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NBME 20 Answers

nbme20/Block 4/Question#21 (74.9 difficulty score)
A 47-year-old woman comes to the physician ...
Contact with parakeets🔍,📺
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 +31 
submitted by masonkingcobra(368),
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Paeg 2 ahs a etrag perciut

a0oe/pl:ht601e46jn1)a79rt.13.oi2f6/pi(wwl0--td/s9n/c/Scir8gw

kamilia20  chlamydophila psittaci?? +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(78),


 +9 
submitted by hayayah(1100),
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yinHrissteeyptiv exs—tiipdiummneno tyep III/VI sipyeenthtivrisy ecnaroti ot emontrvnaline ati.gnne asseCu pa,ysdne uc,goh sthec thesgnits, aeca.dehh Oeftn seen in emfarsr dna hotse xesodpe to irdbs. Reversileb ni erlya ssetga if ustulims si vaeod.id

'tIs a ytep fo ritetrevisc ungl ises.aed


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

+2/- alexp1101(5),


 +4 
submitted by neovanilla(47),
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hWy eth ertoh swnrea chcesoi 'atren ctrorec

A - oNt an hilcyapanact rtaceoni ayilmn eud ot ithincyroc iptuoncso(mn fo ,syo hchwi sha roytpilcesgon hatt lpoepe aym vhae aegelilrs rao)twds

B - otN mtsaah czrc(ierathead by rmeo tacue poseeids fo onrotnisc,botcorihcn zn)hweieg

D - menaAi B6,( ,B9 B2,1) ro aebmy a ynmuarolp bolmsime eud ot 9B ro 1B2 fieeyndcic t-g&;- edvlatee chymoeotensi vsleel g&;--t sohtbmiors &t--g; DV?T

E - rmPoalynu ;anhxtra eTh time ocrsue dlwou eb muhc emor utcae, dan lwodu laso senrpet ihwt yomptssm of -eklfilu stm.pomsy dRiap ahdte oot




 +3 
submitted by monoloco(141),
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hTis tntaipe si niegepxicrne pttvesynyeriiish nponstmuiei fmor hte rta.skeaep I saw igitnnkh M. viumA hwne I eledscet arapteeks -- I nihkt my lcgio swa dwaelf eingv eht csiifcpes fo teh iseap'ttn s.rtyo




 +1 
submitted by imnotarobotbut(168),
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owH dowlu yuo onwk tath it itn's wolo oetsrsr ees?isad

cienfuegos  FA 2018 137: inhalation of spores leads to flu-like symptoms that progress quickly to fever, pulmonary hemorrhage, mediastinitis and shock, with imaging possibly showing widened mediastinum +8  



 +0 
submitted by endochondral1(18),
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nrcgaicod ot rudwol ststyiynepvhirei tsnomupeiin is due ot usdt dan thta asw osal an noi..po.t.

amarousis  so it's definitely dust but the specific type of dust was the most important in this question. the fact that they mentioned the birds is important. the dusty books would cause it but the bird dust is more important -.- +  
charcot_bouchard  Hypersensitivity Pneumonitis - Organic dust (like moldy hay) Pneumocniosis - Inorganic dust none help here though because both will present with same restrictive lung disease picture. i think since dust in library arent neither organic or inorganic and also u dont see many librarians with lung disease but bird ownership is specifically mentioned as cause of HP disease. +  



 +0 
submitted by beeip(129),
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I salo wsa nkniitgh M. vmaiu reeh, utb eevyrinhpistysit tiesimnopun semes ot tif whti hte rrurioglacueanlt hgsneac.




 +0 
submitted by endochondral1(18),
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how od we nkow eastkraep aseuc yvtpsryenshiei iiumeosntpn

smc213  FA18 p.657 bird exposure--> HSN pneumonitis (restrictive lung disease) and FA18 p.214 granulomatous diseases: foreign material-->HSN pneumonitis. I had to make sense of it since I didn't know it was HSN pneumonitis at first. +5  



 +0 
submitted by breis(53),
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icttPosaiss tesm(iemos edlacl sstohirino or oarprt idasese ro roaptr reefv) si an eocftiinn of the nglu (enoniu)amp dcause yb het tebicuram ihCdoamyplahl )ymaiC(dalh .tsictpai

nsigS nad osemrcguf:hptye,o mv s. sullayu uoiwtth cumh sh.uh laegc.eald hcm. sraeephm shc .echseat sns npehroat.is of a toseerhb.r h.tarot

charcot_bouchard  Update on my prev comment : Yes this is psittacosis. not hypersensitivity pneumonitis. How do u know? Lymphocyte and Presence of Granuloma - response to intracellular chlamydia. Now HS can also cause loose granuloma too and the clinical picture still more look like HS You know what ......... fuck this ques +1  
shemle  Here Pt. doesn't have fever! +9  
shakakaka  Noncaseating granuloma, patchy lymphocytic infiltration, and fibrosis are seen in Hypersensitivity pneumonitis , according to Uworld . +