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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 oen asw a titlle t.yikrc roF isht noe hte eky si eht lwo nodoiierida tkupae. shiT neattpi sah ihhg T4 dna low HTS chiwh eskam esnes in a eihrdytrhoyp napi,ett sehprap uroy ftrsi gtotuhh is htat isth atepnit ash eGvasr’ id.asese ,ovewHer ni sae’Gvr uyor iodtyhr is inbeg tmedutlais to akem rome riyohdt neorhmo mofr tarchsc nad sa suhc owlud vhae an desnarcei rdinieoidao eupakt eabseuc hte rdhoity si ingbnrig in the edrruqei o(nw abaoeldi)lerd odnii.e ihTs is why it si ont Garesv lr(esaee“ of iorhdyt mreonoh fomr a torhdyi udseialmtt by diesntbo”i)a.

oS fi sti ton Garve’s ahtw loucd ti b?e roF iths u’ody hvea ot nowk ahtt ’mitsHoohsa iyTsthdriio lo(sa nokwn sa ncriCoh hyomiLctcpy iTdtyoihrsi dan si onfte freerder ot sa hcsu no daorb meaxs to thrwo uyo )ffo sah etrhe haseps - tirsf ehyt ear oredhipyrh,ty neth yio,turehd tenh het scacsil hhyrpityood ttah ouy dulwo cxetpe iwht wlo 4T and ihgh S.HT iThs was het yek to tshi to.iusnqe eTh eaosnr rfo shit si that rdttoiiaynh xreeisdoap tadiobiesn in mas’iohtoHs eaucs het hoyrtdi to rselaee lla fo tis ordets dhtiroy enhorom agikmn the ptaeint eirdhyyohrtp ofr a rtsho oedrip fo .emti teAfr hsit vieassm srlaeee of yhirtdo onohme,r eht aiitndseob kaem mthe laenbu to kame wne HT nda eethoferr teyh eomcbe ideutoyhr orf a srtho dipero nad hent hopyrytidoh hiwch ouy doluw xtec!ep Sncei ehty ’atcn make ewn H,T the otydihr lliw ont eakt up eht iiadidrnooe adn reotherfe eerht lwil eb olw raediiiodno a.puekt ,neHec eesrlae“ fo roteds irtyhod nhermoo mofr a hitydor gnadl tnifrtidlea yb ty”.colhympse aka ythmpLo“icyc h(omstahi)os ”t.tidrisiohy

I iktnh “elrsaee of yoithdr oemrhno mfro a tpuyashmoolm rtyoidh d”lnga is ereirfgnr ot omse nikd of odtirhy rnceac ni wcihh csea uyo wloud eptcex hmte to eb ceigidrbsn a uldeon on ioredonaidi utpae.k

rSm​uaym eovdi ehre adn oasl a rtgea iets in ela:engr aghottnrrrc/inuo/yn/riee/dnpi:oeiqdheeds.polda/tes/mc

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aesalmon  gp 338 fo AF slsit ti ednru sopdyotrhihymi tbu ti deos rptnees as natsnitre mirhiyedrsytoph isftr +9
hyperfukus  epy tath asw the !yke toreiG si "TO"H btu hte mgeairnni rsnaew hicceos wree stlli nkdi of bleh D asw irsgitctdan eht hell uto of em i spent so lgon to ivccenno leyfms ot ipck C adn mveo no +3
hello  Psaitng wnmnsea'lknni mnteomc as an :oatdindi hecioC D"" si nrowg bc/ haoltu"pomsym otyhrdi a"nlgd = rrpmiya ritdohy plhmyoma ylctyp(lia L,HN ihhcw is evry ra)re or htHo'somias tohdriy osnprrsio.ge Hmhissoao't trsdioihity = cpylcioythm ilefniartt hiwt glinmrae B clsle dna thruHle l,elcs iwchh nopu nnicoudet sanmi,tilout anc eadl ot /talnunamoitiamtgn ttrioarsaonfnm ot B clel apml.hyom Btoh fo etehs pntrese hwit porhiyodmhtysi thiw wol T4 dan hgih STH pi(eospot fo ihst ntai.p)te +1
taediggity  I loayblsteu evlo uory rvg@yl,idetineir rveowhe eth oaphtseegnsi fo oprtupamts riiohttsdyi is airsiml ot Hmt,'hoossai os I nktih this renspo hsa tpmrtoupsa iytrioidths and oyru ixenlantapo fo ttaennris isootxtoirhcys si ptso ,no iwchh oudwl saol occur ni urmpotptsa tiotsihidry +16
pg32  I ergea hitw tytdagi.g@ei soAl nteo ttah enwom llayneutev vcoerer rofm masorppttu ihistridyto dna lyapclyti mebceo ehtyudoir ianag, chiwh 'dtsone epnpah hitw omaho'Htss.i +
vulcania  nI AF 012(9 .p )338 it yass that dhotryi is uaulyls maonrl seiz ni psrtopautm iyirtt,dohsi ubt teh eatnpti ni htsi iosteunq had a oihdrty i"cetw eht amlrno "i.esz I sgseu at het nde of het ady it o'nsedt ttamre hcwhi gnaisosdi is thrgi rfo hsit qotusnei ceaus ehyt hotb mees ot edal to the saem ecrotrc weanrs ): +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)

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 +23  upvote downvote
submitted by hayayah(1212)
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hTis si a tpeanti case of rptsomaptu iiy.tsdohirt Cna riesa up ot a raey after iyredevl adn sah yohtlypcimc ntt.iairfle

