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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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 +36  upvote downvote
submitted by liverdietrying(111)
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iTsh oen wsa a teitll ityck.r rFo shti eon teh yke is hte lwo deiniiaoord tea.kpu sihT netapti hsa hihg T4 nda olw STH hiwch makse ensse in a iyodrrhtpehy iae,tpnt speahrp oruy isrtf hhtugto is htat tsih nttaipe ahs aGsvr’e e.seadis w,Heorve ni ’ervGas oury otihdry is eigbn suteamtidl to emak orem yrodiht ohnmreo rmof trcashc and sa shcu uwdol heva na isrcenaed noiddaoriie etpauk usebaec het ohidryt si ingibgrn in eth ueerqird wo(n baidre)olelda .deonii sTih si wyh ti si tno evrGsa “selreae( of odityrh ronmhoe rfmo a todyhri udastitmel by .eb”nt)dioasi

So if tis ton eva’srG htaw lcduo ti e?b Fro hsti udo’y aehv to kwno that o’otaHhssim sytiirdThio sao(l onwkn sa croChin ctopyiLchym shrTtdyoiii dna is enotf eerdfrer ot sa uchs no bardo smxea ot whrto uoy )off sha heert ssepah - srfit ethy aer dhiyrth,oyrpe tnhe ytdrei,huo ehnt eht silccas dyhtprhoioy atth uoy ouldw pexcet wthi lwo T4 dan hihg .HST sihT swa eth eky ot hsit nstio.que Teh enorsa ofr shti si taht tnhdaiortyi xepoadseir siatbednoi in haooisHtm’s usaec the hidtyor ot eeeasrl lal fo tis soetrd ohtidyr oormneh iknamg eth tneipta itordrehyyph orf a ohrts proeid fo t.mei fterA sith asesvmi laeseer fo rhdityo n,orhmoe eth aboidnteis akme etmh aeunbl ot emka ewn TH and reeoehfrt thye obecem itdouyhre orf a sroth direpo adn hten yptooidyhrh hhiwc uoy oulwd peext!c Secin etyh ’catn eamk nwe TH, the irtydho llwi nto tkae pu eth ediidiaoonr nda tefrehreo teerh ilwl be wol oididoiaern k.tapeu ,enHce els“aree fo otresd rhodiyt emhoron mfor a oyidhtr dngal itrdentafil yb tmhc”.yeloysp aak ctyyLcp“mioh )sosh(tioahm iros.dytit”ih

I knhit eseerla“ fo idorthy oemonrh ofmr a mtasuoohymlp ihdtory adg”ln is reenirrgf to meos iknd of htroiyd rccaen in hwcih eacs oyu uwdol xeeptc mthe to eb nredsbcgii a ulnedo on noardeioidi a.uketp

a​umrmSy deiov erhe and also a eragt seit in a:nelegr eltrii//:hgnmdda/dtioooyc/teapoir.sdpeerunqrn//secnhe

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aesalmon  pg 338 fo AF ssilt it durne mitydhhosoypir but ti esod sepnert sa rstnatnei rmdpyyehrhtsiio isfrt +9
hyperfukus  yep tath asw eth eky! iGrteo si H"OT" but hte nmrgeinai senwra iccehso eewr ltlis dkin fo behl D swa rigtdncatis teh hell otu of em i spnte so nogl ot nviocenc yseflm to kpic C nda evom on +3
hello  tsinPga klnninasnmew' tcemomn as an oidtinad: cihCeo "D" si ongwr bc/ "yopmsmlouath rhiytod ldgn"a = ymraipr dtriyoh mphayoml cyliylta(p L,HN wcihh is yver rae)r or sHhsoamtoi' dryhoti pn.irssogore shim'toaoHs rhttiiosidy = ypotcmcylhi ttlienrafi thiw riamelng B clsel dna reltuHh c,llse hhiwc noup dnoiecunt aitnliuot,ms nac aeld to ml/aoninigntuttama stairnnrtmafoo ot B cell .hymmlopa oBth fo sthee psetner tihw riyhmsyhodipto itwh olw T4 nad hhgi HTS ipepotos( of htsi ptna.)ite +1
taediggity  I salbtulyoe levo oyru verdyirnet@gili, woeehvr the ngaehesptsoi fo mtopaprsut dhiytroitsi is rimaisl to othimss,H'ao os I knhit stih erpnos ash tsppruaotm iiihrsottdy nad your itxeapnnalo fo estnnrita siohixytsootrc si tosp o,n whhci ouwld aosl occur ni opurtmspat ihtisyitrdo +16
pg32  I arege hiwt eitai.dg@tgy Alos enot tath mnewo telnavleyu rercveo mofr potmaurtps iythditrsoi dna tiyylplac eocbem yerotduih ai,nga ihcwh 'edntos ppanhe wiht .Hotamss'ohi +
vulcania  In FA (1209 .p 3)83 it ssay ttha triydoh si luslayu alronm zise ni opmtsraupt diisrttohiy, but het taietpn in isth nqtisoue ahd a dtrhoyi "twice hte anrmlo zsi".e I sesgu at hte end fo eth dya ti detns'o tmater wihch sgdsaoiin si tihrg for itsh etunsqoi casue tehy thbo esem ot leda to het seam cocertr asenrw :) +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)


 +23  upvote downvote
submitted by hayayah(1212)
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iThs si a inaeptt ecsa of ptpaosumrt hiosiyirt.dt nCa sraie up ot a arye afetr veirldey adn ahs otchiylmpcy ia.ftlteirn

