, Pretest (B-), Case files (B+, out of date), Blueprints (A++++). I couldn't believe how well written blueprints was, and how spot on it was. Wish I had read it twice rather than just at the very end of my rotation.

 

[genswim24]

Anyone else have any other input on what material was best to study? I am going to have to take neuro shelf before taking psych and I was wondering if anybody had any additional suggestions for people in my shoes. Thanks

 

[TheOcean]

Bump...

Just started Neuro and need on advice on resources and topics to focus on. Everyone has been saying it's random

 

[shiftingmirage]

When I took it last year, I used blueprints, pretest, and uworld. My score was in line with my other shelf exams.

I agree that it seemed random. I did not have as many questions on high-yield topics as I thought I would have. I would say the most high-yield are strokes, seizures, and headaches. And with that, first-line medications and some specific SE like lamotrigine causing SJS.

Otherwise things like being able to differentiate vascular dementia verses Alzheimer's versus Lewis body dementia.

Regarding that past comment about the scenarios being a page long, I don't think that was the case. I'm a slow reader (seriously), and I wasn't as pressed for time on this test as some of the others.

And being able to differentiate diseases of UMN versus LMN versus both.

 

[Coffee Machine]

I think a consideration here is that IV acyclovir would require hospitalization for the full course of treatment. This is a simple case of shingles. You don't need to be hospitalized for shingles. Same reason you don't start IV abx on patients with strep throat. Sure, maybe technically it's a more effective route, but it's not necessary.

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[Elixir6]

Hi, I did this exam and got a couple you got wrong as well. The answer for the shingles one as was said is oral acyclovir - its not that IV is wrong, but less appropriate given that you don't need to admit the patient. A few others:
- for the demented lady, the answer is to decrease night time disturbances
- for the carpal tunnel - injecting steroid decreases nerve and tissue inflammation thus decreasing impingement on the nerve
- for boy with school problems, he has narcolepsy
- the 52-year-old man had the acute onset of right eye pain has glaucoma - therefore tonometry is correct

I was wondering if anyone knew the answer for the vertebral artery dissection. UpToDate says give tPA but also says antiplatelet and anticoag, but the poster with the NBME questions says its heparin? Not sure here exactly.

 

[operaman]

Hi, I did this exam and got a couple you got wrong as well. The answer for the shingles one as was said is oral acyclovir - its not that IV is wrong, but less appropriate given that you don't need to admit the patient. A few others:
- for the demented lady, the answer is to decrease night time disturbances
- for the carpal tunnel - injecting steroid decreases nerve and tissue inflammation thus decreasing impingement on the nerve
- for boy with school problems, he has narcolepsy
- the 52-year-old man had the acute onset of right eye pain has glaucoma - therefore tonometry is correct

I was wondering if anyone knew the answer for the vertebral artery dissection. UpToDate says give tPA but also says antiplatelet and anticoag, but the poster with the NBME questions says its heparin? Not sure here exactly.

It's 5 hours after onset of symptoms = too late for tPA. The other choices are bats--t insane. Answer is definitely heparin.

 

[Elixir6]

It's 5 hours after onset of symptoms = too late for tPA. The other choices are bats--t insane. Answer is definitely heparin.

Ooops - yup, obviously no tPA after 5hrs. The answer is heparin. I got similar questions to it after studying some more.

 

[Jimmy B]

Ooops - yup, obviously no tPA after 5hrs. The answer is heparin. I got similar questions to it after studying some more.

The reason is because a clot can form at the tip of an arterial dissection-anticoagulation (heparin) is used to dissolve this clot and prevent it from going up and causing a major ischemic stroke. You could also give tPA but it's outside the time window of 3 hrs.

 

[Freddie Mercury]

[MOD EDIT: removed copyrighted content]

Not sure... going with empiric antibiotics... thinking its septic emboli (recent fever/chills, hx rheumatic + murmur = endocarditis).

 

[DrShazam]

Took the shelf recently. It was BRUTAL. For a lot of questions I could only narrow down to two, and then had to guess.

What I did to prep:
- Blueprints- made my own notes and read them x3; it's not too detailed and easy to get through. I don't think this is essential, but would recommend if you're someone like me who needs a primary text source
- Did all 500 questions of pre-test (Highly recommended)
- UWorld: all the neuro questions (141) + ophthalmology and HEENT sections in IM (highly recommended)
- Perused over neuro, MSK, and psych section of FA x1 (highly recommended)
- Both NBME exams (highly recommended)

Would recommend Pre-Test, UWorld, and NBME (NBME did a good job of capturing the randomness and difficulty of the exam). Blueprints is a good starting point, but I definitely felt like it didn't prepare me for the shelf as well as SUTM did for IM, Surgical Recall and Pestana for Surg, or FA for Peds. I would highly recommend reading over MSK, ophthalmology, and HEENT (I had a ton of vertigo/hearing loss/tinnitus questions) before the exam because my shelf was quite heavy on these items. Didn't have any psych on mine. Or ethical questions.

