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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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This noe swa a lietlt ktyc.ri oFr tish noe hte kye is teh owl aniddooriie .tpekua iTsh nepttai sah ighh T4 dan olw SHT hchwi ekams senes ni a tyhrpiordehy eitanp,t ppserha ryou sitfr utohthg is taht htsi iaenttp sha ’rGasev i.daesse wvoere,H ni var’eGs uory rhydoti si ignbe eltstamidu ot kmae oemr dirhtoy reonhmo ofrm strcach dan sa shuc dlouw ahve na readicens aondidreioi autekp beasuce teh dthiyro is ingbrnig ni the eiqdurre w(no rieebdadolal) ondie.i hsiT si hyw it si ont evaGsr “eeae(lrs fo ihrdyto oomnhre ofmr a tidryho diasttelum yb itb”)snieaod.

So if tsi ont sG’vrea hwat doucl ti ?be rFo hsti oud’y eahv to oknw ahtt soisaHomht’ oTdrtshiyii oa(sl nokwn sa Corchni myycpoihLtc htiTiydrsoi nda is fotne referdre to sa chsu on baord eaxsm ot owrht uyo ffo) ash heret apsseh - itsfr they are yrro,pidhehyt neth drythou,ie ehnt hte icsscla yydhtirpoho tath ouy wudol cepxet iwht owl 4T nda ighh S.TH Tish aws hte yke ot ihst .unoetsqi heT esrnao orf sith is ttha onrahtyditi sdipraexoe diinoatebs ni saso’thHmoi asecu eht oithydr ot erseela lla fo sti sdoetr rtoyhid roomneh kaming teh eptitna thheypyrirod fro a torhs odriep of i.tem rtAef ihts sevmasi earelse fo iodhytr ,oornhem eht sotbdieian kaem tmhe eanulb to emka wne TH dan ethrfoeer ethy eecobm hdotiryeu rfo a ohrts eriopd dna ehtn oohypydhrit hichw uoy udowl xpc!tee cnSei htye c’atn make wne H,T teh ytihdro lilw tno aket pu hte diaroieoidn dna torehfere hrtee will eb low rddoeoniaii t.upkae eenH,c elersae“ fo dreost hrioydt oeohnmr mrfo a ihdryot alndg ifailtdtner yb cl”ytsyeomph. aka ohyipcytcLm“ oihoa(h)tssm ”toiytris.dhi

I ktihn aeele“rs of tiohyrd noorhme mofr a ohusmlptaomy yoidhtr lngda” is regfirren to osem ikdn fo thidoyr arcecn in ichwh eacs oyu ldowu txpeec ehmt to be nsbdiigecr a eulodn on oioddainire ukat.ep

uyam​mrS idveo hree and laos a terga siet in negre:la eo:thcrnnt/amde/hgod/t/ddcsquoeiipnreainyro.ipelre/s/

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aesalmon  pg 383 fo FA sslit it dreun ymhihopdtrysoi utb ti soed nrtepse sa trsiannet yedthsmoiirhypr tisfr +9
hyperfukus  eyp hatt saw teh ye!k iGreto is OTH"" btu the mniergnai snaerw hcscoie ewer lslti idnk fo eblh D aws tirctngisad het hlle tuo of me i epstn so nglo ot cneconiv fmesyl ot kipc C adn vmeo no +3
hello  istgnaP neamwk'ninsln ntmeomc sa an an:tdiido cehoiC D"" is ogwrn c/b omp"hsyouatml odhyirt "galdn = maiyrrp doyhtri mhplyoam pcy(ltalyi ,HNL wichh is eryv rar)e or ositaHoshm' hridoyt rsnso.pogeri H'hosiotsam iytdotiishr = yhcmtcplyoi ineltrafit itwh ingemrla B escll nad leuHthr sle,lc hhwic unpo udecontni luiitaonsmt, nca lade to t/iantoantiaulmgmn fiorrnmtaonsta ot B lecl lyhmmao.p htoB fo teshe erestnp thwi dihpoistohmyry with wol 4T nad hihg STH o(optispe fo shit i.ten)apt +1
taediggity  I lltaeusboy elvo yoru eiierrit@ng,ydlv ehwvreo the itospganeshe of mpauopttsr hitidoitrsy si iairlsm ot ,os'thiomaHs os I nhkti tish sprone ash putrsatmop itosrthiyid nad yuro aixenaptnlo of nsnarttie ochooiistsyxrt is tosp n,o hwhic wudlo sloa rcuoc ni utrtpomsap yoiiihtrtds +16
pg32  I regae twhi igiae@gd.tyt Also note tath wmoen lyanutelve rrcveoe fmor ursapotmpt rodsyhtitii adn piacltyyl becoem dihoteyru ,anagi hhcwi dnoes't ahpnep iwth hmoot'isasH. +
vulcania  In AF 092(1 .p 8)33 it ssya ttah riythdo si saulyul oalnrm zsie in tmraspotpu rtitsi,dhiyo btu hte itneatp ni tsih esiutoqn had a oidtyhr "witec eht moarnl .z"esi I eusgs ta het edn fo the ayd it esnd'to eamttr hchiw iossndgia is hrgit for htis tenouiqs ausce they otbh seem to dlea to hte esam eccrrot eswanr :) +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(182)


 +23  upvote downvote
submitted by hayayah(1212)
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Tish si a eaittnp csae fo uptrmapsto st.iriydhiot Can areis pu ot a ryae refta ydlirvee dan ahs mpycolhiytc t.ifntelari

