Neurology
High Yield USMLE Step 2 CK Notes
Welcome to the Neurology High-Yield Notes for Step 2 CK.
These are the most commonly tested topics on the exam—ideal for quick review in your last
2 weeks before the exam, when you're short on time, or when you're just starting out and
want to focus on what is high yield. Created and peer-reviewed by physicians who scored
260+ on Step 2 CK in a Q&A style to reinforce active learning.
How to use this file
y
Read the question ➔ cover the answer ➔ self-quiz before revealing.
u
Review the NOTES ➔ they include high-yield details you don't want to
miss.
h G Need tutoring? Scan the QR code or visit The Match Guy Tutoring.
c
Don’t forget to watch the video lessons that go with this file. Learn
t
more here.
Ma
Vascular Neurology
The 1. A 50-year-old man presents with confusion, vomiting, seizure, and severely elevated blood
pressure. Fundoscopy shows retinal hemorrhages and cotton-wool spots. What is the
diagnosis?
➔ Hypertensive encephalopathy (⇑ BP + neurologic symptoms + signs of end-organ
damage ➞ think Hypertensive Encephalopathy)
Note: Fundoscopy shows ➞ Retinal hemorrhages, cotton-wool spots (hypertensive
retinopathy)
Treatment:
⇓ MAP by ≤25% in first hour
IV antihypertensives: Labetalol, Nicardipine, Esmolol, Nitroprusside
Avoid rapid BP drop ➞ risk of ischemia
2. A 65-year-old man with poorly controlled hypertension suddenly develops vomiting, right-
sided weakness, and confusion. Exam shows right sided hemiparesis, hyperreflexia, and
Babinski sign. What is the next step in diagnosis?
➔ Non-contrast CT scan of the head (to detect intracerebral hemorrhage) (sudden focal
neuro deficit + vomiting + HTN ➞ rule out Intracerebral Hemorrhage)
© 2025 TheMatchGuy LLC. All rights reserved. Page 1
Version 1.0 August 2025. No part of this document may be reproduced or distributed without written permission. For personal study only. Medical information
herein is for educational purposes and does not constitute clinical advice. Always confirm with current guidelines and your institution’s policies.
, Note: Most common site ➞ Putamen
Putaminal hemorrhage causes➞ contralateral hemiparesis + gaze deviation toward the
lesion
Cerebellar hemorrhage causes ➞ ataxia, vomiting, no hemiparesis, rapid deterioration
➞ neurosurgical emergency
3. A 78-year-old man with a history of frequent falls and alcohol use presents with
progressive headache and confusion. CT scan shows a crescent-shaped hyperdensity along
the cerebral hemisphere, crossing suture lines. What is the diagnosis?
➔ Subdural Hematoma (SDH) (elderly + fall + slow neurologic decline + crescent-shaped
bleed ➞ think SDH)
Note: It is caused by Rupture of bridging veins between cortex and dural sinuses
Elderly (brain atrophy), alcohol use, Trauma, child abuse ➞ are risk factors
⇑ ICP (papilledema, herniation) ➞ may cause herniation
y
Management:
If Stable, small SDH ➞ Monitor, supportive care
Gu
If Signs of mass effect/herniation ➞ Do surgical evacuation (burr hole or craniotomy)
Subdural Hematoma
tch
Ma
The
James Heilman, MD, Subduralandherniation, CC BY-SA 3.0
Unlike epidural hematoma (lens-shaped, lucid interval doesn’t cross suture line), SDH
is crescent-shaped and slower in onset
© 2025 TheMatchGuy LLC. All rights reserved. Page 2
,4. A 45-year-old woman presents with a sudden, severe headache described as "the worst
of her life." She has photophobia, neck stiffness, and transient loss of consciousness. CT
head is normal. What is the next step?
