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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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gaPe 2 hsa a atger uitrcep

itnlarg(a31w6oet6Srjd.-9p.o/69i/8h0/c40p)7twfe/:s-l/0wcin112

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kamilia20  lhocpimayldha tcp?tisai? +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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speniitiretvHyys nxip—tmseumiieodn eytp III/IV inyeeipyrisvtsht tcroiean ot imroannevnetl g.anenti usCesa aneyd,ps guoc,h cseht gsn,histet eahhecd.a nOtfe snee ni faerrsm dan hsote xdopees ot idsr.b ebvilesRer in yarle easgst if suismult is vidade.o

t'Is a tepy fo ricrsiveett lngu .sidease

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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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Wyh teh rheto rwesna scheoic rtane' orrectc

A - Not an yancpicaathl tnecoira ilynma ued ot ciyocirnth muncntispo(o fo ,yso ihwch hsa gelyoitpornsc atht elppeo yma ehva laslieger ra)otwds

B - toN amshta eet(zdcaacrrhi yb omer tueca eepisods fo itcoonor,cnsotchbrin hwzeegi)n

D - maiAne ,6B( 9B, 2B1,) or eymba a auynoplmr elbsimom due ot 9B or 2B1 eccfydinei t-&;g- tladveee ymnostoecihe leslve >-;- thsribmoos g-&;t- DT?V

E - nuyaromlP trn;haxa ehT emti uesrco olwud eb ucmh eomr tac,ue adn owlud saol rspente ihtw mossmtyp fo efil-luk msops.ymt apRdi teadh oto

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 +3  upvote downvote
submitted by ∗monoloco(155)
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sihT etpitan si pgxcneeienir yespstvniihitery pumntisonei ormf hte ketase.arp I saw tknghiin .M imuAv ehwn I deeestlc skepaetra -- I tnkhi ym ioclg swa lwaedf vigen eht sccipfesi fo het entat'isp .orsty

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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oHw dolwu ouy wnok thta ti tsni' oolw oersrst ieasd?se

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cienfuegos  AF 0281 1:73 aiotilnanh of rpesso dseal to flk-euli mmytsosp tath ropsrges ilucqyk to e,efrv ymuoanplr re,rehomahg itesitindamis and chs,ko tihw anggiim losysbpi sonwigh ndeidwe eindatsmimu +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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rcdniogca ot wludor irttyspeiyhevnsi enpimtonius si eud ot dstu nad tath wsa aols na nto....pio

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amarousis  os i'st fieidtynel dsut btu the icescipf tyep fo tsud aws eht tsom npmottair ni isht o.iqnsteu teh fact that yeht ienemnotd hte idsrb si to.atmnrpi teh sdyut sboko owuld scuea it tbu eht rdib sudt si orem nmiroatpt -.- +
charcot_bouchard  nytisteisyprHvei onieutPsmni - iOrnagc dsut l(eki lymod ou snenmhiaPysc)oi - cgrIainon sndnoeu t elhp ehre ouhght cabsuee both lwli pternes twhi msea ciesttreirv nugl seesdai eci.prut i hktni escin sutd in yraibrl taern eihrent acgrnio ro oiainrngc adn laso u ndto see ynam rnsaalriib hitw glun siadees but ibrd iwreosnph is sciipealylcf dtneemino as saeuc of PH .asedesi +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I asol asw nkgtihin M. ivmau he,re but ienhsryetipysvit nuotiiespmn essem ot tif hwit the oraurluaitelgncr nashc.eg

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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how od ew nowk keteaasrp aeusc nhriesvtieypsy ntinmepsiou

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smc213  F18A .7p56 bidr et&os-xgue;-pr NSH osunpimtnei ircrv(eitest nlug dseaesi) adn 1FA8 1.4p2 tsnouomargalu saede:iss efnorig -Nirl-Htt&g;amaeS uptn.onesimi I dah to eakm snees fo it cisen I tnddi' wnok it aws HSN moiptinnsue ta t.ifsr +5


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 +0  upvote downvote
submitted by ∗breis(56)
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asciitPosst ies(otemms cdlela sirnohitos ro ptraor dasiees ro aoprrt rv)fee si na nocienfit of hte ngul (aeinp)oumn cdeaus yb the rcibeamtu dCimlpoaalhhy md(hlayC)ia .siatipct

snSgi nda recpuomgfsvm osehy: ,.t yalusul ouhttwi humc e msmrp.hselahl cad.eahue.chg thhscsca.ee r.niahos pssnet fo etrrsbeo.ah trota.h

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charcot_bouchard  ptaUed no ym pver cmontem : seY itsh is to.pssiscait ton iyvyetrintihspse uipneints.om owH do u no?wk yoycmhtLpe nad ePescrne fo arGalomun - esnserop ot iuentarlalclr hiNwacd.yoml a SH can osla ecuas slooe agalmornu oto and teh lccanlii rpticeu tlsil rmoe lkoo eilk uS HYo kown tawh ......... ufkc siht euqs +2
shemle  rHee Pt. t'endos aveh rvfe!e +9
shakakaka  ncgeisnNotaa mnolruga,a ptachy lcchtyympoi tiati,irnonlf adn sirfsboi era seen ni tepersiiysitnyvH tneosimnupi , ogcncrida to rdlUwo . +

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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