USMLE Step 2 CS Minicrashes ALL Are Questions And
Answers Graded A
21 yo F presents with several episodes of
throbbing left temporal pain that lasts
for 2-3 hours. Prior to its onset, she sees
fl ashes of light in her right visual fi eld
and feels weakness and numbness on the
right side of her body for a few minutes.
Headaches are often associated with
nausea and vomiting. She has a family
history of migraine. Correct Answer: Migraine (complicated)
Tension headache
Cluster headache
Pseudotumor cerebri
Trigeminal neuralgia
CNS vasculitis
Partial seizure
Intracranial neoplasm
CBC
ESR
CT—head
MRI—brain
LP
26 yo M presents with severe right
temporal headaches associated with
ipsilateral rhinorrhea, eye tearing, and
redness. Episodes have occurred at the
same time every night for the past week
and last for 45 minutes. Correct Answer: Cluster headache
Migraine
Tension headache
Sinusitis
Pseudotumor cerebri
Trigeminal neuralgia
Intracranial neoplasm
CBC
ESR
CT—head
MRI—brain
LP
65 yo F presents with severe, intermittent
right temporal headache, fever, blurred
,vision in her right eye, and pain in her
jaw when chewing. Correct Answer: Temporal arteritis (giant cell
arteritis)
Migraine
Cluster headache
Tension headache
Meningitis
Carotid artery dissection
Pseudotumor cerebri
Trigeminal neuralgia
Intracranial neoplasm
CBC
ESR
CRP
Temporal artery biopsy
Doppler U/S—carotid
MRI—brain
30 yo F presents with frontal headache,
fever, and nasal discharge. There is pain
on palpation of the frontal and maxillary
sinuses. She has a history of sinusitis. Correct Answer: Sinusitis
Migraine
Tension headache
Meningitis
Intracranial neoplasm
CBC
XR—sinus
CT—sinus
LP
50 yo F presents with recurrent episodes
of bilateral squeezing headaches that
occur 3-4 times a week, typically
toward the end of her work day. She is
experiencing signifi cant stress in her life. Correct Answer: Tension headache
Migraine
Depression
Caffeine or analgesic
withdrawal
Hypertension
Cluster headache
Pseudotumor cerebri
Intracranial neoplasm
CBC
,Electrolytes
ESR
CT—head
LP
35 yo M presents with sudden severe
headache, vomiting, confusion, left
hemiplegia, and nuchal rigidity. Correct Answer: DDX:
1 - Subarachnoid hemorrhage
2 - Migraine
3 - Meningitis/encephalitis
4 - Intracranial hemorrhage
5 - Intracranial neoplasm, vertebral a. dissection, intracranial venous thrombosis, acute htn
W/U:
1 - CBC, PT/PTT, CT head w/o contrast, MRI/MRA brain
3 - LP
25 yo M presents with high fever, severe
headache, confusion, photophobia, and
nuchal rigidity. Kernig's and Brudzinski's
signs are positive. Correct Answer: Meningitis
Migraine
Subarachnoid hemorrhage
Sinusitis/encephalitis
Intracranial or epidural abscess
W/U:
CBC
CT—head
MRI—brain
LP—CSF analysis (cell count,
protein, glucose, Gram stain,
PCR for antigens, culture)
18 yo obese F presents with a pulsatile
headache, vomiting, and blurred vision
for the past 2-3 weeks. She is taking
OCPs. Correct Answer: Pseudotumor cerebri
Tension headache
Migraine
Cluster headache
Meningitis
Intracranial venous thrombosis
Intracranial neoplasm
W/U:
Urine hCG
, CBC
CT—head
LP—opening pressure and CSF
analysis
57 yo M c/o daily pain in the right cheek
over the past month. The pain is electric
and stabbing in character and occurs
while he is shaving. Each episode lasts
2-4 minutes. Correct Answer: Trigeminal neuralgia
Tension headache
Migraine
Cluster headache
TMJ dysfunction
Intracranial neoplasm
W/U:
CBC
ESR
MRI—brain
81 yo M presents with progressive
confusion over the past several
years together with forgetfulness
and clumsiness. He has a history of
hypertension, diabetes mellitus, and two
strokes with residual left hemiparesis. His
mental status has clearly worsened after
each stroke (stepwise decline in cognitive
function). Correct Answer: Vascular ("multi-infarct")
dementia
Alzheimer's disease
Normal pressure hydrocephalus
Chronic subdural hematoma
Intracranial tumor
Depression
B12 defi ciency
Neurosyphilis
Hypothyroidism
W/U:
CBC
VDRL/RPR
Serum B12
TSH
MRI—brain
CT—head
LP—CSF analysis (rare)
Answers Graded A
21 yo F presents with several episodes of
throbbing left temporal pain that lasts
for 2-3 hours. Prior to its onset, she sees
fl ashes of light in her right visual fi eld
and feels weakness and numbness on the
right side of her body for a few minutes.
