NBME Step 2 Exam Questions with Correct 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 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?