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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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shTi neo swa a tellti t.cyrik oFr hsti one the eky si eth wol oaiioddenri .etkupa hsTi eapttin sah ghih T4 dan olw SHT ihhcw meska nsees ni a yrihpreyhotd pett,ain ppheasr ryou rstfi hugtoht is htat stih paitetn ahs resaG’v eesi.sad vwreeHo, ni sGver’a uyor horiytd is bgein leusmitatd to eakm erom oyihdrt hormone mrfo cshract nad sa uchs ouldw hvea an ecidnersa iiooadiedrn upetak eesucba eth hiyodrt si gbinnirg ni the rrdeuiqe (nwo lrddeo)beaila edinoi. This is ywh it si not rvaeGs se(eal“er of dthiroy hornome morf a rtohyid saetldmitu by ntas”bei).dio

oS fi sti tno Gasve’r twha ocudl ti ?eb Fro tish oyu’d evah ot wnok thta ah’ossiotHm siotyidhiTr loas( nnwok as Cirochn yLicmpthoyc dritishoiyT nda si eontf eeerdrrf ot sa hcsu no dabro emasx ot rhwto ouy )off sha there psshea - rtfsi hety ear dtyipohyhrre, neht ,yrotuehid enth eht sacsilc yoritypdohh atht oyu wluod extcep wthi owl T4 and hihg H.ST hsTi saw eth eyk to ihts .uiqtosen hTe oanres rfo isth is that inrtotihdya epsixardoe anbtedsoii ni mHsaotihso’ sauec eht odyitrh ot laeeesr lal of sit stoerd trihody nreohmo mnaikg eth pintaet yptrehdohryi rfo a srhot irdepo fo e.itm trefA tshi svmseai seraeel fo yirhotd mnr,oheo hte iasoidnteb akem hmte luneba ot aekm nwe TH adn htreoeref ehyt boecme htyroueid rfo a srhto eoridp nad enth yrhhdtpoioy ihwch you luowd ctxp!ee cineS tyhe tnca’ akme enw HT, eht drihyot iwll not tkae pu eht aidrondeoii and oetreerhf htree lilw be olw idiroinadeo .uaepkt eeHn,c e“leeasr fo soedtr hdtoiyr rmohoen fmor a ytoirdh dglna titilfreand by lhoetpcys.m”y aka iLc“pyotcmyh ihsmoa)tsoh( .rtyio”hidsit

I nkith erae“les fo odrityh hnremoo fomr a lsmuomathpoy odrythi gdnla” is frnregire to eosm ikdn fo yhtdiro ecnacr ni cwihh cesa oyu lwdou ectpxe etmh to eb reibdngsic a uoneld no einrddiaooi .ktpuae

yumrmaS​ ovdei erhe nad oals a atger itse ni :lgnaree /hogreoeiqeiaiyncrtciae/t/dod/eppdnnulre//donrh.tmss:

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aesalmon  gp 383 fo FA stlis ti eurnd dpyihsrymhooit utb it osed rtespen sa nenrtsita etphryrmisdoiyh rifts +9
hyperfukus  yep that saw the k!ey oetrGi si ""THO ubt eth enmgrniia awrnes ocescih ewre istll dikn fo elhb D saw ntdscaigitr the lehl otu of em i tnpse os glon to ncnoicve lymfse to ikpc C adn voem no +3
hello  Pgatisn 'wnnnmiskelan emocmnt sa an :didoanit ehioCc D"" is nogrw c/b "poumhylsmtao hiyrotd gdanl" = mirryap dorthiy pyommlah p(lltyayci NL,H cwihh is yvre rear) or mot'isaoHhs yihtdro inso.rersopg mosHitahs'o iorhdiytsti = mticypolchy ilfetirtna thiw imlegnar B lecls dan Hurthle ,clles ihhwc npuo dtucineno umiao,ttnils acn lade to mtgnaul/nmtianoati trfsionanrtoam to B clel .amhlpymo otBh of eehts stneper twhi ydiomtosiyrhph iwth olw T4 and hhgi THS ptiospe(o fo isth pn)ait.et +1
taediggity  I uotylbaels oevl yoru l,tegirvrdniiey@ ehervwo hte hngaepeossti fo mpusptoart sorytdiitih is iirslma ot ta,miho'soHs os I nktih siht sprneo has rutappotms tryiisthdio dan ouyr entoilpnxaa fo terinnsat ixyhrooticsost si opts n,o ichwh uwdol laso uoccr in trmtapsoup ihstoidyitr +16
pg32  I eager ihtw y@dttgieagi. lAso etno ahtt oenmw eeatlluvny oerrvce fmro ttpsuprmao ttridhiisyo nda iptcyyall mceobe hiuerotyd n,aiga hhwci 'stedno pnahep with soHsmti.'aoh +
vulcania  nI FA 120(9 .p 338) ti syas htta irdohty is ylsauul lnmora size ni ptosuramtp sottyi,drhii btu eth tnetiap ni sthi tiqsunoe ahd a yhiodtr ce"iwt het molarn "isz.e I ssgeu at eth nde fo het ady it 'dnseto amettr chihw ssinoiagd si trhig orf tshi oneuiqst ucsae etyh obht esem ot laed ot hte asme ceotrcr anersw :) +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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isTh si a etipatn case of osrttauppm rioytshtd.ii aCn aersi pu to a eayr rftea rleyevdi dan has ypymotlchic niie.rtltaf

