STEP 2 NBME QUESTIONS WITH
ACCURATE RIGHT ANSWERS .
A 15-year-old boy is brought to the physician because of headaches for 3 months. The
headaches occur most often in the morning and are associated with vomiting. Over the past
month, he also has had increasing visual difficulty. During this period, he has had a 4.5-kg
(10-lb) weight gain, and his school performance has declined. He is also concerned that his
pubertal development has been slower than his friends. Growth charts are shown. Genital
development is Tanner stage 2. Funduscopic examination shows mild papilledema. Which of
the following is the most likely diagnosis?
A. Adrenal insufficiency
B. Craniopharyngioma
C. Gonadal dysgenesis
D. Medulloblastoma
E. Migraines
F. Primary hypothyroidism - Correct Answer -Craniopharyngioma
symptoms:
-headaches (occassionally with nausea and vomiting)
-hydrocephalus
-visual field defects (classical - bitemporal hemianopsia)
-growth failure (below age 20)
-endocrine dysfunction - obesity, lethargy
*Most common pituitary tumor in children
Histology - arises from remnants of the Rathke's duct, benign (mostly, however )
Treatment - Surgical resection and endocrine therapy for endocrine disturbances
1
,A 32-year-old worman, gravida 2, para 1, at 40 weeks' gestation is brought to the emergency
department by her husband because she has been confused for 45 minnutes. Her husband says
that she has been in labor for 3 days at home, and she has recieved all her prenatal care from
an alternative provider. This morning the caregiver gave the patient a natural product to chew
to induce contractions. She began to have strong, regular,, painful contractions, and after 6
hours, she suddenly lost conciousness. On arrival, she is obtuned. her pulse is 140/min, and
palabalbe systolic blood pressure is 60 mm Hg. Abdominal examination shows distention and
rigidity and a 25-cm, irregular mobile mass in the upper right quadrant. The cervic is 3 cm
dilated and 50% effacted; no presenting fetal part can be palpated. which of the following is
most likely cause of thse findings?
A) Coagulopathy
B) endomyometritis
C) methamphetamine use - Correct Answer -Uterine rupture
-shock
-irregular mobile mass in RUQ = fetus
-no presenting fetal part palpated = regression of fetal station?
A 33 year old woman comes for follow up examination one week after a pap smear shows a
high grade squamous intraeptithelial lesion.examinations shows no abnoramlities.Which of
the following is the most accurate next step in the menagment
1.repeat pap smear
2.trichloroaceticacid therapy
3.colposcopic directed biopsy
4.cone biopsy of the cervix
5.cryosurgery of the cervix - Correct Answer -Colposcopic directed biopsy!!!
*Cone biopsy and LEEP more of treatments
*Cone biopsy indications
1. The abnormal tissue cannot be seen with colposcopy but was found in cells collected from
a biopsy of the cervical canal, or the abnormal tissue seen with colposcopy extends high into
the cervical canal. A cone biopsy is done to remove and examine the abnormal tissue.
2
,2. The abnormal cells found on a Pap test cannot be seen with colposcopy or found in cells
collected from a cervical biopsy. The cone biopsy may be used to diagnose the cause of the
abnormal cell changes and remove the abnormal tissue at the same time.
3. Cervical cancer is suspected based on Pap test results, colposcopy, and cervical biopsy. A
cone biopsy can determine the extent, depth, and severity of the cancerous tissue and can
guide treatment decisions.
A 16-year-old boy is brought to the physician because of a 3-day history of right knee pain
associated with redness and swelling. There is no history of trauma.he is at the
50th percentile for height and weight. His temperature is 38.6°C (101.5°F). Examination
shows ery thema. swelling, and tenderness of the right knee ,and range of motion is limited.
select the most appropriate next step in management:
o A) Radionuclide bone scan
O B) MRI of the affected knee
O C) Antibiotic therapy
O D) Nonsteroidal anti-inflammatory drug therapy
o E) Knee immobilization
O F) Joint aspiration - Correct Answer -Septic arthritis --> JOINT ASPIRATION
1. Joint aspiration (get synovial fluid for culture)
2. Empiric abx treatment
3. Narrow abx when cultures come back
13yo boy with 3-month history of left knee pain that is exacerbated by vigorous exercise.
