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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 eno saw a litlte crtky.i orF this oen eth eky is eht wlo dioinaoerid auk.pte Thsi apntite hsa high 4T dan lwo SHT icwhh kasme esnse ni a piteyhoryhdr ,eapntti sphrpea oruy tsfir thoguht is atht hits intteap hsa Gse’var iasdese. rveoeH,w ni serv’Ga uyor iorthyd si gnbei distamulte ot amke erom iytrohd moenorh mrfo crhsatc nad as uchs wdlou ahev na ncerasedi dednoiioari kpateu beuasce hte yirhdot is iinggrbn in eht iedqrure own( iebodaa)delrl niieo.d hTis si why ti is ont vGaers ele“srae( fo dtyhior omehrno omrf a othiydr tdiltaseum by b)”.indosaiet

oS fi sit otn va’rsGe awth olcud it be? Fro htis dou’y heav ot nwko ttha ’satioHhsom odsThiiriyt la(so onnkw as onrChci Lcphmyticoy oihrtysiiTd nda si tonfe dfeererr to sa csuh no odarb exasm ot otrhw you )ffo ash hteer ssehap - itsfr eyth rea ty,oepdhyhrri nhet yd,ihetruo tehn the scisalc pyhoyirdhto atth uyo wldou teepcx hitw wlo 4T nad ghhi HTS. hsiT aws the kye to iths esn.oitqu heT esnrao for hist si atht iohnirtdaty dxiraeeosp iiosdnabte in somHt’ihaos casue het dtrhoyi to lreesea lla fo sit seotrd thyodir rnmheoo agkmin hte nteapit iedyprhoyhrt orf a tshro dorepi fo emti. rfeAt tish eiasmvs laeeesr fo riyodth o,hrmnoe eth otsnieidab mkae mthe nulabe ot eamk ewn TH nad eefrehrot eyht omceeb hyourited rof a orsht poedir dna hnet oyphidrthyo hcwih ouy uowld x!pctee cnieS ythe ’natc kmea ewn HT, het roydhti wlli not ekat up teh iiodironaed nda reertehfo trhee lilw eb wlo irndodoiaie apte.uk Hce,en “arelsee fo droste dytoirh omenorh rmof a yhdroit ldnag idriafntlte yb ltcmpye”y.soh kaa ythyLo“cimcp ihsmaho(tos) rsyidtti.”ioh

I tnkih eerase“l fo otriyhd oerhmno ormf a aotmulmhpsoy hdrtiyo ”gnald is errfiregn ot meos nidk of irhtyod ecarcn in hihwc case ouy udlow teecxp temh to eb icdensibgr a ldeonu no dooreiianid uaketp.

Srua​ymm dvoei rehe dna laos a aetgr iset ni eerng:al leiipoou/ee.dihdh/e:a/p/t/qgotiaonmy/nesensdcrrcrndtr

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aesalmon  gp 833 of FA silst it dnure idyrhypsootimh btu ti sedo erstpen sa saetntnir sdmpietyohrihyr fstri +9
hyperfukus  pye thta wsa eth !yke otierG si "THO" utb het ginamrnei enrwas occhsie rewe sitll kdni of lbeh D wsa cstdiiatngr teh lehl uto of em i entsp os onlg ot vnoicnce mfelys ot ckpi C and vmeo on +3
hello  Pigasnt nwm'alinnsken metmcno sa na :idtidano ochieC D"" is owgnr cb/ otya"ulhopsmm dihrtoy ldnag" = mairyrp ioyhrdt oapmhmly typyai(cll HLN, cihwh is ryve e)rra or 'shmasHtooi hrtidoy ore.gsirpsno hosia'mtoHs sitdohriiyt = cycmpytihol alnfiteirt thwi enlgrami B lslce dan reHuhlt lcel,s hciwh unop oeitdnunc muo,itatnisl cna eald to nltatamtog/muiinan ofoantramritsn to B lecl h.lammoyp tohB fo etseh neptres htwi srydhmtyhopioi htwi lwo T4 nad ghhi STH po(otepsi of hsti etat).pin +1
taediggity  I lsoauylteb oevl ryou ld@r,vieiyngeirt hewoevr eht eohspatesnig of tsumpraopt thriioistdy si lmsarii ot oioatmhs',sH so I kthni ihst epnors ash tmapptruos diriosyihtt adn oyur oxtieapnlna of etrnintsa irchisotostyox is sotp ,no hicwh lduow laso occru in uptotpsmar doiiyttshri +16
pg32  I eager tihw ytdit@egga.i loAs teon htta oewmn lyvaeeutln vcreoer form toapptsumr sodtytiihir dan icypyllta ecboem yeidthuro gni,aa hhicw netsdo' ehnapp iwht Himsato.o'sh +
vulcania  In FA 129(0 .p )338 ti says that rytdoih is salluuy amlrno isez in mattuprpos dirsyit,htoi btu eth teitpna ni ihst tqnouesi adh a ytordhi "weict teh rmalon zie".s I ugsse at eht den of het ayd it dnes'to ertatm whchi dnioisasg is rthgi fro isht tqoieusn sauce yhet thbo eesm ot elad to hte ames ecctorr anrwes ): +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 tnpitae ecsa fo tmruaptpso iiiotyshdrt. anC raies pu to a ayer rfaet lveyrdei nad sha yycmiptchol aflte.tinri

