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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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hsTi neo swa a tlietl ctyrk.i orF this eon teh yek is eht owl eidoodiainr ekaupt. siTh npieatt ash ihgh 4T and wol TSH hhciw kesma sseen ni a tyyehiorhprd atet,inp esprahp uroy tfris guthoht is ttah htsi tnpeati sah sv’eGar desisae. oHwrve,e in reavGs’ uory tdryohi si igbne uasiemtltd to maek mreo hodtyri moeorhn ormf thrccsa nad as husc luwdo hvea na nciderase oiiaddirnoe upeakt ubascee eth hodyrti si inbrnggi ni het dreuqeir wn(o e)ealldaibdro neio.di ishT is why it is otn ervGas e“(earesl fo ohtirdy monoerh fmro a hdryiot idutlatesm by eb”)asdnio.it

So fi sti nto ’Gvsaer ahwt doluc ti e?b oFr tish ydou’ ehav ot wokn htta i’osmoahtsH tiyThidrosi (olas knonw sa iocnrCh yctphmcoyLi rTidtyhsioi and si nofte rererefd ot as schu on baodr smxae to owtrh ouy off) hsa rehte esshpa - irtfs yhte ear idyhrrpeyt,oh nteh yhutdrioe, nhte eth sialccs thdrohypyoi that oyu dowlu pcexet htiw wlo 4T and hghi T.HS ishT was eht yek ot hsti esn.quiot eTh raseno fro tish is htat hdyirattino rapiosxede naodstieib ni sHoaothi’ms eaucs the dtoryih to eearesl lla fo tis seodrt thdyori onmhero imgkan hte paetnti perdirtyoyhh rfo a oshrt pireod of t.emi ertfA iths iseasvm eelesra fo riotyhd romo,enh het oatdeniibs kaem meth uanbel to mkae ewn TH nda eerroefht teyh bmceeo hrtiudoye orf a srhto rpeido and thne drohiyphyot hcihw you ldouw pxeect! cSein tyhe c’tna amke enw T,H hte ithdyor lliw ton etak up het eoordiniadi dna oeefterrh erhte liwl eb wlo noeiirdoida ektupa. ,Hcene selee“ra fo tsodre riothyd mnehoor rofm a hydrtio lagdn iinrdltatfe yb sho.teylpmc”y aka picc“hoLtmyy is()htsoahmo d”irsiohity.t

I kihtn laeser“e of ythidor hroemon omfr a hslmtyupomao oirhytd nlg”ad is geeirrfrn ot mose iknd of ydroiht earccn ni hwchi csae oyu dlwou xptcee mhet ot be gdiensbicr a uolnde on aodeioiidrn aupekt.

​ymaSurm oivde ereh dna laos a atgre ites ni rngele:a droprroeo/unnn/siddchcelaye.d:amesit/teentir/igp/qh/o

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aesalmon  gp 383 fo AF isstl it rnedu hymootsyrhdipi tbu it esdo sprente sa ntntesari hhteiyysmprorid tirfs +9
hyperfukus  pey hatt asw eth !yek eotiGr si THO"" but hte nmiiaegrn enasrw cioches ewre ilstl ndki of ehbl D saw tastrigdcni eht lehl otu fo me i tenps os long ot cevicnno fmleys to cpik C dna eomv no +3
hello  niagPts wnnni'eslnkma momectn as na tdnoa:dii iocehC ""D is wnrog b/c oaysol"mthmpu rdhityo nal"gd = riayrpm tordihy maympohl yltla(icyp H,LN whchi is yerv rear) or o'hsoasmHti htidoyr spnosoreg.ri asioth'smHo rhidsiyttoi = iymycptochl aetfntilir wiht ainmrleg B lcles nda ehlHtru sell,c whhci opun dinctonue mi,tuloitsna nca eald to /tnmaautnniogatilm asratrfintomno to B ellc maylo.mhp oBht of etshe etresnp hwit hsyyoridmtohip thwi wlo T4 and ghhi TSH (pspeioot fo ihts aitpet.n) +1
taediggity  I toslabelyu leov yrou ritin@yvr,gedeil hweoerv the otinseegpahs fo suopmptrta driihiysott is mliasir ot t'mashoH,iso os I thkni itsh espron has tutmpospar rsityoidhit dna uory ietaalnnxop fo ttaiennsr rtiotsiyhoxosc si otsp ,on hchiw wuodl also orccu in putarmpots tiydothiris +16
pg32  I reega twhi @yiadgg.ttei sloA neot hatt wneom letynauvle rercvoe fmor mpoatpusrt tiyhitirosd nad playitylc beemco iyhourtde an,iga hhicw nodt'se phpnae iwth mHoih'a.sost +
vulcania  In AF 19(02 p. 3)83 ti says taht tiyhodr is uyasull nrlmoa isez in uotpparsmt tysridtoiih, tbu teh taintep in htis qonitsue had a htydrio wtc"ie eht naomlr e.sz"i I sesug at hte ned fo eht day ti tosn'de mttaer chhwi odniassgi is grith for thsi otiesunq ceusa tehy btho emse to ldea ot het msea rcteocr awrsne ): +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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Tish si a tnapiet csae of mposttpaur oitri.shdtiy Can rasie pu ot a raye rfate erdylevi nad sha liphyoymtcc nitraeli.ft

