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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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Tshi neo aws a teitll tcir.yk oFr tihs eno the eky is eht lwo idaoidrnoie kpue.ta Tihs inaptet sha ihhg 4T nda lwo TSH hiwhc mkesa ssnee ni a iehrydyrphto itnat,ep eharpsp uyro rtisf thtgohu si tath tsih tnipeta sha vsre’aG di.sesea eoerH,wv ni eGavr’s ouyr tdryoih is geibn dtlesumtia to amke moer yidhotr oenormh from rshatcc dan as hsuc udlow vaeh an nadeiecrs rniiadeiood teuapk uebasec the iodyrth si nignrbgi ni eth qrreeudi (onw dal)eeodralbi i.dione ihTs is wyh ti is otn aevrGs ar(el“ese fo htydior onormeh romf a hyrodti lduasetmit by tn)”eidbiaso.

oS fi ist not ’raeGsv hawt dculo it b?e oFr ihts dyuo’ vhae to kwon that ot’iosashmH ihyrtioTsid al(os owknn sa hocCrin hoiypLtccmy rtThiiyodsi nda is entfo deferrer ot sa husc no rdoab exasm to rtohw uyo )off has ehrte sephsa - fsrit tehy rae ohey,ihrytpdr hent urodhitey, ehtn hte liscacs ohrypiyodth that ouy owdlu xcptee wthi wol 4T nda gihh STH. iThs wsa eth eky ot stih eiqt.snou hTe esanro ofr itsh is atht harttyondii seredixpoa oniitsebda in omtHoasis’h acues teh thidyor ot aerlsee lal of tis otdres othdiyr omehrno iakgmn het nipetta tyoihherpdry rfo a roths droepi fo mei.t Afert tshi sveaism aelesre of iyhrodt ne,omorh eht ebtoadnisi keam tehm lbneua to aekm wen HT dan oferteher thye comeeb dhteouyir orf a ohtsr dropie adn hetn otyhdipoyrh wcihh oyu uodlw cex!tpe eincS yhet nc’ta meak new H,T hte tihydro lwil tno ktea up the dearooiindi dan toerfhree tehre lilw eb wlo oidorieniad p.utake Hec,en “aleeser of desort trdhiyo mnehoor romf a yritdoh ldgna tefndatriil by ct”eh.sylyomp aak pchiyctLoy“m ot)mh(sisoah toii”ydisrht.

I tknhi “eaelrse of odiyrht eroonhm form a atmosyumohpl thrydoi lga”nd si rergifner ot omse idnk of yoridth necarc in cihhw aces ouy luwod etepxc ethm ot be sbcngrdeii a loeund on anreiiddoio akt.uep

a​rmmuSy oevdi here nad aols a getra stei ni rn:eegal nquecetdad/eoc/rl.emhi/aep:ehiigrrtsdt/posrnnooyd/n/i

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aesalmon  gp 833 of FA sistl ti rndue pyohhtysrmiodi tub ti dsoe nreptse as tnetrisan hrtisoeimryydph tfris +9
hyperfukus  eyp tath was the ye!k oitGre si "TH"O btu eth ignimaren awrens eccshio erew lislt kind fo hble D wsa tgadinsrict het llhe otu fo me i tsenp so ongl to noenvicc leymfs ot kcpi C adn move on +3
hello  Pasting nelmks'niawnn omencmt sa na dinto:ida Chceio D"" si orgwn /cb opmohyalmst"u hdtyori aldn"g = mirpyra doiyhrt mhypoaml tl(icayypl LNH, chwhi si vyer a)rer ro asmht'oisoH roithdy issngopoer.r hs'aitHmoso iyshtritdoi = loyitmcchyp iafertntli htiw aingmrle B lselc nad lHhuret l,eslc hichw puno cnnotdieu ltouni,iasmt can eadl to ulnnmaoaagmtti/tin ntiamaforortsn ot B lelc hp.ymmoal Btho of ehtse spenret whit syyhipmiodohtr twih wol T4 adn ghhi HTS poie(tsop fo tshi )ae.tintp +1
taediggity  I slotulbeya lvoe yruo @,ritevyiegnldri vehrewo hte segsoeatnpih of patsroutpm toysiihditr si rmsiila ot tHosh'mis,oa so I ikhnt itsh nersop has ppotmuastr shtyiriidto nad oyur oatlxnpiaen of ritnsetan totioicshosyxr si pots n,o whcih lduow osal ocrcu ni mrapptosut ttiiyodrshi +16
pg32  I graee hwti dea@giiyg.tt slAo oten taht mneow uvnelaelty voeercr rofm autrpomstp htidsoritiy dan iclyapytl eocemb hyodruiet i,naag hwhic 'tsedon ppnahe itwh s.osHmhoiat' +
vulcania  nI AF 2(190 .p )833 ti ysas hatt tiohdry is lsulyau nrolam ezis in tusotrmapp dtityroi,his ubt the pinteat ni hsit eustnqio ahd a rityodh iwt"ce eht aolmrn "zei.s I sesug at eht end of teh dya ti 'teodns aerttm hchwi daniosgsi si rtigh for tihs suntiqeo aseuc tyeh bhto seem ot ldea to eht smae tccrero srnwea :) +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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Thsi is a tnatipe esac of uopmttspar .itisodhirty aCn eiras up ot a yare tfear ylreeivd dan ahs iclmtpycoyh tnriltiafe.

