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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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egPa 2 hsa a rtaeg rcteipu

.-/t.w/wcc6-wlgi0f/rh6ooS2(d391pt1pl/e4)tj:s/n1ae687a90i0nri

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kamilia20  chidalypohaml pcti?s?iat +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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yptniiiHersyvets iixpmdteusnin—oem peyt IIIIV/ viyhseeiyinprtts ritecano ot rveltnenmiona t.nginae aueCss sdy,neap ,cohgu thecs ts,enhstig caaehe.dh neftO esne ni srfamre and ohest eeopdxs to bis.dr lbevrseiRe in realy stegsa fi slmuusti si oed.vadi

s'tI a epty of etricvesirt lgun ssideae.

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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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yWh teh hreto wrsnea ecohsic naet'r ertccro

A - oNt na cnyhplaatcai arinotce mlniay ued ot rcitiohycn ctpui(nsoomn fo soy, ichwh has eoilcpyrotsgn ttha lpeeop mya ahve lleasgrie o)rsdwta

B - tNo hatmsa terheid(cracza yb eomr acetu odieseps fo ootnbrcnociironhsc,t iehwe)ngz

D - nmAiea (,6B 9,B 2B1,) or bmaey a anporyulm mlobmsei ude to 9B or 1B2 deiccinyef t;-g&- eetdlvea netyeiomohcs leselv -;g-&t ismotshbro t&-g-; ?VTD

E - aPmlyunro xhrn;ata eTh ietm eoucsr uowld be umch emro ctuae, nda wdoul lsoa petersn wtih smotsymp of u-iflekl sypms.tmo dipRa hetad oot

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 +3  upvote downvote
submitted by ∗monoloco(155)
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iThs tpnteia is eeegnirnxpci teiietyyphsisnvr umitsonienp romf teh kasprteae. I swa knghinit M. Avium wenh I etelcdse kerastape -- I nitkh my ocigl saw elfwad veign het cspfcsiie of eht etspt'ina sot.yr

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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owH dulow uyo konw ttah it n'tsi oowl esorstr des?eais

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cienfuegos  AF 1280 73:1 ahianntlio of sosper lased to -keullfi smtyspom hatt rgosspre ilukqcy to vr,eef nomypulra hemo,ahrrge tidmitensaisi and h,scok wtih agimngi ybsiplos owishgn edweidn tuisemaimdn +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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roiccadgn to lruwod sspnieeyitrhitvy uomnneptiis is deu to tsdu adn ahtt aws soal na .iop.o..tn

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amarousis  so 'its dyiliftnee stud utb the cpfiisec type fo stud aws eht tmos nmiptarot in tish ti.souneq het fact thta they noeitedmn eht dsbri is apmnort.it eth yustd ooksb ouwld uscae ti utb eth bdri utsd si reom tnpmartoi --. +
charcot_bouchard  tHnipvitsyeyrsei iemnutPonis - anrgcOi sudt le(ik omydl m eonhuiscPsyaino) - coginarnI os nnedut leph eehr hohgut usabece obht ilwl speenrt tihw eams erteritcvis ngul saidees c itrupie. kinht incse dtsu ni bilayrr ertan ehtnrei rcagino ro inncraogi nda alos u tond ese anym snirlraiab iwht gnlu sesadei tub idrb preswinho si yifccsalelip itnndeeom sa uecas fo PH s.ideeas +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I losa asw hngtkiin M. umvai hre,e but etyitpshiserinvy eiminnpostu sesme ot tif hiwt het caagorrtnuiuerll g.esnach

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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hwo od we kown trekpaaes aseuc rtsseyiyepvinh otmiseuipnn

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smc213  FA18 .67p5 bird -g;&usxt-eroep HSN osnietupnmi vctiseietr(r glnu )aesdsei adn A8F1 21.4p saoaruonutglm sseae:dsi roegnfi gSar&;tlem-H-Ntia p.iniutemson I dah to amek seesn fo it csnei I nd'itd wonk ti wsa SNH pmutsninoei ta trisf. +5


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 +0  upvote downvote
submitted by ∗breis(56)
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atoistcssiP otiem(sesm declal tsiohnoirs ro trparo dsseaei ro trapro ever)f is an eniofitnc of hte ungl pnoiaeunm() uaceds by eht aticmerub lmCihlhadpoya iC(aldmayh) saitt.pci

Sgnis and .rcmoy:hpfsuv mtos ege, lyluuas twohitu uchm .asl.ls rm.edhchh ceeuegmahpa c.aehshtsec t.nenisps rsaho fo srbhraeet.o haor.tt

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charcot_bouchard  Utdpae no my erpv omecmtn : sYe siht is itt.ocssaspi ont ytihirespnsetyiv iemun.tsopin oHw od u ?nowk pemtyhocLy adn ePeecrsn of Gmoraluna - preoessn to lctillrearuna awm.hlcdaNoyi HS cna asol ucsae olose nmuaogalr oot nad eth cilalcni treipuc tllis omer okol kile oHu SY nokw tahw ......... ufkc tsih usqe +2
shemle  reeH Pt. ns'tode vahe r!evfe +9
shakakaka  inneacagtsNo ,agomuanrl tycaph hmycoipytlc iatnn,itiolfr dan ssirfoib are enes ni etnyiiersyvHistp topnimuesni , agcrdiocn ot dwUlro . +

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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