Official Neurology Shelf Exam Discussion and Resource Thread

[newhope2015]

thanks!

- 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.

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[dfib slim]

a
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[newhope2015]

yes, it is 25 mm H2O opening pressure, the RBC is high, the only two that cause increase in RBC that I know are SAH and herpes encephalitis/or maybe any hemorrhagic encephalitis

 

[Trogdor_The_Burninator]

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I'm pretty sure this one is D. Subarachnoid hemorrhage. I had chosen D and it was not flagged. I was looking for HSV in the answer choices too. The pink CSF was a tip-off for me to choose SAH in the absence of HSV encephalitis (which also may have CT findings involving the temporal lobe).

Don't really have a good explanation for low opening pressure (it helped me rule out A and C) and small ventricles.

 

[pd1112]

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I'm pretty sure this one is D. Subarachnoid hemorrhage. I had chosen D and it was not flagged. I was looking for HSV in the answer choices too. The pink CSF was a tip-off for me to choose SAH in the absence of HSV encephalitis (which also may have CT findings involving the temporal lobe).

Don't really have a good explanation for low opening pressure (it helped me rule out A and C) and small ventricles.

4000 RBCs in the CSF guys - pretty sure none of the choices other than SAH could cause that high of a count. Normal WBC range 0-5, but in SAH, you can add ~1 WBC per 1k RBC, so 10 is ~WNL with a differential ~WNL.

 

[Trogdor_The_Burninator]

Got my NBME Neurology Shelf Results from a while back - 100th %-ile, raw 96

Used Blueprints neurology (read x 2), Mark Tuttle's Neurology clerkship review pdf (read x 2), uWORLD neuro (about 200 questions; reviewed a few times), and NBME 1 - 4 (4 - 45/50, 3 - 47/50, 2 - 49/50, 1 - 49/50).

Thought the exam was very similar to the NBME practice tests. The exam was fair and featured a few questions pertaining to every chapter in Blueprints, except for maybe the pediatric chapter (no questions about inborn errors of metabolism, childhood milestones, etc.). Quite a few (about 10) questions on whether a lesion involved a plexus, nerve root, peripheral nerve, myoneural junction, or muscle. I'm really glad I reviewed the dermatomes, myotomes, and reflexes right before the exam - I think this is pretty high yield and I think it netted me at least 5 questions.

Good luck!

 

[newhope2015]

Congrats and thanks!

Got my NBME Neurology Shelf Results from a while back - 100th %-ile, raw 96

Used Blueprints neurology (read x 2), Mark Tuttle's Neurology clerkship review pdf (read x 2), uWORLD neuro (about 200 questions; reviewed a few times), and NBME 1 - 4 (4 - 45/50, 3 - 47/50, 2 - 49/50, 1 - 49/50).

Thought the exam was very similar to the NBME practice tests. The exam was fair and featured a few questions pertaining to every chapter in Blueprints, except for maybe the pediatric chapter (no questions about inborn errors of metabolism, childhood milestones, etc.). Quite a few (about 10) questions on whether a lesion involved a plexus, nerve root, peripheral nerve, myoneural junction, or muscle. I'm really glad I reviewed the dermatomes, myotomes, and reflexes right before the exam - I think this is pretty high yield and I think it netted me at least 5 questions.

Good luck![/QUOT

 

[Trogdor_The_Burninator]

Congrats and thanks!

Thank you!

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First q: c. conversion disorder - clues are "staggers side to side" (an exaggerated/psychogenic gait), all senses seem to be lost at midpoint, collapsing effort - all cannot really be explained by a neurological disorder/lesion

Second q: a. cauda equina - tip off is urinary incontinence; also decreased perianal sensation, dropped achilles tendon reflex and radicular symptoms. None of these other choices can give these constellation of symptoms

Hope that helps!

 

[newhope2015]

Thanks!

Thank you!



First q: c. conversion disorder - clues are "staggers side to side" (an exaggerated/psychogenic gait), all senses seem to be lost at midpoint, collapsing effort - all cannot really be explained by a neurological disorder/lesion

Second q: a. cauda equina - tip off is urinary incontinence; also decreased perianal sensation, dropped achilles tendon reflex and radicular symptoms. None of these other choices can give these constellation of symptoms

Hope that helps!

 

[Ismet]

This is a reminder to refrain from posting NBME questions or any other copyrighted questions, either in full or partially abbreviated. Doing so is a copyright violation. You may paraphrase questions. Abbreviating words or removing fillers is not paraphrasing.

 

[Entadus]

bump. taking this guy in a week or so. Uworld ......

