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NBME 22 Answers

nbme22/Block 2/Question#20 (19.1 difficulty score)
A 26-year-old nulligravid woman comes to the ...
HypothalamusπŸ”
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 +1 
submitted by jackie_chan(16),

If estrogen is low and FSH/LH high, the problem at ovaries. FSH/LH both low so problem with the pituitary gland releasing FSH/LH or even higher up with GnRH in the hypothalamus. Best answer hypothalamus




 -2 
submitted by mguan1993(8),
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mguan1993  ^nvm had a brain fart and go adrenal gland mixed up with anterior pituitary lmao +4  
nor16  ovaries are #1 estrogen producer no estrogen no lubricant = dyspareunia no estrogen and no fsh/lh --> there must be a "higher" problem, up there in the brain +3  
pg32  I agree that hypothalamus is the most logical answer, but if she had overactivation of the adrenal gland (cortisol secreting tumor), that could also inhibit GnRH and cause these same symptoms. +  
drzed  @pg32 the physical examination would not be normal with either a ACTH or cortisol secreting tumor. +