Feel like I bombed it since our rotation was quite short, and I don't think I had enough time to process all the stuff I did, but will update once score comes out.

Raw score: 86 --> 91th percentile.

Reflection: Would definitely read up on MSK had I known both nervous system & special senses, and diseases of MSK are tested.

 

[Pericyclic]

Took recently also, tough test ! I had a good amount of time to study for this and felt it was still hard. There was a good amount of spine, rheum and psych on my test , so would definitely recommend refreshing on those topics. If anything lower back pain seemed to be super high yield. Congenital disease not that big , but just know that most of the prep books cover what you need to know but that any of it is for game

Blueprints - I was a fan and read this several times . It won't teach you neuro but it's a good way to get the big picture and fast review after yu do questions

Pretestx2: I usually don't like pretest but this was really good . Some very similar questions on the real deal and it hits relevant minutae

Casefiles- a lot of people like this I. Thought it was OK , good for bread and butter

UWORLD- useful for high yield topics but the real deal is much harder then these . Not much stroke on the actual thing

NBME self assessment - if you want to do well it's worth it to do these similar to actual thing in difficultly.

Not as pressed for time as other shelfs , but neurology is just a tough subject matter in general so def pit time into studying y .

*UPDATE: 94 Scale "raw" score, 99th percentile !! First time breaking 90. Suffice to say I think its a tough test for all and the curve is much more forgiving then some other shelfs.

 

[DryHopped]

Took the neuro shelf recently, walked out feeling confident but ended up with my lowest shelf score this year, go figure. My scaled score was 86.

I used the following sources:

Pretest- I think this was the worst pretest I've used this year but there is not much to choose from as far as questions go.

Uworld- definitely easier than the shelf but good for major concepts.

Blueprints- just did the questions and they were alright for extra questions. The text seemed very basic, didn't read it bc I think reading texts is inefficient.

Usmlerx - needed some extra questions so I tried this out and it was not worth the money.

Nbmes: worth the money, great practice for the real thing

I also read first aid for step 1 neuro and msk sections which were helpful.

 

[AlmostAnMD]

So many of these questions from the practice are complete bull. Fortunately I'm not allowed to discuss answers to help me learn and I have no idea where to even start to look some of these up. And the NBME has the mods of this site by the balls so I can't ask for help here. Nice.

 

[Winged Scapula]

So many of these questions from the practice are complete bull. Fortunately I'm not allowed to discuss answers to help me learn and I have no idea where to even start to look some of these up. And the NBME has the mods of this site by the balls so I can't ask for help here. Nice.

You are misunderstanding the rules.

While you cannot post questions Word for Word you may certainly discuss topics and paraphrase questions and answers.

 

[notbobtrustme]

thought this test was insane. lots of lesion localization, both in the brain and periphery. I wish I studied my dermatomes more, missed 2-3 questions because of that. definitely know your spinal cord pathology (eg abcess, hematomas, bernard-sequegards, transverse myelitis, GBS, inherited myelopathies). gave like 20 people brain cancer on this exam too. not so much bread and butter neurology (eg migraines, pain syndromes, movement disorders) except for strokes. there was a fair amount of pure medicine on this one too. 5-10 questions on psych stuff. felt similar to the NBME 1/2 forms, but with fewer "gimmes".

very difficult to study for because of the breadth of information as well as the hours on the rotation, which don't really match up with what you'll be tested on. Dissecting neuro exam findings 50 times on a test is exhausting and by the end, I was just shooting from the hip.

used MKSAP 16 neuro, Uworld, Case Files.

edit: 86 raw; 94th percentile. Still felt this exam was insane.

 

[atwood]

The reason is because a clot can form at the tip of an arterial dissection-anticoagulation (heparin) is used to dissolve this clot and prevent it from going up and causing a major ischemic stroke. You could also give tPA but it's outside the time window of 3 hrs.

ok so why cant we use dipyridamole. i thought that heparin cant break up the clot but only prevent it from getting bigger. pls correct me if im wrong

 

[Jimmy B]

ok so why cant we use dipyridamole. i thought that heparin cant break up the clot but only prevent it from getting bigger. pls correct me if im wrong

Dipyridamole would only prevent the clot from getting bigger. Heparin will thin the blood out much more and help dissolve the clot along with preventing another one from forming.

