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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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iTsh eon saw a leltti tiykrc. rFo tshi eon the kye is eth wol ioridadinoe eupk.at sTih entapti has gihh T4 dan lwo TSH hwich esmka sseen ni a hdytiyhprero nptaeti, hapepsr oyur rifst tothugh si ttha hsit iaenptt sha ’aGevrs iedss.ea eHoerwv, in vr’eaGs uoyr hytroid is gbeni tsimutadel ot kema rmeo dtyrhio oomenhr fmro artcshc adn as hcsu luodw vhea an idrecaesn irddooieina tekuap abeesuc teh dorthiy is igginnrb ni eth qureider o(nw ordbielldae)a ind.oie hTsi is hwy ti is otn rasevG (reeas“el of itydroh oerhonm ofrm a ydohtri imtasdletu yb eindboa)s”ti.

So fi tis tno raGv’es thwa uolcd ti e?b roF hist ’oduy have ot oknw hatt ’hiosHmtsoa ydioihriTts (laos nokwn as hrocniC ohLctympiyc itTohiidrys nad si fotne erfrrdee to as chus no board amxes ot wtohr oyu of)f sah eehrt apsesh - tfirs teyh era pyohhdeyirrt, tenh o,itdhryeu nteh teh iclassc iytyhpdrhoo ttah you woudl tecxpe itwh wol 4T nad hghi S.TH hTis swa hte eyk to sthi ostqueni. eTh naoers rfo iths is taht ainrtihotyd eiparsdxoe tnibeidosa in mHtoha’ssoi uasec eht dhoyitr ot leereas lla fo sti etosrd oihtdry ronmeoh angkmi eht tpnaite yrrheoityhdp orf a rtosh idpoer fo .etmi etrfA sthi ieassvm eeerals fo htyirdo hem,onor eht iteaoibsdn mkae ehtm nlaueb ot akme enw HT nad fheoeretr yhet eeomcb yuiredoth orf a sohtr odiper and ethn dhhytoiypor ciwhh yuo uowld !xeecpt ineSc yeht cant’ akem ewn TH, the hyoditr lwli otn keta up teh oiiraneiddo and eehfrorte rteeh illw eb lwo iadeioordin autpk.e en,ecH “slreeae fo eotrds hrodyit nomerho mfro a rthioyd angdl itlratnefid by ”mestcy.lphoy aka tLc“yyhmcipo t)ihshsmaoo( si”oiti.ydhrt

I iktnh easrlee“ of trhidyo omneorh rfmo a mtoosphayulm thridyo gld”an is igrenrfer to oesm indk fo drytoih ncarec ni hihcw cesa you ulwod eectxp ehmt to eb erigbidnsc a eonudl no odneiodirai ktu.pea

yamrSm​u evdio ereh adn osla a eartg esit ni agrlne:e /goe/yi/rdstnh:nedonehdqpr/rne/ocac/.arulimteisotdepi

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aesalmon  pg 338 fo FA tsils ti derun himhoisprydtyo tub ti sode esrnetp sa nseartitn ymsieirrphhydto frsti +9
hyperfukus  eyp taht asw teh k!ye Greiot si OH""T tbu teh aginemrni aerwns ihcoecs rewe sltil dkin fo hbel D was gdttiricnas eht hell uto of me i epstn so nglo to iconevcn syfeml to kcip C dan move on +3
hello  Pstaign nm'lwkniasnne mmontec sa an :noiidtda hecoCi "D" is ogrwn /bc usmaytlohmop" thoirdy "gdlna = imyrapr tdohyri yampmlho a(lyctlypi HL,N which si yvre era)r ro t'hsmaoisoH hyotidr oosgrinepr.s 'msoothsaHi irthtodyisi = lpotcyhymci nflieitrta ihwt manerlgi B sllce nda rehlutH leslc, iwchh upon tcudionne amttoui,lnis acn elda ot a/tniatmmunoailgtn sotofrnratianm to B lecl ahloypm.m othB of steeh sneetpr whti roimihpytsdyho hwti wlo T4 dan ihgh HTS esio(oppt of hsti ep.tt)ani +1
taediggity  I yluetlbaso ovel oyur rrtiilvin@e,egyd wrheoev hte iospeagsehnt of tustmproap dorsttiihyi si iaimlsr ot hotmsHio'sa, os I inhkt sith psreno has uposmattpr oiitrsdhyit adn your oxaptenalin of esitnatnr hctotisoriyxso is otsp n,o chihw dlouw aslo cocur in tmsratoupp iyidirsthot +16
pg32  I aerge wtih g@ygtiediat. olsA oten ahtt owenm etyevalnlu evcrero ormf rusattmppo ihisodtriyt nad paytclyli emocbe riyeoduht a,gina ihhwc ndoe'ts nhpeap wiht sos.Hm'thaoi +
vulcania  In AF 209(1 p. 833) it sysa atht hidtroy is uuasyll omnral zise in mappusotrt yihrtostd,ii utb het ttepnai ni hits oitsuqne dha a toyhidr c"ewti teh amonrl e"i.sz I guess at the den fo hte yda ti esn'dot emttra hcwih iosdngias is thrig fro tsih ntoeisuq aeusc htye hbto eems to laed to eht seam rcetorc nsrwea ): +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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ihsT si a tentapi saec of prtmuspato yroiisidt.th naC sarei up to a yare traef dlevyier dan sah cicomypylht trfatni.eli

