All right, welcome. My name is Divine. This is episode 585 of the Divine Intervention Podcasts.

In today's podcast, we're going to be continuing the rapid read, the Step 1, 312 series.

So this is part five. So let's jump into question 41. It says, an 11-year-old girl is brought to the ED by her parents because of a one-week history of breast enlargement.

She has not had pain or nipple discharge.

She has asthma treated with inhaled albuter all as needed.

She does not smoke cigarettes, drink alcoholic beverages, or use illicit drugs.

She is at the fifth-year-th percentile for height and weight.

Vital signs are within normal limits.

Examination of the breast

shows minimal enlargement under the areola and mild enlargement of the diameter of the areole.

Ariole without nipple discharge. No mass is palpated. There is scanned pubic hair. Which of the

following best describes the sexual maturity rating for this patient. So whenever the USMLL is used the term sexual maturity rating, they're pretty much talking about Tanner staging.

And how do you use Tanner staging on the exam?

Well, again, there is Tanner stages 1 to 5.

The truth is usually on the USMLEs, they focus mostly on 1 to 4 because 4 and 5 are kind of awash they're kind of the same thing

so tanner you know i remember it with this mnemonic you know n b i aa n b i aa so the n

stands for nothing so tanner stage one you have nothing and really tanner stage is all they

measure are the breasts and the pubic

and axillary here so tenor stage one the end stands for nothing no breast development

no pubic or axillary here that's tanar stage one obviously that does not apply to this girl

because she has some breast development she has some pubic and axillary hair development so

the b stands for basics the b stands for basics. The B stands for basics.

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