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NBME 20 Answers

nbme20/Block 4/Question#42 (62.6 difficulty score)
A 65-year-old woman dies 6 months after the ...

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submitted by johnthurtjr(139),
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mI' not a naf of srgso phta smigea and sneuoqits hatt yas k"lo,o hwat is tsih ihgnt"? - ahtt siad ignsamiomen era the sotm nocomm barin rotum dan tshi trpuice si is a gdoo elmexap fo .oen I dha no idea ahwt sheet isnght dokloe ielk dan tog ti ogwn,r to.o aekT a olko at itsh one

johnthurtjr  [Here's more info]( +1  
meningitis  I got it wrong because I didn't see any apparent Dura mater nor other meninges (The veins aren't being covered by any "shiny layer"), so I thought the tumor was coming from inside the brain and not compressing it like meningiomas usually do. +3  
meningitis  But it did follow the common aspect where they are found in between divisions of brain and are circular growths like a ball. +7  
nala_ula  Since it was basically implied that the patient died and "here look at what this is" I thought it was a malignant tumor (glioblastoma)... but I guess it's all about placement. +11  
thelupuswolf  GBM would be in the perenchyma. Devine podcast said if they show you a gross picture of the bottom of the brain then it's a hemangioblastoma bc it's most often cerebellar. But this one wasn't cerebellar so I went ahead with meningioma (FA says external to brain parenchyma as well) +2  
vivijujubebe  GBM would have necrosis and bleeding whereas the ball-shaped tumor in the picture looks smooth and very benign...even tho I have no idea how someone can die so suddenly from meningioma +  
seba0039  Minor correction, but I do not think that Meningiomas are the most common brain tumor; they are the most common benign brain tumor of adults (Pathoma), but I'm not sure if they're the most common overall. +  

submitted by smit 24(0),
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'otDn kown wtha if hcsu nisqutsoe rpaeap on aerl aemπŸ˜‘xπŸ˜‘πŸ˜‘

htballer55  I felt the same way. but if you look at autopsy pics on google, you see the meningioma is like a ball coming out of the meninges. compare that to glioblastoma which is within the brain in cerebral hemispheres. so it's mainly one tumor is coming out of the brain and the other is inside the cerebral hemispheres. that's the best i can come up with. but it's confusing +3  

submitted by misterdoctor69(40),

In case anyone was wondering, meningiomas are more common in women (perhaps due to an estrogenic effect, but this is still hotly debated).

Also, GBM's would show up as butterfly-shaped and intraparenchymal. They have a 60% higher incidence in males than females. Historical aside - Ted Kennedy died from a GBM

submitted by thomas(0),
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Aernws is rtys.teAoc iaPttne sah gbsaiaolotlm fo.umrlteim hgoAltuh noamigmeisn yma uccor at snoievt,xeci imnsgnemiao ear bignen adn tnefo s.ttaypacmoim eThy yma escua ah/ srsi,eeuz tbu wloud eb uineylkl ot ceusa tehad /wni m6 of sonet fo /.ah Teh zeis fo mutro nda ouecsr of elsnsil si cessntonit wtih teh uocesr fo MGB

masonkingcobra  Above is obviously incorrect because the answer is Meningeal lol. Here is a link to a good picture: +24  
kernicterusthefrog  Obviously thomas is disagreeing with the presentation of the question, and I agreed with him! This absolutely sounds like GBM, with rapid onset leading to death, and the symptoms. The question stem leads you to GBM, and the gross image to meningioma (I guess). +2  
kernicterusthefrog  Furthermore, where are the meninges on the gross image form which this (meningioma) grew?! It should at least show the tissue from whence it came! +1  
nala_ula  Had the same problem, got confused since it appeared that the growth was malignant :( +  
sugaplum  FA 2019 pg 514, also agree with everyone. weird presentation. Glios are malignant death within 1 year, meningioma are often asymptomatic or have focal signs. just a gross pathology question at this point +  
garima  Δ± think she died bc of pressure or something guys, its obviously round shaped benign lesion, its also extra axial not like GBM. she had this maybe years before death +2