Occasional pain in his right knee. 50th percentile for height and weight. T 37 C. Tenderness
at left tibial tubercle.
a. Bone scan
b. MRI of left knee
c. Antibiotics
d. NSAiD
e. Knee immobilisation
f. Joint aspiration - Correct Answer -Osgood-Schlatter --> patellar ligament (connected to
tibial tubercle) inflammed
3
, -resolves without formal treatment
NSAIDS!!
A 67-year-old man comes to the physician for a follow-up examination. Three years ago, he
underwent radical resection of a T3 N0 M0 epidermoid carcinoma of the floor of his mouth
and supraomohyoid dissection of his neck. He currently takes no medications. He smoked
three packs of cigarettes daily for 40 years but stopped 3 years ago. Vital signs are within
normal limits. Examination shows well-healed surgical scars. There are no signs of local
recurrence. An x-ray of the chest shows a 3-cm mass in the medial upper lobe of the right
lung. Which of the following is the most likely cause of these findings?
A. Bronchioalveolar carcinoma of the lung
B. Metastatic carcinoma
C. Obstructive pneumonia
D. Primary squamous cell carcinoma of the lung
E. Sarcoidosis - Correct Answer -Primary squamous cell carcinoma of the lung:
-only 2 CA of the lung are medially placed, squamous cell and small cell and both are mainly
due to smoking
-The logic, I use to remember it is that the smoke enters the lung parenchyma medially thus
this part of the lung will receive higher dose of smoke so has higher risk to develop those 2
cancers.
T- size, extent of primary tumor
N- #lymph nodes involved
M- metastases
*Bronchioalveolar carcinoma of the lung: peripheric, more common in non smoker
*Metastatic carcinoma: no history of lymphadenopathy; histology doesn't indicate this
*Obstructive pneumonia: Clinical history doesn't correspond, no mention of fever.
*Sarcoidosis: no hiliar adenopathy
. 37yo M with 3-day history of diarrhea. Six to eight watery stools daily that occasionally
contain streaks of blood. Family does not have similar symptoms. No travel. Two weeks ago,
4
ACCURATE RIGHT ANSWERS .
A 15-year-old boy is brought to the physician because of headaches for 3 months. The
headaches occur most often in the morning and are associated with vomiting. Over the past
month, he also has had increasing visual difficulty. During this period, he has had a 4.5-kg
(10-lb) weight gain, and his school performance has declined. He is also concerned that his
pubertal development has been slower than his friends. Growth charts are shown. Genital
development is Tanner stage 2. Funduscopic examination shows mild papilledema. Which of
the following is the most likely diagnosis?
A. Adrenal insufficiency
B. Craniopharyngioma
C. Gonadal dysgenesis
D. Medulloblastoma
E. Migraines
F. Primary hypothyroidism - Correct Answer -Craniopharyngioma
symptoms:
-headaches (occassionally with nausea and vomiting)
-hydrocephalus
-visual field defects (classical - bitemporal hemianopsia)
-growth failure (below age 20)
-endocrine dysfunction - obesity, lethargy
*Most common pituitary tumor in children
Histology - arises from remnants of the Rathke's duct, benign (mostly, however )
Treatment - Surgical resection and endocrine therapy for endocrine disturbances
1
,A 32-year-old worman, gravida 2, para 1, at 40 weeks' gestation is brought to the emergency
department by her husband because she has been confused for 45 minnutes. Her husband says
that she has been in labor for 3 days at home, and she has recieved all her prenatal care from
an alternative provider. This morning the caregiver gave the patient a natural product to chew
to induce contractions. She began to have strong, regular,, painful contractions, and after 6
hours, she suddenly lost conciousness. On arrival, she is obtuned. her pulse is 140/min, and
palabalbe systolic blood pressure is 60 mm Hg. Abdominal examination shows distention and
rigidity and a 25-cm, irregular mobile mass in the upper right quadrant. The cervic is 3 cm
dilated and 50% effacted; no presenting fetal part can be palpated. which of the following is
most likely cause of thse findings?
A) Coagulopathy
B) endomyometritis
C) methamphetamine use - Correct Answer -Uterine rupture
-shock
-irregular mobile mass in RUQ = fetus
-no presenting fetal part palpated = regression of fetal station?
