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NBME 21 Answers

nbme21/Block 2/Question#14 (reveal difficulty score)
A 30-year-old woman comes to the office ...
Abnormal brain development 🔍 / 📺 / 🌳

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submitted by xxabi(284),
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-D5EP brstiniohi g(e.. dsiaflne,il iftaalad)l rae ciedditan ofr ED yb wya of sinacrneig olbdo owfl ni teh srpcou amonurcsve al(deebl )D of eth psien

submitted by taway(33),
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sihT etqniosu is aersdhp ,reganytls utb ti's enllsiestay gksnai atw"h dluwo hpeanp if thsi on'masw ytmphdosiryoih ebcame eunrdotlncol roev the croues fo erh pany?"gcnre

yclutnrre hre SHT is gdoo t-g-;& e-trodlnolcllwe sihHhomiITOpAYEtyodrHCTL yP hhig THS ;g--&t ehr miposhtyoydrhi tsum ONT eb -olocenrdlwllte e(du to rupdiionst fo eht HH/TRT4/TTS/3 dnreicnoe isax)

,oS wno thta we eundtrsand that hte oiuqsetn is snikga wa"th woldu epphna if rhe rhyyidpmithsoo saw ?unlcrod"etonl

n:Awser trisncime

I nitkh ttha itsh iequostn si prsaehd ooascylut,ir utb far be it frmo me ot czticiier the EULSM igeclinns odba..r.

yotsubato  I think that this question is phrased atrociously, Just like the rest of the NBME +24  
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. +4  
b1ackcoffee  Thanks you @notyasupreme! +  

submitted by direwolf(11),
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Tsih hsa to do iwht atgdnudnneris two gnhi,st thta nertamal oirodimyspyhht is enildk to Cnelstrm/nuaeiri pmedvoletne of het ut,esf adn narmlo pncagneyr olygpsho.yi In y,nrnpcaeg nseiacerd nmresoho atulisemt lvrei rcdponiuot of osiuavr ronipest ekli xSe omeornH inBndgi uGoinbll h,oyHrSn)BTi(Gxe nngidBi uolblnGi B(,GT) ce.t oeMr BGT cdouerpd = moer TT4/3 si udon.b seLs 34/TT usasec roem HTR a,eresel orem TSH relee,as nda orme T34T/ icurontopd inutl eefr 3/4TT sevlel aer cbka ot .omnlar nI a arnolm nr,gpcynea siht pphnsea no elp.mobr nI oeomnes whti etpi-rxisgne ohpimhrstdyioy tguhh,o eayldar ash dirmeaip 43TT/ pdtouocirn, nad owt'n be aebl ot kpee pu hwti nicedrsea erihT 3T lwli ers,i ubt shti 'tonw usterl in ainscered T4.3/T calT,plyyi wmnoe iwth Hos'asohmit nregidsi ot gte tgrnepan lwli need ot saerenic trhie orltyhoxveeni sedo in ntocapntiiia fo shit acnyergnp agech.n

submitted by thotaak(5),
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yNrallmo eatnalrm T4/3 rae qierrdeu ofr felta rniab emeodletvpn brfoee tlaef rotyihd dlnag si ormd.fe dAn ratfe eftla toidyrh gdanl si o,dmerf etlaf T/43 pslhe ni abrin etdv.plmoeen oS aerncsie HTS neams adseeedcr elamrtna T43/ nad htus veha nab bianr eplontd.eemv And sye 43T/ scessro

thotaak  According to Robbins pathology +1  

submitted by medschoollovin(14),
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Amntmouuie iiyhtstrdio kaa( sHhoti)oam + n;pg-&e-ttgnar hTink oubta stoybisplii of ealtf htymioohrypisd ued to nytdobia idmdteea matrnela hoiritpyshmod.y dsaeL ot trCe.isinm ningdisF ni finant rae eht '6P P(ot b,elly lePa, ffyPu f,cae irdnrtouPg ulb,usiicm aneoPtrutrb noe,ugt dna rooP Bainr pleenvomtde.

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. +41  
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. +  

submitted by apurva(94),
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Teh alre ghtni si SH,T ,3T T4 dna ublntohgrlyio catnon sorcs pat.ecnal TRH, odI,nie ITS nac sIo hemrot ahs ihhg STH csn(ioednrig rprmiay doistr)hmpyioyh &—gt; rPoo naibr vpnedtlmeef oI motreh ash SIT tiso(maHo)h &tg;— ssocr hte caanlltpe rbrerai Insear—ce ni ordyhit algnd ya(M esentpr thwi toirsdr at rtbih.

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

submitted by b1ackcoffee(91),
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claexty ohw eods ralntmae omhstiaoh can esuac ct?miernis

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  

submitted by thisisfine (30),
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I nthki sith setg ta a nceopct reeadtl ot tohirdy lveesl nad ncoys.epegar/ngetrn

etnErgso rniseesac eth lvlee of tinghibyxnerd-ion gluolinb, hiwhc lptryeimrao sdesrceea refe 4T nda ,T3 dna areienssc SHT ulitn hte iidtloanda GBT comeseb dttes,ruaa and moarnl vellse era tedrs.oer

iecnS sith tenaipt sah omeutmuani tih,oysitrdi dna iqeusrre yrihx,otne hwen ehr refe 4T radsc,eees dna ehr TSH sgeo ,pu esh tonw keam texar T4. oS elsnus she eciaressn hre retixhony ,edos seh illw eb phthdioyroy t&-g;- timsirnce in het sufet

submitted by unknown001(2),
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heer is a oycp tspdea lnki .

rtf,si hgih hts = tsrpoomyiiyhdh

How anc mrhoytsoihpyid faftec em adn my ?abyb ihrdyot emshonor aer tarnmptoi to royu 'bsbay rbina nda enourvs msyste e,podtemevln uneedratt plyohorhycsepeilyadimsi—t guirdn hte irtfs rsraec—mttnie uecas wol IQ dan rmesbopl wtih rolmna .voemeedltnp

submitted by seagull(1794),
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sThi ialrect lfisa to otnnime rpoo ibanr devmoetnepl in HrhiiyRtsPd.EYom eTh htorau tusm aevh mneat ts.iYiPHdohrOmy

iThs esqituno etsups em ot on n.ed

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? +  

submitted by tissue creep(128),
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yM tougthh sspoerc aws fi het roethm hsa eieascnrd T,SH d'seh eb snugi roem doniie to ruopcde .3T4/ ienMgan lsse lwduo eb aebl to get ot the bayb orf rniba t.veelnpdmoe

submitted by neolidone(2),
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sThi si a very krcyit eitnsquo ni rsetm fo prhgisna .it eTyh keam su inthk utoab hwat eftefc hihg SHT osed on a sfuet ihwle it alyrle tnmea athw can pehpna to hte bbay in an emtyo-iiddbadenta miothhpyrydsio ohoeS .rmt snkyea os os .sena..yk

submitted by varunmehru(5),
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ehT eohtmr sha mnaumteoiu iiyhrsttdoi nda ttneaemtr is eginv ofr rhstmyyipoohdi lo.ny yhw deos ti etrtam fi het oh'mrset STH si hihg ro ?wlo ousbnAdoeattii dlwuo tisll be npteers and yeth uodlw awlsay esuac snictierm stprevrieiec fo ortehm roeomshn leel.v 'Itns it?

submitted by hayayah(1171),
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triiesnCm nlgt(coinae sioo)mdyhtyiphr si eht otms comomn ecuas of atertlbea nlmaet lidt.bsiiya esasCu rpoo aibrn nle.dovpteem

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