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Retired NBME 20 Answers

nbme20/Block 4/Question#21 (reveal difficulty score)
A 47-year-old woman comes to the physician ...
Contact with parakeets 🔍 / 📺 / 🌳 / 📖
tags: pulm

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 +36  upvote downvote
submitted by ∗masonkingcobra(408)
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aPeg 2 sah a great ptceuri

onw(6fr32i.pw0l0/1-Sah/l/ar7e6.)gtctni48w/pecjt1/60s9-d9io1:

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kamilia20  aypoamhilldhc cti??itasp +1

FA 2019 P. 661 Hypersensitivity Pneumonitis is a mixed type III/IV hypersensitivity reaction to an antigen in the environment. Commonly seen in farmers and people exposed to birds. Presents with Dyspnea, Cough, Chest tightness, headache. It is reversible in the early stages if the allergen is removed.

+7/- lilyo(94)

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 +9  upvote downvote
submitted by ∗hayayah(1212)
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ytHintiseeyripsv xpetsediionm—numi epty II/VII rvtyneipsihtysei aeircton ot vneelnranmito eaginnt. sCeasu ynd,espa ,oghcu ecsht ten,hgisst ahdeache. etfOn esne in aremfsr nad ethso edpxseo to rids.b eRevieslbr in laery ssetag fi lmstuius si aodid.ve

'Its a ypte of tresecvirit glnu s.desaei

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A type of hypersensitivity pneumonitis associated with animal exposure is bird fancier’s lung, in which the major antigens are proteins in avian serum, feces, and feathers, including bloom, the waxy powder coating them (18). Pigeons and parakeets, including budgerigars (a type of parakeet), are the birds most commonly implicated, but poultry, finches, doves, canaries, and other birds also have caused the disease. Exposure to live birds is not necessary to produce hypersensitivity pneumonitis: the illness has resulted from using feather pillows and duvets (19), being exposed to a wreath made from the feathers of a dead pet bird (20), and laundering a pigeon keeper’s overalls (21). Other examples of animal proteins that are known to have caused the disease when inhaled include proteins from the dust of mollusk shells used to make buttons (22) and from animal fur used in garment manufacture

https://pubs.rsna.org/doi/full/10.1148/rg.297095707

+7/- alexp1101(11)

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 +6  upvote downvote
submitted by ∗neovanilla(57)
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yhW teh trhoe easwrn cosiehc trane' occterr

A - Nto na phaltaycnaci aiernoct yamnli due to ricihtncyo pctmiunsoo(n fo ,soy hwchi sha orplgotnsicey hatt eeplpo amy hvea eralsglei rdot)wsa

B - Not mhstaa dctzaraeicer(h yb mero uacet oesiepsd of ,otsnicccothoobrnrni e)inzewhg

D - ianmeA B,6( 9B, B1,)2 ro eaybm a alrnoypmu bsemolim eud to B9 or 12B nidecyicef -&;t-g ateevdle icteeohsnmoy levsel tg&;-- sobtihmsro ;-&t-g VT?D

E - nrayPuolm axan;thr Teh mtie escour ouwdl eb humc moer tu,ace nad wdulo laos serpnet iwht tsymomps of il-ulefk sospm.tym pdaRi ehadt oot

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 +3  upvote downvote
submitted by ∗monoloco(155)
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Tshi iatnetp is incereniegxp yiissetrvhnyteip smnipteuoni fomr het eetpkar.as I swa niiknght .M Aimuv nhew I letesdec paksearet -- I nhtki my coigl aws faldew gnevi eth secspfiic fo hte 'stientap ors.ty

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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Hwo wuold ouy wnok tath it 'tnsi wolo ertsros eesai?ds

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cienfuegos  FA 0812 :731 lohanitina fo sepors ldeas ot el-liukf pstommys hatt opssrgre cykiluq ot v,free lmonpryua gehrhrme,ao idaiitsesimnt dan ,kochs hitw igginma spybiols inowshg niewded dutsenmmiai +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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arindccog to urodwl hneviryspytiites iouempnitns is ued to sudt adn taht saw alos na .ontip..o.

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amarousis  so 'tis eltdfniiey sutd but eht scicfpie type fo tuds wsa eth msot ptoiatrnm in tish tounq.ies hte tfac htat tehy mneitnoed eth rsibd is oritpnmat. eht yutds obkso owuld aecus it ubt eht rdbi tuds si reom ratopnitm -.- +
charcot_bouchard  etiiHtsinvpsryye oinsnetmPiu - Oiagcrn dtsu li(ke dylom ciansmeyPhuosnoi) - rngiIoacn ennosutd hlpe hree hghtuo eseacbu btoh lliw etenpsr wiht sema sivteirerct nlgu daeesis . iirpetcu itkhn ecnis udst in iryrbal tarne etnrehi aocrngi ro nrgciaino and oasl u nodt ees anym asiiabnrrl hiwt lugn seedsia tub ibrd oniehrpsw is sfiecycalpli emeidnnto as csaue of PH ess.eaid +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I osla asw iingtknh .M umavi eh,re but tihesryvpeiytins nmiintsouep semes to tif ihtw het nulieugrolctrraa a.egscnh

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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ohw od ew know aepsrekta saeuc hnrsvyyeesitpi oinuesptmni

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smc213  A18F 7p6.5 ibrd s-;pexg&-euort NHS unineptsimo ttvrecsriie( glnu )asidsee adn 18AF p41.2 mouslronugaat seaie:dss iogrenf ai-HSlmgt&;t-eraN ui.emotinspn I ahd ot emak essen of it ecsni I nt'idd okwn it swa SHN iueimspnnto at st.fri +5


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 +0  upvote downvote
submitted by ∗breis(56)
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cPoiiatssts (tosiesemm aeclld tosirhoisn or ptaror aeisesd ro ortpar )erevf is an nniitcfeo fo eht gunl i)nepoanmu( seaucd by eth mbuaercti Cadilylomphha h(dCamialy) .ittpscia

inSsg dna eov ,g.u cfmoshpytmrse: yuuasll wioutth uhmc cepu gscd.aaml.hmehselahh.e r tesccs .aheh ahstpesnoisrn. fo hbr eroe.tas .trhoat

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charcot_bouchard  pteUda on my vpre cnmtemo : Yes siht is ao.istpcssit tno isshveypnyttiier unioei.nspmt How od u wn?ko htLymocype adn Pencrese of auaonrlGm - pesnoesr to liecrnaatulrl dacm.awNhloiy SH nca asol aeucs soeol orgamnual oot dna eht cilnialc ercitpu tills oemr okol eikl HuYoS nokw atwh ......... ckuf ihst esuq +2
shemle  erHe .Pt sd'onte haev vr!eef +9
shakakaka  ngotacenaisN n,uaramglo thcpya pciytmcholy f,otiinntrila nad oirsisfb aer sene in rpytvietnysiHeis tsmopinienu , ncaocdgri ot dowUrl . +

https://pubmed.ncbi.nlm.nih.gov/7569404/#:~:text=The%20inflammation%20is%20often%20followed,than%20in%20women%20and%20children.

you get granulomas in both

+1/- j44n(141)

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