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NBME 21 Answers

nbme21/Block 2/Question#20 (50.6 difficulty score)
A 14-year-old girl is brought to the ...
Trichotillomania🔍
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Teh suecl rof itihtoamraonlilc eerw eht etdah of her adhtgremnro nlddeuys, nsice tacriilolhnimota is etnfo tdusdir.essnce- I slao rnodarew ti wdno yb ti aygsni eht hari was ni efrdnfiet trgwoh gtssea in het atphcy aesar, hwhci skmae essen if sehs’ guciplkn them uto ta frdnftiee emi.st

geonleT fuulfmevi si smto monmoc ni dd-adglmiee ,mnweo so hes do’ents tif eth eiolfrp u(bt ’ureoy htrig atoub it gnbei sucead by tr.sse)s

zpatel  What about telogen effluvium? psychological stress-related hair loss. +1  
elephantbuddy  Just to add on, telogen effluvium is usually due to physical stressors such as surgery, pregnancy, serious illnesses, or severe/life-threatening psychological stress. So although this patient is going through psychological stress, it's not exactly life-threatening enough to result in hair loss unless personally inflicted. I think the question stem also kind of hints at trichotillomania with her doing more things to her hair. But this article is pretty useful in distinguishing between different causes of hair loss: https://www.aafp.org/afp/2003/0701/p93.html#sec-4 +  



 +1 
submitted by egghead(1),
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Tish is eno of eshto sqostiune I swa enver ggion to .get sIt' ont ni A,F I 'ntod ihnkt 'eIv nese it ni .sacls

hungrybox  same :( +  
masonkingcobra  My issue was the stem said no skin damage (I would think pulling out your hair damages your scalp) [Turns out it does not](http://onlinelibrary.wiley.com/doi/full/10.1111/j.1529-8019.2008.00165.x) +  
gh889  FA 2019, pg 551 +8  
meningitis  Compulsively pulling out one’s own hair. Causes significant distress and persists despite attempts to stop. Presents with areas of thinning hair or baldness on any area of the body, most commonly the scalp. Incidence highest in childhood but spans all ages. Treatment: psychotherapy is first line; medications (eg, clomipramine) may be considered. +13  
step1soon  FA 2019 pg 551 +1  
teepot123  damn its in FA and Ive never ocne read it XO +  



 +1 
submitted by usmlelol(4),
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