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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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 +45 
submitted by usmleuser007(461),
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irSeen toryphoshlaipno lliw reecud sn'niulsi ft.fcase tI acts on eth eyrnstio s.ekian


 +36 
submitted by liverdietrying(111),
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sTih oen swa a tletil kryict. rFo htsi eon hte key si the wlo oiodnreiaid aup.etk hisT iantpet sah ihgh T4 dna low SHT cihhw aemks seesn ni a hheritproyyd tnt,peia aeshppr rouy rifts ghhtuot si tath ihts etantip sha evasrG’ aedsise. eevwHro, ni sGr’eav uroy ihotdry si bgnie tsademtilu to make eorm oiyhdrt heomnro rofm ctrscah nda sa cshu odwul evha na csderiaen rindoiodeai epakut ceuseab eht rhtoydi is nnigbrig in the uideqerr w(on eralbdl)doaie o.iidne Tihs si why it is otn eGrsva “l(eresae of ytidorh hooenmr mrof a ohtriyd msdiaetltu by dast.”eiiobn)

oS if tis nto Gsrav’e waht uodlc it ?eb oFr tihs ud’yo ehva to wonk that ’oastohmHis htsoyiiidTr sl(ao nwnok sa nrCchio imcchtLypyo tiyrsiohiTd nda si etfno derferre ot as usch no dbaro asmex to ohwrt oyu ffo) hsa ehrte paeshs - irsft ythe ear hyeyiho,drprt tehn u,yrehitod thne the ssclica hptoyhorydi ahtt uoy udowl teexpc hwit owl 4T adn high H.ST hiTs wsa teh yek ot siht tneuq.osi ehT senrao orf this si that ahidtytirno dreeapixso nitbaoesdi ni moahHst’iso cueas teh tyhoird ot rsaeele all fo sti oestrd rtyhido hnermoo angmki het aenptti yhrtiyodeprh fro a orths prdieo fo met.i reAtf tshi vsmaesi eeersal of tyirdho oon,merh the idesaitnbo eakm emth bnulae ot akem ewn TH nda ethofreer thye mceebo uroetidyh fro a torsh eprodi nda ehnt yryhidphoot chhwi yuo dwuol cteepx! iScne yeth ntac’ emka nwe H,T the ihdrtoy llwi ont eatk up the oiioidderna dan rtrhfeeoe rhete lilw be wlo ieiddooinra uekt.ap nHec,e “saeeerl fo oertds ryodthi rhoonme fmro a yirdtoh agldn diireatftln by tplyescoh.”ym kaa cpLmhyiy“cot msoito)ahh(s iotdt”hisry.i

I ikhtn leera“es of hioydtr eomornh form a hosoutymlmap hydrtoi nlgd”a is neeirrgfr to soem knid of trhdoiy enrcca ni iwhhc acse oyu uwdlo eextcp emht to eb sirgdicneb a elndou on direoinadoi aepkut.

uSr​ymam veiod here adn oals a arteg iest in egnar:le dreeaootnh/em/enphgiidloearnrpedoqistd/c.i/tcsr/n:y/u

aesalmon  gp 383 fo AF itlss it undre hitihomysorydp tub ti does petrens sa nantisrte pdyhtromihireys strif +9  
hyperfukus  yep that wsa hte eky! teroiG si ""TOH btu teh ingnrieam nseawr siccoeh erew llist kind of lehb D aws atgicdisnrt eth lhle uto of em i stnpe so lgno to vcinnoec fyesml ot kipc C and mveo no +3  
hello  nPtsgai men'kannlnwsi ncmoetm as na :doitidna chCeoi D"" is nworg /bc ylms"hpmoauto thdoyri gnld"a = irarmpy hitrdyo homalmpy cyllypt(ia NL,H ihhwc is yerv e)rar or stoom'hHsia tdohiry opse.risnrgo at'moiHsosh oititsydihr = iycocphymlt rialfettin with ngaemirl B llces dan eulhHtr ecl,sl ichhw onup nouiedcnt s,tonimtulai acn deal to moamagintnla/uittn tamoriastnfnor to B cell yh.oamlmp Bhto of eshte etnsepr ihtw hioosdpiytrhmy htwi wlo T4 dan gihh TSH poi(epost of iths )tta.iepn +1  
taediggity  I syobealltu evlo ruyo erytidv,lrgeini@ orevehw teh sopetnhseaig fo opprstumat oidyithsrit is rlsimia ot ismothoHa',s so I kthin shit roespn ash ptrmtosupa ttsohyidiir dan ruyo axanlpteion fo eaisnnttr siotsootihrxcy is tsop on, hcwhi lduwo also cruoc ni tspptmroau diyotirtshi +16  
pg32  I eraeg hwti g@igtat.yied loAs teon tath nemwo atenluelyv veorrec rfmo oatmpsrtup irttoidhsyi adn lactiyylp beeocm eyruhdito aangi, ichwh osd'etn pahpne tihw ohtmsoH.'sia +  
vulcania  In AF (1902 p. 8)33 ti syas tath odhityr is sayluul lanmro szie ni ppatmutrso ds,tiirhyoit btu hte pntaiet ni ihst oinsqtue adh a yirthdo etic"w the nmarol s"e.iz I sseug ta het nde fo eth ady ti oet'dns tramte hhicw donsgiisa is rtihg rof this suitoenq seauc yeht htbo msee to dael ot het same ocrtcer rasenw ): +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(180),


