Neurology for USMLE Step 2 CK: Exam Questions and Preparation
How Neurology is tested on Step 2 CK and Step 3, the high-yield topics, a preparation approach and original practice questions with explained answers.
Neurology questions on Step 2 CK reward time-sensitive thinking. The stroke window, the thunderclap headache and the descending or ascending weakness are classic emergencies with specific next steps.
Step 2 CK and Step 3 test clinical judgment: given a patient, what is the most likely diagnosis, the best next step in management, or the most important thing to prevent or monitor. The practice questions here are original and written to show the style of reasoning the exam rewards; they are not real exam items. Management guidance changes, so confirm current guidelines and the official USMLE content outline.
How Neurology is tested
Questions describe a deficit and ask for the diagnosis, the best initial test or the immediate treatment. Chronic conditions such as epilepsy, Parkinson disease and multiple sclerosis are tested through diagnosis and drug selection.
High-yield topics
- Ischemic and hemorrhagic stroke, TIA and the window for thrombolysis
- Headache: migraine, cluster, tension and subarachnoid hemorrhage
- Seizures, status epilepticus and antiepileptic drugs
- Dementia, delirium, Parkinson disease and movement disorders
- Multiple sclerosis and demyelinating disease
- Neuromuscular disease: Guillain-Barre syndrome, myasthenia gravis and ALS
- Meningitis, encephalitis, spinal cord compression and brain death
Preparation approach
- Learn the stroke pathway step by step: last known well, noncontrast CT, eligibility for thrombolysis or thrombectomy.
- For each neurologic syndrome, practice localizing the lesion from the exam findings.
- Make a table of seizure types and the first-line drug for each.
- Know which neurologic emergencies need an immediate treatment before the diagnosis is confirmed.
Practice questions
Question 1
A man has had right-sided weakness and aphasia for 2 hours. His blood pressure is 170/95 mm Hg, and a noncontrast head CT shows no hemorrhage. What is the most appropriate next step?
- A. Aspirin alone and admit
- B. Intravenous thrombolysis
- C. Lower the blood pressure to 120/80 mm Hg
- D. MRI of the brain before any treatment
- E. Lumbar puncture
Answer: B. A patient with acute ischemic stroke within the treatment window and no contraindication, including a normal CT, should receive intravenous thrombolysis. Blood pressure of 170/95 is acceptable.
Question 2
A woman has a sudden, severe headache that began 12 hours ago, and a noncontrast head CT is normal. What is the most appropriate next step?
- A. Discharge with an analgesic
- B. Lumbar puncture
- C. Electroencephalography
- D. Treat as a migraine
- E. Repeat the CT in 1 week
Answer: B. CT is very sensitive for subarachnoid hemorrhage in the first 6 hours. When it is negative after a longer delay, lumbar puncture looks for xanthochromia.
Question 3
Two weeks after a diarrheal illness, a man has ascending leg weakness and absent reflexes. CSF shows high protein with a normal cell count. Which should be monitored most closely?
- A. Serum calcium
- B. Forced vital capacity
- C. Visual acuity
- D. Serum sodium
- E. Bowel sounds
Answer: B. This is Guillain-Barre syndrome. Respiratory muscle weakness can progress quickly, so forced vital capacity and negative inspiratory force are monitored. Treatment is IVIG or plasmapheresis.
Make it a plan
Put this subject inside a dedicated study block with timed mixed question blocks and careful review. See our Step 2 CK preparation timeline for a schedule and weekly milestones. This article is general educational guidance and not an individualized study plan.
Educational content only. Confirm current exam requirements with USMLE.