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Retired NBME 22 Answers

nbme22/Block 4/Question#15 (reveal difficulty score)
A 24-year-old woman, gravida 1, para 1, comes ...
Release of stored thyroid hormone from a thyroid gland infiltrated by lymphocytes 🔍 / 📺 / 🌳 / 📖
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submitted by liverdietrying(111)
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hsiT eon aws a itllte ykit.rc Fro sthi oen the key is teh owl aooediinrdi kaupe.t sihT inpaett sah high 4T and olw THS iwhch makes sense in a rodtrpyyhhie pt,ntiea pshpare yruo tfrsi tohugth si ttah stih pnetati hsa srveGa’ e.daesis r,wHeevo in sG’vera uoyr idyhotr si neibg sdamltitue ot make reom thoiryd oornemh mrfo schract nad sa scuh dwluo ehva na iednserac doinieodrai eaputk becuase teh doihytr is bggriinn ni eht derirueq (own rbaleideodla) .idnioe hisT si why it si tno aveGrs ee(lae“sr fo toryhid homoner mofr a iodyhrt aesuttmdil yb i.iaode)”tnbs

So fi sit not a’esGvr htaw olucd it e?b rFo hsti ud’oy vhea to nkwo ttah so’sHhmtaio tiTshiyrdoi (laos nnwko sa orinCch pchLyiomtcy Toisidhiryt dna si tofen rfederer ot sa ushc on badro axesm ot tohrw uoy f)of sha teerh apsshe - trsfi tyeh are t,rdohiyepyrh hetn yiedhr,uto neht het cassicl oohhirdyytp htat yuo dluow ectxep twih wol T4 adn high S.HT Tsih was eht eyk to hist isuq.oetn The eorsan rof ihts si ahtt tadyohrtiin rasixdepoe ebitondsai ni hm’ooaistHs acseu het riodyht ot ereslea lal fo tis dtreso hoidryt ehroonm nakigm teh itpanet hierpyoryhdt rfo a htros redopi fo m.tei tfAer hsti smvaise lreaese of itrdohy hmonro,e hte baeniostdi mkea ehtm buaenl ot emak enw TH dna eetoehfrr teyh ebomce eouydhrit fro a rhots roeipd nad tehn idohptyyhor chihw yuo odwlu cp!texe eScin yeht cnat’ akme wen HT, teh tyhriod lliw nto keat up eht iidadeonroi dan errtofehe erteh llwi be wol ndadieirooi kept.au ,ceenH reseea“l of dsotre hiyordt mernhoo ofrm a iortdhy alngd rinfealtitd yb ”seytlocmy.hp aka omc“yhiLyctp ihohssot(ma) ”th.iidristyo

I hntki la“seeer of ythdroi rnoeomh frmo a hltuopamomsy thyiodr gd”aln si efrnigrer to osme knid of dirotyh ancrec ni hciwh aecs ouy dolwu eexpct htem ot be scndgrbiie a eodunl on eodiriadoin kuapte.

Smryu​am evdoi erhe and also a eagtr tise in :ereagnl t/o/ra/pgpdea:ontsdueicido//nn.lemshhieerrodrniteq/cy

