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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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ihsT eon wsa a ttille .crykit For sith neo eth key is the wol iaoirindode ekpua.t ihTs iptatne hsa ghih T4 nad wol STH cwhih mseka ssene in a htrhiorpydey nipa,ett sprhpae uryo first thgutho si ttah tihs etaptni has Grae’vs edieass. H,eowevr ni sev’aGr uyor idtrohy si ebgin dseutlmati ot akem oemr tdhoiyr hoeonmr rfmo cachrts and as shuc odwul vahe na iacsenerd oiaddiroien upteka eacesub teh otiyrdh is inggrbin in the eirrueqd now( edaad)iberoll di.onei hiTs is why it si otn vGears eles“er(a fo rdothyi moreohn mrof a dorihty dsaltiteum yb dae)ion”btis.

oS fi tsi tno Gas’vre htwa lcduo it ?be oFr htis oyd’u evah to onkw atth htsoaHmi’os rsdtoTihiyi (saol nnkwo sa ionCcrh hyLoctpcimy doihtiTrysi dna is fonet rfeererd ot sa cshu on oardb mxsae to twhro you o)ff ash hteer apshse - rfist htye ear iyhrhrp,eytod hent dithu,yeor hnte eht aclssci ydhtpiyhoor htat you wduol ectexp whit owl 4T and gihh .STH This asw het kye to tshi otns.iequ hTe ronesa ofr hsit si atht itiyraodhnt xaderipeso bnitdsaioe ni ’ihsoosmHat ucsea het tdyiorh to leeresa lal of its oedtsr dhyotir hnemoro ngimak teh tpanite orhhyedytrpi ofr a hosrt reoidp fo tie.m ftreA hsti esivams aseelre of iydtrho o,ohmenr eth isdioneatb amke ehtm nalbeu ot mkea nwe HT adn etheoerrf yhet omeebc dytoiuerh for a thrso epodir nad enth rooiyhtydhp ciwhh uyo wdoul ptec!xe cneSi yeth tac’n kema nwe H,T hte ityohdr liwl nto aetk up hte idaiordnoei nad erefthoer heetr llwi eb low oieadriinod u.eakpt cH,ene serle“ae of edotrs dortyih oehormn rofm a thdryoi naldg ieltfdirtna by s”y.ymeplohtc aak y“mcyocpLthi sohoit(amhs) o”itsrhii.tyd

I hkint l“seerae fo itdrohy ohomren rfmo a lpaouytohsmm yrtohdi dglan” si nrfgerrei ot osem dkin of ydhrtio rccnea ni iwchh eacs yuo wdoul exctpe thme ot be nrgicbiesd a ludeno no iodeiorndai .kauept

arSy​mmu eoivd ehre dna also a getar tise ni re:angel oghden/onuptlirieime/qs/opecdtr/erd.n//:ecdoynraiahts

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aesalmon  gp 383 fo AF tsils it drnue sdhriphityomyo tbu it odse npesetr as nnirttsea stheroimdryihpy sftir +9
hyperfukus  yep hatt asw eth eky! toeGir is "O"TH tub eth rnngeiami wrsean ocschie rewe tllis ndki fo bhel D saw nsirdtcgiat teh ellh otu of me i ntpes so nglo to ncivcneo flsyme ot kcpi C nad emvo on +3
hello  astPgin 'amknnlnneisw ecmtnom as an ddiaoi:nt ehcioC "D" si wrnog /bc sauytplhom"mo hidotyr ad"lng = ipmrray yitohdr oyhlmpma (lliaytypc HNL, whhci is eyrv arr)e or tsoimHso'ah horydti pn.ooirsrges tohHos'msia isdyoiritth = yylmipcctoh rtanieilft htwi iglnmrae B lelsc dna tlhHure ,lsecl hiwch onpu cuoindten la,imustonti nac adel ot n/aamniitugaomttnl ofmnraiosrtatn ot B lelc ohma.pyml oBth fo teshe perents hwti myoyiiohhstdpr hiwt lwo T4 dna hhgi STH ppestioo( fo hsit it.n)eatp +1
taediggity  I beustloaly love yuor @reiied,nvylrtgi oewrhve the napeotgshsei of rtamptuops tidhisoyirt is iimsrla to Hossi'taom,h so I htkni isht presno sha suattrmppo irdttosyiih nad oyru ilnataponex fo saentnrit ootcrxitsysiho si spto o,n chihw wlduo losa ocurc in orupsptmta iysitdtiroh +16
pg32  I regea hiwt yggat@ieidt. Alos neot ttah wmeon yeevaltunl rcreevo mfor paotumpstr ttihiriyosd dan atcipylly oemecb odierthyu ,aagni iwchh te'nosd npahpe iwth ohmas.to'isH +
vulcania  nI FA 210(9 .p 33)8 it yssa taht irhodyt si uulasyl malnor izes in opaprusttm ihiit,oydrst utb eth tipanet in sthi enuosqit dha a ritydho iwc"et the rlonma z".ise I guses ta hte end fo hte day ti ts'deon rtmaet chwhi idonisags is rigth fro hsti squteoin uaces tyhe boht eems to edal to eht sema rtcorce arwesn ): +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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shTi si a petntia eacs fo ttrpupamos sdtihrtiy.io Can siaer up to a arye etfar elreivyd nad ash ilmyctcpyho raenflt.tii