 

[pampiniformplexus]

Hi guys,
just finished nbme form 1. I am really confused about one question.

32 y/o man comes to the ER w/ back pain. PE shows paravertebral muscle spasm n the lumbar area and increased pain during straight-leg raising. Muscle strength 5/5, DTRs normal, no sens abnormalities. Best next step?
a) CBC, Serum chems, ESR
b) X-ray of the lumbosacral spine (wrong)
c) MRI of the lumbosacral spine
d) Myelography
e) No diagnostic studies are indicated

I put lumbosacral x-ray because in one of the qs in uworld recommends CXR&ESR if there is sciatica. It turned out to be wrong. Now, I assume it is A (because of ESR) or E (it may be not sciatica but maybe mild muscle spasm). Could you guys help? Thanks

 

[dfib slim]

Hi guys,
just finished nbme form 1. I am really confused about one question.

32 y/o man comes to the ER w/ back pain. PE shows paravertebral muscle spasm n the lumbar area and increased pain during straight-leg raising. Muscle strength 5/5, DTRs normal, no sens abnormalities. Best next step?
a) CBC, Serum chems, ESR
b) X-ray of the lumbosacral spine (wrong)
c) MRI of the lumbosacral spine
d) Myelography
e) No diagnostic studies are indicated

I put lumbosacral x-ray because in one of the qs in uworld recommends CXR&ESR if there is sciatica. It turned out to be wrong. Now, I assume it is A (because of ESR) or E (it may be not sciatica but maybe mild muscle spasm). Could you guys help? Thanks

I would say E. I believe the signs of sciatica would include sensory abnormalities and weakness not strictly an increase in pain. Sounds more like a lumbar strain and not a radiculopathy.

 

[seminoma]

I would say E. I believe the signs of sciatica would include sensory abnormalities and weakness not strictly an increase in pain. Sounds more like a lumbar strain and not a radiculopathy.

Agree. There's no s/sx of sciatica in the stem.

 

[pampiniformplexus]

I see. Thanks guys. I think I should look for "shooting pain radiating to legs", "dermatomal distribution".

 

[seminoma]

I see. Thanks guys. I think I should look for "shooting pain radiating to legs", "dermatomal distribution".

Generally sciatica won't be in a young patient either.

 

[dfib slim]

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I would think A. Not the same as discussing end of life care.

 

[Bancrofti]

82 on the shelf
72 on NBME 1 about 1 week prior to the shelf.
Only resource I used was Firecracker.

Test was relatively straight-forward, testing high yield topics and variations of them that you would get exposure to on any rotation. I think I read that there isn't much neuroanatomy or localization required on this shelf, but that was false for me. Want to reiterate knowing your dermatomes - obviously you don't have to go crazy, but you should know the dermatome of all the major reflexes that are checked and anywhere else that was high yield from basic sciences (T4 nipple line T10 umbilicus, etc.). Be able to differentiate well between NPH, Parkinsons, and anything that looks like it, that was well represented.

Also, do both NBMEs. I typically hate doing them because I think it's BS we should have to pay $20 for an exam we can't get answers for or even see all the questions afterwards, but this is the first time where I had multiple questions that were repeats and I regret not doing the second. Neuro is focused enough of a topic that you'll probably get some of the same questions from the practice NBME or some variation of it on every shelf.

 

[DVolle]

I'm writing a reply as I used a resource that I haven't seen linked on this thread and think it is amazing for both the clerkship and the shelf.

The two resources I used were UWorld neuro and optho questions and the UTCOM neurology clerkship study guide. The study guide is a fairly comprehensive and helped me answer several difficult questions on obscure syndromes (PSP, Wallenberg syndrome, axonal neuropathy variants, etc).

Just using these two resources was enough to net a 89 on the shelf; which was good enough for honors for what it's worth.

Here's a link to the UTCOM study guide:

https://utcom2012.wikispaces.com/file/view/Neurology Clerkship Study Guide.pdf/213291650/Neurology Clerkship Study Guide.pdf

 

[1dayatatime]

Nvm.

 

[1dayatatime]

Hi guys,
just finished nbme form 1. I am really confused about one question.

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OMG sorry I got this wrong too. I am so confused. The answer must be E see below

Edit: I'm not sure if in a disc herniation you would have preserved reflexes sensation and strength. I just looked at master the boards three and they said that in classic disc herniation an mri is not needed because first line is NSAIDs..

 

[1dayatatime]

I would think A. Not the same as discussing end of life care.

