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NBME 21 Answers

nbme21/Block 4/Question#20 (reveal difficulty score)
A 7-month-old boy is brought to the physician ...
46,XY πŸ” / πŸ“Ί / 🌳

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CCD needremmodc ttaetrnem of osssmticoah minaons si i.zarnqpaeutl

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hsiT idoev ilsepanx eaitgln lybooemryg lymeerxte ll.ew

fI yuo tlef lyoaltt tslo ilek em, whatc eht idoev trifs ta ,x2 nhet kcceh tuo eht tmtobo gruefi on pg. 068 ni FA 91.02

Rtevlean to htsi quio:esnt

  1. SRY rntepios imtualets movpedeenlt fo esetst
  2. Tihs pt ash stsete tg;&= eh tusm heva teh YRS geen no hte Y choesormom
  3. MFI egdresda hte llaMruine t,ucd hcwhi lwdou roiehsetw eocmbe het ailnernt aelefm iaaengtli
  4. shiT tp ash tnnielar meefla gltieiana g;=t& ntdi'd aekm gnehou MIF

uQzi euyflosr (nswsear in a aeerpsat )spo:t

  1. sTih pieasn'tt idrodrse cna eb cedtra abck ot whchi scl?le
  2. sihT eaitptn dha nalrom i.aealntig If hsti titnpea dah melalrs laetngaii nath rnola,m that wdlou be a tefcde in tahw ezmye?n
ergogenic22  I like to work backwards. 1) patient has normal testicles on histology, normal appearing penis this must mean a Y chromosome is present, as testis determining factor is on the y chromosome (see above post point #2). I.e. you can eliminate choice A and B. Theoretically, 47XY and 47XYY could also present with female genitalia due to lack of MIF, but normal 46XY is more common +13  

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iquz ryeuofls :asrnwse

  1. Sreloti r(Stelio uhtSs dwon, MIF si scdertee by oetSirl cles)l
  2. l-5haap dstaeceur
lovebug  5-alpha reductase is due te that DHT is important for male external genitalia? +  

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iths si a scicals rsoeiincptd fo ttriepsnes iaMunrell cudt rmsnoyed


deu to clak fo IFM nm(toatiu ni the eeng ahtt smaek MFI) β†’ siseepnrcet of hte ulaeiMrnl cudt β†’ ruutse dna ailaflopn bute tnsepre in a YX lmea /w etsset llcty(iypa )dochrp.tycir

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seBueca ihs lettsisec aer ,ndnesuedced hsi eisrtlo lclse rae loabrpby tno nokwrig pper,olyr nda otefheerr not synheisntgiz FIM l.ccetrryo chihW is hwy ish nrnteali fmeale analtigei si elodwal to leeeopvd ni a dfaletu tt.segni

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'Im nhnikitg sthi is ceerseadd vesell of rteulnMiailna- eo?mhron ihTs is wath lluyaus shitibin het ppecaiarmshreno tucd mlitu(ltaye eopvldse inot nnitrael femela eaiagtiln) in sela.m A iaepntt anc be YX nad ilstl veha sedraedec

gabstep  FA 2019 pg 608 +  

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diodAnti ot sn'bgoHyxru x:nenaaoitpl

hWy s'ti ont X:X4,Y7

Thsi udwlo eb fgrrrneie ot Klnseierl',eft hihcw is irdcaheczerta yb m,alls poolry nuticingfon ssilectet.

vowHere, uoietnqs sseatt ooimhcogr"pl tsusdie fo a spbiyo cispenme of het esttse wosh no aiielnb"astrmo

readit  More specifically, in Klinefelter's, you would see "hyaline seminiferous tubules/sertoli cells" on histology +3  
pg32  Thanks! Where did you get the histologic description from? +1  

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