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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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egaP 2 sah a aterg urtepci

1w1297chn-n/.tjw8til)wS60.1s0:/g/4e(l6/6adc/oie0-pfr39aoitpr

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kamilia20  chhdomaapyill tsicpt?a?i +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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iyyiiHnpvstesert npsmod—uniiieemxt epty IVIII/ ptshntsyeeyirvii rctenaio to ranmeonvitnle tgian.en Csaseu yds,pena cguoh, shect tg,nsitehs hhae.cdae etnOf esne in fsarmer adn eshto spedoex to .irdsb ebvreRseil in lraey etsasg fi ituusmsl is deoivda.

I'st a ypet of icrrtvtesie lung siee.das

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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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yhW teh other senawr eccoihs nr'tae ortrecc

A - tNo na cpiaantlyahc oincater myinla edu to yrihoicnct itmnosuoncp( of s,oy hhiwc has oyrpogsecitln htta eopple yma evah aelilsrge dostaw)r

B - toN samhta zrdcaree(cthia yb rmoe ecatu idsepeso fo tinorcs,ohobccntorni egwhiz)ne

D - nAemai ,B6( ,9B 21),B or aebmy a ymonplrau mmesblio deu to 9B or B21 eyniccfeid &;tg-- eeetdvla eystooheicnm levels -t;g&- bmsohrsiot g-t&;- DTV?

E - Pmuaonyrl x;taanrh Teh eitm couser wludo eb mchu rmeo atuc,e dna dwuol laos pntrees with ymsomtsp fo ue-lifkl psoms.tym adpRi tdhae oto

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 +3  upvote downvote
submitted by monoloco(155)
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iTsh npateit is pnexgiciener vitysriseytpneih upominesnti fomr het sretapake. I swa nigkhnit M. Aiuvm wehn I eetdscel kaeerastp -- I tikhn my lgcio swa wldfea igven het iepscicsf fo eht tne'tapis yr.tos

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 +1  upvote downvote
submitted by imnotarobotbut(184)
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oHw woudl you nkwo htta ti tis'n owol rsetsro iedeass?

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cienfuegos  AF 1208 37:1 iloitnaahn fo osrspe lesda to -lfekilu tpyomsms tath reporssg kyqucil to vefre, urpmloayn emoehrgahr, dtaisisenmtii dna oc,hsk htiw iaimngg sslpiybo gnihosw newidde misiemanudt +10



 +0  upvote downvote
submitted by endochondral1(24)
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narcgicdo to odwulr trspieeisyivythn pontmsieuin si due ot dtsu and htta wsa aosl an noto.p...i

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amarousis  so is't infteediyl tsud tub eht csipicfe tyep fo dstu saw hte sotm ntprmitoa in stih tqus.neio eht aftc htat eyth otieendnm eth birds si ot.tmniapr het tsudy oboks dwlou usaec it tbu eht irdb tdus si rome ratoitpmn --. +
charcot_bouchard  itsiietyvHyrnpes onmiPeutnsi - niaOgcr ustd ilk(e olymd m a)husoeocPnsnyii - girnacIon ted onnus hlep eehr ghthou scbueae boht lwli pnrseet twih msae teviesrticr ulng ssideea cr.it peui kinht ecsni duts in rrlbaiy eatnr heretni gcnoiar ro inacoring nda lsao u odtn ees amyn aairbrnsli thwi ulgn iseaeds tbu bdir oisnwreph si pifcialslcye nmnieoted sa cuase fo HP ee.idsas +



 +0  upvote downvote
submitted by beeip(141)
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I lsoa swa ginikhnt M. amvui r,eeh utb ehytvisinseriypt ponsuietinm sseem ot tfi thiw the tuueinglalrarroc hscg.aen

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 +0  upvote downvote
submitted by endochondral1(24)
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hwo od we kwon aertapeks sceau sinvphieesyytr pieutnnoism

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smc213  FA18 57.p6 ibrd -toexrue&;p-gs NSH nuesomipnti cv(itersreit lnug )eiassde nda AF81 24p.1 osrmauaulontg sd:aessei fnieogr Semtr;aiN&tlag--H smutnoinipe. I had ot kmae eenss fo it scein I ddnti' wonk it asw NSH pousmintnei at fi.trs +5



 +0  upvote downvote
submitted by breis(56)
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ioPtssstcai essomei(mt edallc srsoiithon or trpoar esiaeds ro otparr v)fere is na nteiofinc of het ulng on(mepauin) sudaec yb the eribuatcm moChaylaldphi hadl)ai(Cym ct.tsaipi

sigSn nda ,:mugvsot. hysepfomcre lyalsuu wtuihto cmuh ee .hmurcl h ae.smdg.pcslehhaa e.eshc caths h.spnotsnirsae of eeht.bsr aor toatr.h

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charcot_bouchard  Updaet on my erpv nmetmoc : Yes hsti is ps.soiticast nto vsnpieyrtsiiyhte pos.ineunmti wHo od u onwk? Lhpyyctmeo nda enescrPe of romlaanuG - eespnrso ot llaanlreuicrt i.ywcoNhlamad SH nca olas cuase soole roualmgan oot nad eth ilaniccl eptriuc tlils mreo oolk leik oHYSu wnko hwta ......... ufck siht sque +2
shemle  reeH Pt. edsot'n heva !freev +9
shakakaka  oingNcsaenta almgnroua, tcpahy oithlycpymc inlrft,naotii and sbrsioif are ense ni iisyetvytpinersH npetmisiuno , oagncrdic to dorlwU . +

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