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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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 +36  upvote downvote
submitted by liverdietrying(111)
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shiT eon was a lieltt rc.kity oFr itsh oen eth kye si eht wlo iirnodedioa uke.apt ihTs panetti has hgih T4 and olw STH hiwch esakm senes ni a iehdyrtyhpro patie,tn ppraehs uryo srfti tgohuth si ttah stih apetitn hsa G’rsvae isee.dsa eorwHe,v ni Gv’ears ruoy ytorihd si nbegi muldeaistt to aekm emor odhyrti mnoehor form trhcsca and as schu wloud vaeh na crsndeiea diionieraod katuep uaeebsc eth rtyhodi is nbnigrig ni het eudirqre on(w eeaoddrb)alil odi.nei ishT is why it is otn vesrGa “s(eelare fo tidhoyr enmhroo mrof a otdyirh lsidtaumte by ted)”naios.bi

oS fi sti not v’Garse athw loucd ti e?b orF shit yodu’ ahev ot wnok hatt ashtsHoo’mi oriythsidTi loa(s onnwk sa ncroChi pmicLyotcyh rToitidiyhs adn si tfneo dererrfe ot as chus on robad xeams ot htwor yuo ffo) hsa eethr psshea - itrsf htey rea roytdpryhhei, tenh eiouhtyr,d neth teh sascicl rydhpyohtio hatt uoy ldouw tpcexe wthi lwo T4 nad ghhi H.ST Tihs swa eht kye to itsh tqsone.iu heT aosenr orf hsti si htat nrdtyihatoi osdairexpe btdnoaiies in amhsooHsi’t scuea eht oydirht ot lerseae lla fo ist setodr rhtoydi romeonh kamnig the ianttep yrehyhoidptr fro a tohrs oidrep fo tme.i rfeAt tsih msaevsi raeesel fo yiodhrt erhmno,o het eiaidotnbs amek htem uealbn to amek new TH dan fteerehor etyh omceeb urthedyoi orf a sotrh iroedp dan hent oytoyhridhp hwich oyu uolwd p!tcxee neicS yeth c’atn aemk nwe TH, eht ityrohd wlil ton akte up teh iooaiddienr dna fereetrho heetr lwil eb wlo ioidieaodrn ukep.at ,eeHcn rl“eseae fo rtdose htdiory omeonrh ormf a ihdotyr gdlan ldafriitent yb yp.yltmecohs” aka iopmyyt“Lcch sm(thasi)oho o.httiiidyrs”

I inhtk aeeles“r of yirhotd eronmho romf a uothaosmlpmy oiydhtr da”ngl is rnifeergr ot smoe dnki of ohrytid rccaen ni chwhi caes ouy wludo cpteex temh to be ngidcrebis a odeunl on nrddiiiaeoo tka.upe

a​Syummr devio here nad laso a agrte eist ni earengl: aqdct./haonyteteei//pg/rrdnoehlnuidnmpe/rossceo:iid/r

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aesalmon  pg 338 fo AF stlsi ti urdne hysrdyhoipoimt ubt ti edso enesrpt sa stentinar ieshmyyrdpothri stfri +9
hyperfukus  pye htta saw eth ey!k roeiGt si "HT"O but the amrnginei erawsn icheosc rewe lslit idkn of lbeh D asw itgsacitrdn het elhl tou of em i nsept so gnol to cniecvon slmeyf ot kpci C adn oevm on +3
hello  taiPgns weni'anlnskmn omtnemc as an nitidod:a oeCcih D"" is ronwg /bc y"uthsmpomlao odtyrih ag"ldn = pryiarm tryidho aomlpmyh tpya(llyic LHN, hcihw is ryve era)r or imts'osohHa rdityoh sros.rniegpo oHmsohiast' dstriyihoti = oyhypimclct tinartleif iwth alenrimg B esllc and teuHrhl cell,s cihhw npou necnoduti oii,ltntmasu can lade to utatmlimanno/tgian asrotoamrnnitf to B lcel phmmaylo. hoBt fo tseeh senpert whit rotohpydsmihyi whti olw 4T adn ihhg HST po(teiosp of hits .)tipneta +1
taediggity  I etaybollus oevl royu i,itevreyildgrn@ hrwveeo eht pteaisghnseo of ouaprttpsm drtsitoihyi is masilri to osa,tmio'sHh os I kithn sthi psreon ahs smurpoaptt rsiidtohyit adn oyur nixaoantlep fo astnenirt xtssoiytcoohir is opst n,o ciwhh uldwo asol cruoc ni mputroptas dotiirshiyt +16
pg32  I reega iwth git@taei.dgy sAol nteo atht ownem lvnuaetyle erecvro mfro romtptaups ityriiotsdh dna yyaplctli mebeoc ueiroydth aaig,n wchhi tondse' phenap hiwt mstioohHa.'s +
vulcania  In FA 9(021 p. 833) it ssay hatt ohdrtiy is uaullys nlrmao ezsi in sturompapt sdtiyothi,ir utb eth ptieant ni htis esiqntuo had a ihryotd twie"c eht oarmln e."isz I usegs at hte nde of het yda it etosnd' tematr hhcwi osaingisd si grthi fro sith sinoutqe uecsa tyeh boht emes to edla to hte sema occrter waensr :) +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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iThs is a tniapet esac fo rasupttmop .tioshyridti Cna risea up ot a year earft rdeielvy adn sah yplytimhocc ntfr.iaielt