➔ Lumbar puncture to assess for xanthochromia (suspect subarachnoid hemorrhage)
(sudden thunderclap headache + normal CT ➞ rule out Subarachnoid Hemorrhage via LP)
Note: 1st step in diagnosis is CT head ➞ If CT negative ➞ Lumbar puncture➞
shows xanthochromia
Complications:
Rebleed (within 24 hrs)
Vasospasm (days 4–10) ➞ prevent with nimodipine
Hydrocephalus
5. A 70-year-old man has transient right-sided weakness and aphasia that resolve within an
hour. MRI brain shows no infarct. What is the most appropriate next step in management?
y
➔ Start aspirin and evaluate for embolic source (transient focal deficits + no infarct on
MRI ➞ think TIA and prevent future stroke)
Gu
Note: TIA is caused by emboli (from carotid/aorta/heart) or small vessel disease
Workup to know the cause includes ➞ MRI brain, Carotid Doppler, ECG/Echo
Treatment: Aspirin + statin ± anticoagulation if atrial fibrillation
tch
6. A 72-year-old woman is brought to the ER with left-sided weakness. Her family says she
a
was last seen well 3 hours ago. CT shows no hemorrhage. What is the next step in
management?
M
➔ Start IV alteplase (acute focal deficit + <4.5 hrs since last known well + no bleed ➞
indicates a stroke in the window period ➞ give tPA)
TheNote: Stroke diagnosis:
Non-contrast CT ➞ rule out hemorrhage
MRI brain (optional if diagnosis unclear)
Acute Management:
<4.5 hrs: IV alteplase (thrombolysis)
<24 hrs + large vessel occlusion on imaging: Consider thrombectomy
>4.5 hrs + no thrombectomy criteria: Start aspirin
Supportive care: BP control, DVT prophylaxis, statin
Always ask "When was the patient last seen normal?"
7. A 68-year-old man is hospitalized for acute ischemic stroke. He has a history of diabetes
and long-standing hypertension. Which of the following is the most important modifiable risk
factor for preventing future strokes?
➔ Hypertension (HTN is the strongest modifiable risk factor for both ischemic and
hemorrhagic stroke)
Note: Age is the strongest non-modifiable risk factor
© 2025 TheMatchGuy LLC. All rights reserved. Page 3
, 8. A 64-year-old man with hypertension and diabetes presents with sudden right-hand
clumsiness. He has no facial droop or speech changes. CT head is normal. What is the
cause?
➔ Lacunar infarct (focal motor deficit + no cortical signs + HTN/DM ➞ Think Lacunar
Stroke from small vessel disease)
Note: Lacunar stroke = small vessel occlusion due to lipohyalinosis
9. A 66-year-old man with poorly controlled hypertension presents with vertigo, nausea,
ataxia, and left-sided facial numbness along with right arm and leg weakness. What is the
cause of this presentation?
➔ Posterior circulation stroke (vertebral artery occlusion) (crossed findings + vestibular
symptoms ➞ think brainstem stroke from vertebral artery occlusion)
Note: Posterior circulation stroke Presents with ➞
y
Vestibulocerebellar signs: Vertigo, vomiting, nystagmus, ataxia
Ipsilateral CN findings: Dysphagia, dysarthria, Horner syndrome
Gu
Contralateral findings:
Hemiparesis (corticospinal tract)
Pain/temp loss (spinothalamic tract)
Homonymous hemianopsia ± macular sparing (occipital lobe)
ch
Differential Diagnosis: Posterior Stroke Syndromes
t
Ma
Condition
Vertebral artery occlusion
Key Features
Vertigo, ataxia, ipsilateral CN signs, contralateral
e
weakness/sensory loss
Th
PICA infarct (Wallenberg)
Basilar artery occlusion
Cerebellar infarct/hemorrhage
Hoarseness, dysphagia, vertigo, ⇓ pain/temp
ipsilateral face + contralateral body
Locked-in syndrome, preserved consciousness
Ataxia, vertigo, nystagmus ± signs of ⇑ICP
10. A 68-year-old man with hypertension presents with sudden right-sided weakness and left
eye ptosis with a "down and out" gaze. He also has a dilated left pupil. Where is the lesion
located?
➔ Left midbrain (Weber syndrome) (CN III palsy + contralateral hemiparesis ➞ think
midbrain stroke)
Note: "Crossed signs" = CN findings + long tract signs on opposite sides ➞ think
brainstem lesion
Localization rule: "Crossed signs" (CN deficit on one side + long tract signs on the
other) ➞ brainstem lesion
© 2025 TheMatchGuy LLC. All rights reserved. Page 4
High Yield USMLE Step 2 CK Notes
Welcome to the Neurology High-Yield Notes for Step 2 CK.
