USMLE Official 2017 Step 1 Experiences and Scores Thread

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WeedForLunch

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I know this is quite early but most American Students have finished giving the test for this year.
I am an IMG and have been prepping for the steps since quite some time and have seen Phloston, Transposony's and others' threads for their respective years and how helpful they have been.

I intend on giving step in Jan.. let's share timetables, plans and other stuff on how everyone intends on taking on this beast.

P.S. : I think it is not that early.. the 2015/2016 threads were started in September/October.. but in true SDN gunner style..i wanna start it in August.. :)

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What's up guys... Just took NBME 19. I thought the question stems were insanely short, like half of the test was one line questions. Also I felt like the questions were pretty straight forward. It seems like questions on the real deal are much longer and more convoluted from what Ive been hearing. Anyone want to compare NBME 19 and the real thing (question length/difficulty wise)?
i felt they were short for the most part but i also noticed there were alot of knee jerk questions that i had to catch myself on. Some question for me were to close to call, and lastly bio stats. I got everysingle question wrong. Any one got tips for biostats ?
 
i felt they were short for the most part but i also noticed there were alot of knee jerk questions that i had to catch myself on. Some question for me were to close to call, and lastly bio stats. I got everysingle question wrong. Any one got tips for biostats ?
B&B. And YouTube "biostatistics Summary Step1 --The Basics" by Randy Neil. Doing this in one night made me get 85%+ on UW questions over Biostats. I plan to do it again this upcoming Thursday.
 
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B&B. And YouTube "biostatistics Summary Step1 --The Basics" by Randy Neil. Doing this in one night made me get 85%+ on UW questions over Biostats. I plan to do it again this upcoming Thursday.
thank you, i appreciate it. Idk why but im really struggling at it. i tried doing the uworld biostats but i feel like i memeorize some of them
 
Great score. My practice scores are pretty darn close to yours so I'd be ecstatic with a 255.
Thanks! Mindset was the biggest issue for me. If I didn't feel 100% focused, or if I expected to do well on the practice test, I did worse. A lot of the wrong answers I picked were careless mistakes like failing to read a word or erratically changing an answer from right to wrong without data or reading too much into one word after picking the correct answer. This was the main source of variation in my scores, in my opinion, so if you can lock down anything like that, you know what you have to do before and on test day.

How did you improve 19 points in one week from nbme 15 to 16 : O
In my above reply, I mentioned careless mistakes from overconfidence. When reviewing 15 with a friend, it was question after question where I read too much into one word or thought I found a trick in the question to change from my original correct answer to a wrong one (NBME isn't trying to trick you in virtually all cases). I think it was artificially depressed (I had done a CBSE for my school and gotten a 230 without any prep and that was before 2nd year ended), but it could have just been my 2nd week of UWorld with a bit of review in my most deficient areas (biochem and embryo). The first week or so helped refresh a lot of ideas I "knew" but hadn't seen in a while. In summary, I would probably say: recognizing how my mindset affects my performance-- if I didn't respect the test I would lose big time, using UWorld to refresh, and visiting a couple areas I never learned well.

How many points did it differ between your other nbme scores if you don't me asking? Just trying to get an idea of the curve. It seems about a 20 point difference for most?
When I got 255 on NBME 16 and 257 on NBME 18, I had missed 16 and 14 questions (I think that's respective to each form). NBME 19 I missed 20 questions and got a 238. The percent correct didn't vary much, and in absolute terms, there was no greater than a 6 question difference for about a 20 point drop on form 18 to 19. I think it's good for practice, but it helped my confidence that I did the free 120 and UWSA2 between NBME 19 and test day. That's not to say I wasn't unsure about my performance afterwards, though.
 
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gonna do that now. Every time someone drops a nbme number , i feel people are fighting the androids from Dragon ball Z :laugh:
He seems to have decent videos overall, but he does botch a few things like p-value and conflates a correlation coefficient and a slope (his "best answer" of -1 correlation isn't right, since the points don't fall perfectly on the line-- it should be -0.2, and a correlation only tells you how tight the points are to a line and what direction they generally go...slope is change in Y for change in X), if I recall.
 