 

[Entadus]

Got my result today... scaled score 88, I'm happy with it! I was a little surprised since the test seemed pretty hard with a number of "hmm not sure" questions. I messed up some of the epliepsy/seizure questions since I wasn't quite prepared for how they asked them. It tended to be straightforward "What kind of seizure was this?" type of questions and I have never been very strong with it. (Know what "complex", "partial", etc mean)

I also screwed myself over on the Myopathy/muscle/MSK type questions. I didn't know there would be so many, so definitely be very familiar with all of those processes, including congenital/inherited anomalies like Dystrophies, etc

The hardest questions (and there were quite a few) for me were the Pediatric questions. That's the only 3rd year rotation I hadn't had yet, so I was guessing on a lot of it.

For study materials, I used UWorld (neuro+ophtho, 1x) , Clinical Neuroanatomy Made Ridiculously Simple, and if I had to add one resource, I would have used the NBME practice tests ..... I just didn't have the time or motivation to complete those this time around. M3 burnout is real

 

[doyouhaveaflag]

Got my NBME Neurology Shelf Results from a while back - 100th %-ile, raw 96

Used Blueprints neurology (read x 2), Mark Tuttle's Neurology clerkship review pdf (read x 2), uWORLD neuro (about 200 questions; reviewed a few times), and NBME 1 - 4 (4 - 45/50, 3 - 47/50, 2 - 49/50, 1 - 49/50).

Thought the exam was very similar to the NBME practice tests. The exam was fair and featured a few questions pertaining to every chapter in Blueprints, except for maybe the pediatric chapter (no questions about inborn errors of metabolism, childhood milestones, etc.). Quite a few (about 10) questions on whether a lesion involved a plexus, nerve root, peripheral nerve, myoneural junction, or muscle. I'm really glad I reviewed the dermatomes, myotomes, and reflexes right before the exam - I think this is pretty high yield and I think it netted me at least 5 questions.

Good luck!

I realize I'm replying a year later, but I want to emphasize what you wrote in the bottom paragraph. Tons of questions asking if the lesion was spine, plexus, nerve root, or peripheral nerve. Lots of MSK-type stuff asking about myotomes and radiculopathies (ex - identify level of disk herniation for person with a set of specific signs/symptoms.) I recommend reviewing the brachial plexus.

The localization questions are actually fairly basic, just asking if it's cortex, subcortical, brainstem, or spine (or in other questions nerve vs neuromuscular junction vs muscle). I way overstudied for localization questions - I even memorized all the brainstem stroke syndromes (I recommend against this for future test takers). Also agree with Trogdor on inborn errors of metabolism, I didn't see any.

I just used the Mark Tuttle Neurology clerkship review (made my own flashcards on this), uWorld neuro (1x plus incorrects), Firecracker, and NBME 2 - 4 (missed 2 on each). I thought the real exam was slightly easier than the practice NBMEs.

Actual result: 97 raw (no idea what percentile, our school doesn't provide them)

 

[NervousNerd]

I realize I'm replying a year later, but I want to emphasize what you wrote in the bottom paragraph. Tons of questions asking if the lesion was spine, plexus, nerve root, or peripheral nerve. Lots of MSK-type stuff asking about myotomes and radiculopathies (ex - identify level of disk herniation for person with a set of specific signs/symptoms.) I recommend reviewing the brachial plexus.

The localization questions are actually fairly basic, just asking if it's cortex, subcortical, brainstem, or spine (or in other questions nerve vs neuromuscular junction vs muscle). I way overstudied for localization questions - I even memorized all the brainstem stroke syndromes (I recommend against this for future test takers). Also agree with Trogdor on inborn errors of metabolism, I didn't see any.

I just used the Mark Tuttle Neurology clerkship review (made my own flashcards on this), uWorld neuro (1x plus incorrects), Firecracker, and NBME 2 - 4 (missed 2 on each). I thought the real exam was slightly easier than the practice NBMEs.

Actual result: 97 raw (no idea what percentile, our school doesn't provide them)

How much optho was on the exam. Should i do the 33 UW optho questions for this or save them for medicine

 

[doyouhaveaflag]

How much optho was on the exam. Should i do the 33 UW optho questions for this or save them for medicine

Just a few questions, but I think they would be worth doing. You could mark them all so you can do them again on medicine. Alternatively, Pretest has an entire ophtho chapter.

 

[moto_za]

What is the best resource for the dermatomes, myotomes, reflexes and MSK material? Would greatly appreciate any advice!

 

[ngc 2170]

What is the best resource for the dermatomes, myotomes, reflexes and MSK material? Would greatly appreciate any advice!