These are the most commonly tested topics on the exam—ideal for quick review in your last
2 weeks before the exam, when you're short on time, or when you're just starting out and
want to focus on what is high yield. Created and peer-reviewed by physicians who scored
260+ on Step 2 CK in a Q&A style to reinforce active learning.
How to use this file
y
Read the question ➔ cover the answer ➔ self-quiz before revealing.
u
Review the NOTES ➔ they include high-yield details you don't want to
miss.
h G Need tutoring? Scan the QR code or visit The Match Guy Tutoring.
c
Don’t forget to watch the video lessons that go with this file. Learn
t
more here.
Ma
Vascular Neurology
The 1. A 50-year-old man presents with confusion, vomiting, seizure, and severely elevated blood
pressure. Fundoscopy shows retinal hemorrhages and cotton-wool spots. What is the
diagnosis?
➔ Hypertensive encephalopathy (⇑ BP + neurologic symptoms + signs of end-organ
damage ➞ think Hypertensive Encephalopathy)
Note: Fundoscopy shows ➞ Retinal hemorrhages, cotton-wool spots (hypertensive
retinopathy)
Treatment:
⇓ MAP by ≤25% in first hour
IV antihypertensives: Labetalol, Nicardipine, Esmolol, Nitroprusside
Avoid rapid BP drop ➞ risk of ischemia
2. A 65-year-old man with poorly controlled hypertension suddenly develops vomiting, right-
sided weakness, and confusion. Exam shows right sided hemiparesis, hyperreflexia, and
Babinski sign. What is the next step in diagnosis?
➔ Non-contrast CT scan of the head (to detect intracerebral hemorrhage) (sudden focal
neuro deficit + vomiting + HTN ➞ rule out Intracerebral Hemorrhage)
© 2025 TheMatchGuy LLC. All rights reserved. Page 1
Version 1.0 August 2025. No part of this document may be reproduced or distributed without written permission. For personal study only. Medical information
herein is for educational purposes and does not constitute clinical advice. Always confirm with current guidelines and your institution’s policies.
, Note: Most common site ➞ Putamen
Putaminal hemorrhage causes➞ contralateral hemiparesis + gaze deviation toward the
lesion
Cerebellar hemorrhage causes ➞ ataxia, vomiting, no hemiparesis, rapid deterioration
➞ neurosurgical emergency
3. A 78-year-old man with a history of frequent falls and alcohol use presents with
progressive headache and confusion. CT scan shows a crescent-shaped hyperdensity along
the cerebral hemisphere, crossing suture lines. What is the diagnosis?
➔ Subdural Hematoma (SDH) (elderly + fall + slow neurologic decline + crescent-shaped
bleed ➞ think SDH)
Note: It is caused by Rupture of bridging veins between cortex and dural sinuses
Elderly (brain atrophy), alcohol use, Trauma, child abuse ➞ are risk factors
⇑ ICP (papilledema, herniation) ➞ may cause herniation
y
Management:
If Stable, small SDH ➞ Monitor, supportive care
Gu
If Signs of mass effect/herniation ➞ Do surgical evacuation (burr hole or craniotomy)
Subdural Hematoma
tch
Ma
The
James Heilman, MD, Subduralandherniation, CC BY-SA 3.0
Unlike epidural hematoma (lens-shaped, lucid interval doesn’t cross suture line), SDH
is crescent-shaped and slower in onset
© 2025 TheMatchGuy LLC. All rights reserved. Page 2
,4. A 45-year-old woman presents with a sudden, severe headache described as "the worst
of her life." She has photophobia, neck stiffness, and transient loss of consciousness. CT
head is normal. What is the next step?