Does anyone know what type of questions fall into the "Physician Task (PBL): Evidence-based Medicine" category on NBME assessments? My performance profile on my last two NBME's have been low in this area and I'm wondering how to strengthen it.
 
I would do it! Just to get exposure because people have said that similar questions show up on the real thing from the exam yes your ego might take a hit but that's why you do the easy one last uwsa2


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We'll see how I do on time. But my general confidence on exams is important for my overall performance. Not completely ruling it out but we'll see.


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Does anyone know what type of questions fall into the "Physician Task (PBL): Evidence-based Medicine" category on NBME assessments? My performance profile on my last two NBME's have been low in this area and I'm wondering how to strengthen it.

Next order management; more logical type of questions.


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So I have read that they have Gibb's free energy on the exam?! All i know is the whole negative delta G=spontaneous.

Anyone else hear anything about this?
 
So I have read that they have Gibb's free energy on the exam?! All i know is the whole negative delta G=spontaneous.

Anyone else hear anything about this?
Oh man I hope! Bring out my Chemistry degree! It's basically just another way of asking which direction the reaction will go..
 
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studying endocrine today so I'm going to be asking some questions because I'm desperate for quick explanations.

Why does cortisol cause hirsutism? I get that cortisol decreases GnRH which decreases FSH and LH but my thought was that low FSH and low LH would decrease androgens. Is it because the androgens that remain are so low that they can only undergo one step (conversion to androgen) and not two (androgens to estrogens)?

Why does low cortisol cause postural hypotension? This has me confused. It also causes abdominal pain and diarrhea, so does cortisol have some type of muscarinic effects or something?

Not sure about hirsutism, the first correlation I could see would be due to increased ACTH levels having agonist effects at the reticularis in addition to the fasciculata. As for increased Cortisol specifically, I haven't reviewed it in a while so I'm not exactly sure why it would.

The second question is because of the effects of cortisol on a-1 receptors. Pretty sure it increases a1 receptor density on arterioles.
 
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Just took it

Will share score when it comes out. I didn't have a survey at the end. I just had a screen saying I was done but that doesn't guarantee I finished all sections (I answered every question, so I guess that's just a standardized message). Goal score is 250. I can live with anything 230+.


Practice Scores
U World Average 71% timed random while I was doing organ systems. One week after finishing organ systems, I did last 16 blocks and averaged 75%.

(All taken before studying)
CBSA 190
NBME 13 180
UWSA 180

(2 weeks into hardcore studying)
UWSA 236

(Taken while going through organ systems)
NBME 15 236
NBME 16 232
NBME 17 222
NBME 18 236

(After reviewing all organ systems)
NBME 19 244
Free 117 85%

What I did
Study time: 10 weeks about 8-10 hours a day (took some time out of school's normal curriculum to begin early and lowered my grades a bit for the last module)
U World 1.5X (I did my incorrects and marks after my first run through on tutor mood)
First Aid 2X
Pathoma 2X
Goljan 1X
DIT (About 70% and coupled it with first aid, since I lack the discipline to sit there and read)
Kaplan 70% completion (mostly done through med school)
USMLE RX 70% completion (along with First Aid and DIT to hammer first aid)

Test Experience
Some blocks were easy and felt like NBME 18 and 19. Some blocks were about the difficulty level of U World. It felt like recall questions with weird organisms or drugs as the correct answer were all purposely designed so that someone who knew all the high yield information could effectively eliminate all of the other choices. The most difficult questions had to do with pathogenesis. It was a lot of "can you figure out the most reasonable explanation/mechanism for this common medical phenomena." The physiology was easier than both Kaplan and U World. The pathophysiology was on the same level. I'm generally a good standardized test taker and fast reader, so, when practicing, timing was never an issue. On the actual exam, the easy blocks took me about 40-50 minutes and left me a good amount of time for double checking. However, I needed almost all the time just to get through the tougher blocks. The people at my test center were super slow at signing people in after breaks. I lost a bit of time on my last block. I still managed to finished, but it wasn't a good feeling to see those red digits wind down as I frantically clicked the bubble for my last answer.

