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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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gPea 2 hsa a gtaer uicpetr

eici9i1prt0rlp-nw1we/o/740ls1)t.Sh/6dgo9-a/8.fcwt/:n66(0a32j

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kamilia20  hiplhlcdamyao ?iicstpat? +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)


 +9  upvote downvote
submitted by ∗hayayah(1212)
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etsysirivypentHi xendoitnmp—smiiue yept IVII/I nipiheyiesrttyvs ernctiao ot rmlveoatnenin engi.ant aCsues spen,dya uh,ogc hesct itsgthsne, aca.hheed tOfen esen in ersfmar and eshot sdepoxe to drb.is Rvsreilebe ni ylear tsgsae if stlsuium is i.eodvda

s'tI a pyet of iivtcetrres nlgu diessa.e

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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)


 +6  upvote downvote
submitted by ∗neovanilla(57)
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hyW eth etohr nearws ioshecc trane' retcrco

A - tNo an ncpctyahaila nocraite lanyim eud to yirncihoct nsiocomtun(p of s,oy wcihh hsa ntlrpyooeigcs atth oeplep aym heva lilageres tr)awsdo

B - toN taashm c(zhrrcteadiae yb eomr eactu dspoisee of notooihbnsoccnt,cirr hieg)znew

D - aAmein 6(,B 9,B 2B1), or abmye a myaorpunl bisolemm ude ot B9 or B21 ecyeciidfn ;-&-gt levedate tnoesyceiomh leelvs &;g--t ssombiohtr &-gt-; VDT?

E - Plmyoruan ;tahanxr heT emti cureos doulw eb hmuc erom tcae,u nda wdolu loas nreptes wiht omsypsmt fo ellikuf- msmosty.p adRip detah oot

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 +3  upvote downvote
submitted by ∗monoloco(155)
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hTsi paenitt si pecingnieexr trivihnesypetsiy msipntoinue mfor eht .tpkeraeas I wsa gkninhti .M uivmA hnew I cetldees krteasape -- I nhikt ym igloc saw lwfaed ginve eht epicsscif of hte ita'stnep soyt.r

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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How uwldo ouy kown hatt it sni't lwoo sretsor eaidse?s

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cienfuegos  AF 1028 71:3 thlinoiaan fo srpeos ledas to leik-flu smptsymo tath resrgops clyiuqk to ,revef urpynalom ,arhgroheem sneittdisiima and ,hksoc thwi ggiainm bsliposy hoiwnsg edenwdi eudmtainism +10



 +0  upvote downvote
submitted by ∗endochondral1(24)
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narcogidc to olrwud yrvsttipnseiehyi onueismiptn si ued ot utsd nda ttha saw osla na .pnitoo...

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amarousis  so si't tdniylefei sdtu ubt het pseicfic tyep fo dsut aws teh tsom iratpnomt in isth iuteq.sno the atfc ttha yteh idotnemen teh dirsb si ptaomn.itr hte dyust oskob lwodu sueac ti tbu the rdib dstu is reom otrmpnita --. +
charcot_bouchard  vystiiysreinHetp tnioPimesnu - grOainc dtus leki( mldyo yc)esPiosnaom inuh - oIgcrnina t duesonn lhpe ereh ghutho ceasebu boht llwi nrsptee hitw mase ettsivirecr ulgn seeaisd iui pcert. hkitn eincs utsd ni aliryrb taern etehinr iognacr or gainrionc dna also u tond ese mnay sairrlabin ithw glun dsisaee ubt brid onhseirwp si ciecslaylfpi tneoemndi sa ucesa fo PH aeiesds. +



 +0  upvote downvote
submitted by ∗beeip(141)
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I oasl asw kniitnhg M. uivma e,her but nrtsheyietvspiiy neuiimtspno esmes to fti tihw eth grnratuailecolru cag.hsne

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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who od we wkno esktaarep uecsa erpyivshitseny iunenstpoim

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smc213  18AF 5p6.7 bidr ;eeox-t-pgr&su HSN nimsuiontpe c(eirevttris lung aed)ises adn A18F p421. orgaluunsatom ias:sesed ogneifr aiSHmatlg;&-tN-er uitnspoei.mn I adh ot akem nsese fo ti cnsei I n'tdid wkno ti saw HSN uioptinnems at if.rst +5



 +0  upvote downvote
submitted by ∗breis(56)
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tisitcssoPa tomessm(ie eacdll osiriotnsh ro arorpt eiaessd or trapor ferev) si na cinnfeiot of het gnul e)pnmiua(on adcseu by eht abmtuirce aphoadilymClh Cihla(yadm) c.aiittsp

sginS dna set govhympu:crso,me.f auysull wtotuhi hcum meep.mlrelhsu ahaehacs gch.d . hhacesce s.t eiap nrnsos.hst fo eobrhsa.ert toart.h

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charcot_bouchard  dpeUta on my verp encmomt : Yes stih is actossti.ips tno syevsrintyipeiht itonu.sipmen How do u n?kwo oLmcyyhpet and nsrPceee fo Ganlmruoa - nsrspeoe ot itculaernrlal iwhyN oa.ldcam HS nac asol sceua soleo lmarangou oto nda teh laiiccln eutpcir tlsli remo oolk keil YoHu S oknw thwa ......... ukfc isht quse +2
shemle  eHre tP. ntoed's evha ferv!e +9
shakakaka  nscoitegaanN nmoar,algu ptyhac lhtmyicycpo fl,tntnioiria nda srsboifi rae seen in rniepsytHveysiit imuonitpsne , gnoaidrcc ot rwUdlo . +

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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