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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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'hrees a gegool

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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owh od you rarnwo ownd taht oeotrssteten neriadces mhnoielgob cnnceartio?otn sujt a nrmaod actf ot ?wkno i tpu lakniale sphasatpoeh suaebce i ugifder srecinaed oeoesstenrtt iwll nresecia boen hwotrg adn ldeur out -ftcceepsisptiaro agnneti cb sit’ a maon.w

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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tFsir Aid 9102 gape 226 saolyrimutt hortgw tfeefsc of eseonrttseot uieclnd rde lbdoo el.lsc I hinkt hety tepxce us ot nowk

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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ohoeSwm I aws beal ot eccninvo esmfly that arnedicse ntrteessoote t-&g-; reedesdac grtsnoee >-;- dcdeeaesr etaengvi bdackefe no /FHHSL oieenrstc &--gt; aeirdncse SHF. sDoe oaenny erac to ealpxin why this glico si o?ngrw hsnkaT :)

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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re'hes hatw I udofn

submitted by rogeliogs(9),
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My mdin enwt hist :awy in enM sdrunAepao = less ssrottetneoe = elss enbo eisy dtn ni Wnome omer tosotsertene = eomr neob dnesiyt = erom alnkaeli m agloehshppae.tHnobsoi saw my sdocne nioopt uesecba I t'ndo reha too hmuc aotub neiama in otps aepsuonem or psot ps,aeuoradn tub bdons eitsndy is a igb dlea reht.e


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 entpditeerr the aetnitp ot haev SOCP ,uitirhs(ms eharnamo,er oraianv asm)s hguhto hte espru deevtela rtoeteossent si eorm gnocneinrc orf ecnr r(pe siht rt:ileac a0i7n.slp6t0gln/tcw6w//9./rwCp1//besnhmMomPcv:it.c.hi.) fI hte antpeti sha PSCO, she si kyllei seeob adn at egihhr ikrs orf DNALF hicwh anc eb csisdoaate htiw eleadvte anialkle aohp,tpsehas lidpi aucnulcaitm,o adn eldaveet ,reonsesotett btu not DUE ot ogaencdrin ecsftfe mer"s(u dngeraon velesl eewr ont oaeascisdt tiwh eth eecsnrep fo NFAD.L Tshi is rdnilcyite nmdeficro whti uro estlur no ohyneept.sp amNeyl, ereth is no rfifenedec ni LNADF envpaeerlc eewtben oee,ncpdgniyrhra dan paorrnneoyc-eihngdn or erdtrcioeupv SPOC hseeypo.ntp FANLD si scdoreedin a hpatcie tmnonopec fo cloimtbea neymrdos thwi a rclanet aocheptnig elro fo nsliinu cnitrsesea ttah oals tfcefas het oitioyahthupnrvair-ymptaal-oa ixsa ni jcseusbt htiw S...OCP creoyneagpHridn eastt amy eb edu to uilnnis s"te.incersa iyFltGpjb2t/

n,The as dasi by ,ctb@ny-l dteeevla enerottsotse in a aflmee is vrodcenet ot etsgoern nad enteosr adn akeecbfd tiinbsih eht lpahoamytshu ldaigne ot dederscea HFS dan LH s,lelve but FSH si bdetnhiii ,roem so etrhe is na cnsdeeari SLFH:H aoti.r

,liylanF gnrdgeira ASP hh(ciw edso urocc ni omwn,e ohw ?knwe l,l)o eht rcntoilaeor eewebtn rntseteeotos dan SPA in nem is lstli yptret eewk ni( isth dtusy, reeht asw lyon a iertarcolon and a keaw eno ta ,ahtt tfear virltuitamea saysanil undstajgi fro esaverl thigns alit5whr.i.n/4.swnwm/:nvtMm56gc0c/P/ptlieoh3pC//0bs.c) so trhee si ilyifteend ont a clrronaeoit ni o.enmw Hewo,evr per tsih uydts (itu2b6mwnb1/ ethre mya eb an niaotasicso etenweb neartci ngsaondre (not erstoten)eots nad ASP ni .wenmo

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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Esay ywa: baL .euvals ehT lnoy noe hatt edam snwssae/e erfeitdfn fro emn sv mnoew = Hb