NBME Step 2 CK Form 7 Brisk rotatory nystagmus on left lateral gaze (NBME Answers)

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Retired NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 3/Question#35 (reveal difficulty score)
A previously healthy 82-year-old woman comes ...
Brisk rotatory nystagmus on left lateral gaze 🔍 / 📺 / 🌳 / 📖
tags: Aging inc

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submitted by ∗thajoker(21)

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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.

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submitted by ∗carolebaskin(109)

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thajoker's comment is spot on

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

https://pubmed.ncbi.nlm.nih.gov/15114040/

Can dogs look up?

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etherbunny What about tigers? Can tigers look up, Carole? +8

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submitted by ∗step_prep5(246)

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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

https://step-prep.org/tutoring/

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submitted by ∗jlbae(159)

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I picked decreased upward gaze because I thought PSP might be on the differential as it is a Parkinson-plus syndrome. But apparently the vertical gaze palsy is usually a downward gaze palsy. Fun fact of my day.

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