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almondbreeze  AF 1209 gp 338 +1
waterloo  Aghluoth rsothyi emses ot topin tdswaro h,tta she sah an agnlrede trhyo,di nad ni prtamuspot ,iiitdsythro hyoritd alylusu rmnlao in esiz rmof( A.F) easrlgdesr ihrtee wlodu veha ceysphmolty iilntgfn.iart +



 +4  upvote downvote
submitted by nwinkelmann(366)
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heT apxninaetlo yb yeiiridvlegrnt pusl the nnoaxaltepi ni teh lreacti pedsot obwel (.ihn/9mccmbt./t:csr4il9PCw4th.wMw/n9p8g/ap6.siln/oev/) aer hte ,tseb tsju nede ot be boimnecd ):. ehT ideieatflfnr inaigsdos eblat 1 (/ht0O-Cm9grjeppolll/4i=.-bhwLa.t/a6o4er9e/stc?lm/:1pbTbnSe..4nctrwvBcwi1oPs01//n8t/yMnt0M9oi-c) alyisflpccei seieitfdin teh ioncndtio in this tsneoqui sa tuotsapmrp otir.sihiydt

lttmeial,yU fi uyo nkow ttha hyhmiopodtriys sha a reatstinn deirmhityyohrsp saeph u(ed ot moinemuatu truitdonesc of hte lslec cwhih rdayale ahd epmrdoerf HT adn os it was adreesle puno ceditsuont)r ofeber tshidyrhoymoip ngonoifnniutcn( sllce os 'atcn teka pu iodni)e dna ahtt rohyiydpsmoith si a icmopltcyhy airnnftiilgt ,ihsitortdiy yuo illw kwon eth r.weans I hda a hadr etim nsaunedirdtng hsit at srfit escbeua we eusvltoa/egdneaai sbeda on het escreenp fo PtT-naiO ,bA tbu eht nigldeurny hgnopassteei fo hte htdoiry tcdrtiuones si lc-dalemeetdi typ(e VI )ryshsipeeiivtynt ont Ab teimdaed ype(t II tteii)yiysphnvers klie rvsega. sotihma'Hos = ocymcpyhitl ioaftinntlir whit grilmaen necster (hwchi can nromastfr to B clel myha)olmp thwi lrehuth lecsl ri(kenp ycltposam lec)sl.

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 +1  upvote downvote
submitted by niboonsh(409)
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aCn mnoseoe inlaexp teh efedercnfi ewbtene .C eera(esl fo etosdr iytodhr hmnoero mfro a ythdior adnlg dlretiainft yb etph)oylmcys and D. aeRe(sel fo ryodith hnoermo mrfo a mltsopymauoh yotdhir dnlag.

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drdoom  ohnn,bos@i eingnd a ommtnce hwti a onuetsiq rmka lliw amek it pareap on teh ncmtes"om geesikn snw"ears slsti +4
nwinkelmann  A toupmalhyosm hdioytr dlgna can reihte be deu ot yrmiapr rdyioht lampmhoy c(hhiw is latsmo aalwys L,NH btu si yevr re)ra or ude ot sitsa'omHho rhotyid .seopoinrrsg 'tsiHsohaom rhydoittiis = yptclyicomh tneaftiirl iwth nrilmega B llsec dna uhrletH le,csl hwcih ponu iutoecdnn taoituislnm, anc edal to /nniaittutmloaanmg iaartotnrsmfon ot B lcle yolmpham. ,hseTe I ebilee,v wulod ltsli treespn htiw ,shryipioydomht nad tuhs wudlo aevh lwo 4T dan ghhi THS p(eotpsio of tish eitat.np) +1



 +0  upvote downvote
submitted by seagull(1933)
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ispvcne8/mp.whC9nm:a..//Pt9Mn/6wo.4t9bilitsg/cw4hlcr/

ogndriAcc to itsh are,pp tsutoPpram hiitTiysdor terepssn htiw Otn-aTiP asinebt.odi ehT rnewsa cihceo sesu ot.peslhmycy So isth is a snaeinttr hotoasHmis tms.iprieoHhdyry Gdoo uckL htiw tath en!o

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seagull  EDTI: ycmhosetLyp are laos nptseer ni thsi as w.ell yM dba +1



 +0  upvote downvote
submitted by hyperfukus(111)
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I thnki ttah inces reyt'eh gksain ofr an etnlapxoina fo hte it'naestp eurrctn SxS whchi sswoh htta e'hss ni eht attse fo arestniTn mohr:syriedptiyH wihhc si ued ot :C selaRee of dtsero otrydhi roohemn rfmo a tdyiohr ladng letidranfti by smeytlcphoy

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 -1  upvote downvote
submitted by mdmikek89(6)
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cbSueuta ymctohpycli icdbiia Ssryutohettu ihcptoycmly ortisytihid is cdaartehzceri yb maeagd to luairlolcf sclle twih omipylyccth inrtiiltnfoa gmrilesben imtsosah'Ho hoitrstdiiy isaetnd of nragulmao if.armnoto srDug: rn-ie,tnfαeor umi,tlih doemran,oai r,e2-nienitlku eniorsty saknei soiibomnAi inretuhtum isaeeds otu tPasmrp orytidt:iish cffstae %5 fo mnwoe rnguid teh tmpopaustr pedior nad si 3 eismt rmoe oomcmn ngmoa enwmo twhi type 1 dsaibtee eli.umtls

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