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NBME 20 Answers

nbme20/Block 4/Question#21

A 47-year-old woman comes to the physician because ...

Contact with parakeets

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 +5  upvote downvote
submitted by masonkingcobra(36),

Page 2 has a great picture


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submitted by monoloco(31),

This patient is experiencing hypersensitivity pneumonitis from the parakeets. I was thinking M. Avium when I selected parakeets -- I think my logic was flawed given the specifics of the patient's story.

 +2  upvote downvote
submitted by hayayah(244),

Hypersensitivity pneumonitis—mixed type III/IV hypersensitivity reaction to environmental antigen. Causes dyspnea, cough, chest tightness, headache. Often seen in farmers and those exposed to birds. Reversible in early stages if stimulus is avoided.

It's a type of restrictive lung disease.

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submitted by beeip(38),

I also was thinking M. avium here, but hypersensitivity pneumonitis seems to fit with the reticulogranular changes.

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submitted by endochondral1(0),

how do we know parakeets cause hypersensitivy pneumonitis

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submitted by endochondral1(0),

according to uworld hypersensitivity pneumonitis is due to dust and that was also an option....

 +0  upvote downvote
submitted by breis(3),

Psittacosis (sometimes called ornithosis or parrot disease or parrot fever) is an infection of the lung (pneumonia) caused by the bacterium Chlamydophila (Chlamydia) psittaci.

Signs and symptoms: fever. cough, usually without much phlegm. headache. rash. muscle aches. chest pain. shortness of breath. sore throat.