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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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iThs eno asw a tletil yt.cirk For isth noe teh key is eth lwo aneiidiodor uaet.pk hTsi ptantei sah ihgh 4T and wol TSH hhwic aeskm essen ni a horerdypihyt ttipnae, paprseh oruy isrft thhgout is atth stih aetnpti ash esav’rG eesdis.a wHo,eerv ni ’aevsrG yuor tyordih si bengi ltatmedusi to eakm rmeo hodiryt rehonom romf acscthr dan sa cshu oluwd eahv an reendiasc ioidroniead aepukt acubees the torydhi is bngirign ni het derirqeu wno( elriab)edadlo oni.die ishT is why ti is nto varGes a(leer“es of dhrytio neoromh romf a dytrhio adimteutsl by bdin.osi)te”a

oS fi sti nto ’vsrGae hatw udclo ti be? roF tihs ’yodu aveh to oknw thta tosihm’aHso siihoiTdtry (oals knonw as oirnhCc yLiphcmoyct hTyoirsdiit adn si enfot edferrre ot as schu no aordb asmex to torwh oyu )ffo sah eehrt apsshe - sftri eyth are hreiotyrhpyd, nhet douehtriy, then the saciscl tprdhoyohyi ttha uyo udwlo ctxeep htwi wlo 4T dna hgih HST. ishT saw eth yek ot isth q.iosunte Teh enrosa orf ihts is ttah rttdhiiynao soxairdepe anebdiitso ni iHsstah’oom eacus hte yirdtho ot eealser lal fo tsi stoedr rdtihyo eonrmho gnmika eht tiaeptn trhiperdyhyo rof a srtoh reipod of .eitm Aretf hits msaisve arelese fo trdyiho r,omoenh hte itoaenbsid aemk mhte bunael to meka new HT dan terehfero hety mboeec etuodryhi ofr a orsht rpoied dna hetn tdyhohiroyp chhwi yuo wudlo c!eetxp Sicne hyte cnta’ make ewn ,HT het hdrioty lilw not etka up eth doioinrdaei and oehterefr ehrte lwil eb low iorioeaddin tu.apek ce,neH ree“easl fo esrdot oydhtir mreonoh ofmr a tdoyrhi dlnga eantlfiidrt by ymh.tocypse”l kaa mcLpy“choyit sh)(otimhaso .riiith”otdsy

I nikht erelase“ fo othdiry hneorom mrof a otaumopshlym tihoydr al”gnd is ferinregr to mose dkni fo rdiyhot cncrea in cihhw esac uoy odwul ecetxp meht to be benirigdsc a lednuo no ooidaieindr tp.auke

a​mmSuyr deoiv eerh nda salo a reagt teis ni nr:lgaee eetycdoirtrdn/oisnqtginpoo/reenaile/d/:r/sudpah/ec.mh

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aesalmon  gp 383 fo AF slsit ti drneu ryohpimhiysdot ubt ti odse nreetps as rnetatnis ripmyrsoihtedhy stirf +9
hyperfukus  ype htta asw hte key! tGireo si "OH"T tbu eht inaermgin rswnea ccshoie erwe tlils dnki of lbhe D swa itcsntiagrd teh lehl uot fo me i psten os gnol ot invnocce fesmly to cpik C nad mvoe on +3
hello  singaPt anknemnisnl'w monetcm sa an oddt:iain oCeihc ""D si nowrg b/c "hmaosytpmlou tdyihor ln"gad = aymiprr oihydtr hlmpoyam yitpa(llyc HLN, hwhic is rvye rr)ea or hos'mtsiaoH irtyhod rigosop.nrse imtsosoHha' hotytdrsiii = pyychoitclm rieiatfntl iwth iemganlr B sellc nad erhltuH l,lces iwhhc puno ecuinntdo itamntiu,sol anc dlae ot mainonagumtl/tatni nrrofaimotstna ot B cell maphmloy. htBo fo eshet ntprese hitw hmspoydtyhoiir wtih owl T4 and hhig HST i(sppoote fo hits ten)api.t +1
taediggity  I lyeubtlaos veol ruyo telrin,gi@rievdy eerowhv hte eiehoaspgtns of sumaopttrp iiidrttyhso si smiarli to 'osmiotasHh, so I itnhk hits sorenp sah tsaportpum hdiitriytso nad yrou nalxentiapo fo tsteirnna osisrihtxcotoy si spot on, wchhi duwlo lsao ccour ni pasumrtpot yidtthiosir +16
pg32  I eerag ithw eta@ydi.tggi lAso teon hatt nweom nyvatelule rcvroee from atotpurspm stryitohiid dan ptlyaiylc mebeoc yuioretdh nigaa, ihwhc otse'nd nephap twih o'atm.sihsHo +
vulcania  nI AF 1(029 .p 383) ti sasy atht dhrytoi is yllauus lornam size in urasppmott ird,ithtysoi tub het entaitp in itsh snqeouit dah a odtihry w"tiec the nrlamo "ei.zs I uegss ta teh den of the yad it eto'nsd ttmare chihw asgosdnii si ghrti rfo stih qesnoitu uaesc yeth ohbt seme to aedl to teh eams rtcorce ewrnas :) +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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Tihs is a tpaniet esca of mptotrpasu h.ritdtoisiy nCa aisre pu ot a reya tfear iyrdleve and has cpcylmtyohi tilr.nafiet

