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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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ihTs oen was a ilttel tyrik.c oFr sthi one eth yek si eht lwo iidorniaedo tp.euka Tish ittnape sah ihhg 4T dan lwo HTS wihch kseam nssee in a ohtyyrrdhepi ntet,api rseppah uyro ifsrt thhugot si ahtt shit atpetni ash Gsvera’ eids.sae ,overewH ni srG’ave uyor ohtdiyr is enigb ldiattmesu ot kaem erom yhtidor omnohre rmfo tsccrah adn as such oduwl veah an drenicase eodorndiaii ktupae scabeeu eht oihtryd si rgingbni ni teh idqrereu won( bd)eilodarale edin.oi isTh si why ti si not esvGar ese(“elar fo throdyi meroohn mrfo a toiyrdh asmditlute yb te)iiobsad.n”

oS fi its tno Grvaes’ hwat dlouc ti ?eb orF tihs ’ouyd evha to wkno ttah sHasooti’mh iyTdsoihtir (slao wnkon sa oicnrhC icpoycmhLyt ytioiTshrid dan si eotnf reefedrr ot as schu no rdbao msaxe ot othwr you ff)o sha ehert psashe - frsit yeth rae yetihr,hyrodp neth ,rtdoehyui then teh asslcic yhythiodpro hatt uyo dluwo xeptec with olw 4T nda hghi .TSH Thsi swa eth eyk to shti .tionuesq Teh onrsea ofr itsh is that tntoriyhida reidxapeos eatdiobsni ni s’Hioatsmho eusca eht doihyrt to seaerle lal fo sti oderts dyritho nomerho mkigan eth eattinp priothdryhye fro a thosr idepor of imt.e Atrfe hits aivsmes erelaes of iyohrtd reoh,onm the tendasobii kaem ethm uanble ot meak wen TH dna rrohteefe they eecmob oirdyethu for a hstor epodri nad hnet hhoroitdypy hhciw yuo wuldo ptcee!x Sienc hyet at’cn emak wen ,TH teh ryditho llwi ont eatk up eth idoornidiea dna feeortehr rheet wlil eb lwo aiieodoindr taup.ke neceH, eal“esre of destro tihdyor rnhomoe ofmr a thdrioy lngad tladniifret yb o”pehc.stmlyy aka hmiycLocyt“p )thsomo(isha titsdh.yr”iio

I thkin “aseeelr of irodyth nrhoemo rmfo a lmaompyhotsu irhdyot dnag”l is rrfreegin to oems nkid fo hoirytd anecrc in wichh ecas you udwol etpxce thme ot be ibiecrnsgd a enuold on nidadirioeo auktp.e

​mmSyura vedoi eerh nda olas a rgtea iste in rle:eagn poacradlpcdinsirroey/nighse/h/te/roim:toqet/ued/denn.

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aesalmon  pg 383 fo AF itssl ti ndeur otmyhyiprdiosh utb it dseo sernpet as nitearsnt iyrthpyomeridhs sirft +9
hyperfukus  epy thta aws eth e!yk ieotrG is T"OH" tub eth gnaimreni awnrse oisecch reew siltl dkin of bhel D saw tcsantrigdi eht lhle uot of em i estnp so nlog to cneiovnc slyfem ot ikpc C dna voem on +3
hello  gPnaits en'wilnmsknna teonmmc as an :inotddai ohcCie D"" is grown bc/ "tooylpmuhsma drthoyi and"lg = iayrrpm royitdh lmhamyop ati(pylcly H,LN hichw is revy )arer ro stiooHmsah' hrdyoit .oorsrngipes miaHstosho' hyttsdoirii = loicmyyhtcp ftieitanlr itwh lrnmaegi B cllse nda htleHur ,clsel hwhic unop ceounndit ittmasnlu,io cna adel to mtingaatanlomiutn/ oantntirmaofsr ot B cell hylmpmao. tBoh of hstee rnetpse with hidrsomhyiytop tihw wol T4 and hihg STH otepi(osp fo ihst etpi.)tna +1
taediggity  I ealboysutl velo yruo ,livigey@rterdni eheorvw eht ngotseeaishp fo trtapsmupo oiihtditsyr si iasmrli ot sa'hiH,smoot os I nihkt tihs oesprn has spmuptoatr iiorsithdyt nad your pnxnltaeiao of etannitsr syihrcotisoxot si sopt n,o hciwh udlwo soal courc ni trmpauostp dhriotytiis +16
pg32  I eegar with @idtty.igaeg olAs ntoe that oemwn aylvuleent vrcreeo orfm paotmurpst ihsitioydrt and lliacpyyt obmcee odtiuyher ai,gna hiwch td'osne anppeh twih moaioshtsH.' +
vulcania  nI FA 201(9 p. 3)38 ti asys atht oihrtdy si yuuslla oamnrl iesz in paormtsupt sty,ioihrdit but eht npettai ni tish sitneuoq adh a iothrdy eti"wc het monlra zei.s" I ssgue ta hte ned of het ayd ti stdo'ne mtarte cwihh soigsdina is thgir fro tihs siutnqoe saecu yhte otbh seme to eadl ot teh saem rtorcce nraews ): +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)


 +23  upvote downvote
submitted by hayayah(1212)
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Tshi si a ptneita csea of atmstppour rsthiido.iyt aCn esiar pu ot a reay traef rldeieyv nad ash yopilcytchm nfiietal.tr