 +23 
submitted by hayayah(1207),
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hTis si a nptteia esca fo otmpspurat yrdsoti.ihti Can siaer pu ot a yera tefar dieevyrl dan hsa lcmyhtpioyc .ltitrafine

almondbreeze  AF 1029 gp 833 +1  
waterloo  utoAghlh rsthyio meses ot tnpoi rwoadts h,tta ehs has na eaengdrl dtr,oiyh nda in umpotsprat iorshdy,iitt drhtioy lasyulu ornmla ni iesz mrfo( ).FA drgsslaree reheti wluod ahev mlsecpytyho ntt.iiiarnflg +  



 +4 
submitted by nwinkelmann(366),
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The xinaolpaten by rrieviigneltyd uslp hte axlnnpaieto in eht ralceti optdes owble (/n/:cw6/49.9gcpa/bMimlP.rhn.4tliwhwptencC/ms8v.soit9/) era eht s,bte just ndee ot be emibndoc :). eTh fatdierenifl ssdganoii eblta 1 (wn.b4tv94waotnni-s-pl/wp.1P:l/06-4j/C/om.r1LSiBceT9c=lbo/ati/mrsyt9e/cephM0/81nOgolbMetchtr.?0) lciayseficlp iisnfetdie hte ioncotndi ni shit iuotseqn sa mptopsatur htiidyir.ost

ttylema,Uli fi yuo wokn htta yoipyithhsodrm hsa a srateinnt eimyhrhysdpotir ahsep (edu ot emaoiumunt oercudnistt of hte lescl whhci rdalyea hda eerpfmdor TH nda so it swa sreledea puno ctud)trionse ebrfoe ishyidoprhoytm (ntconininoufng lselc os 'actn teka up ien)doi and ahtt shryphomdoityi is a tpicclyyohm tintiigrfnla ,ioittryhids yuo iwll kwno eth n.sawer I adh a rhad itme udnadinegsnrt sthi at istrf ucsebea ew eveeunigotslaa/ad aesbd no eth eescpenr fo ai-ntPTO Ab, ubt the delyignunr gsaepsoeithn fo eht dhyotri duttsocrien is imlde-detcela tey(p VI itit)spyvnrheysei tno Ab idaemedt pt(ye II iitehyvi)npetsysr like evgr.as 'iatoHmossh = cptclyymioh fiatiritlnno thiw eamnrgil scenetr wih(hc nac fmtnrsora to B clel mphylm)ao whti hrulthe llces r(iekpn yompsalct llc.se)




 +1 
submitted by niboonsh(408),
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anC esoemno ialenxp teh fcednifree ebenwte .C le(eraes fo otesrd htrdyoi moenrho frmo a yhtodri ldnag atrneftdili by lehostmypc)y and D. (eResael fo htrodyi onoemrh romf a omhtymusalpo itorhyd ln.adg

drdoom  nsnh@i,boo indneg a nmmcote hiwt a ustoeniq ramk lliw meka ti arppae on hte mt"scmeon ekgesin "wenssar lisst +4  
nwinkelmann  A lohyotasumpm yhritdo ngdla nac eirteh be due ot mrirpay hydoirt pmayhlom h(iwhc si sotlma slaawy ,HNL ubt is evyr earr) or edu ot htmossi'aoH tdoiyrh .nsgieoosrrp oshsatmi'oH iottdsyirih = tmicohycply filrteinat twih gemlianr B lslce nad theluHr ,cesll chihw ounp denocunit tantuoslmii, cna edla to intoa/antgimmnualt nonttsmorraiaf to B lcel amm.ylpoh heT,es I ,evelbei doulw lilts neesrtp htiw opryihiyot,hmds nad uhst uoldw eavh owl T4 and ghhi THS oo(esppti of hsit eta.tn)ip +1  



 +0 
submitted by seagull(1923),
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wnw/nor6wt/el8//.ptc./ltccn4s9m.vMPh/bipi94:hsamig9C.

dAigcrcon ot hist pepr,a pPmtoaurst soitTryhiid strnpsee wtih Ont-TPai dot.iaisneb Teh anewsr eciohc seus oyclth.ysemp oS thsi si a rtsentain ohtsiasmHo .Hypsmtihioyrdre Gdoo uLck wthi taht !noe

seagull  :ETID Lphotysymec rea loas etnrpse in hist as lwel. yM dab +1  



 +0 
submitted by hyperfukus(111),
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I inkth that cinse ehyr'et nasikg rof na axnotanliep fo hte a'nieptst nteurrc SxS wihhc swsoh htta 'sesh in teh sttae fo aennTrist siydhoitpmy:eHrr wchih si edu ot :C Rleseae fo ordest hrtydio oeohmrn from a rhdoity dalng retniafitdl yb hscmtyloype




 -1 
submitted by mdmikek89(5),
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uuateSbc lyyothcpimc edocait trbSuuiyhits ctlmpyyohci dorthistyii is eazhcrtacrdie yb amaedg to lllirfauoc clesl tiwh octylmiphcy iftlnaiontir lmbesigren msHst'hooai ysittidhiro ndseait of angruolma o.itorfanm Dgsur : eentrro,i-αnf mili,uht ir,aaodmnoe ,rlti2en-keuin ntresyio nkseai Attrhmiinmo iuunobeis asdseei s uPpttamor tiiyhdrtio:s ctseffa %5 fo omwen unidgr hte autpstmopr iporde dna is 3 tiesm rome monocm mnoag oenwm iwth etyp 1 tsbiedea iusllt.me




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