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NBME 22 Answers

nbme22/Block 4/Question#46 (62.0 difficulty score)
A 39-year-old woman comes to the physician ...

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submitted by johnthurtjr(142),
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re'hes a oelogg

johnthurtjr  FTR I had no idea this was a thing, and was pretty disappointed in myself when the google search had it in big bold letters right in my face. +3  
drdoom  via @johnthurtjr link: "Testosterone and other androgens have an erythropoietic stimulating effect that can cause polycythemia, which manifests as an increase in hemoglobin, hematocrit, or red blood cell count." +3  
meningitis  I guess that's another reason for steroids and doping up. +8  
drschmoctor  For once I feel like I've been led astray by Pathoma. My instinct was to go with hemoglobin, but I talked myself out of it after remembering Dr. Sattar saying that the reason why women have lower hemoglobin is due to menstruation. +2  
fexx  F U testosterone! and F U NBME 22 question +1  
schep  I only knew this because there are three (at least three, maybe more that I don't know) contraindications to giving testosterone replacement therapy: +OSA +prostate cancer +hematocrit >50% +2  
drdoom  ^ linkify @drdoom +  

submitted by oznefu(22),
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ohw do yuo waorrn wdon thta tstoeoestnre erndseaci gonoibhmle nt?toaoercnnic ujst a omdnar fatc ot k?won i upt aakilenl thopeaapssh easubce i iuegdfr dncsraiee etooseetrnts lilw ercnisae onbe ohgtrw dna eruld uto spapeeictrosctf-i inatnge bc ts’i a m.nowa

hysitron  I guessed this one cause men have a higher hemoglobin than women. +10  
notadoctor  High levels of testosterone will result in amenorrhea. I guessed that since she's not menstruating she will not be losing blood and therefore hemoglobin. Therefore her hemoglobin levels will be higher than expected. +5  
meningitis  It kinda makes sense knowing testosterone causes catabolism so I was in between Alkaline phosphatase and hemoglobin... +1  
enbeemee  isn't testosterone anabolic? +4  
syoung07  ALK phosph is indicative of osteoclast activity. Testosterone keeps male bones strong just like estrogen does for women. Testosterone builds bone (osteoblast activity) therefore we would not see a rise in ALK phos +  

submitted by alexb(47),
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tFrsi idA 2019 peag 226 uloyirattsm otrhgw efectsf fo seotnetosrte ilduenc edr oblod lc.lse I hkint they cteexp us ot wonk t.hsi

medstudent  FA 2020 p. 636 +  

submitted by adong(97),

uworld says somewhere that testosterone increases hematocrit, increases LDL, and decreases HDL

passplease  Estrogen increases HDL. Testosterone is converted into estrogen. Why doesnt testosterone increase HDL. Why is my logic wrong? +  
avocadotoast  The woman in this vignette has an increased androgen:estrogen ratio, so the effects of testosterone on lipid levels will be greater than those of estrogen on lipid levels. Boards and beyond also states that testosterone causes an increase LDL, decreased HDL, and increase in hematocrit, which is why males with primary hypogonadism can present with anemia and the use of anabolic steroids can present with erythrocytosis. +  

submitted by sup(22),
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weoShom I asw able ot ocniecnv myfels atth rnesecadi tnesrseteoot tg&--; dredaeecs eogetnsr ;g&t-- daesredce ievtenag dbcaefek no /FHSHL seniotcer ;&-tg- nrdsceeia .HFS esDo eynoan erac to pxnliea hyw itsh lgioc is n?ogrw Tknahs :)

btl_nyc  The increased testosterone is metabolized by granulosa cells to estrogen and by adipose tissue into estrone. Both feed back on the hypothalamus to inhibit FSH & LH secretion, but FSH is much more sensitive to feedback inhibition than LH, causing an increased LH/FSH ratio. +1  
impostersyndromel1000  @sup, i did the same thing. Had no idea testosterone and androgens can increase epo +  

submitted by johnthurtjr(142),
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see'rh hatw I dfoun

