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NBME 23 Answers

nbme23/Block 4/Question#49 (28.8 difficulty score)
A 15-year-old boy is brought to the physician ...

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submitted by thomasalterman(147),
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eAsrnondg ausec c.aen eTrnsotsetoe si a trtbee serwan ntha ieroaAslotdndn /cb eth nseseoertTot is itacsodeas whti pter,uby donAanostildre si omer edsatoicas wthi eth drnlaae ad.gnsl

meningitis  I chose Testosterone but I almost chose GnRH because it is surged when starting puberty and therefore increases everything downstream. +10  
temmy  When answering the question, i thought to myself that if GnRH is correct, LH will be too cos GnRH stimulates the Leydig cells via LH to release testosterone. That left testosterone as the best answer because it had the most direct effect. +10  
goaiable  GnRH and LH are increased in a pulsatile fashion at the onset of puberty, so idk if that constitutes as the "rapid increase" that this question is asking for. Tripped me up also. +  
tallerthanmymom  I originally eliminated testosterone and chose androstanediol because women can have Acne Vulgaris too, and Testosterone should not be rising to the same degree. Do I not understand how puberty works? +1  
drzed  Women can still make testosterone though; and androstAnediOL is not the same as androstEnediONE +3  

submitted by almondbreeze(82),

Testosterone--> dihydrotestosterone (DHT)

DHT + early - differentiation of penis, scrotum, prostate + late - prostate growth balding, sebaceous gland activity