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NBME p2ck_form7 Answers

step2ck_form7/Block 3/Question#35 (4.7 difficulty score)
A previously healthy 82-year-old woman comes ...
Brisk rotatory nystagmus on left lateral gazeπŸ”

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submitted by thajoker(7),

Nystagmus is almost always pathological unless congenital. Especially gaze evoked nystagmus is almost always pathological.

BPPV btw is head movement induced nystagmus, which isn't the same as gaze evoked. Gaze just means moving eyes whereas bppv usually the nystagmus comes from moving the entire head.

The rest are normal findings for age, except e, which could be normal pupil size for any age.

submitted by carolebaskin(35),

thajoker's comment is spot on

And: decreased upward gaze is a normal sign of aging, not always parinaud syndrome

Can dogs look up?

submitted by step_prep5(25),
  • Physiological nystagmus: Alternating smooth pursuit in one direction and saccadic movement in the other direction (WOULD NOT BE ROTATORY)
  • All other answer changes represent normal changes in aging