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almondbreeze  FA 0921 pg 383 +1
waterloo  hogAluth tosyhri messe to optni swortda ,taht ehs ahs an degranel yotdh,ir nad ni pstamroptu oitthyirids, ydithor yuulasl lrnmoa in izes (mfor FA). lgrasdrese eithre dolwu aehv cphlyotemys fgiitrnnt.lia +



 +4  upvote downvote
submitted by nwinkelmann(366)
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Teh alxeiptnaon yb ediryilevtginr lsup hte xtpinloeaan in het tcrleai oetdsp lwobe (ww89Co/c//t/mnh/ivb4n:.spptte6rMilc.9cgPamn/4sli9w.h.) era the t,bes sjut deen ot be codenibm ).: heT ffreadtlneii siangiods lbaet 1 (Cta94otw/c1P0=4B.rb4bcm-./99eih-eov/OL1e.o/a6opStirrwh/lltwln/sM-0.ty?Ticm/p/ng0Mnej:cpn1tsb8l) yiclialfespc efiinsited hte nntiiocod ni htis uqesiton sa ttopupsram yiihs.rtodti

emtt,aylliU if yuo kwon htta htdooyprysiimh sah a ettnrinsa mshorehryipdtyi asehp (due ot mouatiuemn dustentirco fo het lcsle hcihw adelyra adh mdefoerrp HT dan so it asw seedalre npuo odtetncr)isu efbroe hhstporimoyiyd (nncougfinonnti sclle os 'tcan etka up )ideion adn ahtt mriihosphoyydt is a moyhctcpyli tgfainirlint drtiyhoitis, yuo lilw nowk the was.enr I dha a hdra meti utrgdniednsan itsh ta ftisr cebuase ew l/doateaivuesngae sdbae on teh persenec fo t-inPaOT bA, tub hte nyrligneud peogisesnhta fo eth irotdhy usrteoicntd si dimcatd-eleel (type VI ptnyityv)hieerssi ont bA idaedmte (ypet II neh)reisypiysitvt leki rsagv.e soiomthsaH' = cyyhiomplct tnfoanitilir ithw gnelarmi nsetrce hwihc( nac aonstmrfr ot B cell lmpamyo)h whit uethrlh escll rpnike( mspolacty elc).ls

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 +1  upvote downvote
submitted by niboonsh(409)
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Cna eonsmeo xalpnei hte iefdrnecef ewntebe .C (reeelsa fo orsedt ithrdoy omeorhn from a ityodrh ndagl riaidtfnelt yb yyhclopt)sem dan D. slae(eRe of idthoyr omohner rmfo a utamhlspomyo hrtyido ndgl.a

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drdoom  h@inosn,bo egnind a ntmomce wthi a estuqoni rkam lilw eakm ti paerap no teh esno"tmcm iesnkeg srweas"n isslt +4
nwinkelmann  A uphylomotsma ytihdor ndgla nca herite be deu to ryrapmi ritodhy mhpaolmy iwhch( si lmotas swaayl HLN, but is eyrv )rare or ude ot Hhomotiss'a ihryotd ernr.ssgopio smashHioot' yirdohsttii = tcymliphcyo tlieitrfna thiw rgeinalm B lselc nad ruehltH llces, hicwh puno cuoteidnn t,somntuiial anc deal ot immitugoalatt/nnna stnimfaornorta to B clel .yplammho These, I ,eebleiv uodwl sltil retpesn wtih tpiosym,odihyrh dan stuh woudl ehav wlo 4T dna gihh TSH pioote(ps of sthi nit.aet)p +1



 +0  upvote downvote
submitted by seagull(1933)
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n9lc4.g.pws//nmm:/sPhMi//lcettw..i6can9brC4oiphw/vt89

cingoAdcr to thsi ,praep tsarmoptuP siodhTyrtii peetssnr htwi P-aOiTnt tbaos.iedni Teh arsnew icoehc usse ytolecyspmh. So this is a rttinnesa sHoahstimo eytymd.Hihpirors oGod cuLk wthi atht eo!n

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seagull  DTEI: myocesyLpth are sloa strepen ni htsi as le.lw yM bad +1



 +0  upvote downvote
submitted by hyperfukus(111)
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I kthni tath cneis ehr'tye gniksa rof na aleinantpxo of eth ts'itnepa nturerc SSx whhic wsosh that ses'h ni the steat fo rTsnnieat rdhpeiioHsrm:yyt cihhw is deu ot :C eeRsela fo etsdor dytorhi morneoh fomr a ydohtri dalng lrtteandfii yb pmsloehtycy

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 -1  upvote downvote
submitted by mdmikek89(6)
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Stacueub occphltyimy cSoaruiui tdthbyetsi hmtolpiyccy hirsoiyttdi si ezceciahatrdr yb edamag to frocilalul ellsc hitw otycicphmyl annrtiitliof legbermnis mssHoth'oai ihtodtysrii anseidt of ogualmnar tmfonriao. r:su Dg t,eroαif-nrne ihumlt,i oimerdnao,a e2ie,nlrk-iunt syoetrin kniase smimtthuiorbienouAn i eiesasd pPutr matso th:iiystrdio tcffsea 5% fo wnmeo urdnig eth rouamtstpp rpeodi nad is 3 tmsei omer mncoom ngmoa oemwn whit tepy 1 biadeste .timulels

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