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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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eagP 2 has a gtear pretcui

l/i8jwirn0/d(6/4ew66tt7ogresf/:pptc.3/0)9a1naho-.iSl211c9w0-

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kamilia20  hymipdllhaaoc ist?ai?tpc +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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evspnsirHttiyyei xuedsntiei—imopnm epyt III/VI rsntieisyhtpeviy ncroaeti ot rnvneteaoimln eaint.ng aeCsus ,anepdsy gcuho, hestc heinsttsg, eh.cdaeah ntfOe eens in rarmefs and seoht dsxpeoe ot d.birs sReibrelev ni aeyrl eatsgs if usmtulsi is d.eidavo

st'I a eypt fo veietrtcsri nugl dess.iae

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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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Why het eothr raswne osechci r'taen ocrerct

A - Not an hacatyapncil ineoacrt inymla deu ot conthcriyi i(uoptnmsnoc of ,oys wihhc ash oerlcioygspnt hatt ppolee yma heva leriaegls )worsatd

B - otN aashmt trecza(archied by moer ueatc osesiedp of tonitrisccoon,chrbon wgh)ezein

D - ainmeA 6,(B 9,B 1B)2, or aybme a rnyaolupm mbelsomi eud to B9 or 21B dcfecnyiei g--;t& taveeeld etomynoshcei levesl gt-&;- rsoibtohsm g;&--t ?VTD

E - uolrPnaym ar;antxh The imet euoscr lodwu eb cumh eomr ,uaetc dan wluod lsoa entespr htiw msmptyso of leiuf-kl mymsspot. Rdpia aehdt oto

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 +3  upvote downvote
submitted by ∗monoloco(155)
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sihT tiptane si pcinxnergiee peivthytssriyine oeisnpuintm mrfo teh asek.aretp I aws gnniikht .M vmiAu wnhe I tdeeslec atperseak -- I knhit my ogcli aws edaflw eignv eht pisfesicc of teh natt'eisp yst.ro

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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wHo uwdlo ouy okwn thta ti it'sn owlo rtesosr sdeei?sa

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cienfuegos  FA 0128 3:71 liiotnhaan fo orseps dlsea to lkfi-uel omtssmyp tath prgeosrs uyklcqi to ve,fer pumnloayr hamoeh,egrr seiiaitdntmis dan hck,so twih ngimiga slopibys iohnswg dewendi imstdunaiem +10



 +0  upvote downvote
submitted by ∗endochondral1(24)
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ongdaircc ot ldurwo etseiihnyvsripty petnomnisiu is edu to tsud nad ttha aws saol na tno..pi..o

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amarousis  os 'ist eyldieftin sdtu btu teh ciceisfp etpy fo tsud wsa teh otsm rtptnmaio ni this e.oqntsiu hte tfac that hyte tdieonemn hte isrbd is omanitr.tp het tysud osobk dolwu uesca it tub teh dbir tuds is ermo trianpmot -.- +
charcot_bouchard  ntsyyitHpiserive uPonieisnmt - ancgiOr dtsu iel(k loymd oumcisnny)s hiaeoP - nirnacgoI unotdesn lphe eher gthhuo casbuee btho wlil npseert iwth easm ttcsvrieeir glun edaseis iiupc.r et khint siecn dstu ni rarilby rtane hneiert incagor or niroaincg dan sola u nodt ees ynma lasanriirb wiht gnul sdiesea but rbdi ponhewrsi si ilelifccapys nntodeime as sauce fo HP esei.das +



 +0  upvote downvote
submitted by ∗beeip(141)
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I lsao saw nktniigh .M uiavm ehre, ubt ithsyntyereipsiv tinpeuonims emses ot fti iwht het etiaruungcarllor agscnh.e

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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hwo do ew onwk tsrpekaea eascu tnivpssereyyhi mutsnipoeni

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smc213  F1A8 p5.76 irbd tu--e&rogxs;pe HNS sipoutnmien sitirvt(ceer ungl e)dissae adn FA18 12.p4 rloatmasuugno sasdees:i rfngeio m-SNrltHaagit;-e& u.mienpnsoit I adh to meak seens fo it siecn I dt'din wkno ti wsa SHN suitnmpnieo at sit.fr +5



 +0  upvote downvote
submitted by ∗breis(56)
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asitictsPso oitsmes(me lcaled noirthsios ro trprao esaside or potarr vrfee) si na tciiefnno of het nlgu onueam(np)i ecdsua yb the muibteacr ahmoyCdplailh )imyCd(laha csiatp.ti

igSns adn fuc.mprtmvh,eg sy:oos e lluaysu thtuiow cmuh rl. cpmldhshs.ea.meuch eaeag h heascse. cth .nr asneohsspti of eb. tahsrroe ohatt.r

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charcot_bouchard  deUatp no ym prev mmetcon : seY hist si iaoissctspt. tno yepsyetstvnirhii otn.enipumis Hwo od u ok?wn ympycLoeht nad snercPee fo mrlnaaGuo - ensserop ot lteaalrncluir Ni ywa.dcaolmh HS nca also cueas looes uomrlagan too and het nialiclc cuieprt tlils mero olko kile SYu Ho wnok athw ......... ckuf hits sqeu +2
shemle  Hree .Pt 'nedsto heva efe!vr +9
shakakaka  sicgaaNntneo gnlarmaou, hpctay thpiccmolyy litit,onifnra nda iiofbrss aer sene ni ittenpseyriHyvsi ispmnnetoui , rcanodgic to lwUdor . +

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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