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almondbreeze  AF 1290 gp 383 +1
waterloo  thuolhAg hryitos seems ot tipno swoadrt t,ath she sha na rlegnaed tohyr,id and in pumorstpta yiottsh,riid riyothd ualyusl nromla in isez o(rfm .AF) ldsesaergr ieehtr lduow hvae pyymclhseot gftalinnti.ir +


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 +4  upvote downvote
submitted by nwinkelmann(366)
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eTh inxlaaepont yb rgvdyiierliten slup het laentpniaxo in eth eicrtal tesdpo wbole (.eCtv:4h9mw6i//cwpM9h.8nlbncla/i4nom.gsr9i./p/P/wttsc) aer het bet,s tusj edne to be menboicd :.) eTh dflreeitinaf igsaisond tbeal 1 (p/Tnn0r4i.lncrptS9h:-Bg6?tePtam-19s.18L4tes.-c/mp/co/1otnw=w0OlCle/./e4hvb/bcyoi/9wljtrMiaMbo0) clfsiicyplae eitidnsfie the ionidctno ni htis otnqiesu sa ostrmuatpp yoiitst.dihr

itymtae,Ull if oyu nowk ttah hiioythdopsmry hsa a nrtsitean ihrioprdtsyhemy phase (ued to uoaiemutnm sdircnotute fo eht cllse wichh dalyera dha pfemdroer TH nad so it asw eaeerlsd nuop duortsc)eint ofbree htirhsmopyyiod c(onungionntnif eclls so tn'ca tkae pu eid)nio nad tath ihytmophsyirdo is a mhiytyocclp ainftilgitrn isytr,idtoih uyo wlil okwn eth n.ewsra I had a hrad item inddaensunrtg htis ta rtifs esubeca we atondsgaelveiuae/ debas no teh ecpeenrs fo tiOPTan- bA, tub teh inylnerdug stnhaeogieps of het yhtirod stntdueiorc si elmee-dtialdc y(pte IV v)rtinipyssyethie otn bA iemeatdd ye(pt II pssiirvettyih)eny ielk .avgsre ihsmotHo'sa = chpctylyomi lrinntfiaiot thwi alnmegri sreecnt h(hcwi can trfrnsamo to B clle )omyamlph whit lehuthr sellc en(irpk mcatsoypl cel).sl

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 +1  upvote downvote
submitted by niboonsh(409)
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anC osenmoe pnexali the nfdecrieef bwetene .C lres(aee of esrodt rhydoit oreomhn romf a ihyortd lndag aefrdiitlnt yb lmoy)cytpseh nda .D eR(aseel of ytihdor oormehn mrof a tuomyosplamh dohryit g.nlad

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drdoom  n@nboohs,i dnngie a cemtonm thiw a osiqnteu kamr lwil aekm ti aeppar no hte cmmnt"oes nkgisee ssnra"ew sstli +4
nwinkelmann  A ouhmlayspotm iotrhyd ndgal nac riehet eb ued to mrayirp yrihodt lyphmaom whi(ch si oltsam saaylw ,NHL utb si eyvr earr) or due to 'samhosioHt rdiothy ngosre.sopri sosimat'ohH ttiihoydsri = htlpmiccyoy inelttrifa wthi eringaml B sellc nda lhrutHe ecs,ll hiwch unop tucninoed nosm,tutliai can eald ot /lntniimamgtoaanut nsttaofimrrona ot B elcl pammo.lyh ,eTesh I eeleib,v odlwu tlsli npetesr tihw ootimsphirhyyd, nad suht oulwd haev low 4T and hhig TSH ppse(tooi of shti eita.)pnt +1


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submitted by seagull(1933)
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gs//:t9P..ahcc/nlhiceoppmi/rl/s.4C49b.wMw68/9tvmwntin

iAcndrocg ot isth ,appre rtotumPpas iiothyTrisd snetpers htiw OtP-niTa adib.oitsne The asrnwe echico ssue .pyehlsocymt oS htis si a nanstreti oasstHimho porreHihs.dytyim dGoo Lukc iwht thta no!e

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seagull  :EITD spyheoyLmtc are alos erenpts in hsti as el.wl yM dab +1


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submitted by hyperfukus(111)
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I ihntk that nesic tehre'y snkgai fro na innlaetaoxp of eht 'nptesiat tncuerr SSx hchwi swosh ahtt e'hss in the tetsa fo teiTsanrn Hroihdeiysmyprt: ihhwc si deu to :C elseeRa fo dtores oirhdyt enoohrm fmor a tydiohr lndag idtfilanert by lcpyomsyhet

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submitted by mdmikek89(6)
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cbuaeuSt ciclotpmyhy byrietohsSaituid tuc coympithlcy tyiiodtrshi si ciatrdzeehrac by dgmeaa ot llirfcauol lcesl ithw oimlptyychc fatronniiilt bnlgsmieer sihoaoH'stm itiitsoydhr aitnsed fo augloamnr mr.otnifoa Du:sgr orrtniαe-n,ef tlhum,ii eomdniao,ar ni,lkte-nrue2i sierytno aeiksn miuuniAhiobtionr tsem ssadeei uomat Ptprs itdih:styrio tfsecaf 5% fo owenm rnuidg eth sttrpmpauo pdorie and is 3 itsem reom cmoomn naomg omenw ithw tepy 1 esatdebi ilmestl.u

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