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NBME 21 Answers

nbme21/Block 2/Question#14 (86.8 difficulty score)
A 30-year-old woman comes to the office ...
Abnormal brain development🔍,📺
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 +24 
submitted by taway(32),
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Tihs tqniueso si edhrsap yragnelst, utb s'ti stsaleelyni ingaks t"wha owdlu ppehan if hist nwm'soa hiyipomyrsthod eebacm ndcretlunolo vore eth crusoe fo reh ynr"a?ncegp

eurytlcrn hre HTS si odgo --g&t; lcl-lnrelowteod TPphOmHrdtLhoHEysACioyIY iT ghhi HTS gt&-;- her srdhoohtpiyyim mtsu ONT be -lrndteolwclole du(e ot iisutrnodp of het /3TS4RT/THT/H ncdeeniro )sixa

oS, won that we endutsadnr taht hte oeqistnu is inkasg ah"tw wlodu ahppne if her hotidmhyysopir saw oounl"ertnl?cd

eArswn: nerictsim

I hktni atth stih qsuntioe is phrased scaouir,oytl btu raf eb it mrfo me ot ecitzirci eht MUSEL eslinginc .a.b.rod

yotsubato  I think that this question is phrased atrociously, Just like the rest of the NBME +22  
b1ackcoffee  exactly how does maternal hashimoto can cause cretinism? +  
notyasupreme  @b1ackcoffee, it's not maternal hashimoto, basically you just have to disregard the ENTIRE question stem and the last part of the sentence (if the mom's TSH goes up) means that there's hypothyroidism going on, which causes cretinism. +3  
b1ackcoffee  Thanks you @notyasupreme! +  



 +10 
submitted by direwolf(10),
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sihT hsa ot od hwit ngsnnrtuiedad wot gist,hn atth aarmlnte myiodthirpoyhs si nelikd to aseiCnlimrnt/reu nevedmtelpo fo het eustf, nda moarln aycgernnp lhis.yygpoo In rncen,gypa ricdeanse orehsonm utmtelais eilvr rcupidoton fo vruisoa psoetrni klei xSe ormHoen nBigidn linGubol nieHhBxy)T,rS(Go niiBngd blGlunio ,B)(TG .cte Meor BTG rcoduped = rmeo 4T/T3 si o.dunb esLs T3T/4 sscuea remo RHT s,leraee remo TSH elsra,ee dan erom 3T4T/ otrodcinup iultn eref 43T/T esevll aer kcba to onra.lm nI a mloanr ngy,nerpac isht hppeans no breo.lpm nI eeosnmo ithw rxgnipesiet- oipsymhryodhti otuhhg, dyelaar ahs ipidrmae 3T/4T oo,ctpduinr adn n'owt be laeb ot keep up tihw eiascrned dm.daen hriTe T3 illw srei, tbu hist 'twno slrute in eeicdsanr 4.3TT/ Tapcyll,iy mwoen ihwt oasis'hmoHt nrisdgie to teg ntepgnra llwi eend ot niresace hetri iyhevtoelnoxr edos in nniapcaottii fo iths nacerygpn enah.cg




 +4 
submitted by thotaak(5),
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ormNyall rnlaaetm /34T era rrduieeq rfo tealf anbir ntvmoepeled obfree etalf yohdrit agndl si rfo.edm Adn rtfea elfat ytrodih aldgn is f,rdeom tlaef 43/T hlesp in rbnai dm.lpnoeteve So erecasni SHT anems esdercdea nemtraal 4T3/ dan utsh aevh anb abirn oenmedtpl.ev dAn sye /T34 ssrcoes eantpc.la

thotaak  According to Robbins pathology +1  



 +4 
submitted by medschoollovin(14),
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eoimntuAmu ihdiotysrti aak( tshm)iaHoo + engr;n&-gat-pt kinTh ubaot iybotsilsip fo aeltf myirpdhiytosho edu to dbtoaniy tiedadme laeamtrn pdymh.iosthoyri sLdea ot ieC.stmirn inigsnFd ni atninf rae eht 'P6 (tPo lb,eyl ,aPel fuyPf ea,cf dgrtuPirno ium,sibcul ebornPrtaut o,nuteg nda oorP Brain ltnde.vemope

neonem  I don't understand the last part of this question stem though... if the mother's TSH *increases* during pregnancy? Wouldn't this further increase her (and/or the fetus's) production of T4 and thus counteract the hypothyroidism? +  
poojaym  @neonem no. Autoimmune hypothyroidism is a destruction of the thyroid gland, and a decrease in production of T3/T4. An increase in TSH means that there is not enough T3/T4 to inhibit TRH, and so TSH is being released to stimulate the thyroid gland. +39  
arezpr  TSH, T3, T4 and thyroglobulin cannot cross the placental barrier. +  
chamaleo  @arezpr although those hormones can't cross, the autoantibodies from Hashimoto's can +1  
yotsubato  The baby has its own TSH though +  
sbryant6  TSH comes from the pituitary, and act on the thyroid. Autoantibodies attack the thyroid, so TSH doesn't work. +  
kimcharito  no goiter then? +  
lola915  I think there is no goiter because the baby's thyroid gland has not fully developed and these immunogloblulins from the mother could attack the thyroid gland leading to issues with it's development. +  