I felt a lot of that stuff was basically Step 1 material plus a little bit. So you could try FA for Step 1, or a dedicated neuro book like Blueprints. Neuroexam.com is also nice

 

[ClandestineStar]

Starting Neuro in a week: What do ya'll recommend as a text?

I was planning to do my FA neuro anki deck + Uworld neuro (already did them in IM so just reviewing my notes) + Pre-test x2, and wanted to add a text incase I couldn't get in the high 80'/low 90's on NBME (it's the field I want to go into, so I want to honor it). What do you all recommend between:

1. Blumenfield's neuroanataomy through clinical cases
2. Blueprints neurology (read x 2)
3. Mark Tuttle's Neurology clerkship review pdf? (this is the shortest so I'm leaning towards)

 

[Entadus]

Starting Neuro in a week: What do ya'll recommend as a text?

I was planning to do my FA neuro anki deck + Uworld neuro (already did them in IM so just reviewing my notes) + Pre-test x2, and wanted to add a text incase I couldn't get in the high 80'/low 90's on NBME (it's the field I want to go into, so I want to honor it). What do you all recommend between:

1. Blumenfield's neuroanataomy through clinical cases
2. Blueprints neurology (read x 2)
3. Mark Tuttle's Neurology clerkship review pdf? (this is the shortest so I'm leaning towards)

blumenfield's is a basic science textbook, you'll never get through that one. I never used blueprints but i'm betting that's more realistic.

Again I recommend Clinical neuroanatomy made ridiculously simple, it's extremely short

 

[woodstock255]

This post has been deleted.

 

[ClandestineStar]

Well it's a pre

Hi all, I'm using pretest neurology to prepare for the shelf and came across this question that I don't understand the answer:

39 yo female has diplopia x 6 wks, pain behind right eye, dilated right pupil, then acutely has stiff neck, photophobia, stuporous, worst headache of life.

I get that's SAH. But I'm stuck between berry aneurysm and AVM. In the answers they say people <40 usually hemorrhage due to AVMs, not due to aneurysms (usually aneurysms cause hemorrhage in older people like 40s - 50s, and especially women in their 40s - 50s). And they state her hemorrhage is due to a berry aneurysm hemorrhage.

Is this an errata or am I missing something?? Shouldn't the answer be AVM?

AVM are the most common cause of bleeding in kiddos. It sounds like a pretty acute process and with AVM, it's more chronic as the AVM grows big (possibly causing sx of headaches for longer than a day) and then bursting. Since it was more acute with sudden (that day) worst HA, it sounds like a berry aneurysm suddenly burst.

 

[ClandestineStar]

Very confused by Neuro NBME 4. To avoid copyright issues I'm just paraphrasing:

1. 62 yo has trouble emptying bladder + ascending (starting at the feet) progressive weakness and numbness + moderate mid back pain exacerbated by cough + hx of breast CA tx with rads/chemo + 4+ DTR in lower extremities + Babinski + Sensation decreased at a defined spinal level. I don't know whether this is a paraneoplastic syndrome or transverse myelitis or epidural spinal cord compression

2. 62 yo has decresed sphincter tone and trouble emptying her bladder + metastatic breast CA + large suprapubic mass + pain entire lumbar spine on percuss
is this due to anticholinergic drug effects or urethral spasming or something else?

 

[ngc 2170]

First one sounds like cord compression, likely from mets to the spine. Mid-back pain sounds less likely to be paraneoplastic or transverse myelitis to me, though it could be. I would think imaging would be the next step.

The second sounds like neurogenic bladder... maybe related to chemo (vincristine --> neuropathy)? I didn't take any of the neuro practice NBMEs, so I don't have a definitive answer nor full context of the questions. Someone else chime in?

 

[doyouhaveaflag]

Very confused by Neuro NBME 4. To avoid copyright issues I'm just paraphrasing:

1. 62 yo has trouble emptying bladder + ascending (starting at the feet) progressive weakness and numbness + moderate mid back pain exacerbated by cough + hx of breast CA tx with rads/chemo + 4+ DTR in lower extremities + Babinski + Sensation decreased at a defined spinal level. I don't know whether this is a paraneoplastic syndrome or transverse myelitis or epidural spinal cord compression

2. 62 yo has decresed sphincter tone and trouble emptying her bladder + metastatic breast CA + large suprapubic mass + pain entire lumbar spine on percuss
is this due to anticholinergic drug effects or urethral spasming or something else?

1. Answer is A, epidural spinal cord compression. Hx of breast Ca plus UMN signs plus back pain is the clue.

2. Answer is D, mets to cauda equina. Again, clue is the history of metastatic Ca plus pain on percussion. Pain on percussion should always make you think either spinal mets or vertebral fracture. None of the drugs listed commonly cause major anticholinergic effects. Anticholinergic drugs also wouldn't affect sphincter tone to my knowledge.

