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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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hiTs one aws a itltel ytkric. For shti noe hte yek is eth lwo addooiriine atpeku. ihsT petaitn has high 4T nad lwo STH hihcw mskea esnes ni a hirryyehtpdo tie,patn hrseapp yrou ifrst gthtuoh si tath hist taetnip sah vse’Gra eas.edis eoH,evrw ni a’evsrG yrou oyrdthi is niebg mdeltaistu ot akme emro ithryod nreomho from hccarts dan sa ucsh dwlou hvae an eesdrncia oaiindodire atkpeu eeucsab het hdtryio si gngnrbii ni eht rqdieuer own( drealdeiaolb) e.noidi This si why ti si ton Gavesr e“rsl(eae fo ohdyrti hnmoero rmfo a odityhr miuateltsd by obdaiensi)”t.

So fi sit otn Gsar’ve hwat cuold ti be? oFr thsi u’ydo hvea to nwok atth ohmHs’atios yTsihoiirtd als(o woknn as nrocChi myLoipchyct riidthisyoT dan si ftone efdrerre ot as schu on brdoa emaxs to hrwot you )ffo hsa ehert hseasp - strfi tehy ear yrtyhe,dhiopr ehtn tudhoyrie, tehn the ssaiccl tdyhyhrpooi atht yuo odwul xpetec wtih wol 4T adn hihg S.HT Tshi wsa the yek ot shti snuqit.oe hTe oersan fro this is ahtt thaodtinyri oxaredpies sitabioned ni Hm’soitaohs ecsau eth idoyhtr ot ealsere lal of sit rdsoet dhyiort omnrheo kimgan eht tntipae oryitedhhpry ofr a hstro oriedp of .iemt tAerf tshi simsvea ereleas of tirhdoy ,norheom eht biisotaedn eamk mthe elbaun to aemk ewn TH dna eehrfrtoe hety boceem ydohtueir orf a ohtrs opiedr and tenh phioytodyhr iwhch uoy wduol e!etcxp Snice hyte tan’c meka nwe H,T het dhitryo liwl ont tkea up hte nididioeaor nda reeertfoh etreh iwll be lwo deaindoioir apetuk. ,ecenH l“saeeer of odters idtryho ohrenom mrfo a thiordy landg litfidaentr yb ylo.esytmh”cp kaa hL“ptcmcoyyi (hotamoi)shs ii.drs”iohtyt

I hknti “ealeser fo trydohi eronhom fmro a olysmhmputao tdyhoir dalng” si enfgrrier ot emso indk of hidytor rceacn ni iwhch esac ouy wudol pxecte thme to be nsiidrbceg a nduloe on oiairndeido ptak.eu

r​ySuamm eidvo rhee and lsao a rateg iset ni :elgenar icec/srrenntpiondeoqersyet:edaua./imrhld/t/hondg/pi/o

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aesalmon  gp 383 fo AF tsisl ti udrne poymrhdishiyto ubt it sdeo sretnpe as atstneinr ieiyhdpmohsrytr frits +9
hyperfukus  eyp tath aws het !key eoritG is "HT"O utb eth miinegran waensr scihoce rewe llsti iknd fo ehbl D was ndgstiaitcr het ellh uot of em i pntse os nlog to evicncon fyselm ot ckip C nad emvo no +3
hello  igasPnt nlk'snanwmnie emnmoct as an i:dtdniao hoeicC D"" is rnogw b/c lsoyut"hmmapo ityhdro a"lngd = rrpmiya hytrdoi pyahlmom pilcyty(la ,LNH ichwh is veyr err)a ro smo'otHshia riydhto igrps.reonso isha'soomtH itithdrisoy = phctmoyicyl efralttnii ihwt rmiglena B lslce dan heuHtrl lcs,el hiwhc ponu unnceodit ,aitionlsumt nca ldae to /gamlunnoaitmintta tatnnfiorrsmao to B clel la.phyomm htoB fo eshte etpners whit yimtsdyhirohop hwit wlo T4 nad ghhi SHT se(ptoopi of ihst nai.eptt) +1
taediggity  I yetsoballu evol rouy it,rneidyi@regvl eevhorw het ssihaotgenep fo rauostpmtp ihiositrdty is rimails to 'aomissh,Hot so I nikht siht ersnpo ash pstpoaumrt sriihodtyti and oruy lixtapaenno fo rnntaites soihsticyrxtoo is post ,on ihhcw owdul losa courc in mtpopausrt iityridsoht +16
pg32  I egare wiht @.eiygitdgta lsAo onet that wmneo tuvllnayee vrecoer orfm oautprmpts ihritdoiyst and iylyptcla eocebm otheduriy g,iana whchi todn'es hpepna ihtw h.'miHtsasoo +
vulcania  nI FA 2(910 .p 833) ti ysas taht tidhyor is yuausll rnlamo isze in pmratuotps i,irtydohtis tub eht enatitp in sthi qesoiutn had a ydtrhoi teci"w the rlomna se.z"i I sgeus at teh dne of hte ayd it dtsno'e reattm hciwh signidaos si tgrhi for siht etosqinu euacs they hobt smee to laed ot eht seam eorctcr rasnwe ): +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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hTsi is a ptietan sace fo upptormsat oihtrst.ydii anC arise pu to a year afetr rlvedyie adn hsa omchcypylti teafrniilt.

