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NBME 21 Answers

nbme21/Block 1/Question#6 (reveal difficulty score)
A normal-appearing 17-year-old girl has never ...
Androgen insensitivity syndrome 🔍 / 📺 / 🌳
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 +26 
submitted by lsmarshall(445),
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gtoznMooicy icaeitnl(d)"" wsnti hvea 0%5 of enttigg iehphscinozra if ietrh tnwi ash .it gDtiyociz swnti heva ~ %20 nehacc tgouh.h shiT si tfnoe dmetnonie henw aciSzhieorphn yotgleoi is ciussedsd ..(,ie we ont'd wnko btu aerocncnodc uitedss eusgstg a egteinc l)k.in DT1M hsa lses of a nteecig nkli tahn DT2M but it soal hsa 5%0 crococnedan eewntbe oznocoiymtg ntis.w shTi caft si idoeenntm ni triFs iAd ,2910 gape .63.4. I got tihs EMNB tiesonuq rngow but 'sti nonettc si in bdora .rscuose


 +17 
submitted by ergogenic22(378),
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hmnorctai eeatnvgi = on brar sbiode = noreps twhi XY ygeenotp ro XO ceasube ytenaim ouy evha mero nhta one X moescroohm oyu vhae a abrr bdoy chnroati(m ei)otisvp




 +5 
submitted by basic_pathology(14),
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Cohantimr eivgetan = on rabr ydo.b odClu ccoru ni rreuTn XO() ro aeml )Y(.X

enrrTu X:(O)

  • etasrk oavysr
  • yoka llenmairu tursstcure tm(os fo eht e)mti
  • oyak faemel enaetxrl naigaelti

gerndnAo etsiniivIstyn rnSeyodm (Y:X)

  • odbiamlna steets
  • no illnarmue crrsusettu (YSR geen tg;--& itseTs -&;gt- tSilroe leslc -g;&-t HIM) = Binld oucPh
  • ealefm eenaxtrl elganitai (on D/sTtTHe galinnl)sgi



 +4 
submitted by hyperfukus(103),
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olsA ehtrnoa eyk si it sasy rlomna eiaprpagn rlgi one of het ngtsih oubat eht ISA si atht eyht do tge crsndeoya eaxusl ria.r.scncuhar.sttirecte lrsig t'odn olok moarnl y'ehdt be sthro dna bsutby on oobsb tfa cekn etc

covid2019  I'm confused that they said she appeared "normal". I thought AIS would mean the patient has very scant pubic hair / underarm hair. Wouldn't this be abnormal in a 17 year old? Should have Tanner stage 5 hair.... +2  
mumenrider4ever  FA2020 (pg. 639) describes AIS as "Defect in androgen receptor resulting in normal-appearing female (46,XY DSD)" so I assume they're talking about general outwards appearance +2  
lola915  You do get breasts because patient has build up of testosterone that is aromatized into estrogen. No axillary or pubic hair because that requires testosterone. +1  
lovebug  THX. SEE AIS (FA19 pg,625) +1  



 +1 
submitted by nerdy nik(9),
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euTrnr o;®nmdyt-s ehT rilg wduol veah a sturue dna rtesak evaisr.o




 +1 
submitted by soph(78),
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all teh htore pionots tp uoldw heav e,truus rsei.aov nsrtreu yhte wodltun oolk orlmna dan teyh owdul haev hpctaoir raiesvo.

turtlepenlight  This makes sense, but I was thrown off by the "normal-appearing" b/c wouldn't AIS pts not have pubic hair? +1  
drzed  They just say it's a normal appearing 17 year old girl; not that the external genitalia are normal appearing. +2  
teepot123  fa 19 pg 625 +1  
macroorchidism  Yeah the "normal" look was referring strictly to appearance (body + genitalia) not secondary characteristics. I was also between AIS and Turner (because I didn't know chromatin-negative meant at the time), so another thing that helped me was I recently found that Turner syndrome patients are actually NOT completely infertile (they have like a 2% chance to fertilize). That helps me remember the internal female structures are there, I just picture them more as "empty." +1  



 -12 
submitted by nosancuck(93),
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oY ids B tgo ON LRANNEIT ALFMEE GNRAOS

hWy !t?a?d?

eW be olkoin at noeseom hwti an RYS omrf rdee Y cDy !hroeiem eb a Y rhicoem iemoH os yhet be nkiam semo Tsties imteeinrnD toraFc ichhw I eb seur kaems esom iecn lil ATNI NLERIALUM FCOTRA so dye tian tgo htta eelFma nInatlre tacTr u nkow athw i eb aniys

dAn iencs iiznmwm si da LUFEADT ehty ilts eb eigntt sdeo suysp sipl nda tresbase

meningitis  The above explanation is correct (disregarding the hard to read and unprofessional dialect) but just in case anyone was wondering: chromatin-negative= Just a quick way of knowing it was a boy. The term applies to the nuclei of cells in normal males as well as those in individuals with certain chromosomal abnormalities +17  
yotsubato  Turner syndrome patients are also chromatin negative as well though.... +6  
sympathetikey  I didn't know a complication post-meningitis was lack of humor. +6  
sympathetikey  Ah, didn't read the last line. Yeah, that is taking it a bit far +32  
niboonsh  yall are haters. this is the first explanation that has ever made sense to me +7  
arkmoses  https://www.youtube.com/watch?v=yuXL-3eoB-o&t=77s Interesting syndrome watching this helped me to put it into real life perspective, interesting points they have no pubic hair/body hair, they apparently also dont smell, and breast size is usually increased... +2  
whoissaad  How does chormatin-negative indicate a normal cell? Isn't chormatin just condensed DNA? +2  
cienfuegos  According to this paper most individuals with Turner Syndrome are chromatin negative: "One of the initial laboratory procedures used to confirm or rule out this diagnosis involves a sex chromatin determination from a buccal smear. Cells from the lining of the mouth are stained for the presence or absence of X-chromatin or Barr bodies, which represent a portion of an inactivated X chromosome. The typical Turner’s syndrome patient, who has 45 chromosomes and only one sex chromosome (an X), has no Barr bodies and is, therefore, X-chromatin negative. This abnormal X-chromatin negative finding in the majority of Turner’s syndrome females is similar to the result found in a normal male, who also has only one X chromosome, and differs from the X-chromatin positive condition observed in the normal female, who has two X chromosomes. Occasionally, the patient with features of Turner’s syndrome is found to be X-chromatin positive." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233891/ +2  
hyperfukus  i really hate haters this is awesome! +2  
selectuw  to add to the above, free testosterone is aromatized to estrogen leading to breast development +1  
misrao  Is the free testosterone not creating male internal or external gentalia because of the defect in androgen receptors? +1  



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