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almondbreeze  FA 2019 pg 383 +1
waterloo  luthAgho htsoyir smees to itopn raowdts tah,t she ash na dlegrena ryotdh,i dna ni ttmrospapu ihtotidsyri, hdiytro aulyslu mlnaro in sezi r(mfo F)A. sdegrerlsa itereh duwlo eahv lecypthsmoy rntlin.aiitfg +


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 +4  upvote downvote
submitted by nwinkelmann(366)
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heT inaeonxalpt by glnteirivrieyd uslp het atolixannep ni the icealrt tdoesp belwo (v.pmMliCbcn/cthlatts.i9.ce846o9gwPishr//m/n4w//nwp9:.) aer het etsb, ujts eend ot be nciombde .): ehT alideffintre iaigsdsno tblae 1 (/b0chSM=nsm9Orrj0n?411cB1o-0bvn-/lomseceelw/wt/MtoPpt-.h9i/6Ctppat4ni/L/4:oa.cl.9gi/wr8ebT.lty) ifeyiscpacll sfneediiti the nidntooci in sith nsoeqtiu sa stpomuratp .htdosiytrii

yUetmialt,l if uoy wnok htta oyiophrmytshid hsa a nnttearis yyospmhrhtreidi hpase ue(d to atumomineu tsrnditecuo of teh elslc hwhic ldayare dha dmroepref TH and os ti aws eeseradl nopu snoidurttec) rebfoe dymisohhtioypr nii(ngfncontnuo ellsc so n'tac etka up )ioiedn and ttha yphiomishyrtdo si a iccpyymohlt tafiringnilt ,ytidtiirhso you liwl okwn eht e.nsrwa I ahd a ahdr emti dgnnsunradtei hits at rfsti bacseue we gons/avueaetaield basde no the epcsrnee fo OnPTait- b,A btu hte gdreunylin eetihsnopasg of het tidohyr tueonrtdics is lmlee-daecdti (yetp VI hyseis)ypvttirnie nto bA ddietmae ptye( II vyseittnhei)pyirs elki .avsreg ohosmsaHti' = cmypylticho atfltroiinin with elgrnami enetrsc hciw(h anc ornstfmar ot B lecl a)ylmpomh itwh hrtlueh eclls pi(ekrn psclmytao leslc).

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 +1  upvote downvote
submitted by niboonsh(409)
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naC mesonoe laiepxn the ffcreeedin eeetbnw C. aesre(le of teodsr iyrhtod meorhon mfro a dhryito lndga treaidtfnil by hspctymoe)ly nda D. leesRe(a fo oyrhdit rehoonm fmor a ypaolohsummt hditory dgn.al

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drdoom  hi,b@onnos dninge a enmtocm thwi a tsqeiuno amrk illw emak ti parepa no hte "omnstmce gkieesn aens"rsw slist +4
nwinkelmann  A utyomomalhps ohyirtd galnd acn heetri eb ude ot ampyirr ryoihtd ophaymlm wi(hhc is osamtl lasawy LHN, ubt is vyer e)rra ro ued to Hoismoahts' rtyihdo orgo.esrpsin ossatH'ohmi hittrdoyiis = ohcclipmyyt nieratftli wiht rleginma B celsl and eltHhur scell, cihwh ponu tninodcue ititl,asnuom nac alde ot nmmt/atnaognluiiat mraoirfsnatnot to B llec hm.ylmpoa s,eeTh I e,vleeib uolwd llsit rtsneep thwi yhoyhmds,tpoiri dna shtu dwlou haev wol T4 dan ihhg SHT iots(oepp of hsti api.tt)ne +1


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submitted by seagull(1933)
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wnn/8w/n.99m.p9ch4v//mca6CiiplrMesh:..4ws//Pgotbcltti

dccAoingr ot stih aepp,r tauPtmprso hsTryitodii epesrnts wtih -PanitOT tdsai.ienob ehT asrewn eoccih sesu hotcmy.slepy oS shti is a anttirsne ashtoioHsm sort.yimhdryeHip Godo kLcu iwth htta eo!n

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seagull  TDI:E yepmtyoshcL rae alos psrntee ni thsi as .ewll yM bad +1


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submitted by hyperfukus(111)
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I think ahtt inecs ertye'h kiagsn orf na nitpanxeola fo hte tansp'tie rrcteun SSx ichwh owssh ahtt sshe' ni the staet fo Tsiatennr Hipyysdt:ormihre wihhc si ued ot C: esaRlee fo desrto yrihtod mnreoho fmor a itohryd ngdla itrfaitendl yb mphtlyyesoc

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submitted by mdmikek89(6)
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uaSbtceu ihpcocylymt iturhiyscttad uSboie ciopcmylhyt isrhiiydtot is acitdcrerheza by adgeam to llcfraloiu escll ihtw icymlhcypot aottnfriinil elsnbegmir aoHtmsshi'o ihtoidyrsit dtesnai fo ongamulra .aomnortif : Drugs eetnrno-r,fiα hiitlm,u damoianreo, -ueiiertnn,2lk oytiners esikna um mitriueAsnohontibi sisadee Pusamrpott it:shitiroyd afecfst 5% of mweno iurgnd teh topumrpats dioepr nad si 3 itsem rmoe nmocmo naogm mewno twih epyt 1 abetdise it.lslume

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