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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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Paeg 2 ahs a agter pcuitre

06ws(./694d-07ie-1t:w)Spil//chj1lw/tn0ecaip68o/o21.9na3rrtgf

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kamilia20  oyaalcidmhhlp ?c?pastiti +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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nrpiytyevsteHiis tpsi—xuendioeminm ypet IIVII/ ereittypsisvynhi rioecatn ot tnivnreoelmna ianten.g asseCu nyspea,d oughc, teshc thgntesis, dhhaece.a eftnO eens in srraefm nad htseo xdpseeo ot idbr.s lRerisveeb ni eylar esatsg if iumsulst is dda.ovei

s'tI a type fo ievscretitr lung eds.ieas

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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 eht rtoeh nresaw eoscich r'etna troeccr

A - Not an hiancctyapla caieontr lmaniy edu ot htnyrcoici o(nictmousnp fo o,ys cwhhi ahs ptcnorigolyse tath epoepl aym vahe elilrsgae w)oatdsr

B - Nto amthas daaerheczct(ri yb emor tacue iepodess of ocbticticoshnnrro,no e)ngwzhei

D - eaAmni 6(B, ,9B )1,B2 or abyem a puoamrlny bmolmsie due to B9 or 12B dfcieyneci g&-t-; elaetedv eteohnmisoyc ellsve &g-;t- brstmsoiho -;-tg& V?DT

E - Pmoyalnur ;arthanx ehT mite orceus duwol eb cmhu rmoe acte,u and uodlw aols snetepr with pmsostmy of ulkl-ife .pstsmmyo apdRi hdtea oto

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 +3  upvote downvote
submitted by monoloco(155)
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hsTi piatnte si ngerceinixpe yrhveypistitisne eioisnumntp mrfo teh sae.rkteap I was ignthnik M. mivuA ewhn I ledectse asrepkate -- I ihtkn ym ioclg was ldfwea vgnei eth sfcipcies of hte 'pntaeits ys.tro

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 +1  upvote downvote
submitted by imnotarobotbut(184)
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owH luwod ouy nkwo thta it t'isn oowl ersosrt adese?si

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cienfuegos  AF 2018 13:7 tolhnaiina of rospes desal to l-ieulfk ysmtpsmo atth respsrog iycqulk ot fev,re yupolmarn haoeehm,rgr siistditiaemn nda cshk,o hwit ggnmiai spbyosli gionshw eneidwd stdimunamei +10


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 +0  upvote downvote
submitted by endochondral1(24)
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iogrdncca ot olwurd iestpniesvryihyt mnopintiuse si ued ot tdsu and ahtt saw losa na p.o.no.t.i

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amarousis  os s'ti fitenyedli duts but eth eipccsfi yetp of udst swa the otsm impoartnt ni sthi .uenitsoq eht ftac tath ythe itnendemo het isrbd is anmtiptr.o eht tdysu bsoko dlouw ascue it but eth irbd duts is mero tmnaorpti .-- +
charcot_bouchard  rstiytiyHpsnivee nuoPnimitse - acrgiOn tusd eli(k lmdoy )ncoeyh inomsiaPus - gaioInrnc dstneu on hepl heer hhutgo ubsacee btho ilwl rtneeps ithw esam ceititrvers lngu edeassi ciietp.ru htkni ciens udts in birryla ntrea eitnhre oniarcg ro ioainngcr and aols u ontd ese anmy nlairsbria hitw ngul aissede btu bdir pnwohersi si lecalpfiicys noentidme sa ecuas fo HP .sadseie +


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submitted by beeip(141)
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I osal swa hitnigkn M. amuiv ,here utb iyihtrepssynteiv ipnuemsitno meess ot tif hwit het tacureuronglilra gahs.ecn

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submitted by endochondral1(24)
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ohw do ew konw aekprsaet ecaus hysiinrvtpeyes pisotunnime

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smc213  AF18 6p75. rdib eor-&e-xts;pug SNH eopunmsniit rcrtteev(iis glnu eide)ssa adn A81F 124.p oualaoutsnrmg aee:ssisd egofnir &HmS--laarteNtgi; iinp.sotmune I had to kema esnes fo ti secni I d'tndi wonk it saw HNS pnsontmiiue ta srit.f +5


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submitted by breis(56)
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asioissctPt sme(imoets dceall nhstrisoio or oprart eeissad or prtrao )evrfe si an intifecon of het ulgn imu(opan)en uaecsd by eht rtucmaeib adomhiClaylhp laCiyd)h(am .istctiap

sSgin dna e,:hmuopstg csyv.fmoer uuyasll tuowtih mchu m.su hleeha.em hslccr dpehg.aa ahe.ch stces hsrsni. aostnpe of hrbteser a.o r.aotth

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charcot_bouchard  dtpeUa on ym rpev ncmomte : esY tshi si oscssati.ipt not eyienvstisiphyrt iensmpot.inu How do u nwk?o mytecphoyL and Prceesen fo nrualGoma - eesonspr to erirallltancu iolyca wmhdaN. SH acn aslo uceas leoos uranlagom oto adn teh aiiccnll cieurpt lslit rmeo lkoo ekli u YoSH wnko ahtw ......... ukfc iths usqe +2
shemle  eerH tP. onts'de eahv !ferve +9
shakakaka  asNgtnnaeoic arloamgun, ptcahy copmhlyticy flntin,rioati adn bssroifi ear esne ni seinyHrisivyptte esoptinimnu , odncgaric ot drUwlo . +

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