(I had to go back to my old notes from when I took these to see what the answers were - I think maybe you paraphrased too much for the question to be clear)

 

[AthleteDoc7]

anyone have insight here?

my plan for this shelf is UWorld neuro + ophtho with incorrects, OME neuro, Pre-Test Neuro, and maybe read FA neuro section. is this sufficient, or is reading something like Blueprints necessary to crack 80th percentile? Thanks!

 

[CoffeeBean1]

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[step1almostdone]

Can anyone confirm the answer for the second NBME test? Thanks!
- 20 something year old male unable to void for 24 hours, progressive bilateral leg weakness, onset of low back pain, IV drug use, temperature 102. Weakness and hyperreflexia of the lower extremities bilaterally. Babinski present bilaterally. Sensation to pinprick decreased below the umbilicus, and other sensation decreased in both lower extremities

 

[Jesus1]

Can anyone confirm the answer for the second NBME test? Thanks!
- 20 something year old male unable to void for 24 hours, progressive bilateral leg weakness, onset of low back pain, IV drug use, temperature 102. Weakness and hyperreflexia of the lower extremities bilaterally. Babinski present bilaterally. Sensation to pinprick decreased below the umbilicus, and other sensation decreased in both lower extremities

I believe its an epidural abscess if that's one of the answer choices.

 

[Jesus1]

anyone have insight here?

my plan for this shelf is UWorld neuro + ophtho with incorrects, OME neuro, Pre-Test Neuro, and maybe read FA neuro section. is this sufficient, or is reading something like Blueprints necessary to crack 80th percentile? Thanks!

Blueprints neuro may not be super necessary, but its a quick read. Pretest however is quite good.

 

[kmonkey55]

A 77 year old man with a 6 month history of memory problems, frequent falls, and urinary incontinence. His wife says he "shuffles" and falls forward/backward when getting out of a chair. He has gotten lost several times when driving to the grocery store and couldn't do his taxes. Muscle strength and tone normal. Gait is narrow with small steps, takes 8 steps to turn 180 degrees. Arm swing is normal. MMSE 22/30. What is the most likely diagnosis:
A. Brain Tumor
B. Normal pressure hydrocephalus
C. Parkinson disease
D. Subdural hematoma
E. Vitamin B12 deficiency

I'm pretty sure the answer is B but there were a lot of things that make me want to choose C instead...

 

[it'sabeautifullife]

A 77 year old man with a 6 month history of memory problems, frequent falls, and urinary incontinence. His wife says he "shuffles" and falls forward/backward when getting out of a chair. He has gotten lost several times when driving to the grocery store and couldn't do his taxes. Muscle strength and tone normal. Gait is narrow with small steps, takes 8 steps to turn 180 degrees. Arm swing is normal. MMSE 22/30. What is the most likely diagnosis:
A. Brain Tumor
B. Normal pressure hydrocephalus
C. Parkinson disease
D. Subdural hematoma
E. Vitamin B12 deficiency

I'm pretty sure the answer is B but there were a lot of things that make me want to choose C instead...

“Memory problems, frequent falls, and urinary incontinence” sounds like the “wet, wacky, wobbly” of NPH. Can see why the gait and cognitive impairment could make you consider Parkinson’s. Another hint was that the patient’s muscle strength and tone is normal; patients in Parkinson’s questions usually have increased tone if it is mentioned—cogwheel or lead pipe rigidity. Also, arm swinging is normal for this guy, Parkinson’s wouldn’t be. [at least IRL lol—just spent the past few weeks in rotations with movement disorder specialists— saw at least 20 Parkinson’s patients.]

 

[Jesus1]

93 raw. Not sure about percentiles.
Missed about 7 questions on NBME 1-3, 87 on NBME 4.
Resources-Pretest, Firecracker, BRS Peds neurology chapter, select chapters in Blueprints/Mayo Neurology review. Loved pretest. NBMEs are an excellent indicator of question styling on the exam. Exam felt easier than the practice tests.

 

[step1almostdone]

.

 

[Mr. Clastogen]

Would like some help on a question from NBME self-assessment #1 if anyone has insight. Doesn't look like it's been covered yet.

To summarize: 12 yo boy comes in with b/l heel pain since starting basketball a few weeks prior. Hurts to run and jump, heels are tender to palpation. Spinal flexion is limited. He is small for his age. ESR is elevated. What's he got?
-ankylosing spondylitis
-tethered spinal cord (think it might be this, but can't find much about this condition)
-pauciarticular juvenile arthritis (wrong)
-growing pains
-inappropriate arch support

 

[Jesus1]

Would like some help on a question from NBME self-assessment #1 if anyone has insight. Doesn't look like it's been covered yet.

