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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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egaP 2 sah a etagr ctiruep

cw-/w0w/oS/0ot1lh-:616a2e9jfs)rtrl/cn/de37p809(t1.6ign4.iapi

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kamilia20  ioypachlmldha attips?ic? +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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etHsyriiysevtnip indemnieupsxtoim— teyp VI/III eyhsvipnrsytteii tnrecioa to reonnvnilamet ietnn.ag ussCae ,pdseyna ,ouhcg htces eitt,nssgh ahdea.ehc fOtne nese in amfsrre dan those xeesopd to irs.bd Rervelebis ni rayle tsgeas fi muisluts is ei.dovad

Its' a tpye fo eirttrivsec nulg esse.adi

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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 hte ohrte eawsrn oicecsh rt'nea ccorret

A - toN na pltyahaancic cntaorei aimlyn due to ciycronhti mtinnpooucs( fo oys, wihch sah pgrnscooelity atht lpopee yam have gerlealis wtd)sora

B - Not tahasm d(arzeiccahter yb moer aeuct iepesdso fo oocr,hsitntbnoiccrno gnzehiw)e

D - naAime (,6B B9, )21B, or mybea a ymnapurlo mmelibso ued ot 9B or 2B1 cinfecydei g--t&; davteele cieyothmnsoe eslevl --tg&; irsstoomhb -g-t;& DT?V

E - nylrmaPou nthrxa;a The time rueocs wduol eb umch reom ce,aut dna wudlo aosl etrespn whti psmmtoys fo ilf-lkue yspms.tmo adRpi hdtea too

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 +3  upvote downvote
submitted by ∗monoloco(155)
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sTih tptneai is nexerepgicin pnsyreishtietyiv nipousitmen romf het eskaa.pter I was ningkthi M. mvAiu nweh I eeletdcs ekptaesra -- I itnhk my cilgo aws wledaf ginve eth ecficssip of teh naptseti' ryo.ts

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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oHw doluw yuo kwon atth ti tins' lowo orsster ies?ades

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cienfuegos  AF 8012 1:37 tianainhlo of osprse lesda ot luklef-i sopmtysm tath sorerpsg cyqikul ot v,erfe nolpumrya roregmhhae, ainiitimsteds and ,cohks iwth igngmia ioybspls sigownh idnedew mdneutaismi +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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nigocdrac to lrdwou ryeiniytssepivht punnteimios si ued ot tdsu nad atht asw loas na o.ion.tp..

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amarousis  os 'tis etfydilnei utds utb het scepfcii pety of tsud aws hte msot prttmiona in tshi ns.teuioq teh tfac ttha etyh enetoindm eth drsib is mt.naroitp eth stuyd ookbs wdoul ucsea it ubt het drbi sdut is rmeo otmtanpri .-- +
charcot_bouchard  nieiystyvHitsrep nsoiumtPine - agcOrni udst eik(l ylmdo sioahnnocs) iueyPm - iaoInngrc untsdoen phel reeh thuhog ubaeecs hobt llwi senrept wiht ames eeirctvsrti nulg sseedai epi. rictu tikhn cinse dtus in iablrry raetn ieenthr ngrocia ro canrongii adn salo u dont see namy rialarnsbi iwht lugn esseaid but dbri soipnrhwe si cfspliyelica eimeotndn as auces of PH seiesad. +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I alos swa hitngkin .M iavmu eh,re utb esipiethtysrnyiv nsomutiiepn messe to fti twhi hte onlueigrrulcrtaa hesnac.g

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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woh do we okwn aktespera euacs tinshrveyyspei tpismionuen

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smc213  18AF 67p5. idbr xtpsu-gre&;oe- SNH ispoemtnniu iirvsrtet(ec nlgu easei)ds dna 8AF1 42.1p ruotaansuomgl edassse:i inofegr N&mie;a-HaSgtr-lt nuitse.nimpo I dha ot eakm sseen of ti cinse I dtdni' wokn it asw NSH inintupseom at tsir.f +5


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 +0  upvote downvote
submitted by ∗breis(56)
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asiPssitcot mstemos(ei alledc nirotihoss ro rtrpao eidsesa ro porrta f)eevr si an fncotenii fo eht unlg (paneomnu)i caused yb eht utcbriame aoyialdhmpChl Ch(aly)iadm citai.tps

Ssgni and go:ssr,mcef mhuvo. epty luulsya ttuwioh hcmu md.ehapr.mhclash cugehae s le. tcsee sa.hch t.pnisssh oaren fo oth saber.re trho.at

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charcot_bouchard  Uadpte on my evrp tmnecom : Yes tihs si .citpasssoit not hssnteityiiryevp uniito.mpsne wHo do u ?konw hyemcoytpL adn nceerPse fo aroalmGun - seopensr to lilclaareuntr ym.acN hiladwo HS nca alos saecu sloeo nluomgara too dan het ncilcali eutpirc illts mreo kool elki Su oHY nowk athw ......... fcuk siht esqu +2
shemle  reHe tP. otndse' hvea eef!vr +9
shakakaka  insagNnecoat lg,amunoar ahpytc choylctmpyi oi,ntflnriita nad ofsiirsb aer sene ni ypHreseisvtitiny nsnoiitpuem , crdncaigo to odwUlr . +

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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