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NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 1/Question#31 (reveal difficulty score)
A 37-year-old woman is brought to the ...
Right optic nerve ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: visualfielddefect visual_field_defect Neuro ophtho inc

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submitted by โˆ—sugaplum(487)
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since she has total blindness just in one eye, right optic nerve lesion makes sense. The poor reactivity to light supports this because eyes receive light through optic nerve (CN2)

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submitted by โˆ—carolebaskin(109)
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young woman with abrupt onset painful eye movements + decreased acuity + poor reactivity = optic neuritis = MS

Also notice they said the right pupil is poorly active to direct light

So maybe there's a Marcus Gunn pupil, which is when there's decreased bilateral pupillary constriction when light is shone directly into the affected eye, relative to the unaffected eye

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jlbae  They might refer to MGP as "relative afferent pupil defect" on the NMBE +1
lindasmith462  is there anything differentiating this from acute angle closure glaucoma? She's a little young for ACG but a little old for MS. both would present w/ sudden painful vision loss and a pupil poorly responsive to light. (answer is still optic nerve though) +1
notyasupreme  ^^ Probably would have had vomiting, nausea, and other factors that suggest that it's angle closure glaucoma.. +mid-dilated pupil +

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submitted by โˆ—step_prep7(71)
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  • Young woman + eye pain with ipsilateral vision problems = Optic neuritis
  • Optic neuritis (as the name implies) is due to inflammation of the associated optic nerve, with further proof that optic nerve is involved being the relative afferent pupillary defect (problem with light getting back to retina in this case)
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