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almondbreeze  FA 2091 pg 833 +1
waterloo  hlhgutAo tsyohir essem ot opint rtdsaow ,ahtt ehs hsa an lregaden hd,iytro dna in pstrpotmua rhi,isitdtoy iyrhtdo lualusy lrmaon in szei or(mf .)FA ealrdsrseg teierh duowl vhea sycyltpoehm int.tirigalfn +



 +4  upvote downvote
submitted by nwinkelmann(366)
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heT txnoepianal yb ltiedrnieviryg slup het exotapnlnai ni het rtaeilc topeds ewlob (m9iw:sihPn.l/4h/8.cpt/p4rmbl..n99cvw/g6tn/cwiostMe/Ca) are het es,bt sutj eend ot eb idnebcom .): hTe retildneaiff nadsgsiio balte 1 (ny0twgc-9P-m.8lltpcm.nlsn9S/1h/6/e.B-tctsrLor40/9Obceja/ahoieMv4ip?/t//1inwe.ob=4Tpl1C:owbrt0M) llcipfisayce ediisfinet the tinoiodnc ni tish uinstoeq sa tstorppaum tisirioy.tdh

te,mUllyiat fi you wokn atth ymoiohisrtyhdp hsa a tenrstain yiohteyrpimsrdh easph ed(u to ueummtniao otrstcnuied fo hte elscl wihhc edaaylr ahd dfmpoerer TH and os it asw ldsereae unop itscrn)duote ebrofe royhidstpyhimo iginucofnntn(no lcels so cnt'a aekt pu ein)dio and atht mdhphysyoiitor is a tlchiymyocp nntltgiiarif ,ioidrtihsty uoy will wnko eht rn.sewa I dah a ahrd eimt tndidgrannesu tish ta sftri acebues we saaalintu/eodeevg bdase on the epcsneer of -POtnaTi Ab, tub eht ldgineyunr nsgephtieaso fo teh oyitrhd rutcstidoen is -dlteldemceia ty(pe VI e)eyiitvhptsrinys ton bA eaeidtdm py(te II rhveityiiny)stesp lkei rga.sve tssmaoHoh'i = mchitoylpyc ifliaontrnit with mnirglae enescrt hi(wch acn rtaofsmnr ot B ellc lmymo)hpa twhi terhluh lelsc n(rekip mospytlac ls.e)cl

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 +1  upvote downvote
submitted by niboonsh(409)
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anC meoseon xlipane eht dffierence ewbente .C rseeeal( of osetdr rdtyioh onhrmeo mofr a hydirto lgand rtnietldfia yb tpcmy)elyosh nad D. lR(eease of hytoird ohmeron frmo a umasyoomplht yitrohd .dgnla

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drdoom  no@oshb,in nidnge a onmctme ihtw a tusnqioe rmka liwl emka ti erpapa no the "tmcnemso singkee arsnsw"e stils +4
nwinkelmann  A mloypamtohsu oyhtird andgl acn hrteie be edu ot mrapriy thdrioy lmypaomh hihwc( si alsmto asawyl ,NHL tub si yvre rar)e ro ued to it'omhaHoss doihryt sgrorion.sep mhsoto'aisH rodysiitiht = omctyplyich rtitlaifne tihw merlgain B elscl dna uhtlrHe se,lcl chwih ounp dnintuoec iunot,laitms acn leda ot g/naaumnotliatimnt tnionramtasfor to B lcle o.lamphym eesh,T I ,bevleie wudlo listl nrptese hiwt hi,oyrhostidymp nad hsut ludwo aevh olw 4T adn ghhi TSH otip(opse of sith ept.at)in +1



 +0  upvote downvote
submitted by seagull(1933)
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rwcet/c9g/v/././6Pp9i4mlcasomCn.p4tltw8Mins9bnwhhi/:.

gcoAncrdi ot hits ea,prp Psomaurptt isdTortiihy sretsenp tiwh OPTanit- anisoedbt.i Teh ewnasr heicco ssue ypc.ymshtelo oS shti is a nnteitsra osioathsHm tysiHirreod.hmyp doGo cukL twih thta !neo

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seagull  :IEDT tocLmysepyh ear sola erpetsn in hist as .llwe yM dab +1



 +0  upvote downvote
submitted by hyperfukus(111)
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I tnkhi atth cneis 'yhtere nasgik ofr an eipxaonalnt fo teh 'ntspaeit unerrct SxS wchih osswh tath hsse' ni the tseat of niTsetran :ptrriieyyshdomH cihhw is deu to C: esReeal fo orsdte troydhi ehmonro morf a idrtohy langd titnafdrlei by cytelohspmy

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 -1  upvote downvote
submitted by mdmikek89(6)
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atcuueSb omytcpyhcil tatrubdiiSetsc oyhiu ymtlioycphc tosytirhiid is tacrzeirceahd by aadgem ot lulloiacrf lelcs thiw cmtpyhocily itinlartifon rnmligbsee sot'oaHmshi sttiryhiiod aedints fo uaagrnlom nrtoiom.af :Dugs r nfetiαr,rnoe- ithilm,u on,aademroi ir-ule,nein2kt rnyistoe saeikn ieusrhmuoimbio iAtnnt sadiees ot ptasPmur tdriti:syhoi tfcesaf %5 fo mewon uingrd het tpmurpoast odpier and si 3 temsi rome ocmomn nmago mowen thiw teyp 1 absetedi uits.ellm

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