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Retired NBME 22 Answers

nbme22/Block 1/Question#18 (reveal difficulty score)
A 13-year-old boy is brought to the physician ...
Reassurance ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +18  upvote downvote
submitted by โˆ—meningitis(643)
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Tanner stages start at TEN years old

Stage I:

  • I is flat, as in flat chest;
  • I is alone, as in no sexual hairs.

Stage II (2): stage II starts at 11 y/o (II look like 11)

  • 2 balls (testicular enlargement)
  • 2 hairs (pubic hairs now appearing)
  • 2 breast buds form

Stage III (3): starts at 13 y/o

  • If you rotate 3, it looks like small breasts (Breast mounds form);
  • If you squiggle the III they look like curly+coarse pubic hair
  • Increased penis length and size can be represented by: II --> III
    (your penis was thin II but now its thicker III)

Stage IV (4): starts at 14 y/o

  • First imagine: The I in IV represents the thigh, and the V in IV looks like the mons pubis between your legs:
    MEANING: you have hair in mons pubis (V) but you have a border detaining the hair from growing into thighs.
  • The V is pointy, as in now the breasts are pointy (raised areola or mound on mound)

Stage V (5): 15 y/o

  • V has no borders detaining hair from growing into thighs (pubic hair + thigh hair)
  • 5 fingers(as in hands) flattening the areolas when grabbing them (areola flatten at this stage and no more "mound on mound")

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meningitis  Sorry about the format, it came out wrong but I hope his helps. +2
drdoom  looks good to me! +25
gh889  According to FA2019, stage 2 ends at 11, stage 3 starts 11.5-13, and stage 4 starts at 13-15, where did you get your info from? +1
meningitis  You can change it to ENDS at 11, ENDS at 13, ENDS at 14... I simply have it as a range just like you stated in a couple of them. The importance is in how the kid presents because he/she will have some things mature but others not, the age will vary in questions. +1
endochondral1  stage 3 breast mound is for females not males btw +4
endochondral1  see pg. 635 in FA it just pubertal. Idk if that correlates to the same stage as females +1
angelaq11  this is just too funny, I LOVE it! xD +4
snripper  While this is impressive, this doesn't help with answering the question. +2
yng  Pseudogynecomastia (False gynecomastia): this has nothing to do with puberty or hormones. Simple d/t the fast some guys have extra fat in chest area, making it look like they have breasts. The boy weight at 60 percentile while height at 50 percentile. +1



 +14  upvote downvote
submitted by โˆ—dr.xx(176)
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Pubertal gynecomastia is thought to be a physiological phenomenon, and is most commonly seen in midpuberty with Tanner stage 3โ€“4 pubic hair and testicular volumes of 5 to 10 mL bilaterally.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706045/

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 +8  upvote downvote
submitted by โˆ—paperbackwriter(161)
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According to Goljan, men have boobs three times in their lives: when they're babies, when they're going through puberty, and when they're old. It's physiological/normal.

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sars  I agree, babies-estrogen transfer through placenta from mother puberty-testosterone conversion via aromatase to estrogen elderly-increased fat content with androstenedione conversion to estrone read this somewhere and it sticks LOL +2



 +2  upvote downvote
submitted by โˆ—impostersyndromel1000(42)
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so its reassurance bc some boys can have mild breast development at 13? I've never heard or seen this before can someone please clarify. Basically reassuring that this is (relatively) normal?

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 +1  upvote downvote
submitted by โˆ—moloko270(77)
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increased amount of estrogen compared to androgen activity is physiologic in puberty

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 +1  upvote downvote
submitted by mishudishu(1)
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Who else chose reassurance thinking this was a question about raising the child's self confidence?

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