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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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gPae 2 sah a atgre reptuci

iwjc/Sfl8:or1nitd1e2teawt3.7/6w/gp69p/6oal(i0s/n01-04hr)9-c.

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kamilia20  mhpyilalachod is?atiptc? +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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Hiyivesirtypsetn deimutixsimonn—pe tpey III/VI epitsynrheisviyt rceointa to lnnateveimorn ngi.neta essaCu s,edypna huocg, sceht hnettssig, eaheadch. tefOn esne in smaefrr nda etsho oxdpsee to dis.rb isblRveere ni ryeal agstse fi smustliu is o.aiddve

sI't a tepy fo eicrtevirts nglu ai.eseds

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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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Why eht thero wrnesa hccesoi a'nret toecrrc

A - Not na altynhacpica ocainert ialnym eud to ihnyctcroi mcno(noutisp fo y,so whcih sah oyptciogsnrle htta eopple amy ahev gresaelli to)dwsra

B - toN satahm ira(ezearthdcc by emor cutea pseseodi of cricbtohsrnn,onictoo gnzwieh)e

D - mAiena (,B6 B,9 1),2B or eabym a apmurlony lemiosmb edu to B9 or 21B ecdneiiyfc ;-&g-t eateeldv syoecehmiotn lelsve -;gt&- rhsobtomsi ;->- TD?V

E - ayuorPnlm atrhnax; Teh mite ocsreu dwoul eb hmcu remo ,ceatu nda udwlo oasl ternpes htwi mtyssomp of ef-ullik mtmsy.spo pRaid dhtea too

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 +3  upvote downvote
submitted by monoloco(155)
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sihT eatntpi si nrgpcexneiei hrestyypsitevini npiuiomnset rmfo het arktep.ase I asw tknnigih .M Aumiv enhw I dcseltee sapkterea -- I kithn my ocigl wsa lfwead vegni eht isfeccsip fo hte n'titpesa soyt.r

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 +1  upvote downvote
submitted by imnotarobotbut(184)
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woH douwl uoy wkno ttha it si'nt owol rtsorse sies?eda

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cienfuegos  AF 1280 1:73 hlianaitno fo sprseo asdle ot klfli-ue ymsopmst thta rresgpos ciyuqlk to ,vfeer lnyroamup hr,emrohage dntemiiisiats dan kos,ch hwit imgiagn bypsilso wnioghs nieedwd tdismaimenu +10


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 +0  upvote downvote
submitted by endochondral1(24)
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ciagdorcn ot owdurl sirvyitstnieheyp tumnsiopine si ued to usdt nad that saw soal an i.pn..oo.t

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amarousis  so sti' eenilytifd tsud but het sccifipe etpy fo tuds aws teh omts ritntpaom ni hits qtosnui.e hte tcaf tath eyth ontiemdne the brsid is iatopm.nrt eht udtys obsok ouwdl aeucs ti tub het bdri tsdu si emro timoatnpr --. +
charcot_bouchard  sitprisnyyHtviee uniinmtsoeP - nracgiO duts ke(li mdyol ys)msPcono iuhenia - oninIracg en tdsoun hpel rehe thoguh eacuebs tboh wlli speentr wtih smae sceirttivre gunl iessdae .cuip irte intkh icesn dust in lrabryi trena nitrhee ocrangi ro igocninra adn slao u ndto see mnay lriiasbrna ihwt ulng esiasde btu dbri eihpwrson si lscfcelpayii mendieotn sa uaces of HP ses.idea +


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submitted by beeip(141)
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I slao aws ktiihgnn M. aiuvm ,eehr tbu yheisnipirvttsey sniiontumpe msese ot ift ithw eht ulgcnriaeaturrlo gs.eanhc

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 +0  upvote downvote
submitted by endochondral1(24)
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how od we wkon ratpkaees ucsea pnvesehsriyity emnuistoinp

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smc213  F8A1 p75.6 irbd -egsperu;xto-& NSH iunetponims irerc(vtitse ulgn ei)dasse dna 8F1A .4p12 trosaluagomnu das:essie nifgeor ltt;Hrem-iNgaa&-S npmi.enutsoi I adh to mkae seens fo ti incse I idtn'd knwo ti was SNH iosepmnutni at ifstr. +5


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submitted by breis(56)
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tPoaisiscst otsmiems(e lleadc ihoontsrsi ro orrpat asedise or prtaor efvre) si an inoiecfnt fo eht lung einun)pam(o scudae by teh ebuctmrai dCmahaolyhilp a(liCadmyh) atp.iscti

Ssing and mtssof chu:.rveo m,pegy allusuy tuhotwi hucm el eega .r hahlcmdamu.cpsh.seh .staehhcsec p.etnshssarion fo .rraboste he thoat.r

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charcot_bouchard  paUtde no my pevr nmocmte : eYs ihts si itc.sposasit ton ysinetvihrpitsey otui.pnmnesi woH od u kno?w ceyoLmhpty dna cPeresen of auoGalrnm - roesnpes ot arainulllerct ha.wyNo amclid HS anc slao aecus osoel augnlraom oto nda the cicnlila uctipre tills rmoe oklo kile YHuSo wkon hwat ......... cukf hsit uesq +2
shemle  ereH Pt. not'esd aevh fv!ree +9
shakakaka  gtiasNenacno no,aruaglm thaypc lhcyimoytpc nftotrlni,iia and orsfiisb era eens ni iipyssntrHteeiyv punmintoies , carngodci to roUlwd . +

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