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NBME 21 Answers

nbme21/Block 2/Question#37 (reveal difficulty score)
A 17-year-old boy is evaluated for ...
Craniopharyngioma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +6  upvote downvote
submitted by โˆ—sbryant6(205)
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Craniopharyngioma with Calcifications and Cholesterol Crystals (motor-oil fluid). Remnant of Rathke's pouch. Not to be confused with pituitary adenoma.

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dubywow  Also, craniopharyngioma is most common supratentorial childhood tumor. That was the big clue for me. +2
skonys  I was confused because cranipharyngioma's have a bimodal age distribution with most occurring in people 5-14 yrs. This guy is 17 and presenting for a constitutional growth and puberty delay which points to prolactinoma, the most common benign pituitary tumor. He also doesn't have bitemporal heminopia which is THE presenting sign of craniopharyngioma. Craniopharyngiomas are the most common to be calcified but prolactinomas can also be calcified. Idk I just think it's a garbage Q written by some sweaty usmle guy cackling in his office like "haha, you have studied what we told you to study so heres a nice wrench just to make the curve" +1



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submitted by โˆ—aesalmon(95)
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Can anyone explain why this is not a pituitary adenoma? Is it just a lack of other symptoms?

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benzjonez  I think that they just wanted you to notice the **calcifications**. Per FA, "calcifications are common in craniopharyngiomas," whereas I don't think you'd expect to see calcifications in a prolactinoma. +21
epr94  also the option is prolactinoma not broad pituitary calcifications and he doesnt show any specific signs of high prolactin +
madojo  It says hes coming in for constituional delay in growth and puberty, i took this to mean that he had low LH, FSH due to decreased GnRH from the prolactinoma. Why did they have to say low-normal serum gonadotropin, why not just say normal? fck u nbme +2
madojo  It says hes coming in for constituional delay in growth and puberty, i took this to mean that he had low LH, FSH due to decreased GnRH from the prolactinoma. Why did they have to say low-normal serum gonadotropin, why not just say normal? fck u nbme +1
ac3  @madojo I believe since suprasellar tumors can cause a mass effect on pituitary gland to decrease gonadotropin levels. Where as prolactinoma causes a rise in prolactin which downregulates gonadotropin secretion. Please correct me if I'm wrong +2
teepot123  fa '19 pg 516 +
macroorchidism  Yeah the low-normal threw me off...that and the fact the "kid" was 17. Thats basically an adult. I always thought the Craniopharynngiomas meant like children <10 y.o. +



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