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almondbreeze  AF 2109 pg 383 +1
waterloo  Alhutogh triysoh esmse ot optni asdtowr aht,t esh ash na gldnreae ,ohyrtdi dna in tmtpaursop rtiyoi,idhst dythori alylusu amlonr in zise m(ofr )FA. raersegdls tieerh uwold hvae thcposymyel al.irtiitgnfn +



 +4  upvote downvote
submitted by nwinkelmann(366)
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The oanitepnalx by ltgvirdiyeeinr supl hte oetapanlxin ni het ciralte dospte oelbw (s99.iP4wt/nb8hacMtgn.mw.9/6lpC./mw:hs/l4rctonvicpe/i/) aer the ,tbse ujts ndee to eb edibmcno ).: hTe etflairfdein dsgaonisi bealt 1 (moeoC0?/emah6c/41neh-l-Toi.ilplvO.wwtlnw4r9bcsy=0ts./abPttg/9Mic/r/p-Bt.ob4:nLjnr1c/0SpM819/te) ilpsfaceylci neitsfieid het oicnndoit ni sith qnesiuot sa tspopmuatr thid.iyisrot

e,Utlaltmyi fi you ownk htat otpyhmhdroiysi sha a ireatnnts ytdesriyiohhmrp asehp ue(d to eantiuommu noicesudttr of hte eslcl wcihh lyadaer adh erdpmoref HT dna so it aws reealesd opnu )tndroscteui broeef roymhhpsdtiyio notnniuncinfgo( slecl os tnca' eatk pu oei)nid nda that homyyirtshpiod is a cmyltoicphy lifrigatnnti o,isrityhdti oyu lwil onkw eht wers.an I had a rhad eimt nsidnrgnedaut thsi at tifrs esuecba we uteseoanavaedgil/ edsba no hte ceeesrpn fo -atPnTiO A,b tub eht lgynirudne othpiasgesne of eht ihtdory ortsudnitce is -ameetcdlleid yte(p IV teiphitv)yynirsse nto bA tdaeemid eyp(t II nitysiehypvs)rtei like gesa.vr stimosohaH' = cihymptcloy otlfitnniria itwh gnealimr eresnct wih(ch nac mnfsotrar to B llce omh)pmyal hitw reuhhlt lcesl pir(nek pamclosty llsce).

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 +1  upvote downvote
submitted by niboonsh(409)
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nCa nesemoo ipnaexl eht rfiefdneec nwbeeet .C er(selae of edstor hoytrdi roomhne rfmo a dirhyot ndalg dtflentairi yb cey)ptlmsyoh nda .D eeelRsa( of hrdioyt ronheom ofmr a uhspaommltoy hrdoyit dla.ng

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drdoom  ,sboh@inno nedngi a emtncmo ihtw a eutosnqi makr llwi mkea it paraep no teh ecm"tmosn ngiseke "searnws slist +4
nwinkelmann  A ymsmoolatpuh rthiody adlgn can ihtree eb ued ot mparriy itrodhy ahymomlp ic(hwh si atomsl sywaal ,LHN but is reyv rrae) ro deu to 'ashotsmiHo hydotir sonspr.regio Hossthia'mo iroydtihtsi = ctohmyycilp fltnetiari htiw inglmear B elslc nad euthlHr ,eclsl hwihc nuop ctindeuno iotsm,altnui can eadl to nagit/uotnamlimnat atnamoisrnofrt ot B llec aymho.lmp esTeh, I ebevile, wolud isltl etpnser hwit iyop,dmrshhyito and stuh oludw ehva low 4T nda ighh THS oippseto( fo iths tne)pat.i +1



 +0  upvote downvote
submitted by seagull(1933)
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6/wn.pp/blg/t.9o:nhcvc4imc/.Clw/99i/ri4sh.8tMtnPawems

ncgiordcA ot isth ,rppea atsptmrPou ioriyThdtsi nsrptese iwht nitPOaT- ianbosdite. heT narsew ciohec esus .hlpomsctyey So hsti is a tartnisen hmsaHotsoi ydoirhyrteHsp.im oGod Lukc thiw ttah neo!

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seagull  I:DTE eytpsyhLcmo era lsoa tprenes ni htis as lwle. yM dab +1



 +0  upvote downvote
submitted by hyperfukus(111)
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I ihtkn atht scnie eh'rety nskgai ofr an tilopnnxaea fo teh t'pinstea recurtn SSx hchwi sohsw atth sh'es ni het sttae of nrtasnTie oihespHtrrd:iymy whhic si ude ot :C sleeaRe of sotrde rihtydo neromho ofmr a irotdhy dalgn edflrantiit yb pyymtoscleh

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 -1  upvote downvote
submitted by mdmikek89(6)
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cbauSteu clioyytcmhp uitubrihcsitt Sdoyea pylhicycomt ishiidrotty si trrcizchaaeed by mdegaa ot oclilafrlu slecl hwit cyymhcptoli tfninirtiaol iebmnrsgel mHoss'aohit htydsitroii enasidt fo lugrmaaon ontir.fmao Dsgur: tfαoneinrr-,e ,hiltmui aedonamrio, ilne2niuekr,t- serniyto nsaeki noeitmrtAnubi somuhii eaedsis Parmspttuo htrtsdioyii: ffascte 5% of ewnom rgdinu teh atmtopsrup ipreod and is 3 istme eomr cnoomm gmona noewm wiht etyp 1 eaeibtds .mtelsliu

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