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almondbreeze  AF 1209 pg 383 +1
waterloo  uAthhglo oyihrst essem ot itpon awdrsto tah,t hes ash na glraeend dho,ytri adn ni srmptaoupt yoiid,irstht hroityd alsuuly nmlora in sezi (mfro )F.A saegersrdl heteir woudl vaeh eptlhsymoyc iilftnar.ting +



 +4  upvote downvote
submitted by nwinkelmann(366)
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Teh naeailxopnt yb eelrvygtiinrdi plus eth plianxeaont in eth caltrei dpotes bolew (Ph/4n9cM:pnmw8o/9tgwa4t/hmnli.wblcr..pst/esi9/cC6v./i) are eht s,tbe stju nede ot eb ncdbmeio :.) heT eneliaffirtd iissanogd lateb 1 (m8ptjt09:h1eysrai9/t-prwp-nn4Lio/clPw9/g0b.b-crhM/iesoaTB4eCtM/l.oen1ccOS/nt/1t.4.bvl0l?=wo/6m) cseilfcyialp ieiifstend teh tinincodo in tihs unesiotq sa promstutpa .ithyorsidit

l,aUlmtyeit fi you konw hatt sytmoporyhihdi sah a atsinnter ryhodrphitsiemy aephs d(eu ot ianeouutmm onctsitdure fo eth csell ihwch ydleraa hda erdfoermp HT nad so it swa adrselee ponu c)sdriottune rbofee yyhmptohoisird ntnnonf(niciuog lselc os 'ctna atek up nodi)ei nda atth drytophmiiosyh is a htplciymcyo tirlannifgti tiirosidyht, yuo llwi ownk eht wena.rs I dah a darh tiem tdgunriseannd sith at ifrst uesabec ew veui/eagoanaetsld sabed on eht nceeeprs fo naiOtTP- Ab, tbu het glnudrynie osineagtesph of eth dirohty oertutndisc is caieellded-tm pyte( IV phiivyis)nyretets ton Ab etmdidea p(yet II inyieetspyr)stvih kiel gresva. amo'hssHito = cythmilycop onntitailfir with nelairgm ecstner (hchiw nac rfasrontm to B ecll olampmy)h wtih lehrhtu elscl neiprk( yaomsltcp e.cl)ls

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 +1  upvote downvote
submitted by niboonsh(409)
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Cna smeoeno exailnp the ecfdeerfni nebetwe C. (lreaese of sedotr thridoy hnomreo rfom a rdhotiy aldgn iifndartlet by ec)lmyptsyoh and .D l(eesRea of odrthiy nehorom mrof a moyashplumto oytdihr nalgd.

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drdoom  nbon@i,osh ingend a mctmoen htiw a uqitnose rkam liwl make ti aapper no eth cmts"moen skegeni raewssn" islts +4
nwinkelmann  A tuhoyoamspml yodhrit gdanl anc terhie eb eud ot iarrpmy rdyohit holmmayp hwic(h is tasolm lywsaa LN,H ubt si very )arre or ude to toshi'sHoma otdriyh sporgse.roin i'atoomsshH driihoytits = iplytyohmcc nrttaifile thiw mgiernal B lslce nda rtueHhl ,elcsl iwhch ponu ioutnnced unmi,tolista nca aled to tgot/itanunanalmmi nrtaaoofintmsr ot B llec .lyamhomp ,heesT I ,eleebvi wlodu ltsli spetern wthi yodhyimtr,osihp adn shut oudwl vaeh olw T4 nad hihg STH tesppi(oo of shit pa.ti)net +1



 +0  upvote downvote
submitted by seagull(1933)
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tst6.ht./pC8i.ac./9/wo/hncwicgsmPMr49v9lbp/:ln4m/inwe

cAicgnord ot tihs aprp,e osamrptPtu rshitdiiTyo epnssret hiwt OPntTi-a to.ibidnaes The aesrwn eoicch essu mhe.ylcyostp oS isht si a tsrtinnea stomaHohis otmiHhp.ydsyrrei Good kuLc ihwt atth one!

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seagull  :EITD Lhemypscyot rae asol tepensr in sith sa well. My abd +1



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submitted by hyperfukus(111)
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I ihtkn htta einsc tee'ryh nigsak rof na xainenoplat fo teh 'tnatepsi urrctne SSx ichwh oshsw ahtt eshs' in hte astet of Trainnset Hmisd:reiyrtoyhp hciwh si due ot :C Reelesa of tdreos dohityr eromhon mrof a ohrdtyi agnld nlfrtdaetii yb hesytympocl

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 -1  upvote downvote
submitted by mdmikek89(6)
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btucSuae tlcypicmoyh itcbhosay iuduriteSt hlmtcypyico oytriisitdh si azerahdiecrtc yb agadme ot rclllfauoi eslcl hitw yhocpmitlyc inoantrtilif breilgmnse 'Hsimhtasoo tsdirohyiti tdisnea fo nlguaramo mf.atorion :s Drgu eef,nnα-ortri tihlmui, ,donroiamea utiri,neek2n-l yoeintrs iasnke itumn hAibonrtiumsieo seiseda oamrtu tPsp oiitshtydr:i afsfetc 5% of emwon dgruin teh souartmppt pdeior nda si 3 emtis mreo cmonom gaomn onwme whit ptye 1 tsdieaeb su.lmtiel

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