 +2 
submitted by apurva(82),
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The earl htgni si S,HT ,3T 4T and rothlbygionul canton ocsrs pecltnaa. HRT, id,nIoe TSI acn rsIfo c.s etmroh ahs hgih HTS cgeonsdin(ri yrmrpai oot)hhyimiyrpds &;tg— oroP abrin dnIompve felte tohrme hsa STI tm(hoHsoa)i —g;&t ocsrs eht palactenl arrebir ncese—Ira ni yriohdt gndla ay(M nseterp ihtw itrdsor ta ith.rb

demihesmisome  Ahhhhh Thank you. This was what I was trying to understand. +1  
apurva  please note that free t4 can cross the placenta +3  



 +1 
submitted by b1ackcoffee(58),
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tylxcae woh deos nlaamrte oaohsthmi acn sueac t?nmirecsi

lola915  Hashimito is caused by antibodies against thyroid peroxidase and thyroglobulin. Those antibodies can cross the placenta and affect babies thyroid gland causing congenital hypothyroidism. +1  



 +1 
submitted by thisisfine (27),
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I hknit tshi gset ta a otpcecn etlaedr to ytihrod ellves dan /gpaneeers.cognrnty

oErntgse scensraei hte elevl fo itroiednixgn-hynb gn,bliluo cwhih mlyoretarip csdeeesra rfee T4 nad 3T, nad rensceisa SHT intul eht ltaodndiia TGB combsee ue,adttars dna nolamr vlesle rea rortedse.

eScin htsi ttpeina ash ntmoemuiau tsiytodhii,r and erqiuers ixtnoyh,re hnwe erh feer 4T sdsraeeec, dan her HTS eosg ,pu ehs wtno keam ertxa 4.T So susnel hse nrssiaeec rhe nyioxhetr eosd, ehs lliw eb oohyphirytd --tg&; cetriinsm in the etufs




 +0 
submitted by neolidone(1),

This is a very tricky question in terms of phrasing it. They make us think about what effect high TSH does on a fetus while it really meant what can happen to the baby in an antibody-mediated hypothyroidism mother. So sneaky so so sneaky...




 +0 
submitted by seagull(1675),
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.wigC//wotih/27/ctppb.l0cPsm.m2/M/whc:.8svalnrite9n1n

hsiT clerait flsai to mnoient orop arbin lpdneemoevt in mryPHsYoihR.tidE The ohatru stmu ehva meant .hyimPrtsHdiOoY

hTsi utqoeins seputs em to on e.dn

aesalmon  I agree, the article you linked states "signs of fetal hyperthyroidism such as tachycardia, intrauterine growth retardation, cardiac failure, and the development of fetal goitre" I chose answer E during the exam - "Thyroid gland enlargement" Still trying to understand how they linked cretinism to a case where the mother's hypothyroidism was well controlled, and then asked for the sequelae if her TSH increased. Maybe increased TSH is supposed to indicate worsening hypothyroid - low T3/T4 needing to be stimulated by TSH? +  



 +0 
submitted by tissue creep(116),
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My outghht ecsosrp was fi eth throme has adeecsrin ,SHT sd'he eb nigus omer dniieo to ecpudor /T.34 gneinMa elss odlwu be beal ot teg ot eth baby ofr rnabi ldenteepv.om




 +0 
submitted by hayayah(1097),
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Creimtnsi gilcneta(on odmisryh)ihtopy si teh mtso ocnmmo escau fo ataerlteb mltena dtbiy.islai seCasu oopr nriba evel.tdpnemo




 +0 
submitted by varunmehru(4),
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Teh hotmre sah uiemmotnau ihsytitrido dan mrtteetna si engiv for phydisrtoymhio .nloy hwy oesd it amrtet if teh hetsrom' HST si ghih ro ow?l Aebaiudtstoion udwlo llist eb eersntp dan eyht ouwld ayswla asceu mcnresiit preseicrveti of hoterm msnhroeo ele.vl It'sn ti?