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aesalmon  pg 383 of FA sstil ti ruedn hismotprhdyoiy ubt it edos teenrsp as rattensin drmiiypheysorht sftir +9
hyperfukus  eyp ttha was het yke! tiGero is "TOH" utb het ngienamri rwnsea seocihc erew lsitl idnk of hebl D was ntgdritacsi the lleh tou of me i setnp os gonl to ncvineoc eflsmy ot pick C dan mveo no +3
hello  aiPtgsn mln'ainnknesw omectnm as an oatndi:id eChioc ""D si nowgr /cb osmpl"tuhamoy dothriy "ldgna = rampryi ohrtdyi opylammh aycyllp(ti H,NL iwhch si vyre r)era ro mstsHoahio' drtiohy e.spgsrrioon oth'iHssoam ityoihitrsd = tymocycliph lieafnritt hwti glamreni B csell dan tHluerh e,clsl hiwhc opun dteunoinc ii,sntumotla anc elad ot gatmlonnmitanuai/t iotanrtnsmfrao to B ecll o.ymalhpm toBh fo teehs prseten hitw hydmyhiooptrsi wiht wol 4T nda gihh THS toospe(ip fo iths epn)tit.a +1
taediggity  I abuteylols loev yrou trigvdnyileeri,@ wehvoer hte sheotiapsneg fo orstatppum iirtiostdhy si rmailis ot Hishmso,ota' os I itnhk htsi pnrose ash ttpmrspuoa sidittiroyh and uory axlepannito of tsearintn iroioxsscthoty si ospt n,o ichwh oulwd lsao crcuo in pstmortapu iiyotthdirs +16
pg32  I aeegr twih itai.gy@tdge soAl oetn atht enwom uvlyenatel cerveor rmof aotuspptrm syoirhdiitt dan pcitllyya boeecm hutirydeo n,aiga hcihw odt'ens phepna with maooi.'Hhsst +
vulcania  nI FA 91(02 p. 3)83 ti syas taht dthrioy si lsuulay amonlr iezs in tsptupomar tit,ioryhdsi btu eht pnitaet in ihts qesutoni dha a oirdhty wicet" eht armlon ei".sz I sgseu at the den fo the dya ti nodest' rattme hhwci dionsigas si rtgih fro stih uitoqsne ecuas etyh tobh esme to aeld to het smea rctocre nwreas ): +2

This is definitely not Reidel's thyroiditis. I remember getting a question wrong on UW, in regard to subacute granulomatous de quervain's thyroiditis. The pathogenesis is granulomatous inflammation destroying the thyroid follicles and releasing stored T4/T3, with a LOW radioiodine uptake. I think this line is super important to get the diagnosis right. Like liverdietrying mentioned, you need to understand that in thyroiditis of basically any cause (postpartum, hashimotos, subacute), there is a release of thyroid hormones leading to a transient hyperthyroid state which then BECOMES hypothyroid later after a brief euthyroid phase. Hence the term thyroiditis, inflammation of the thyroid gland, with release of it's contents.

+/- imgdoc(183)

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 +23  upvote downvote
submitted by hayayah(1212)
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ishT is a ateitnp csea fo putsmrtpao t.hroyisidit nCa isrea pu to a raye eafrt yidervle nda has ymiochtpcyl lietatfrin.

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almondbreeze  FA 2190 pg 833 +1
waterloo  tAhughol syoihrt msese to pntio twrsado t,aht esh sah an edlnagre rt,dyhio and in atposrtupm tdroyshiit,i itdoryh slayulu laomrn in size o(rfm ).FA rsgdaleser erethi ouwld aveh hmtplyosyec lian.ngrtiitf +


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submitted by nwinkelmann(366)
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ehT natxoelainp yb tivyerldgriien ulsp the ipnoelxntaa ni eth lateric dtspoe webol (9sansc49v8tMtwm4lwhhob.6mC/iP/ig.:n/.ewc/9pilr/c/.ntp) rea teh t,ebs jstu ndee ot eb ndobcemi .:) ehT tidefnlirafe snsoiagid tbeal 1 (-netacew4v1rs6tLelP.t9/-:8C4irtanp?ncMoob0=//.Scwlg04/sn0y/bThB/ijhtMl.Ooli1-o.pe9bpt/rm91w/mc) fcispilaeylc feesditini het cdoonitin ni tshi soineutq sa atopmruspt hdti.trysiio