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almondbreeze  AF 2109 pg 338 +1
waterloo  uloAgthh hotrisy essme to itonp dsrotaw h,att esh hsa na galeenrd ,hyodrit and in amtsutorpp siyod,trihit tydriho suulyla onlmar in szie or(fm .F)A lrdegeasrs ehteir ldwuo heav stlocpmyhye innrtlg.atfii +


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 +4  upvote downvote
submitted by nwinkelmann(366)
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The otnnxilapae yb dtveirleginiry plsu eth apntienxalo in the iaelctr otdeps woelb (vi.6wCn4ct/9t.oblc9/h9wnphpi8/wacgsMP/inlmtm/..:rse4/) are het ,tbse tusj deen to be ocedmnib ).: heT ntdieaefrifl anoisdsgi btale 1 (hecee.9pt-rh0/p.rm1ysnTM9o=0slCw/bmcrocg.-c:ttj6-iM/1?4.l9ni4oit/1wlvoBntn/laL/pO/P08bwbe/4aSt) lyscpecilaif fdieeinsti eht iocntnoid ni tshi iuenstqo sa ptaosurtmp yir.ihdtoits

y,Ulamiltte fi you nwko that tpdmshyoyhiior ash a ttenrnias pydrhistimhoeyr speah e(ud to uumenmaiot ntoistdercu of teh slelc ichhw daeayrl dah erfpedrmo HT dan so it aws reesadle ounp cdtri)uentos feroeb imdhorpsiohtyy tiniungnonfco(n elcls so 'cnat tkea pu )niedoi dan ahtt dioryhmtyihops is a mplctihyocy inraglttinfi itrsdih,tiyo ouy will okwn eht na.resw I ahd a ahrd teim ddgntisneranu htis ta tirfs asecueb ew ogetlasva/uaeinde besda on hte prseeenc of TPtOna-i bA, utb the undgieyrnl pahegnseiost of het hrydoti ditrcutsone si dm-ltiedlecea y(pet VI )pierysitsvyetnih tno bA diemtdae (tepy II hn)sreiityvsetyip ikel vaegrs. Htimo'asosh = itycpmycloh onfrtnitliai wthi lirngmea tecrnes hw(hci cna asfmnotrr to B clel m)mayhplo whit hrhetlu elcls riknp(e compsalty sel).lc

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 +1  upvote downvote
submitted by niboonsh(409)
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aCn nsemeoo pnexali het eefndfcier wenbete .C eel(ears of seotdr todyrih nermoho ormf a thdoiry dlnga tdielfirnta by lspcet)mhoyy dan D. seeaRle( of todiryh renohmo rmfo a aushooymplmt yhtoird gand.l

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drdoom  ,bsoionn@h ngnedi a oecmmnt hitw a tonsuieq amrk lwli eamk ti eppraa on teh "smmnecot eigsnke rsnswe"a tssli +4
nwinkelmann  A mtomuslyapoh ihrtdoy ngdla nac treehi eb due to rpiyram ithroyd hloamypm ichwh( is ltsamo wlyasa HNL, but si ryve r)aer or deu to ooshmaHist' tidrhoy sor.soriegpn tsa'msoihHo itihsdiyrto = hytomyicpcl iianfelttr iwht anlmrgei B eclls dna ehtuHrl ,escll cwihh unpo ndocteinu atluots,nimi anc aeld to iaam/mntgouttainln noimtaaftnrors ot B lcle ahpmlo.my eeshT, I evei,elb luwod tills enpesrt htwi hsmdorptohy,yii nad htus wuodl avhe wol 4T dan hhgi HST eoitp(osp fo siht ni.)teatp +1


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submitted by seagull(1933)
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n:lcPvt4gn//m./hap..9oi9iws///eww.6th9MCl4rmcscbiptn8

ndccgAior to hits r,epap Ptmortsupa yhTiosdriti seetpsrn wtih O-TtaiPn itsadeoinb. ehT newsra icohec esus losm.hycytep So ihst si a sitaetrnn Hsistoamoh e.mhHrsydtiopryi Godo Lcku thiw atht eon!

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seagull  TEDI: yoptmLshecy aer also seerptn ni thsi sa .well My dba +1


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submitted by hyperfukus(111)
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I intkh that secin eehy'tr sigank ofr na lnaintxpeoa fo teh estnaipt' ntcurre SxS cihhw owhss tath 'hsse in teh tseat of iteTnrnas miroyyphetr:diHs ihhcw si deu ot :C elseeaR fo odsetr rthdoyi nooehrm rfmo a oriyhdt dlgan iiltfnrdaet by emyolchtspy

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submitted by mdmikek89(6)
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ucbSeaut opmycltyhic asythtSbcirduoeu iti polccyiyhtm osirthytiid is rdecaaehctzir yb dmaaeg to alofcilurl lslec with cclmhoptyiy ailntfnrotii enelrismbg sitoaoH'hsm tydoshriiti edistan of gulomnaar nrfma.ioot gD:s ur -noeαte,firnr mihtil,u aoimrndo,ea uter-in,elink2 enoiyrts kesani tooA nrnitmiihmseuiub eissdea tmrt soaPup t:hdsoitiyir ftesfca 5% of oenwm idgnru teh uoapptrtsm ridpoe dan is 3 tesmi mroe ocmomn namog wnmoe iwht ypte 1 iebsedta .tulsimel

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