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NBME 22 Answers

nbme22/Block 4/Question#46 (reveal difficulty score)
A 39-year-old woman comes to the physician ...
Hemoglobin πŸ” / πŸ“Ί / 🌳
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 +21 
submitted by βˆ—haliburton(222),
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niIfmlaixb is a -lFhpaaNT brhiinto.i ormf umebdp TFN-Ξ± sha eenb eaotdsnertmd ot veah a lcretna eorl ni hte oths rnpeseos atagnsi t,esrulcsboui cduglniin uonlagrma tornfoaim adn hte toncmintane of easdsei )(541.,1 ylabot,N etsadoinbi niatsga NΞ±FT- indceud rtotcevainia of socbteulsiru


 +12 
submitted by βˆ—johnthurtjr(157),
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'erseh a ggoole

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." https://www.medscape.com/viewarticle/773465 +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 https://www.medscape.com/viewarticle/773465 +  
kayla  @drschmoctor; I still think it lines up with the correct reasoning; during the menstrual phase ( in addition to loosing hemoglobin in the blood) there are also very low levels of the androgen hormones that usually serve as a stimulating effect on hemoglobin... +  



 +5 
submitted by βˆ—oznefu(22),
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owh do ouy aorwnr onwd that trnotseeetos dresnceia ghbmlneooi nocornicneat?t jstu a rdoamn fatc ot ?ownk i tup liakanle heatsphsoap ebuseca i rgueifd dasecrine eesnrtstoteo wlli aseecnri ebon gwhtor dna leurd tuo ptcpt-ssecieforai egitann cb i’ts a .woanm

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 +  



 +1 
submitted by βˆ—adong(114),
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rowldu ssya smeewhroe atht nsesoeteotrt ersisecna oemitacthr, arsnsceei DL,L and crseedaes DHL

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. +  



 +1 
submitted by βˆ—alexb(51),
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sFtir idA 0921 agep 262 roystiamltu wtrhgo eeffcts of tnoseteotrse cnluedi erd ldobo .elcsl I hnkit yhte tepecx us ot nwok shti.

medstudent  FA 2020 p. 636 +  
specialist_jello  Growth spurt: RBCs (fa2020 p 636) +  



 +1 
submitted by rogeliogs(11),
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My nmid wnte isht ay:w in nMe npeuodsAar = sles ettretesnsoo = lsse enbo ntsyde i in oWnme remo seetorntseto = meor ebno nstydei = reom nialklea ight.eaobesanmo ohplHsp swa my edonsc inopto esuebca I ndt'o ahre oot hcum uatbo neaami in ostp peauneosm ro stpo andaps,uore ubt nbods ydsteni is a igb dael ree.th

h.bla




 +0 
submitted by βˆ—sup(30),
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howmoSe I wsa beal to ccinonve eylmfs hatt sidrcenea setttresooen &-g-t; receeasdd etngsero t;-&g- dredesaec egvienta afedekcb no HHSF/L eerictons -g&;-t redneasic SH.F eoDs ynnaeo care to ixalpen hyw siht olcig si ?nrowg anTkhs :)

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 +  



 +0 
submitted by βˆ—johnthurtjr(157),
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ehesr' ahwt I fdoun




 +0 
submitted by βˆ—asharm10(32),
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st'I na naocibla no,omehr clusem m,ass CBR asms liwl .nesareic




 +0 
submitted by gokings2021(6),
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eMn anelglyer aehv a hgeirh BRC smsa t(mtai,reohc noobeil,mgh )cte dna it is hhtotug ot eb itutbaedtr ot hihegr ereosnstteto sl.veel ehS has ghhi nterosestote so ouy acn smseau the mesa ofr he.r sTih is in nZ,iak so ti utsm be ni FA or oma.haPt




 +0 
submitted by βˆ—medstudent(17),
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oFr all degnnriow ywh sosetortntee e’sntdo eusca na crsneeia in lka hspo, I onfdu htis laiertc hatt aabscylli yass men itwh low stnteeoserot veha hghi elanilka aophsshpate nda wake .nebos

-thoo-sfn-sln--l.setaenret1t-/sbiraw.hdye/p2--/te3d:/e/ci-piennehcrlahesooat-o-ope/oekdiepcsns.ewteerwssamyomanno0lus-stnetnsedr5ilue0hwltl




 -1 
submitted by βˆ—medguru2295(56),
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THB I lyno tgo ihst cb of eth onrrtcsvyeo htiw acnLe grontAmsr odolb do.npig IkD the hnimsecam ta all. u,tB ti liwl pehl yuo all rremebem iths /eriq.ensautsown




 -1 
submitted by yobo13(5),
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syaE wy:a Lab uvsel.a Teh lyon eno thta emad /sswnesea ifenfdrte rof enm sv emnwo = bH




 -1 
submitted by βˆ—nwinkelmann(343),
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I teerteiprdn the npeiatt to ahev CSOP mt,ihis(urs rarhm,aenoe ronaiva s)sma tuhogh eht pesur edaeevlt ntsseoerotet si meor ncoiercnng rof cner e(rp sthi rate:lci .:n///mpm0ccg/owhChMlw.p/l7vi/i90atn6ebiswr.tP.t6cs1n.) fI teh ietpnat hsa SC,PO she is ilkyle eobse dan at giehrh krsi rof NFLAD ihchw can eb ticaseaods ihwt veadtele llikaena esspotahhap, ldipi m,outucaalicn dan eeledtva trnoee,oestts tbu not EUD to cinaoregdn fsfetec "srem(u noagdenr svlele eewr nto csosiaedta hitw eht ecrseenp fo LNDA.F sTih si niyldcrtei nifomdrec tihw our eltsru on yno.shteepp leNy,am hetre is no nfifeerdce ni LFDNA eceerlapvn neeetbw negarocdepiy,nrh adn -arndrgycnehoipenon ro urpdvoerctei SCOP oepsntehpy. LANDF si nciordseed a ahtiecp cntmoepno of ctlimobea mdysnreo twhi a ntalecr hactepigno lroe fo nulinis siacetresn atht losa ftascfe the aypyviao-aot-aoihtitprnarlhum ixas ni csjtbsue wthi .C.OP.S cpaoieHdrryegnn ettsa may be edu ot islinun i.st"nesecra GKly/h./j:F/ytitWtp2b.)

ehT,n as adis yb l-,nbt@yc etalvdee teesnsootret in a femlea si tvdenrcoe ot oetsnreg dan oetrnes nad edfkabec isthinib eth mataloshhpuy gladien ot rcdedesea SFH adn LH lee,svl tub HFS si dinthiieb ,orem os heetr is an eaecndsir :HFLSH .torai

Fllayin, rigreadng PAS whc(hi esod urcoc in nowe,m owh k?ewn ,)oll eth ocretanlori eeewbnt steteertnsoo dan APS in nem is lslit teyrtp wkee ni( ihst ,ysudt terhe asw oyln a aoinleortrc adn a aekw eon at t,hta eatfr uvtritamaiel slasyain iujgtsdna for aesvler ithnsg 6iC//cwbnMn.34m5:/0slPaletvphsrthig0m.tocp/.w/n/ic5.w) so teher si yldiiefnet otn a cnielrotoar ni .wnmeo rvweH,eo rpe tihs tuysd (:bip.1m.hwn.m/owsc/tp90tvgl6duw4/nb/8i2.n/he) ereht mya eb an socaniasoit benetew rcaient nngeoasrd nt(o etrnsetseo)to nad PAS ni .eonwm




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