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NBME 22 Answers

nbme22/Block 4/Question#46 (59.7 difficulty score)
A 39-year-old woman comes to the physician ...

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submitted by johnthurtjr(139),
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'seehr a oeggol

johnthurtjr  FTR I had no idea this was a thing, and was pretty disappointed in myself when the google search had it in big bold letters right in my face. +3  
drdoom  via @johnthurtjr link: "Testosterone and other androgens have an erythropoietic stimulating effect that can cause polycythemia, which manifests as an increase in hemoglobin, hematocrit, or red blood cell count." +3  
meningitis  I guess that's another reason for steroids and doping up. +7  
drschmoctor  For once I feel like I've been led astray by Pathoma. My instinct was to go with hemoglobin, but I talked myself out of it after remembering Dr. Sattar saying that the reason why women have lower hemoglobin is due to menstruation. +2  
fexx  F U testosterone! and F U NBME 22 question +1  
schep  I only knew this because there are three (at least three, maybe more that I don't know) contraindications to giving testosterone replacement therapy: +OSA +prostate cancer +hematocrit >50% +2  
drdoom  ^ linkify @drdoom +  

submitted by oznefu(20),
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how od oyu rraown nowd htat ntettosoeres resniaced nmhbogleoi annon?ciettroc jstu a drmoan ftac to wnk?o i ptu ilkalaen tohpahsaspe cbaeeus i urdgeif eceaisrdn seseonorttet illw iaeesncr ebno hogwrt and ulder uot stifcpoeeiptarsc- geitann bc s’it a owmna.

hysitron  I guessed this one cause men have a higher hemoglobin than women. +10  
notadoctor  High levels of testosterone will result in amenorrhea. I guessed that since she's not menstruating she will not be losing blood and therefore hemoglobin. Therefore her hemoglobin levels will be higher than expected. +5  
meningitis  It kinda makes sense knowing testosterone causes catabolism so I was in between Alkaline phosphatase and hemoglobin... +1  
enbeemee  isn't testosterone anabolic? +4  
syoung07  ALK phosph is indicative of osteoclast activity. Testosterone keeps male bones strong just like estrogen does for women. Testosterone builds bone (osteoblast activity) therefore we would not see a rise in ALK phos +  

submitted by alexb(45),
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ristF Aid 9102 apeg 262 tryamoitlus torwhg ecetffs fo serontotseet iucdeln der odbol .llesc I tnkhi yeth eetcxp su ot kwon ith.s

medstudent  FA 2020 p. 636 +  

submitted by adong(94),

uworld says somewhere that testosterone increases hematocrit, increases LDL, and decreases HDL

passplease  Estrogen increases HDL. Testosterone is converted into estrogen. Why doesnt testosterone increase HDL. Why is my logic wrong? +  
avocadotoast  The woman in this vignette has an increased androgen:estrogen ratio, so the effects of testosterone on lipid levels will be greater than those of estrogen on lipid levels. Boards and beyond also states that testosterone causes an increase LDL, decreased HDL, and increase in hematocrit, which is why males with primary hypogonadism can present with anemia and the use of anabolic steroids can present with erythrocytosis. +  

submitted by sup(19),
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eSohomw I saw elba ot onnviecc yfslme thta eraescnid nsoeestrtoet ;-gt-& cdedearse rnseeogt ;t&g-- erddcease agnvteie cedkfeba no FHHS/L eiresntco gt-&;- ieracedsn HS.F Deso oynaen erac to inxleap why shti lcogi si rg?now nskTha ):

btl_nyc  The increased testosterone is metabolized by granulosa cells to estrogen and by adipose tissue into estrone. Both feed back on the hypothalamus to inhibit FSH & LH secretion, but FSH is much more sensitive to feedback inhibition than LH, causing an increased LH/FSH ratio. +1  
impostersyndromel1000  @sup, i did the same thing. Had no idea testosterone and androgens can increase epo +  

submitted by johnthurtjr(139),
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ser'he hawt I odnfu

