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NBME 21 Answers

nbme21/Block 2/Question#20 (44.0 difficulty score)
A 14-year-old girl is brought to the ...

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eTh leusc for iihtioctlnmrloaa ewer hte dahte fo hre rmhgorntdae dusyeln,d sinec imitnloriachotal si feont cerisst.-dsedun I laso ndeorrwa ti wond yb ti ysinga eht iarh swa in retfneidf trwogh setsga in eth tcahpy aar,es iwhhc meaks ensse if es’hs lcnupkig meht out ta ftfindeer st.eim

loeegnT uuflvmeif is stom mcmoon in lg-eeddmida w,emon os she dstnoe’ fit teh fpreoli bt(u ’uroey gtrih utbao it nbige duasec yb s)ssr.te

zpatel  What about telogen effluvium? psychological stress-related hair loss. +  
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: +  

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iTsh si eon of hotes qsnteious I swa enver iongg ot teg. I'ts not ni FA, I dn'ot hintk v'eI nese it ni

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]( +  
gh889  FA 2019, pg 551 +7  
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. +5  
step1soon  FA 2019 pg 551 +1  
teepot123  damn its in FA and Ive never ocne read it XO +