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NBME 24 Answers

nbme24/Block 2/Question#49 (37.9 difficulty score)
A 17-year-old girl comes to the physician ...
Increased serum testosterone concentration🔍

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 +54  upvote downvote
submitted by seagull(1080),
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ta MIB 51 ont lnyo has she nreve had a prodei utb hse evenr had a .meal

sympathetikey  You're on fire man lol +  
monkey  How the fuck is it not related to anorexia nervosa is beyond me. +2  

 +27  upvote downvote
submitted by lsmarshall(345),
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rAndegno tnsseIitvinyi demonSyr - eeDfct ni ognaerdn rcoeterp seitrulgn in prnoamnle-apiarg fmleea X6,(Y4 )SD.D gFintncnuio etstse esscua ndaecesir ottstseeneor at yb,tuerp cihhw si odvtrnece ot serngoet aeirheplrpyl, nvgiig lafmee dyasnreoc usxela eicihscctasrtra a(lmfee aeretlxn engailiat). caLk of dngreoan ecroprte foiunctn ldase ot asebtn or stcan rlxaliay nda bpcui raih. Peatsnit heav unrateyrmid ,ivgaan tub rutseu nad apinlaolf eusbt bte.asn

Aordegnn viietysinsnit ydnsoerm is eth narews btu oyu tgmih eavh cddseeroni ilnMülera esgneisa -rMksR-oyatkyin(ae r-eesusüKHrat )meyodnr.s

lrulManei issgneae wlli evah ramonl noomehr evlsel nda yma nestrpe as 1° aenrmorhae d(ue to a lack fo treeiun enotmvede)lp ni efalmse twhi lluyf evopededl 2° auxsel aeitsrcrsitahcc cao(ufltnin voeri)as. Hair eovdptmeenl is nomlra sa wlel. seinaPtt sola heav orlnam .hteihg

semeS ielk thsi eutqiosn idd not evgi us hucm ot inuhtsigdsi eesdsbi higeht nad nnaret tesag 1 liyripc/abxlau ihra.

dbg  100% agreed. Mullerian agenesis was on my mind too. The full breast development kept me fixed at this dx. Did not think how high testosterone at this age and insensitivity would push towards peripheral conversion to estrogen and hence breast development. Thanks. +  

Androgen insensitivity syndrome

Defect in androgen receptor resulting in normal-appearing female (46,XY DSD); female external genitalia with scant axillary and pubic hair, rudimentary vagina; uterus and fallopian tubes absent due to persistence of anti-Müllerian hormone from testes.

Patients develop normal functioning testes (often found in labia majora; surgically removed to prevent malignancy). High testosterone, estrogen, LH (vs sex chromosome disorders).

Paramesonephric (Müllerian) duct develops into female internal structures— fallopian tubes, uterus, upper portion of vagina (lower portion from urogenital sinus). Male remnant is appendix testis.

Müllerian agenesis (Mayer-Rokitansky- Küster-Hauser syndrome)—may present as 1° amenorrhea (due to a lack of uterine development) in females with fully developed 2° sexual characteristics (functional ovaries).