I definitely made some really dumb mistakes here and there, especially in the later blocks. Test fatigue is very real. I practiced taking 8 blocks a day on more than a few occasions. However, the pressure and multistep questions on the real deal really do wear you down. By the last three blocks, I started to be less thorough with my reading of questions. But I'm not really going to beat myself up over this because I think test fatigue affects almost everyone and almost everyone makes a few dumb errors they wouldn't normally make due to it.

How I would study differently?
Specifically for STEP 1, I wouldn't study differently at all. I can distinctly remember questions on my exam that I only knew because of a combination of one or two of the resources listed above.

How I would study differently in med school to be in a better position at the beginning of my dedicated study period?
READ more. The exam tests if you know the mechanisms behind disease. All of the rote facts can be readily memorized in a few weeks. It's hard to gain a good background in pathology in that time period. Reading Robbins during your actual coursework is golden. If you had lecture based exams that asked nit picky details off of slides like at my school, time spent reading might take away a bit from grades on exams. However, I think sacrificing your grades a bit to read the right resources more is worth it for two reasons: #1 you gain a broader background and framework to actually understand medicine as a system rather than an assortment of disjointed facts #2 It helps a lot come boards study time, when you start with a strong base of understanding the "why" and the "how" rather than just the "what" of processes.

Would you mind sharing your score?
 
Oh man I hope! Bring out my Chemistry degree! It's basically just another way of asking which direction the reaction will go..
someone wrote about how there were two elementary reactions with two delta G's, and you needed to combine them or something. I vaguely remember needing to flip around the reaction or something like that in gen chem....

Its just stupid though to ask that stuff for a test like this :sour:
 
Hey guys recently took my step 1 and thought I would share my experience while it is still fresh in my head.

STATS

CBSE January 2017:188
CBSE April 2017: 243
NBME 17:238(curve is ridiculous)
NBME 18: 256
NBME 19:250(curve yet again ridiculous but I got better at step I guess)


Ill try my best not to break any NBME laws but if I do please let me know so the NBME lords don't come to my doorstep and seize everything I own.


I feel like while I was taking the exam I was having so many epiphanies that I feel like you can only have if you've taken the exam but by then its too late. No amount of SDN, reddit reading can help you fully capture the exam experience but I will try to give you some lessons I learned while taking the exam.

1. Having good exam day mentality is so important. I never took strictly test setting practices, full lengths, paused my tests alot, looked up answers before finishing a block, and was very lazy with this overall. Well during the exam I was running low on time on almost every block and the uncertainty of not knowing the answers was killing me. You have to be prepared for the exam day itself as a part of your studying. I.E getting good sleep, food, not getting worn out, not getting thrown of by distractions(for example someone taking an exam other than STEP which requires a lot of typing and ANNOYING LOUD KEYBOARD BANGING THAT THREW ME OFF FOR THE FIRST TWO BLOCKS). ughhh Time plays a big factor in making you feel unsure. You dont always have time to check all your answers other then maybe marked questions and I think thats why people feel awful.
As important as this test is dont try to change how you answer questions. I remember in the beginning I would make sure to read every little detail in the question and make sure I wasnt missing a single thing and was very slow at answering. I ended up going back to my old approach of answering questions midway through and had a better experience from there on it.

2. The material is all in in UFAPS. I was so afraid of SDN people talking about questions outside of these resources, questions that are completely left field. I barely had any of these types of questions. I did notice alot of questions that could LOOK left field but ultimately they were testing a basic first aid concept so know these cold and do UWORLD. People also say that the exam is more clinical rather than buzzword heavy. Maybe theres not as many buzzwords but I still could recognize the description of buzzwords. I feel like having the mentality that STEP 1, as convuluted as it may be, is testing a basic concept helped me answer questions and navigate through the crap.

3. The test is very similar to UWORLD but even UWORLD doesn't capture the higher ordered nature and trickiness of step. The trickyness of step isn't necessarily that they are deliberately trying to make you choose the wrong answer like MCAT or sometimes UWORLD. Its more that they just make you uncomfortable picking answers that you know are probably right but there are other answers that could be right too. I felt like I was making so many educated guesses but at the same time I felt like I was still choosing the best answer. You need to get used to this feeling by doing a lot of practice test and UWORLD.

