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NBME 21 Answers

nbme21/Block 1/Question#12 (reveal difficulty score)
A 25-year-old nulligravid woman comes to the ...
Endometrial hyperplasia🔍,📺

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submitted by lsmarshall(437),
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submitted by mcl(632),
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SPCO is osatscaeid twih larnbmao cotoripdnu of xes sedi,otsr dcnnligiu ndtsucfoiyn of ongeestr otdiucronp nad osgeor.eeptnr ryocChanill detleaev elvels of etrnosge nac eascu entealrdiom a.yspepahirl


meningitis  Why isnt it endometriosis? Could someone help me out on this? +2  
meningitis  Sorry, I was confusing with higher risk for endometrial carcinoma. +1  
vi_capsule  Estrogen is responsible for cyclical bleeding and pain associated with endometriosis hence progestin is a treatment modality. But estrogen isnt a risk factor for Endometriosis. Rather theres retrograde flow, metaplatic transformation etc theories are responsible for endometriosis. +1  
sympathetikey  Tfw you get so thrown off by a picture that you don't read the question properly. +31  
hyperfukus  @meningitis idk if u still care lol but always go back to endometriosis=ectopic endometrial tissue outside of the uterus so you can rule it out since increased estrogen would cause you to have worsened endometriosis or a thicker one but not can see the clumps of the follicles in the ovaries if you look super close so that along with the presentation takes you to PCOS and anytime you don't have a baby or stay in the proliferative phase(estrogen phase) you get endometrial proliferation-->hyperplasia--->ultimately carcinoma +2  
lovebug  FA 2019, page 631 +1  
lovebug  Other answer H)Meigs syndrome : triad of 1) ovarian fibroma, 2) ascites, 3) pleural effusion. “Pulling” sensation in groin. FA 2019, pg 632 +1  
xw1984  Isn't option G, Leiomyomata uteri, associated with high estrogen level? Per FA 2020, fibroid is estrogen sensitive. +1  
ownersucks  @xw1984 gross image would show multiple whorled masses +1  

I feel the clearest way to understand this question/answer hasn't been stated yet. Recall that the cysts in PCOS are unruptured follicles. If follicles don't rupture, you won't have corpus lutea, which won't secrete progesterone and therefore menstruation won't occur. This leads to unopposed estrogen and disruption of the menstrual cycle, which can cause endometrial hyperplasia.

+16/- pg32(191),

The patient here is obese and has hirsutism. Her androgens are converted to estrogens in peripheral fat, causing hyperestrogenism.

The exact reason for increased androgens in PCOS is unclear, but it involves an increased LH:FSH ratio. Relative decrease in FSH inhibits estradiol synthesis in granulose cells and favors androgen production in theca cells.

+6/- mafoo_xtreme(12),

submitted by pparalpha(89),
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