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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(460),
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nSiere yipsaoholpthron lwil eceudr ul'nsisni fsact.fe tI satc on the snriyote anisk.e


 +36 
submitted by liverdietrying(111),
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sThi eno saw a letitl rk.ytci Fro tish eno eth eyk si het owl niairooddei ekup.ta ihsT tteinpa hsa ihgh 4T adn low TSH hchiw kmeas nesse ni a prtdoiyheryh ttpai,ne pehrpas oryu sfirt ghthuot is taht shti tatipne sah raGes’v siasee.d wovr,eeH in ’vGrsae oruy yoidhrt is engbi iteslatudm to amek remo tyihdor noremoh rofm stchrca adn sa ushc luowd aveh na eesiancdr ddiooaeirni utkeap baceuse hte dohytri is grnbgiin ni het erduqeir (onw )dreoaildlaeb indoi.e ishT is hwy it is nto reGavs (esraeel“ of hiotrdy ehoonmr omrf a ydorhti uatesdltim by eboi)t”aisdn.

oS if sit tno vasr’Ge thwa oculd it e?b oFr hsit you’d eahv to wkno htta H’tmhoossia idthsrToyii laos( wonkn sa icCnroh hyiypcoctmL dishiritTyo and si oentf rreerfde to sa ucsh on baord msaxe ot wtroh oyu ff)o sah erhet ssaphe - sirft yhet rea hedoitp,yrrhy ehtn eyi,thuodr htne eht ascscli ydhhityopro thta you lwodu ptecex whti wlo 4T dna hgih SHT. Tish was het kye to isth tqn.useio hTe sornae rfo tish is thta nhrtidotiya seedaioprx niaeibstdo in oiosa’hmtsH ceasu hte tiyohdr ot eeresla all of its trdoes rothiyd reomhon mainkg eth teiatpn hreidyothpyr rfo a thsor irodpe fo met.i feAtr shit iamssve ereslea of hritdoy ,ooerhnm the tiiesnbado emak etmh ubnael to meak wne HT nad heoertfer ethy ecmebo tiheouyrd orf a srtoh eoprdi dan nhet dyohhoyrpit hwihc yuo wldou pceex!t iceSn ehty n’tca mkea enw ,TH teh yhrtiod llwi not ekta up hte aidoioenidr adn eerfohetr ether wlli eb wol oeidiinrado ukep.ta Hnce,e eeea“lsr of sdtroe orihytd mhenoor rfmo a ihdtryo ngdla neratldtfii yb tymo.lsechpy” kaa c“ycoiLyhtmp (oo)hitsashm y”d.rsithoiti

I hiktn aeel“ers of rdoiyht mhoroen form a mlhmpaoyuost otdrhiy agnl”d si grreinefr ot esom nikd of toyidhr crcean ni chiwh sace ouy dluow teepxc hemt to be ebdgnsciir a nduloe no doniorediia kapte.u

uymam​rS dvioe rehe dna osla a teagr iset in ngra:ele odlcdncdontmseiae/rhtipee/or/aotnu.qnede:h/giry/rpis/

aesalmon  pg 338 fo FA sstil ti rdneu srypiidmyoohth utb ti deso prseetn sa antsiretn ireyhpomsryitdh rifst +9  
hyperfukus  epy thta swa hte ke!y iroteG si "OTH" but het egnimrina wseran eichocs eerw illts kdni fo behl D wsa ctiidsngrat the lhle tou fo em i nptes so gnol ot inocvcne emfysl ot cpki C dan vome no +3  
hello  aiPstgn nmwnlinksaen' ncteomm sa na td:doniai oeCihc "D" si ongrw /cb halymotpum"os dhtoyri gad"ln = ayrpmir throidy plhoaymm clyypitl(a HLN, hicwh si vyer ae)rr or ssotiah'Hmo tidhryo orgerisp.ons sH'mootiash ioisidttyrh = hclmtyiyopc rtltenfiai itwh mlaiegnr B eslcl nda leHhtur lsecl, which onpu unoinctde austoinitm,l nca lead ot ag/tlmuoiiaanmtnnt taomantsrorinf to B llce y.mmhlpoa othB of teshe trnesep wthi rthmdiiyoyhops htwi olw 4T nda ghih THS osoep(tip fo hsit pit)eant. +1  
taediggity  I bsylautoel oelv oury girle@nid,riteyv evhwore eht phseiesaotng fo rutoatpspm otysrdhiiti is limiras to s'Hiato,hosm os I thkin ihst oprens hsa tompprsuta dyitroisthi dna oury anxnpaloeti of rnsenatit oitcoyxsoirtsh si spto o,n ihwch loduw laso rccuo in toatusppmr yshiiiotdtr +16  
pg32  I egear ithw eit.it@aydgg Asol note that onwem yntvleaule verecor ormf spoumttrap yitirtdhsio dan yyitcllap ebcoem eyirodhut ,nigaa wchhi t'nsdoe phpane iwht is'soomhH.ta +  
vulcania  In FA (9021 p. 33)8 ti sysa ttah rotidhy is ysuaull malnro seiz ni tropmutasp ihrdo,ytsiti btu het antetip in this tosnieuq dha a oiyrdth itc"ew the oalmnr ".eisz I eugss ta eth ned fo eth ady ti otes'dn etarmt hcwhi igasonisd si griht ofr hsit oistequn eascu ehyt btho seem to eald to hte emas recrtoc arnsew :) +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(176),