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almondbreeze  FA 0921 gp 833 +1
waterloo  uoghhtlA oirhyst ssmee to noitp tsaowdr ,htat hse sha na relegnda hdrt,ioy nda ni prautstmop idisthrty,oi hitrdoy ausulyl aonmlr ni eszi ormf( .F)A rrsldesega itreeh owudl heva etphmolyycs ginftltriani. +


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 +4  upvote downvote
submitted by nwinkelmann(366)
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heT npxnaleotai by lrridnityvigee lpus het olanapnexti ni eth acrliet tpoesd lwobe (csMwh//arplv.b:p/toci/snniC/99m.4.iwg/mt9n6whtl.8cPe4) rea hte b,est just eend to eb cmnbidoe ).: Teh itaferfienld aioissdgn atlbe 1 (6ttwth.r/.ocw/0hiMr/se4911Ppe-/mTl4jbp4cMnr.pta-sia9gB=/-c0emlyLnl:ntv0itSOo.ooenwb/c8/lb1?C9/) sliciclaypef efeitiinds het tniidoocn ni sith notqisue as aouptsprtm thisitdi.ory

,lileUtmyat if yuo wkon thta dyhmsrhoipioty sah a rsninatet yysihtdmerhpori paesh de(u to aunetmiuom tcnsotediru of the selcl hhwci dearlya adh mpeeofrrd TH and so it was eesraeld npuo iur)osctnetd eerbof tyisrymodopihh (otunnocinifngn eclsl os nac't kate pu )eoniid and ahtt yosomhhitirdyp si a coclmhiypyt arngiifitnlt dittsihoi,ry you will kown the .wrnsea I adh a dhar mtei etngdurandsni itsh at itrfs uebceas ew laogiesvunda/atee edbsa no teh nesecpre of nTOiPa-t A,b tbu teh uyglidnenr gassihenetpo fo eht hodytri rdtieonctsu is detlecl-imdea t(yep VI iiypnvetehtisrs)y ont Ab adetmdie epty( II si)tsnhivpyeteyri keil ga.vrse stohHa'siom = lticphymoyc tionlrinatfi iwth naeirlgm scteern hwich( can otrfrmsna ot B ecll omaypml)h wiht htehurl scell pinke(r otcymalsp elc)l.s

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 +1  upvote downvote
submitted by niboonsh(409)
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anC oemesno xnileap hte rffecdiene twnbeee .C a(eelrse of tdsoer rtoiyhd erhmoon mfro a rydhoti nglda aiiedlrntft by yocmltpseyh) adn .D saleee(R fo riydhto ehmnoro mofr a atlmhmsyupoo yihdort dnagl.

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drdoom  binnho@o,s dnineg a mnmotec ihwt a ensiuotq arkm lliw akme ti apaepr on hte tcmn"smoe ekgnise "swesrna slsit +4
nwinkelmann  A yltsmmoupaho iodtyrh lngad cna reieth be ude to pimayrr irythod apomyhlm hiwc(h is sotlma alsyaw N,LH btu si eyrv r)aer or due to soostmhH'ia ytdoirh gsrnsoi.orep iHms'ohaots othytsriidi = cpmoytiychl tritalnfie wtih iemlanrg B slcel dan uhrHetl ,lsecl chiwh ponu notcduien oanliiuttms, cna aedl to anttmnani/lugmoait mnrnafsoarotit to B elcl .pmhomyla h,eesT I liee,veb lwoud lilts eeprtsn whit isyr,phtmihdoyo dan tsuh wludo heva low T4 dan hihg THS iopseopt( fo tshi tt).napei +1


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submitted by seagull(1933)
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/w4ngC.99vc.s.hlnbnm/tMw4pptilrh.sm8iea9/ti//6ow:Pcc/

gcicrdnAo ot sith ,rpeap atpuormtsP riTotysdihi eetnprss wtih -iPtOTan bines.adoit eTh rswane chicoe sseu yhpmtyos.elc So hsti si a tirntaesn ssmthaiHoo hiHemptiordy.yrs Gdoo ukLc hitw ttha !noe

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seagull  TDEI: pycsehtLmyo ear salo sertepn in tsih as w.lle My dba +1


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submitted by hyperfukus(111)
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I inthk thta iescn yhre'et kngsia orf an iaanneoplxt fo the et'tainsp trnceur SxS wchih hswos ahtt es'hs ni eht attes of ansTriten myrdioHtiprse:yh wchih si due to C: aseeeRl fo erodts rohtiyd meohorn fmro a hotyird dglan ltrniafedti yb plmseycothy

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submitted by mdmikek89(6)
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batceSuu ilpcyhycotm bcttdoiyhsuiueti Sar hyoymlccpit dithiiosrty si raziehetdcarc by madgae to farlociull lcsle ihwt mhcyltopcyi rnfttliinaio erelsngibm otis'amohsH tsdrihtoiiy tanieds fo aaglmurno tmnfoo.rai srg :Du r,nα-rfneteio muiih,tl ,enaaomirdo ,ni2-tulnkriee rsienyot inksea iihneniboostAmiumrt u aeissde trtsoamP pu hiios:trityd tcefsfa 5% fo mwoen grniud the muptrtopas oipedr dna is 3 tesmi emro mncmoo omnga enwmo hwti epyt 1 eatebsid .tsmiellu

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