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almondbreeze  AF 1290 pg 833 +1
waterloo  tohuglhA hoyirst msese ot toinp wtsodra h,tat hse sah na eraendgl to,diyrh dna ni rmaupttpos itsi,tryoidh otdhyir luyuasl mrnaol ni eizs or(mf F.)A srledearsg eirhet wodul vahe hopylseytcm ainlntgi.frit +


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 +4  upvote downvote
submitted by nwinkelmann(366)
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The oilpxteanna yb videglerniiryt psul eth eannixlatop in hte ricetal pteosd lowbe (pl///:gnstnb.MP.siv4ttiwcre.6oc//c94an8w.wpmCmih99/hl) rae hte ebst, just ened ot be iebmnocd .:) Teh nlieitfredfa ndsisgaoi eabtl 1 (ti1Bp48re.1T=.9ythCe/nP:r9otsvtoc-4wm0LblSaiilswhj?gt10la9r/c/ctemon.eM-b/6/nop//OMpb4l-n/.0wc) ecalsiiypfcl tnsideifie het cnitodnoi in ihts nesuoqit sa pprtotamus riohtt.yidsi

yaeml,Utilt fi uyo know ttah posmyioyhrdhti has a isnttnear merohyiidysrthp ehsap eud( ot tumoiumane sioudntrtec of hte elcsl hwchi dalyear adh rfordmeep TH nad so ti was eaerdlse puno iudc)ntoster eoerfb rsmdiyihohopyt touonnif(ncgnni lscle so tacn' ekat pu nid)ieo dan that ohiysmpoihdyrt si a ypylcomitch iagnntriftil dhyiitrt,soi ouy wlil wkno hte es.anwr I adh a drah eitm sieanddngrtnu stih at ifrts secbuea we daeunv/selogtiaae bdesa no hte cnesepre of Pti-nTaO ,bA but het rdgyenilun ptsghinasoee fo the otdirhy neriustdotc si liecdaldme-te pyet( VI iiy)hpetiynstrsev ont Ab emitdead (ptye II )vyieenitprssyiht like a.gvers mhtoiosa'Hs = pcichoytyml ontafiiniltr itwh aiglenmr erscnte ihh(cw acn tonrmasrf to B elcl hayo)pmml ihtw etulhhr lclse kinr(ep tplcmyaos esc.)ll

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 +1  upvote downvote
submitted by niboonsh(409)
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Cna eooesnm lanepix het erdecfeinf tebeewn C. aeles(re of rsodte dtyroih hrnooem omfr a dtyrhoi nglad tlfaiienrdt by otcempy)lhys and .D ee(alseR fo iythrdo mnorheo fmor a uytommoahlsp hdiotyr agn.dl

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drdoom  ,oonhbns@i dgnine a mtnmeco ihtw a qsetuion mrak will kmae it pearpa on hte o"tcnemms eskngei asre"nsw tisls +4
nwinkelmann  A oomlamsuhpyt iytohrd ngadl nca eetrhi eb eud to ripmyra hytdoir opamhylm whh(ic is msoatl ysalaw NL,H but si eyvr a)rer or ued ot sso'tmHoahi irdtoyh iresrsoonp.g ms'haoHosti ihdortysiti = yihlpycomct ftaniertil ithw emganrli B slecl nad ehlHrut lesl,c wcihh npou cenountid ulaotisnimt, acn elad ot ngmto/nimaaalnutit rfoatsmitnaorn to B ellc hmy.polma ,esehT I ieeev,bl ldwou isltl npsteer thwi yioihhprsdytmo, dan huts would eavh lwo 4T adn hghi SHT sopoi(ept of sith tn.t)aepi +1


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submitted by seagull(1933)
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w:r..w9i/v///8lwnltPhtccs.4biehi//m6mg49Ca9tpnp.Moncs

Aignrcdco ot siht ppa,er sotPpmuart sioidThytri psentesr iwth PaTtniO- tioibasd.en hTe ewsran ihocce esus .hysypoemlct oS isht is a tnartneis mitohossaH yiieHr.yhdrsptmo odGo Luck ihwt ttha eo!n

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seagull  TID:E otyhmLyceps rae saol nstpere ni thsi sa .wlel yM dba +1


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submitted by hyperfukus(111)
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I tkhni thta escin reyhte' skniag orf an xonalaetipn fo the etnspita' rerctun xSS whihc wssoh taht 'ehss ni hte attes of eaTtrnsni meoyytsiHidh:rrp whihc si edu to :C easRlee fo edotsr drtihyo hmoonre mfro a rythiod gndla etidlfntair by yoyemtplhcs

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submitted by mdmikek89(6)
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uStbauec yoymlptcchi cdtasieruiuitySbth o hopcitylycm itrtiihsydo is czrdaetriahce by agamde to oircalfllu sllce ithw hiyotpcclym nifntrtlaiio lbegmenirs h'Hosstoaim tdsiyiihtro idtneas of aolranugm oa.nomtifr r gsuD: renn-αoeit,fr hlmu,iti adromio,ane ter2unn,iel-ik yriosetn eksnia imtAinohneisubutmroi dsseiae mtsPtoupra ridtoysih:it teaffsc 5% of emnwo ugdirn eth sprotmtapu rpedio and is 3 estim orme cmoomn gmnoa nowme wiht tepy 1 aetbside m.lsliteu

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