submitted by rogeliogs(9),
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yM idmn ntwe hsit yaw: ni Men nsearAupod = lses eesnreototst = lsse eobn sdtnye i in eonmW rmoe etsontreoset = orme eonb tndesyi = oemr alelanki ahatosHosmple o.pgenbhi swa ym osdcen oopitn aseebcu I n'otd hera too cmuh btaou aaimne ni post unpmesaeo or tpos sordpeau,an utb ndosb idsynte si a big aled .etehr


submitted by gokings2021(3),

Men generally have a higher RBC mass (hematocrit, hemoglobin, etc) and it is thought to be attributed to higher testosterone levels. She has high testosterone so you can assume the same for her. This is in Zanki, so it must be in FA or Pathoma.

submitted by medstudent(11),

For all wondering why testosterone doesn’t cause an increase in alk phos, I found this article that basically says men with low testosterone have high alkaline phosphatase and weak bones.

submitted by asharm10(22),

It's an anabolic hormone, muscle mass, RBC mass will increase.

submitted by nwinkelmann(284),
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I itertnepedr het taentpi to veha SCPO us(,imtsirh m,eaarrneho vrniaao ms)sa houhtg eth spuer tledveea otetreotssne si oemr rcnneocgni for recn e(rp htis r:tcaiel wM/v.0otcnght/m6i.rit/w0mPc/bhn/plpC:.eal/w61sinc.7s9). fI het tneptia ahs OSCP, esh is kelyli soeeb dna ta rhgieh skir orf ANDLF hcihw nac be dasacteosi with deevltae eialnalk eaoaht,phssp lpdii ulctoimaa,cnu nad delvetae ere,tsenostot btu tno UED to igodrncean fsfetec u(re"sm oenarndg vlseel eerw nto saatsdeoci whti hte eeesrcpn fo DL.FAN ihsT is dnietylirc ficerdnom whit uor lrsteu no hpnseot.epy mNyea,l eehtr is no rcdfeniefe ni NDFLA epnlrvecae entbwee rcndeagohrnyeip, dna d-rnyoocgphanreienn ro roetcediurvp SCPO psop.yeenth NLFDA is dreiednocs a tpicahe ponemtcon fo aciteolmb dmyesnor whti a nectlra pthaecniog lore of linunis ncasesteir atht oals csteffa eht atoioa-uarhmpivptyya-atilnhro saix in utsbecsj ihwt .OCSP.. cipyrdnoanrgeHe ttaes amy be eud to nusilni nsra.seitec" p//lbtij2y:yKthtWG./F.)

eT,nh sa isad yb -@,cnlbyt eltdeeav nestsoteoter ni a flaeem si netodvcre ot engeorst adn rtseeon dna beacfdke iitihnsb het laohhysptamu neilgad to eersacedd HFS nad HL ,vlslee btu HFS is ieditnibh eom,r os rtehe is na ncradisee :LHFHS oti.ra

Fly,ilna gnidgerar SPA hciw(h odes ucrco in weo,nm woh w?enk ,l)ol eth canreorotil etebnew sstreoontete nda APS ni men si sltli etpyrt ewek n(i stih ,uysdt ether saw nylo a notrclriaeo dan a keaw one at aht,t afret uaetiamlitrv nlsysaai jgsntadui fro rleseav gishnt rlnc:Mi.6btaeh5/tniw// so hrete is tiynilfdee ont a rcleootarin in nm.ewo eveoHw,r rep shit sdytu (n.t48twc0v1ow6g2nipb.l/i.m/se9/:npmu/.bdw/hh) treeh aym be an tiisasnocoa nbewete arintce ganeosnrd nt(o ttor)eeseostn dna SAP ni oewmn.

submitted by medguru2295(33),

TBH I only got this bc of the controversy with Lance Armstrong blood doping. IDk the mechanism at all. But, it will help you all remember this question/answer.

submitted by yobo13(2),
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aEsy yw:a Lba esauv.l Teh yonl noe that mdae wsseae/ns fereifntd rof enm vs monew = Hb