➔ Lumbar puncture to assess for xanthochromia (suspect subarachnoid hemorrhage)
(sudden thunderclap headache + normal CT ➞ rule out Subarachnoid Hemorrhage via LP)
Note: 1st step in diagnosis is CT head ➞ If CT negative ➞ Lumbar puncture➞
shows xanthochromia
Complications:
Rebleed (within 24 hrs)
Vasospasm (days 4–10) ➞ prevent with nimodipine
Hydrocephalus
5. A 70-year-old man has transient right-sided weakness and aphasia that resolve within an
hour. MRI brain shows no infarct. What is the most appropriate next step in management?
y
➔ Start aspirin and evaluate for embolic source (transient focal deficits + no infarct on
MRI ➞ think TIA and prevent future stroke)
Gu
Note: TIA is caused by emboli (from carotid/aorta/heart) or small vessel disease
Workup to know the cause includes ➞ MRI brain, Carotid Doppler, ECG/Echo
Treatment: Aspirin + statin ± anticoagulation if atrial fibrillation
tch
6. A 72-year-old woman is brought to the ER with left-sided weakness. Her family says she
a
was last seen well 3 hours ago. CT shows no hemorrhage. What is the next step in
management?
M
➔ Start IV alteplase (acute focal deficit + <4.5 hrs since last known well + no bleed ➞
indicates a stroke in the window period ➞ give tPA)
TheNote: Stroke diagnosis:
Non-contrast CT ➞ rule out hemorrhage
MRI brain (optional if diagnosis unclear)
Acute Management:
<4.5 hrs: IV alteplase (thrombolysis)
<24 hrs + large vessel occlusion on imaging: Consider thrombectomy
>4.5 hrs + no thrombectomy criteria: Start aspirin
Supportive care: BP control, DVT prophylaxis, statin
Always ask "When was the patient last seen normal?"
7. A 68-year-old man is hospitalized for acute ischemic stroke. He has a history of diabetes
and long-standing hypertension. Which of the following is the most important modifiable risk
factor for preventing future strokes?
➔ Hypertension (HTN is the strongest modifiable risk factor for both ischemic and
hemorrhagic stroke)
Note: Age is the strongest non-modifiable risk factor
© 2025 TheMatchGuy LLC. All rights reserved. Page 3
, 8. A 64-year-old man with hypertension and diabetes presents with sudden right-hand
clumsiness. He has no facial droop or speech changes. CT head is normal. What is the
cause?
➔ Lacunar infarct (focal motor deficit + no cortical signs + HTN/DM ➞ Think Lacunar
Stroke from small vessel disease)
Note: Lacunar stroke = small vessel occlusion due to lipohyalinosis
9. A 66-year-old man with poorly controlled hypertension presents with vertigo, nausea,
ataxia, and left-sided facial numbness along with right arm and leg weakness. What is the
cause of this presentation?
➔ Posterior circulation stroke (vertebral artery occlusion) (crossed findings + vestibular
symptoms ➞ think brainstem stroke from vertebral artery occlusion)
Note: Posterior circulation stroke Presents with ➞
y
Vestibulocerebellar signs: Vertigo, vomiting, nystagmus, ataxia
Ipsilateral CN findings: Dysphagia, dysarthria, Horner syndrome
Gu
Contralateral findings:
Hemiparesis (corticospinal tract)
Pain/temp loss (spinothalamic tract)
Homonymous hemianopsia ± macular sparing (occipital lobe)
ch
Differential Diagnosis: Posterior Stroke Syndromes
t
Ma
Condition
Vertebral artery occlusion
Key Features
Vertigo, ataxia, ipsilateral CN signs, contralateral
e
weakness/sensory loss
Th
PICA infarct (Wallenberg)
Basilar artery occlusion
Cerebellar infarct/hemorrhage
Hoarseness, dysphagia, vertigo, ⇓ pain/temp
ipsilateral face + contralateral body
Locked-in syndrome, preserved consciousness
Ataxia, vertigo, nystagmus ± signs of ⇑ICP
10. A 68-year-old man with hypertension presents with sudden right-sided weakness and left
eye ptosis with a "down and out" gaze. He also has a dilated left pupil. Where is the lesion
located?
➔ Left midbrain (Weber syndrome) (CN III palsy + contralateral hemiparesis ➞ think
midbrain stroke)
Note: "Crossed signs" = CN findings + long tract signs on opposite sides ➞ think
brainstem lesion
Localization rule: "Crossed signs" (CN deficit on one side + long tract signs on the
other) ➞ brainstem lesion
© 2025 TheMatchGuy LLC. All rights reserved. Page 4