4. Process of elimination is important. There were a lot of questions that sometimes felt like there could be 3 or even 4 answers that are correct but then I would go back to the passage and be like "hmm that cant be right, this doesnt make sense within this context" Until I get to the answer.
This plays into the higher orderedness of the questions. One question can have information about a disease and ask you a detail on that disease, and then they include bits of information on other diseases that you have to eliminate because they dont make sense within the context. Mix that in with physio/pharm/ anatomy tie ins and youve got one gigantic monster question that requires you to know the full presentation of 4-5 different diseases and some knowledge on other Non organ system topics to get one question right. Oh and you have about a minute and a half to move through your brain access all the info you need, make the best decision and move on without any assurance of whether you got the question right or not. So when you are learning first aid keep this mentality of mind. Take disease, know their full presentation ask yourself how changing certain factors can make you choose another similar disease. There were so many questions where I felt like I knew 90% of the information in the questions and answers but could not make that last link to the answer which really frustrated me.

5. Topics are skewed, thankfully they favored my strengths but they may not so know everything well, show no weakness!!
There were also a good chunk of straight forward questions so don't neglect memorization from first aid, sketchy, pathoma. There are people who are UWORLD fanatics and go over the top about how great it is and how it is all you really need. Thats somewhat true but you still need to memorize the dumb details which I found to be lacking in UWORLD.

6. Anatomy is pretty low yield. wasted so much time freaking out about CTs,MRIs, gross path, and overstudied for it. Most high yield is probably Neuroanatomy, GI, and I guess cardiopulm but that anatomy is simple so need to worry.

7. The main difference between UWORLD and Step 1 is that step 1 questions don't try to trick you as much as UWORLD. UWORLD goes overboard with this. I also feel like STEP 1, questions tend to be more muddy and exclude a lot of information(like NBMEs) that could give you more confidence with your answers. STEP 1 also had questions even higher ordered than UWORLD.
Essentially, a good chunk of STEP 1 questions felt like NBME and UWORLD questions did a FUSION Ha and then took it to the next level and went super saiyan three.

8. Do your NBMES. Noticed some similar appearing questions. One question that I obsessed over for the NBMEs because I could not find an explanation for it actually came up on my test.

Overall, I would say what makes the step 1 hard is the actual test experience itself, knowing information so well that you can apply it to difficult, uncomfortable questions, memorizing the dumb details for the gimme questions, and overall maintaining composure, being confident and efficient.
 
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someone wrote about how there were two elementary reactions with two delta G's, and you needed to combine them or something. I vaguely remember needing to flip around the reaction or something like that in gen chem....

Its just stupid though to ask that stuff for a test like this :sour:
Flip reactions to cancel out stuff
So
AB---> A +B delta g -5
BC---> B + C. Delta g - 10

Flip second equation to make B+C-->BC flip sign of delta g (+10). Add the two to get AB+C---> A+BC. You'd get delta g of +5 (nonspontaneous).
 
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Flip reactions to cancel out stuff
So
AB---> A +B delta g -5
BC---> B + C. Delta g - 10

Flip second equation to make B+C-->BC flip sign of delta g (+10). Add the two to get AB+C---> A+BC. You'd get delta g of +5 (nonspontaneous).

Wait why would there be Gibbs free energy questions on step? What context would they use it in?


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Another endocrine question...

Can someone explain the idea behind DKA?
Mostly the idea of potassium and phosphate in relation to Acidosis. I guess I've just never grasped this concept. H+/K+ antiporters will allow for acid excretion in the urine and then cause hyperkalemia. Right? And phosphate levels go down because it tries to buffer the urine, leading to muscle weakness (including the diaphragm). But why do you give K+ in the IV for DKA? B&B says you're hyperkalemic but you really have low K+ and I guess I just don't get it. Is it because you give the insulin load which forces K+ into cells? If so, could you explain the mechanism?
 
i felt they were short for the most part but i also noticed there were alot of knee jerk questions that i had to catch myself on. Some question for me were to close to call, and lastly bio stats. I got everysingle question wrong. Any one got tips for biostats ?
Yeah I agree, for the most part it was pretty straight forward but there were a few that I had to slow down to make sure I was taking everything into account before answering. And yeah.... I scored average on biostats but in reality I suck. I got semi lucky on this one.
 
