NBME 20 Ovaries (NBME Answers)

Retired NBME 20 Answers

nbme20/Block 2/Question#43 (reveal difficulty score)
An 18-year-old woman comes to the physician ...
Ovaries 🔍 / 📺 / 🌳 / 📖
tags: repro

+6 upvote downvote
submitted by ∗step420(32)

get full access to all content ⋅ pick a username

This is mullerian agenesis. Normal ovaries but absent uterus.

get full access to all content ⋅ pick a username

endochondral why not androgen insensitivity? +

shaeking I was wondering the same thing because doesn't androgen insensitivity also have normal female secondary characteristics. Was it the levels of hormones because she doesn't have abnormally high testosterone? +3

swb Androgen insensitivity has the same presentation and symptoms. What's the clue that it is mullerian agenesis instead ? +27

sugaplum Testosterone would be high if it was androgen insensitivity FA 2019 Pg 625 +22

charcot_bouchard Testo would be high in AIS. in AIS pubic hair, axillary hair doesnt devlop because of androgen insensitivity. both have normal breast dev and primary amenorrhea +2

dickass This is not androgen insensitivity because she has perfectly normal Estradiol, which means she has perfectly normal ovaries. She also has regular female levels of testosterone. +5

rockodude thank you @dickass +1

j44n Also AIS has paradoxically large boobs-> tanner stage 5 and thats not mentioned anywhere +

fatboyslim Androgen insensitivity syndrome will have high testosterone because the testosterone receptor isn't functional, therefore the body is like what the heck and starts dumping more testosterone trying to make them a male but it doesn't work unfortunately +

+5 upvote downvote
submitted by ∗sympathetikey(1600)

get full access to all content ⋅ pick a username

Mullerian Agenesis (aka: Mayer-Rokitansky-Kuster-Hauser Syndrome)

Underdevelopment of the Mullerian system leading to congential absence of the vagina. Usually no cervix or uterus.

May present as 1° amenorrhea (due to a lack of uterine development) in females with fully developed 2° sexual characteristics. Functional ovaries allow for normal sexual characteristics and hormone levels.

get full access to all content ⋅ pick a username

+2 upvote downvote
submitted by ∗temmy(153)

get full access to all content ⋅ pick a username

i think it is not androgen insensitivity because the testosterone levels are normal. They should be high in AIS.

get full access to all content ⋅ pick a username

+1 upvote downvote
submitted by ∗imgdoc(183)

get full access to all content ⋅ pick a username

I know it's tempting to think that this may be Androgen insensitivity syndrome but its not, for it to be AIS there needed to be an increase in testosterone. In this case it was in the normal range for a female. Now that we know the person is definitely female -> Mullerian agenesis becomes the best answer.

get full access to all content ⋅ pick a username

+1 upvote downvote
submitted by ∗topgunber(68)

get full access to all content ⋅ pick a username

Rokitansky Kuser Hauser syndrome.

Hormones are normal as well as gonads.

INTERNAL GENITALIA are malformed (mainly uterus/tubes). Uterus can also be unicornate or there can be didelphysis or whatever that word is. though you don't need to know that long name by heart it helps with speed. Understand: Hormone profile is normal. If this patient had testes, the testosterone and estrogen would likely be opposite.

get full access to all content ⋅ pick a username

topgunber right theres a mayer somewhere in that disease name... ffs +1

Must-See Comments from nbme20

amorah on Cytomegalovirus infection
masonkingcobra on Contact with parakeets
hayayah on Capillary hydrostatic: increased; ...
hayayah on X chromosome-linked isoenzymes
medbitch94 on Mannose 6-phosphate
hello on Capillary hydrostatic: increased; ...
hayayah on Osteoblasts
imgdoc on Hypophosphatemia
hayayah on Missense
celeste on 50%
justgettinby on Omeprazole
andrewk1 on Cold, dry air
yotsubato on Jugular venous pressure of 12 mm Hg
strugglebus on Drug effect