myiUl,atlte if uoy nkwo atht oidhoymrtyhsip hsa a irsattnen ithyrsihymedrop eapsh ude( to utieomnaum outtcnsried fo the clels hhciw ylreada had ofprmeder TH nad so ti swa elasered unpo uit)snetcord ebofre yhpooytdhisrmi ogotn(nfncuniin elcsl os ant'c teka up deiion) dna tath hymiyidohtopsr is a cmthoyciply gratitnfnili itrihdstiyo, yuo lwli nkow the ner.wsa I hda a darh etim inrgdadtnneus hsit at fistr eeusbca ew deaatugenlisvae/o abeds no teh ecsenerp fo nTPOait- Ab, ubt teh rugydlnein eisohsgeantp fo hte idyhtor onucetdrsit si aee-delmtlcdi pet(y VI )rtenpihtsyiiysve tno bA dtmdiaee t(pey II svhepnii)ryttysei elki srave.g imoha'tsosH = cymthyilcpo aiotniirfnlt wtih ernmglai stnrece i(chhw nac oftnarsrm ot B ecll lmpya)hom whti uethhrl sellc ekrnp(i asmclyopt s.lecl)

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 +1  upvote downvote
submitted by niboonsh(409)
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nCa smoeeon ilxanpe het ndierefecf wneebte .C a(lreees of drsteo tiyhrdo nooherm mfor a tihyrod gdlan etifitlrand yb ytc)hposlmey and .D (eesReal fo tdoyhri hmnooer ofmr a otoyamhupmsl tyidhro gna.ld

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drdoom  onoibhs@,n eigndn a tmocmen wtih a utnqosei ramk lwli eamk ti epapar on eht "moctenms sineekg an"erwss istls +4
nwinkelmann  A yopauomsltmh ytdrhoi gladn cna etireh be ued to yprmair rtdiyoh mhymlapo c(whih si saotml laywas ,LNH but is yevr )erra ro ued to t'oHmoishas hyrdtio orsonsipgr.e Hasotsohm'i drtitsiyioh = yypocmhclit fiitraelnt hitw irmnglae B lselc dan thueHlr sle,lc whcih uonp noneuictd t,asomiunilt acn laed ot /mittatuianlgamonn otrsnmfritoaan to B cell .mhlapomy heTs,e I elvi,ebe olwdu tlils enestpr iwht ,hodiorytysimhp dan hsut doulw heva low T4 and high HTS o(piesotp fo htis i.ap)nett +1


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submitted by seagull(1933)
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i/4/c:s8PM/soc9ihwnl.cp9hw.pga9C/mt.lvm/.46/eriwnnttb

odAcicgnr ot hsti perpa, arpuPmsott sTrthioyiid tnerseps ihwt TnatiO-P dtsbae.inoi eTh raeswn cichoe essu c.yhsetmyplo oS tihs is a tarnsinet stmaioohHs spyrtiHhoiye.mrd Godo cukL hwit taht o!ne

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seagull  I:TDE cshmyLtyope are loas eesnprt ni stih as lwle. My bda +1


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submitted by hyperfukus(111)
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I kithn ttha secni ye'trhe inakgs rof na ataxnopinel of hte nptsei'at treurcn xSS wihch shsow thta 'hsse ni eht satet fo entanTirs iphsyedirt:Hyrom hihwc si eud ot C: elsaeRe of toersd yrtoihd noohrme rofm a tihordy dalgn tifarntelid yb cplyosemthy

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submitted by mdmikek89(6)
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bauutSec mycycthploi tdthcySiosaiueubi rt ymylthcoipc idhritiytso is riacatcedhzer yb amgdae to ofraillclu llcse hitw pctlhmcyoiy itiatnnfilor smergilneb his'soaHmot dhyiirottis dsantie fo mngaaorul aitmr.onof :srDgu fnioe-,αretrn ihltuim, ,nriaomoade n,kulteiie2-rn tsorieny eaknsi nmitb uohiumisriAtoen aesesid pua stPomtr itiihdsryot: fcetfas %5 of nwmeo urndgi eht ptmuportsa edopir and si 3 meist mroe nmcmoo ngmao mwneo iwht pety 1 bsieaedt elumlits.

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