A 33 year old woman comes for follow up examination one week after a pap smear shows a
high grade squamous intraeptithelial lesion.examinations shows no abnoramlities.Which of
the following is the most accurate next step in the menagment
1.repeat pap smear
2.trichloroaceticacid therapy
3.colposcopic directed biopsy
4.cone biopsy of the cervix
5.cryosurgery of the cervix - Correct Answer -Colposcopic directed biopsy!!!
*Cone biopsy and LEEP more of treatments
*Cone biopsy indications
1. The abnormal tissue cannot be seen with colposcopy but was found in cells collected from
a biopsy of the cervical canal, or the abnormal tissue seen with colposcopy extends high into
the cervical canal. A cone biopsy is done to remove and examine the abnormal tissue.
2
,2. The abnormal cells found on a Pap test cannot be seen with colposcopy or found in cells
collected from a cervical biopsy. The cone biopsy may be used to diagnose the cause of the
abnormal cell changes and remove the abnormal tissue at the same time.
3. Cervical cancer is suspected based on Pap test results, colposcopy, and cervical biopsy. A
cone biopsy can determine the extent, depth, and severity of the cancerous tissue and can
guide treatment decisions.
A 16-year-old boy is brought to the physician because of a 3-day history of right knee pain
associated with redness and swelling. There is no history of trauma.he is at the
50th percentile for height and weight. His temperature is 38.6°C (101.5°F). Examination
shows ery thema. swelling, and tenderness of the right knee ,and range of motion is limited.
select the most appropriate next step in management:
o A) Radionuclide bone scan
O B) MRI of the affected knee
O C) Antibiotic therapy
O D) Nonsteroidal anti-inflammatory drug therapy
o E) Knee immobilization
O F) Joint aspiration - Correct Answer -Septic arthritis --> JOINT ASPIRATION
1. Joint aspiration (get synovial fluid for culture)
2. Empiric abx treatment
3. Narrow abx when cultures come back
13yo boy with 3-month history of left knee pain that is exacerbated by vigorous exercise.
Occasional pain in his right knee. 50th percentile for height and weight. T 37 C. Tenderness
at left tibial tubercle.
a. Bone scan
b. MRI of left knee
c. Antibiotics
d. NSAiD
e. Knee immobilisation
f. Joint aspiration - Correct Answer -Osgood-Schlatter --> patellar ligament (connected to
tibial tubercle) inflammed
3
, -resolves without formal treatment
NSAIDS!!
A 67-year-old man comes to the physician for a follow-up examination. Three years ago, he
underwent radical resection of a T3 N0 M0 epidermoid carcinoma of the floor of his mouth
and supraomohyoid dissection of his neck. He currently takes no medications. He smoked
three packs of cigarettes daily for 40 years but stopped 3 years ago. Vital signs are within
normal limits. Examination shows well-healed surgical scars. There are no signs of local
recurrence. An x-ray of the chest shows a 3-cm mass in the medial upper lobe of the right
lung. Which of the following is the most likely cause of these findings?
A. Bronchioalveolar carcinoma of the lung
B. Metastatic carcinoma
C. Obstructive pneumonia
D. Primary squamous cell carcinoma of the lung
E. Sarcoidosis - Correct Answer -Primary squamous cell carcinoma of the lung:
-only 2 CA of the lung are medially placed, squamous cell and small cell and both are mainly
due to smoking
-The logic, I use to remember it is that the smoke enters the lung parenchyma medially thus
this part of the lung will receive higher dose of smoke so has higher risk to develop those 2
cancers.
T- size, extent of primary tumor
N- #lymph nodes involved
M- metastases
*Bronchioalveolar carcinoma of the lung: peripheric, more common in non smoker
*Metastatic carcinoma: no history of lymphadenopathy; histology doesn't indicate this
*Obstructive pneumonia: Clinical history doesn't correspond, no mention of fever.
*Sarcoidosis: no hiliar adenopathy
. 37yo M with 3-day history of diarrhea. Six to eight watery stools daily that occasionally
contain streaks of blood. Family does not have similar symptoms. No travel. Two weeks ago,
4