Flip reactions to cancel out stuff
So
AB---> A +B delta g -5
BC---> B + C. Delta g - 10

Flip second equation to make B+C-->BC flip sign of delta g (+10). Add the two to get AB+C---> A+BC. You'd get delta g of +5 (nonspontaneous).
ah it came back to me, thanks!
 
Another endocrine question...

Can someone explain the idea behind DKA?
Mostly the idea of potassium and phosphate in relation to Acidosis. I guess I've just never grasped this concept. H+/K+ antiporters will allow for acid excretion in the urine and then cause hyperkalemia. Right? And phosphate levels go down because it tries to buffer the urine, leading to muscle weakness (including the diaphragm). But why do you give K+ in the IV for DKA? B&B says you're hyperkalemic but you really have low K+ and I guess I just don't get it. Is it because you give the insulin load which forces K+ into cells? If so, could you explain the mechanism?
There is an H/K antiport on the surface of cell membranes. Acidosis, causes H+ into the cells, and therefore K+ out of the cells. You pretty much urinate yourself to death in DKA, and K+ goes along for the ride an is lost. So, although you SEE hyperkalemia on serum electrolytes your TOTAL body K+ stores are actually depleted (from urinating it out). Just as an add on for clarification, there is also H/K antiport on the basolateral membrane of kidney tubule cells. This is the reason you give K+ and lots of IV fluids for DKA.

Not sure about the phosphate, but ive seen a question where they want you to know they become hyponatremic (osmotic activity of glucose)
 
btw, I totally had some sort of flash forward as i was studying Tay sachs and Niemann pick where they ask WHY you have a red macula spot, never know this it would be helpful to others
Answer=everywhere surrounding the fovea (which contains ganglionic neurons), die, and the fovea does not (since it lacks ganglionic neurons).

You heard it here first folks
 
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There is an H/K antiport on the surface of cell membranes. Acidosis, causes H+ into the cells, and therefore K+ out of the cells. You pretty much urinate yourself to death in DKA, and K+ goes along for the ride an is lost. So, although you SEE hyperkalemia on serum electrolytes your TOTAL body K+ stores are actually depleted (from urinating it out). Just as an add on for clarification, there is also H/K antiport on the basolateral membrane of kidney tubule cells. This is the reason you give K+ and lots of IV fluids for DKA.

Not sure about the phosphate, but ive seen a question where they want you to know they become hyponatremic (osmotic activity of glucose)
Hypo or hypernatremic? I would think glucose pulls water out of the cell and into the lumen of the renal tubule, creating a hypernatremic state. But could you explain why K+ goes into the urine? H+ goes into the urine so K+ goes into interstitium/plasma.
 
Hypo or hypernatremic? I would think glucose pulls water out of the cell and into the lumen of the renal tubule, creating a hypernatremic state. But could you explain why K+ goes into the urine? H+ goes into the urine so K+ goes into interstitium/plasma.
I have in my notes (forgot the source) that fluid goes from ICF-->ECF causing hyponatremia. Uptodate says they are "mildly hyponatremic."

The urine potassium loss is from osmotic diuresis
 
I have in my notes (forgot the source) that fluid goes from ICF-->ECF causing hyponatremia. Uptodate says they are "mildly hyponatremic."

The urine potassium loss is from osmotic diuresis
Gotcha I think my frame of reference is from the kidney and it's screwing with me. Yeah it makes sense that a lot of glucose in the blood will cause a shift of water into the blood and cause hyponatremia. Still not getting the potassium thing though. I guess the hyperkalemia from the acid excretion also means there will be a lot of K+ filtered into the tubule and lead to excess K+ loss
 
Gotcha I think my frame of reference is from the kidney and it's screwing with me. Yeah it makes sense that a lot of glucose in the blood will cause a shift of water into the blood and cause hyponatremia. Still not getting the potassium thing though. I guess the hyperkalemia from the acid excretion also means there will be a lot of K+ filtered into the tubule and lead to excess K+ loss
Osmotic Diuresis – RCEMLearning

"When the concentration of glucose exceeds the maximum re-absorption capacity of the kidney, glucose remains in the filtrate. This causes an increase in osmotic pressure causing water and potassium to move out and into the urine."
 