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almondbreeze  AF 0912 pg 833 +1
waterloo  hlhAougt ryitsho meess to tinop rswdtao th,at hse sah an erlgneda othiydr, nda ni rmappstuot is,dyiotithr ydhtroi ulausyl lnroam in isze mo(rf )FA. sslearrdge rteieh uwdol eavh lctpmsohyey talt.nfiigirn +



 +4  upvote downvote
submitted by nwinkelmann(366)
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eTh eotlipxanan yb vdiiernglyteir spul the lxianneaopt ni hte leacitr sptdoe bewol (mwa/c6m:r9vibhep.sc.ln/witt4lohpPi/t.C./gsM/w9489nnc/) era hte e,stb tusj deen to be ondicbem .): hTe nefalriiefdt ssaoigdni table 1 (rO-6al?-cP/l1cg/p=t0l1ntc81ejLrl0vmpwteMnbSM94/TnswCy.4i/9i/ps/4:bro0/i.beteot9o-hnmht.B.ocw/a) syfalcipecil dsfeinetii hte itncdoino in isht itqoneus as atotrpspum iiysthot.dir

lUi,lyttema if uyo wkon ahtt iyithsdphyormo ahs a nsantriet yiyhrriedtsomhp hsaep deu( ot manuteiumo dntrctesoiu fo het lcsle hcwih laaryde dha fdreompre HT adn os ti asw erldeeas nopu euctnid)ostr rfbeoe otyhmphydsiior nifooinn(gnnctu lcles so c'tan ktea pu die)oni nda taht ptdiriyyhoohms si a yctmloihypc nttnigaifilr srtiyh,dioti uoy ilwl kwon the wsea.nr I adh a rdah iemt enuntdisrdgan hits ta risft euaecsb ew voaensaeguit/adel ebads on the epnscree fo TaniPt-O ,Ab tub eht dnyieungrl ighpnaseetso of eht htoydri druneoistct is etilldeadce-m te(yp VI t)ithpniivesesyyr ont Ab eedamtid etpy( II hirsvty)epnsyeiit like aers.gv aoHosst'him = oymplcytich itlfiatrnnio iwth meniglra stneecr (hhicw can mnartfsor ot B elcl y)hpmolam wtih hhelurt cslel kre(pni opystaclm sl.le)c

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 +1  upvote downvote
submitted by niboonsh(409)
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naC soneome enialpx eht edfceirenf wetnbee .C eseel(ra of odsert hiyrdot oneorhm ofmr a rodyhti ganld ntrifdlatie by ymyltoehpcs) dan .D seleaR(e fo hdroyti onmeorh omrf a oytmaopmhuls tdyoirh adn.lg

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drdoom  ninb,@hsoo gdeinn a mmocnte itwh a insuqoet ramk lwli mkea it apeapr on the m"nctoems nekgise rsw"aesn lisst +4
nwinkelmann  A uhypomotamsl tdryhio nalgd acn eriteh be due ot yaprrmi tdiohyr ohmmlpay wich(h si aotsml sylawa NLH, ubt si evry erra) ro edu ot ihsost'amHo yrtoidh pnre.sgiosor omh'ssHtaio iioityhdsrt = yilcphomyct eiinlrftat wtih ianlmrge B clesl adn tHlhure clels, hchwi unpo etdunnico tiutminsalo, nca lead to tmgnn/tuatioianlam inrosnomfatatr to B elcl ymaomp.hl ,sheeT I ivbeele, loduw lsitl enestrp ihwt ,hyhsprydiiootm nda utsh udlow veha low T4 nda ihgh SHT (osiopept fo this e)ta.inpt +1



 +0  upvote downvote
submitted by seagull(1933)
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/l/r/ow.l6tP.m9:wcn/n.c/iMmp/ci4sab9.C9hsvgt4itph8wne

ncdcgiroA to ihts r,appe puPmsttaor oistirdThyi erepntss hwti On-TiPat sae.iobndit Teh warsne eihcoc euss myplsoeh.yct oS sthi si a tiersatnn haositHmso yorhisptdrHeym.i ooGd cLku htiw ahtt on!e

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seagull  EDIT: ymcstopeyhL ear losa esrpten ni tihs as le.lw yM dab +1



 +0  upvote downvote
submitted by hyperfukus(111)
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I nhtki atth since ethr'ey ksgain ofr na leanxpontai fo the iet'ptnas rrneutc SSx wichh ssohw atht ses'h ni teh astet of anTtneirs psHrtdryi:hmieoy iwhhc si ued ot :C sleeaRe of tdsero hdyriot eomnhor mfro a rdotyih gdlna daiitlfentr by postehyclmy

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 -1  upvote downvote
submitted by mdmikek89(6)
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tceuSbau lictyhmoypc dhutarbiisiecSu ytot oyhpicmtcly iiditrotyhs is hticrcaazdere yb adgema to fcraouilll elcls hwit lmcpioycthy arliiotnnift lmrniebegs 'msosoaHhti ordisttiyih dnastei of nguolaamr faitoomrn. Dr gsu: fniretr,-enoα tiiml,hu aone,iormda -lkte2nuen,rii soiryent kneias iiruAiehooum mtnnitbs idsesae umaPrtt sop io:tihidrsyt efcatsf %5 fo nomew urdnig the ouppttrasm preoid nda si 3 tmesi remo mcnomo oagnm onwme whti tpey 1 aebesidt lm.etusli

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