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almondbreeze  FA 0219 pg 383 +1
waterloo  lthhAuog syhrtio meess to niotp sadotwr ht,at esh sha na gelraedn thidyo,r nda in tasupmrpto dioist,ihrty tdhoyri ulayusl rloamn in ezsi for(m F.)A sdgeaerlrs hirete ouldw eahv ypsocyhemlt t.gifrtiinnal +



 +4  upvote downvote
submitted by nwinkelmann(366)
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hTe apioanntlxe by lvinegdireiytr upsl hte xinatolneap ni eht ltaicre ostdep loweb (t9reb././:/9/w/ipmphlc/.lcnt6it4cMmaw9gsis8wCvP.ohnn4) ear hte tbes, tsuj dene to eb emcbdino :.) eTh ileifafrntde niodsgsai eblta 1 (svm-1.6n0e/?Spnogri09w4PB9plt:sta.9iew-1tcrej=t8o/tlL/.4.rb/cncb1/T/t4mMM0en/lCpwbc-hoiOoyh/la) icciafpseyll fieenidist eth inoitodnc in shti tienuqos sa utmpartosp tt.iioirysdh

Uylmati,lte fi oyu nwok ttha hmiyoospdtyrih ahs a erstnntia ydehrpmoshyiirt apseh (deu to umunmaioet unrsetcdtio of teh cllse chhwi yleaard dah erefomrpd HT adn so ti saw leearesd uopn nidttures)co robefe hoimtyydipshor nn(nocfontgniiu slelc os 'tanc ekat up i)oiden dna ahtt iyoophrdyhsmit is a ccoilyhptmy itinagifnrtl i,odhsitrtyi ouy will wonk eth .wsaner I hda a hdra eimt rusangiddennt stih at rsift saebceu ew euvgaoaent/saledi edbas no teh nepesrce fo TtO-iPan A,b utb teh nyeinruldg neospsghiaet fo eth diyhrot tsrdntiuceo is medeiecdta-ll etyp( IV stsiyhinpetrv)yei not Ab ediemdta t(pey II yiyptitrsne)ihsev ikle vg.easr o'htHsiaoms = htyyciopclm altnniofiirt wiht raligemn resecnt (ihhwc anc rmsnofatr ot B elcl ymhampol) whti uehtlhr lselc pirnk(e plmtscyao .cll)es

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 +1  upvote downvote
submitted by niboonsh(409)
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anC mnoosee xnlipea eth fdrefneeci tweenbe C. aleres(e fo rsotde rythodi mhroneo mfor a ridhtoy ndalg ilndirattfe by )ltpycsheomy dna .D eselRea( of dyoriht eohonmr rmfo a opylmohumtsa othrydi gnadl.

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drdoom  obn@,ioshn ngedni a moetmcn htiw a itnesuqo amrk will meak it praaep on het nmoesct"m ksneieg rnwe"sas stsli +4
nwinkelmann  A hmoomaltusyp yotihdr nlgda anc eierht eb due to rrampiy hotrydi ommylaph i(whch si atosml wsayla ,LNH ubt si vrye earr) ro ude to sihamHs'oot oihdytr ierson.pgors ot'smohsaiH styotirhiid = ocythicpylm itnlairfte whti laigrmne B cesll dna lheutrH ecsll, wichh opun onutcdnie mtiust,liano can aled ot mnuatngmi/itatnalo tosfmtannirroa ot B lcle hyomal.mp eTs,he I e,ievble loudw tilsl seenrpt itwh oodtyy,ihmisrph nda hsut woldu evha low 4T nad hgih SHT e(otospip of shti etnt.p)ai +1



 +0  upvote downvote
submitted by seagull(1933)
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ol:/i/bpnwia/th.sg6/4tr9eMc/wn4.slPv8/p.mcnct.iCwh9m9

cidrogncA to hsit perpa, tmPuroatps dhrtyiioTis tenssrpe tihw itnOaP-T eansoitdb.i hTe rsanwe cohcei seus t.oyplmeychs oS this si a srninttea hHisomsoat esh.rHptriymidoy dGoo cuLk iwht ttha eon!

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seagull  E:TID tyeLpmyscoh ear also pstnree in shit as wl.le My dab +1



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submitted by hyperfukus(111)
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I itkhn ttha eicsn eeth'ry giskna rfo an plinaeoatxn of eht n'etasipt ucnrert xSS cihwh oshsw hatt hs'es ni eht staet fo tsTaniren ririoypHdhm:esty ihhcw is ude to :C Reeasle fo tsdoer iydthor ornhome ormf a tyhdiro dglan itarlinedtf by ypecmsltoyh

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 -1  upvote downvote
submitted by mdmikek89(6)
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ctauueSb oclmthycpyi codSaubrittetusih iy yypiomtlchc iitsytoridh is cetzhariradec yb aeagdm ot rclolaflui llecs hwit ytiycocplhm tiointilfnra bgmelsrnie Hotsaihoms' shtoridiiyt stnaide of uoamlnrga no.mtoafri :s Dugr nαfr-ione,tre ,hlimuit ona,emodair lii-,tr2ekennu esnryito skiaen breimtmihouioAt iusnn esdaise rptmos Paut drtisiot:yih tfafesc 5% fo noewm niudgr eht puasttoprm iodrep nda si 3 estmi orme oncomm mngao nwoem ithw tepy 1 ietbsdea leislum.t

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