Ugh, I came down with the worst cold, fever and all, over the last couple days...test is on Monday. Today was supposed to be a heavy biochem review day but I took 3 naps instead. Got a little done but not much. At this point in the game though, I gotta imagine that I'll benefit more from being well-rested on test day than one more day of studying. I'll read my "stuff I'm bad at" notes one more time in tomorrow morning and then let the cards fall where they may, I think.

"Stuff im bad at"

LOL


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Ugh, I came down with the worst cold, fever and all, over the last couple days...test is on Monday. Today was supposed to be a heavy biochem review day but I took 3 naps instead. Got a little done but not much. At this point in the game though, I gotta imagine that I'll benefit more from being well-rested on test day than one more day of studying. I'll read my "stuff I'm bad at" notes one more time in tomorrow morning and then let the cards fall where they may, I think.
Nobody really improves much in those last couple of days man, rest well and you got this
 
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Took it 3 days ago. Since then I've realized I've gotten at least 12-15 q's wrong. FML. It feels HORRIBLE waiting, holy ****.
 
share your experience while you wait homeboy
Aite. Had no problem w/ anxiety or anything- Adrenalin completely took over. My first block had about 10 management questions, and of those, 5 of them had the EXACT SAME ANSWERS. 3 of them were derm based. It was awful. I narrowed it down to what I could, and picked. The first block I finished w/ 10 marked. After that, it was much better. My last block was very hard as well. Very specific anatomy q's, which all had the same answers...idk, I got a 242 on USW2 and averaged 237 on NBME's. I was hoping for a 240+, but I'm seriously doubting myself. Also, my ethics was ridiculous, and some of the random wtf questions were VERY WTF.
 
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Aite. Had no problem w/ anxiety or anything- Adrenalin completely took over. My first block had about 10 management questions, and of those, 5 of them had the EXACT SAME ANSWERS. 3 of them were derm based. It was awful. I narrowed it down to what I could, and picked. The first block I finished w/ 10 marked. After that, it was much better. My last block was very hard as well. Very specific anatomy q's, which all had the same answers...idk, I got a 242 on USW2 and averaged 237 on NBME's. I was hoping for a 240+, but I'm seriously doubting myself. Also, my ethics was ridiculous, and some of the random wtf questions were VERY WTF.
Anatomy in first aid?
 
studying endocrine today so I'm going to be asking some questions because I'm desperate for quick explanations.

Why does cortisol cause hirsutism? I get that cortisol decreases GnRH which decreases FSH and LH but my thought was that low FSH and low LH would decrease androgens. Is it because the androgens that remain are so low that they can only undergo one step (conversion to androgen) and not two (androgens to estrogens)?

Why does low cortisol cause postural hypotension? This has me confused. It also causes abdominal pain and diarrhea, so does cortisol have some type of muscarinic effects or something?

With excess cortisol (looking at the diagram on page 312 in FA16), there will be a back up of the substrates, accumulation of 17-hydroxyprogesterone which will be shunted towards the synthesis of androstenedione and testosterone. These 2 products will be accumulated causing hirsutism.

If you ask why aren't these two getting converted to estrone and estradiol, respectively, then the reason is that just like every enzyme, Aromatase has a maximum rate (Vmax). It can only convert as much androstenedione/testosterone to estrogens. Those two are way too much in excess that's why not all of it is getting converted to estrogen, hence, exerting its effects.


Coming to your second qs about low cortisol. I don't know about diarrhea or abdominal pain. But regarding postural hypotension I can say that remember cortisol is a stress hormone. It contributes to all the flight of actions seen in stress. Look at the diagram on page 95 of FA16 (catecholamine synthesis), Cortisol upregulates the conversion of NE to Epi. So if you have low cortisol, you don't have a lot of Epi.

But I don't think that cortisol has any direct effects on the adrenergic receptors. Please correct me if I am wrong.
 
Nope, way more specific than FA. Also, no, it wasn't about the pudendal. My questions had every ****ing answer EXCEPT the pudendal N.

I'm shocked, every damn question have something about the pelvic or pudendal nerve. And they tie it in with something about a guy Who can't get an erection. Maybe the writers are trying tell us something


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