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almondbreeze  AF 1902 gp 833 +1
waterloo  glAuhtoh sohtiyr sesme ot otpni trawdso ttah, esh ash na aengelrd iotryd,h and in uraoppmtts rhtidiyi,tso rhtyido ualyuls lnrmao ni zsei r(mfo A.)F rseseagdrl eeriht wdoul vhae phlotemcyys nafiiittnl.rg +


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 +4  upvote downvote
submitted by nwinkelmann(366)
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The nlnxaopiate by rrdveglyiiietn upsl het ailoxennpat ni het rlcatie tosdep woleb (pntwh4//p9bl:6snlw/.vs9mP.c/ia9.h4nM.wtcme/oi/rcitC8g) ear the etbs, tjus eden ot eb bcneomid ):. Teh ifirdaeetnfl dogsnsiia tebla 1 (1.-ogbww/4=s9-v-.:rcoMCt0O6etmr.llh/c4aibct0mhnt90t9yp.MPTt/BinSap/lenL1w//on?i4/sb8l/jepc1ero) ipcsfleilyca eiesnidift teh dinotoicn ni tish ituosneq as smrtpautpo ythtsirdio.i

imtlat,Uley if ouy knwo tath iymyohiprdsoht sha a naeittnsr eyoiishrdrhytpm ahspe deu( to meunoaimut etsctniorud of teh ellsc chihw earlday dha errepdomf TH nad os ti asw erdlesae upon utint)csedro febore yydsioohpithrm fnnn(ctigunioon lscel os tan'c aekt pu eiodi)n dna htat iphdtoryisymoh si a ciotpymyhcl agniiilfrntt thyod,irisit yuo illw nowk the wa.nrse I dah a rdha meti ernntsdgnadui ihst at trifs ubeeasc we slad/eiaoatgenuev absed on het eeerpsnc of iaOt-nPT ,bA utb eth nrngdiulye eihogtnepsas fo the ortyhdi trotendicus is eiee-madcdltl (ytpe IV yhritevin)tssiype not bA amtieedd pety( II t)pshyiryisetevin leki r.svaeg haHot'msiso = itylcpmycho nraiotiitlnf thiw ermangli setencr w(ichh nac mrratnsof to B llce yolmmpa)h twhi hheulrt lselc ki(prne yplmaotsc esc)ll.

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 +1  upvote downvote
submitted by niboonsh(409)
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anC msoeone axnelpi het eifrecefnd eeenwbt .C le(rseea fo srdtoe horydit meohnor romf a yhtirdo dglan nadtrteifil by ceymlpyto)sh adn D. Rsa(eeel fo riotdhy onhermo rofm a apmuslymohto drohity ngald.

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drdoom  bnho,nsi@o idgnne a memnoct twhi a ieunoqts makr wlli meka ti areapp on eht meo"cnmts egnieks wn"erssa tlssi +4
nwinkelmann  A auytlsmohmop ioytdhr lgdan nca ehtire be ued to iprymar rtydiho apmhmyol hwich( si tlasom ywlaas NLH, btu si vyer )aerr or ude ot oimH'thssoa rtyihod sn.rioreogsp Hoais'hsmot hoitsyrtdii = topchcmlyiy tefniltria wtih rmenaigl B lecls nad utHlreh c,slle wihhc uonp ndcneotiu ,attiinsmoul anc elda to aa/mmlnangioutttni rntiormatnfosa ot B ellc yol.mmahp ,Teehs I lbee,vei uowdl tsill epsnetr thiw rsiptm,hhoyyiod adn uhst ludwo ahve wol T4 dan ghhi STH pieops(to fo this tn.ti)pea +1


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submitted by seagull(1933)
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nPeviwp.l8c9i:cCnwtMm9tl/og6./r/w4/cs/.han/ithbms94.p

irAocgndc to iths arppe, mrtsuatopP sirioTyithd tesrsenp whti niaTPOt- odti.ibeans eTh wasner eocihc uses tyhlpeocm.ys oS tsih si a taernnsti aoHtssoimh yomyrHip.dihrets odoG ucLk twhi thta e!no

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seagull  ED:TI oyephcmtsyL are loas etrepns ni hsti sa w.lel My bad +1


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submitted by hyperfukus(111)
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I knhit atht neics 'teehyr nkisag rof na niapxlnateo fo teh itetp'sna rutcner xSS whihc swhos htat s'ehs in teh ettsa fo Tierastnn :irirspmHteodyyh wchhi si deu ot :C eeealsR of tsrdoe tdoirhy oeonmhr rmof a yrditho angdl latetnidrfi by sletyyophmc

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submitted by mdmikek89(6)
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uSbactue myclycotiph iiedoybtcsuS ttharui ithmyoclcyp oyrihtstiid si zrhecadreacti yb eagdma to lcfrluloia cllse with miypclyhcot ntitiarlionf lrgieemnbs t'Hoasmhios ityrhdstioi itadens fo lmnrougaa aofirmotn. gruD:s rni,enfteoαr- tmhu,lii ai,emodoran r,uiene-2lknti neiyorts isknae tiAusutbrmeiho nimion eiessad otmauprPts h:idorsityit efactfs %5 fo wenmo ugdrni the ppsmatortu epirdo and is 3 tsmie eorm mnomoc angom oewnm tihw etpy 1 eeibtdas l.mlteius

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