United States Medical Licensing Examination (USMLE) is a professional examination taken by a physician to assess his knowledge and skills in handling a safe and effective patient care.
USMLE is composed of three parts:
Step 1 Integrated Exam
Step 2 (CK) Clinical Knowledge
Step 2 (CS) Clinical Skills
Step 3 Specifications
Gynecomastia is one of the medical conditions that should be part of an examinee’s USMLE review.
Here are some of the questions associated with the condition:
1. Definition and Causes
This medical condition is defined as enlargement of the glandular part of the male breast. Two of the causes of this condition are liver failure and toxic reaction to drugs such as spironolactone and cimetidine.
Some medical students use mnemonic to memorize causes of this condition: SACKED (Spironolactone, Alcohol, Cimetidine, Ketocanazole, Estrogen and Digitalis).
2. Dopamine antagonists’ effects
It should be noted that gynecomastia is also an effect of dopamine antagonists.
3. Association to chronic liver disease
One of the signs of chronic liver disease is enlargement of male’s breast. However, there should also be other signs that go with it before you can diagnose chronic liver disease. Some of these signs include ascites, varices, palmar erethyma, and testicular atrophy.
In Step 3 of USMLE, there will be case scenarios where physicians are asked to make a diagnosis on the patient. One of the classic examples of this is trying to determine a patient’s case.
For example, a patient with normal electrolytes, no infection and hypoxia, yet has not taken any medication and corticosteroids started to get delirious 24 hours after surgery. Knowing the signs of chronic liver disease will help you determine whether the patient is suffering from alcohol withdrawal.
4. Alcoholism
Alcohol abuse is one of the reasons why male adults aged 50 years and up suffer from breast enlargement. If a man has been drinking alcohol for several years, it will eventually cause his liver to fail resulting in enlargement of breast.
5. Leydig Tumor
Another condition associated with gynecomastia is Leydig cell tumor which is considered typical for adolescents. If there is a question in USMLE regarding breast enlargement in teens, this should be considered normal. These cell tumors secrete hormones causing early signs of puberty for young people.
6. Low HCG (Human Chorionic Gonadotropin)
In USMLE Step 3 exam, there might be a question asking for a diagnostic test. Say there is a man who already has three kids but for the past 6 months, he started to notice progressive enlargement of his breast. He does not take any recreational drugs or any other medication. However, you noticed that his LH and testosterone levels are low. What should be your proper diagnostic test on this?
Remember that when there is low LH and testosterone levels, HCG and estrogen production must be high. HCG should be measured to ensure that the ratio between testosterone and estrogen is high. It should be noted that increased estrogen can indeed cause the patient’s breast to grow in size.
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