I got this correct too. A is the right answer

 

[Bancrofti]

OMG sorry I got this wrong too. I am so confused. The answer must be E see below

Edit: I'm not sure if in a disc herniation you would have preserved reflexes sensation and strength. I just looked at master the boards three and they said that in classic disc herniation an mri is not needed because first line is NSAIDs..

It's E I think. Vaguely remember the question, but I think the point of the question was that the guy was faking it, so no further testing.

Another paraphrased Nbme q I couldn't find elsewhere (I guess most ppl don't have to take the neuro shelf, this seems less popular than the other shelf exam threads). Any help appreciated b/ c I am really clueless.

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B

 

[1dayatatime]

bump, test on thursday, any help please?

 

[1dayatatime]

thank you so much @lostintranscrip - your explanations were wonderful too - best of luck with the rest of your M3 year!

 

[dfib slim]

On NBME 1:

12 yo boy with increasing pain in his back and both of his heels since began playing for middle school bball team 3 weeks ago. difficulty running/jumping b/c of pain. No fever. Ibuprofen has minimal relief. 3rd percentile height and weight. limited forward flexion and cant touch toes. dorsiflexion of ankles is limited to 70 degrees. tenderness over heels bilaterally at the insertion site of the achilles tendon. ROM otherwise full, no jt pain and swelling. Strength nl and symmetric in all extremities. Nl gait, DTR 2+ UE, LE. ESR 55. Most likely cause of heel pain?
a. ankylosing spondylitis
b. growing pains
c. inappropriate arch support
d. pauciarticular juvenile arthritis
e. tethered spinal cord

62 year old woman with severe rheumatoid arthritis admitted 24 hrs before scheduled right total knee replacement. arthritic sx well controlled on methotrexate. Not taken corticosteroid therapy for more than 2 weeks during past year. Exam with swelling deformity of MCP, PIP, ulnar deviation, several rheumatoid nodules. Bilat degenerative changes in knees worse on right. Rectal exam shows poor spincter tone but no other abnormalities. Which of following studies most appropriate before surgery?
a. serum rheumatoid factor assay
b. overnight dexamethasone suppression test
c. measurement of serum cortisol concentrations immediately before and 30 minutes and 60 mins after high-dose cosyntropin injection
d. flexion and extension x-rays of c-spine
e. pulmonary function testing

Thanks!

Haven't taken this NBME but the first one sounds like A. Enthesitis with elevated ESR and limited forward flexion that indicates sacroiliitis. Second one may be E. Check PFTs since they are on MTX.

 

[starstarie]

Hey all! Can anyone comment on how much pediatrics was on the Neuro shelf? Ie, were there things like intraventricular hemorrhage in premature infants and that sort of thing? And Botulism spores in honey? those themes?

Thanks!

 

[asdfTT123]

Ended up getting 89 on this (96-ish percentile according to the score guide). It was pretty straightforward having already done medicine. If you studied neuro for the IM shelf then don't sweat it. I just spent a week redoing the UW questions as well as MKSAP (recommend it) + the 4 NBME's. Did not read a text. Real thing is pretty much identical to the NBME's in terms of difficulty...maybe a little easier.

I had zero questions about inborn errors of metabolism and most of the peds were just common adult neuro questions that presented in pediatric patients. Somehow I had like 3 questions about the ulnar nerve (lol). Also study the basic dermatomes as those can make random guessing into low hanging fruit.

 

[mcollins426]

Might be a dumb question, but can someone explain what these NBME tests are you're taking to prepare for the neuro shelf? And where do I find them? Thanks!

 

[pd1112]

Might be a dumb question, but can someone explain what these NBME tests are you're taking to prepare for the neuro shelf? And where do I find them? Thanks!

Google nbme neurology; second hit. Same as nbmes for every other clerkship.

 

[NWwildcat2013]

Wow I just took the first NBME and got rocked. This would be a much easier exam if you were to take it at the end of the year with a more comprehensive knowledge of other specialties.

So when you see your score, you have no way of knowing what percentile that correlates to? Say I got a 24 which is like 87% correct. Still says nothing about what percentile I may be around? I ask because one of the requirements for honors at my school is >85th percentile on the shelf.

 

[Trogdor_The_Burninator]

please help with the following qs from nbme 3 thanks!!

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- 72 y/o man with diabetes - c. diabetic radiculopathy; for epidural abscess I usually look for a patients to have localized spinal tenderness, fever, and radicular symptoms with some antecedent exposure (IVDU, ...)
- 23 y/o woman with SCD - I believe this is a. I had put c and got it wrong.