 +23 
submitted by hayayah(1200),
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sThi si a peittna ceas of oprttupams sitt.oryhiid naC reais up ot a ayre rfaet eeiylrvd nad sha cphtyyiomcl tlaiirefn.t

almondbreeze  FA 0192 gp 833 +1  
waterloo  Aulhtohg syrtiho eesms ot tiopn sdraowt h,att hes ahs na aegnerld hrodyt,i adn in tpproutams rst,dtihoiiy rotidyh yallusu anmlor ni zise omf(r F.)A arsdreegsl reieth dwulo vhea pylosmethyc tifi.tnargnil +  



 +4 
submitted by nwinkelmann(365),
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hTe naaexliotpn by lvtiridnerygie ulsp het tloeinaanxp ni eht ircltea tpoeds blowe (m.bs.wh.9ct9:/9istnw8cvM/n.m4C6gitl/ihP/wl4pon/prcae/) are eht ,tseb juts ende to eb imdneobc :). ehT ntirfeedliaf osdainsig btale 1 (?./LoaM/9ne9.-p4Pl.-p6oiCt/l./e4gtsjnb1aytwh=/tmo11sB:nc8n0r0/ivhc4t0iT/Omler/o9cSwcwbltpbM-er) flyieiplascc neiiestdif het tnoncidoi ni sith onqieust as prtuatopsm tdihs.ryitoi

Ulamti,eytl if ouy onkw htta otdhmpioshyiry hsa a istrnnaet ostyiriehhrpdym eahsp (ued to atnmuomuie ietntudrosc fo eht slcel hwcih arleyda adh rpfeemdor HT dna so ti saw eelerdas unop tcnteriu)sdo beorfe ismyroiyhtohpd ntogfuc(inninon lelcs so ncat' atek pu iodin)e and ahtt yiohytmphiosrd si a lomyhcyctpi gtfnialiitrn iyoitrstih,d ouy lwil nkow eht .wasner I ahd a dahr temi erainngtudsdn thsi at ftris uesbaec ew u/aaagelvdeeitson ebsad on eth eecnprse of OitTn-Pa A,b tbu teh ndegliurny sotigahpnees fo teh ryodith iodunstrtec is dldtalmcee-ie yet(p VI ryipiystteevi)nhs nto bA edimaetd te(yp II yt)spsievirhytnei iekl .rsaevg isH'thsmoao = cyhlytipmco oltraiifnnit htiw melgrnia rnecset hcw(hi nca rtosframn ot B clle plmahomy) htiw tuhhrel sclle i(nekpr lctoaspym l.eslc)




 +1 
submitted by niboonsh(406),
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anC oeoesmn aipnxle hte idernffece nebeetw .C a(serlee fo rtosed ryohtdi heornom orfm a dohytri gadnl ilintrfteda by yephylscto)m dna D. eael(Rse of dthoriy heronmo mrof a ytmopshlomau yoridth d.lnag

drdoom  ino@bo,hns inegdn a nmetcmo thwi a ieontqsu akmr will kaem it apreap on the eso"mctnm esingek aw"snser silts +4  
nwinkelmann  A ytolsmhpoaum yroitdh lnagd nac trheei be ued ot ymrirpa iydtrho pmhyalom h(cwih si mtaols awlasy LNH, but si yerv erra) or ude to oH'sthmoais iohrdyt sognoisrr.ep Hshtiom'soa rhiittidsyo = ylocymicthp lntrfetaii iwht aregmnli B lcesl dan uelhtrH e,sllc ihwhc puon cuiondnte lu,itatsoinm nca leda ot militmonngtaanu/ta norfoartitansm to B lecl mahl.pomy ,Tehse I lbveei,e uwodl lstli pntesre wtih iihdyhrsmotoyp, nda htus wludo heav wlo 4T dan gihh HST tosep(poi fo thsi naei.tt)p +1  



 +0 
submitted by seagull(1912),
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nh8w/h.6mnsp.tesoMw/w/i9.4ir/liCvmp4Pnb/.99:c/acltgtc

cngAricdo to ihst ap,pre staopmurPt rToiydtiihs etnspser htiw tPOTian- .iioesatdbn hTe awerns iecohc sesu .olysmpecthy oS htis is a titnsenra iHmashtoso ytr.hprimydiHeos Good cLku htiw hatt !neo

seagull  DITE: sLyhpmceoyt era loas petenrs ni hits sa wel.l yM dba +1  



 +0 
submitted by hyperfukus(111),
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I ktihn hatt esnci 'reethy gkaisn orf an nxloaaeitpn fo het npetaits' errtncu xSS hchwi woshs that ehss' in teh sttea fo nnastTrei reymroityihsp:dH hwchi si deu ot :C eResael fo otresd rtiodhy heomron form a odrhtiy gldan rltitfaedni yb myhloyctsep




 -1 
submitted by mdmikek89(5),
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btcuuSae chltoimypcy eisct ytdtiauhuirSbo iplcmoyycth iiytotisdhr is thazedacicrer yb egdama ot clfirllaou clesl whit lmpcohcityy ntitorfilani slgnreebim tHahismsoo' hdyrsotiiti ienasdt of rgnmauaol not.afmori ruDgs: nfrt-neαoie,r luthmi,i oirndm,aaeo u,krn-ltieen2i snreoyit aeiskn ibAhnies utiomtiuomnr iaessed usorpPttma :dyrsotihiit staffce 5% fo meown rigudn teh orttpusamp pedrio dan is 3 emtsi more omomnc gnmoa menow iwht epyt 1 itebades .uelistml




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