Headaches are often associated with
nausea and vomiting. She has a family
history of migraine. Correct Answer: Migraine (complicated)
Tension headache
Cluster headache
Pseudotumor cerebri
Trigeminal neuralgia
CNS vasculitis
Partial seizure
Intracranial neoplasm
CBC
ESR
CT—head
MRI—brain
LP
26 yo M presents with severe right
temporal headaches associated with
ipsilateral rhinorrhea, eye tearing, and
redness. Episodes have occurred at the
same time every night for the past week
and last for 45 minutes. Correct Answer: Cluster headache
Migraine
Tension headache
Sinusitis
Pseudotumor cerebri
Trigeminal neuralgia
Intracranial neoplasm
CBC
ESR
CT—head
MRI—brain
LP
65 yo F presents with severe, intermittent
right temporal headache, fever, blurred
,vision in her right eye, and pain in her
jaw when chewing. Correct Answer: Temporal arteritis (giant cell
arteritis)
Migraine
Cluster headache
Tension headache
Meningitis
Carotid artery dissection
Pseudotumor cerebri
Trigeminal neuralgia
Intracranial neoplasm
CBC
ESR
CRP
Temporal artery biopsy
Doppler U/S—carotid
MRI—brain
30 yo F presents with frontal headache,
fever, and nasal discharge. There is pain
on palpation of the frontal and maxillary
sinuses. She has a history of sinusitis. Correct Answer: Sinusitis
Migraine
Tension headache
Meningitis
Intracranial neoplasm
CBC
XR—sinus
CT—sinus
LP
50 yo F presents with recurrent episodes
of bilateral squeezing headaches that
occur 3-4 times a week, typically
toward the end of her work day. She is
experiencing signifi cant stress in her life. Correct Answer: Tension headache
Migraine
Depression
Caffeine or analgesic
withdrawal
Hypertension
Cluster headache
Pseudotumor cerebri
Intracranial neoplasm
CBC
,Electrolytes
ESR
CT—head
LP
35 yo M presents with sudden severe
headache, vomiting, confusion, left
hemiplegia, and nuchal rigidity. Correct Answer: DDX:
1 - Subarachnoid hemorrhage
2 - Migraine
3 - Meningitis/encephalitis
4 - Intracranial hemorrhage
5 - Intracranial neoplasm, vertebral a. dissection, intracranial venous thrombosis, acute htn
W/U:
1 - CBC, PT/PTT, CT head w/o contrast, MRI/MRA brain
3 - LP
25 yo M presents with high fever, severe
headache, confusion, photophobia, and
nuchal rigidity. Kernig's and Brudzinski's
signs are positive. Correct Answer: Meningitis
Migraine
Subarachnoid hemorrhage
Sinusitis/encephalitis
Intracranial or epidural abscess
W/U:
CBC
CT—head
MRI—brain
LP—CSF analysis (cell count,
protein, glucose, Gram stain,
PCR for antigens, culture)
18 yo obese F presents with a pulsatile
headache, vomiting, and blurred vision
for the past 2-3 weeks. She is taking
OCPs. Correct Answer: Pseudotumor cerebri
Tension headache
Migraine
Cluster headache
Meningitis
Intracranial venous thrombosis
Intracranial neoplasm
W/U:
Urine hCG
, CBC
CT—head
LP—opening pressure and CSF
analysis
57 yo M c/o daily pain in the right cheek
over the past month. The pain is electric
and stabbing in character and occurs
while he is shaving. Each episode lasts
2-4 minutes. Correct Answer: Trigeminal neuralgia
Tension headache
Migraine
Cluster headache
TMJ dysfunction
Intracranial neoplasm
W/U:
CBC
ESR
MRI—brain
81 yo M presents with progressive
confusion over the past several
years together with forgetfulness
and clumsiness. He has a history of
hypertension, diabetes mellitus, and two
strokes with residual left hemiparesis. His
mental status has clearly worsened after
each stroke (stepwise decline in cognitive
function). Correct Answer: Vascular ("multi-infarct")
dementia
Alzheimer's disease
Normal pressure hydrocephalus
Chronic subdural hematoma
Intracranial tumor
Depression
B12 defi ciency
Neurosyphilis
Hypothyroidism
W/U:
CBC
VDRL/RPR
Serum B12
TSH
MRI—brain
CT—head
LP—CSF analysis (rare)