To summarize: 12 yo boy comes in with b/l heel pain since starting basketball a few weeks prior. Hurts to run and jump, heels are tender to palpation. Spinal flexion is limited. He is small for his age. ESR is elevated. What's he got?
-ankylosing spondylitis
-tethered spinal cord (think it might be this, but can't find much about this condition)
-pauciarticular juvenile arthritis (wrong)
-growing pains
-inappropriate arch support

It is ankylosing spondylitis. Sacroiliitis + limited spine movement + elevated ESR. Don't overthink it.

 

[bom602]

I'm about to start my neuro rotation and wanted to make sure I was understanding which resources everyone recommends. Does someone mind letting me know if this is sufficient or if there are any other resources I should use:

1. Uworld Step 2 CK - Neuro + Optho questions
2. Blueprints 2009 edition (i think it's second)
3. Clinical neuroanatomy made ridiculously simple

Are there practice Neuro shelf exams available? If so, where can I find those? Thanks a bunch everyone - really appreciate the help.

 

[bom602]

Starting Neuro in a week: What do ya'll recommend as a text?

I was planning to do my FA neuro anki deck + Uworld neuro (already did them in IM so just reviewing my notes) + Pre-test x2, and wanted to add a text incase I couldn't get in the high 80'/low 90's on NBME (it's the field I want to go into, so I want to honor it). What do you all recommend between:

1. Blumenfield's neuroanataomy through clinical cases
2. Blueprints neurology (read x 2)
3. Mark Tuttle's Neurology clerkship review pdf? (this is the shortest so I'm leaning towards)

What did you end up using for your neuro rotation?

 

[doyouhaveaflag]

I'm about to start my neuro rotation and wanted to make sure I was understanding which resources everyone recommends. Does someone mind letting me know if this is sufficient or if there are any other resources I should use:

1. Uworld Step 2 CK - Neuro + Optho questions
2. Blueprints 2009 edition (i think it's second)
3. Clinical neuroanatomy made ridiculously simple

Are there practice Neuro shelf exams available? If so, where can I find those? Thanks a bunch everyone - really appreciate the help.

Restudying neuroanatomy will be way overkill. The extent of the anatomy you need to know is whether it's brain, brainstem, spinal cord, peripheral nerve or other (like neuromuscular junction) and the laterality of a lesion. Also know brachial plexus.

I wrote a post a while ago (above) about what I used but I forgot to mention Pretest. I thought Pretest was a terrific resource. I also used U World, Firecracker, the Mark Tuttle Clerkship review. It helps to have psych before neuro because there's a random smattering of psych questions but it won't hurt you too much if you haven't. There are definitely practice NBMEs that I did and recommend doing. With just those resources I got a 97. One of the easier shelf exams I thought.

 

[RavenReview]

What did you end up using for your neuro rotation?

I'd like to let you know about a new textbook specifically written for the neurology clerkship:

Raven Review: Clinical Neurology for the Medical Student Clerkship - available on Amazon

It starts out with an overview of neuroanatomy, the neuro exam, and neuroimaging, and then has topic based cases with questions and discussion - very practical, but also covers necessary information for the shelf exam. There are lots of images and explanations of key topics at the start of each chapter.

 

[idkididk]

Working through the Zanki step 2 deck for the neuro shelf, and it has cards like this:

"The dentate nucleus sends axons that decussate in the superior cerebellar peduncle and then synapse in the contralateral ventral lateral (VL) nucleus of the thalamus"

Do we really need to know this sort of neuroanatomy for the neuro shelf?

 

[mistafab]

I have completed the zanki step 2 deck for neuro and I can promise there was not a single card in my deck that said that at all.

Make sure you actually have zanki step 2.

Working through the Zanki step 2 deck for the neuro shelf, and it has cards like this:

"The dentate nucleus sends axons that decussate in the superior cerebellar peduncle and then synapse in the contralateral ventral lateral (VL) nucleus of the thalamus"

Do we really need to know this sort of neuroanatomy for the neuro shelf?

 

[idkididk]

I have completed the zanki step 2 deck for neuro and I can promise there was not a single card in my deck that said that at all.

Make sure you actually have zanki step 2.

It was in the neuroscience sub-deck within Step 2 neurology. At this point I'm probably going to take out "Extra basic neuroscience" and "neuroscience" and just do Step 1 neuro and UW neuro (+ophtho, +peds neuro)