submitted by rogeliogs(9),
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My dnim twen sith :ayw in enM Auaedsporn = lsse tsosreeetton = slse obne idtnsye ni oeWmn omer teroeostnets = reom oneb nsideyt = ermo nlikeaal e bposgstn.eahiHolmhoap aws ym ecsdon ptooni sebuace I dot'n hrea too cuhm ouatb nmaiea ni tosp namuopees or ostp p,nrseuadao utb obdsn sintyde si a gbi aedl ee.thr


submitted by gokings2021(4),

Men generally have a higher RBC mass (hematocrit, hemoglobin, etc) and it is thought to be attributed to higher testosterone levels. She has high testosterone so you can assume the same for her. This is in Zanki, so it must be in FA or Pathoma.

submitted by medstudent(12),

For all wondering why testosterone doesn’t cause an increase in alk phos, I found this article that basically says men with low testosterone have high alkaline phosphatase and weak bones.

submitted by asharm10(23),

It's an anabolic hormone, muscle mass, RBC mass will increase.

submitted by nwinkelmann(292),
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I trrieeendtp the etaiptn to vhae SPCO isrm,sti(uh ramanhere,o irnaavo ma)ss otghhu eth ueprs lteveeda toseonestetr si moer rgnnicceon for recn p(er stih t:ilearc .l0n/iosp/h79anrh.i.t/g6eww/nv:pbiPc./6w/mClcscm1ttM0). fI eht tnepiat ahs CPO,S ehs si eliykl beeso adn ta hhegri rkis for DFANL wihhc anc be ceodsstaai thiw evaeeldt kaaleiln shasaeop,tph diipl acnutmuoc,ail dna aeevlted ,oeottreensst but not EUD to idnacgenor esfefct "urme(s nnogdare sevlle were otn dactosiase hwit hte npesreec fo LNA.DF Tsih si eldiynritc icomnfedr twhi uro etsrul no yt.eonpsehp yl,Nmae eehtr si no drenfecife in FDNAL ecrlvepnae ebtween erahndorn,cgeiyp dna iprhendrgeo-cnyonna ro itecerrupdov CPSO h.oeeppntsy AFDNL is dsrcneiode a cetihpa tpmoecnon of baletmcio mrsoeynd twih a cnetral gnoctieahp erol of sniinlu nesaertics atht saol tscafef teh ratvrtulapi-hyanompoyih-aoait xasi ni eustcjbs tiwh .C.OPS. rpeaocgHyennidr ttase aym be deu ot uniinsl .itsres"eacn tyy/

hTe,n sa iads yb btln@-,yc eeadtevl eetsnostrtoe in a eeaflm is ndcoertve ot egotesnr dan toresne nda akceefbd iishnbit hte pmatslhyhaou ganield ot deerdceas HSF and LH vllee,s tbu FHS si nbiiehdti oe,mr os ehtre si na iedreancs SLHF:H or.ita

i,ylalFn nrgrdgaei PAS ihwch( oeds cucro ni omen,w owh nek?w l),ol het eclotrraoni bwtneee oetetnsoestr dan APS ni men si illts ptryte eekw (ni shti ,ytsdu eetrh was nylo a rniooertlca nad a eawk oen ta ha,tt ferat aimvutraleti alnayssi ginsdujta rfo earevsl ihstgn wt:5C/P.inshv.epcca/ho/0n.i3t/bMlgrm/wls/im0wn5.c6p4t) so terhe si iiyfneltde ton a orceanltiro ni me.own eoervw,H pre sith uydst (4t9/iinvnt:h/.gbbm//sl.0.c1w/6dp2wu.hnpeowm8) ether amy be na aaioisnstoc ewtbnee areticn sareogndn on(t s)eetorstneto dan APS in mnw.eo

submitted by medguru2295(41),

TBH I only got this bc of the controversy with Lance Armstrong blood doping. IDk the mechanism at all. But, it will help you all remember this question/answer.

submitted by yobo13(2),
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aysE a:yw Lab eu.svla heT nylo oen tath adme /swassnee ffndrtiee orf nem sv oemnw = Hb