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NBME 21 Answers

nbme21/Block 1/Question#32 (60.0 difficulty score)
A 50-year-old man has had progressive dyspnea ...
Usual interstitial pneumonitis🔍
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 +30 
submitted by notadoctor(152),
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suUla tirtinitelsa snpuetnmoii si het oiitolshaclg ieifidnotn fo adptihIcoi punaoylmr fob.sisir We nkwo ttha thsi anepitt sah ranmpoluy isiosrfb ceuasbe teh ountqsie ttesas htta terhe is ofusbri hncegintki of eth aaervlol tsa.ep shiT ineustqo saw stuj itstgne hatt we ewkn hte eorht nmesa rof ayurolPnm iisF.osbr

aneurysmclip  Nbme back at it again +24  
pg32  Is it still considered idiopathic pulmonary fibrosis is it appears to have been caused by an atypical pneumonia? +1  
zevvyt  Why not Sarcoidosis? Wouldn't Sarcodosis also be a chronic inflamation with fibrous thickening? +2  
swagcabana  UIP is a better answer. Sarcoid is a leap in logic, usual interstitial pneumonitis is textbook histological definition of idiopathic pulmonary fibrosis. The biopsy has no mention of noncaseating granulomas and the clinical picture is not consistent with an inflammatory process. You have to focus on the better answers, try not to get caught up in the "why nots?" Calling this sarcoidosis is like someone coming in with prototypical asthma and jumping to eosinophilic granulomatous with polyangiitis. Sure its a possibility but its definitely not likely. +6  
mangotango  I picked “diffuse alveolar damage” with Pulmonary Fibrosis in mind but these are actually key words for ARDS :/ +1  
zevvyt  thank you swagcabana! Very good explanation and strategy! +  



 +8 
submitted by gabstep(14),
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fondu this ni nbsbi:or teh roidagiolc dan hiotisgocl rtaetnp fo sfirsbio si edreerrf ot as suula ratiiinttles amnioepun, chhiw is erudqier ofr eth idsgaison of IPF.

drdoom  pneumonitis* +  
drdoom  ^nevermind! +  



 +4 
submitted by neonem(550),
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atmaoPh ayss that slrinttiieat l(ypi)atca neuiopmna si iarzhececdtra by fieufds tnisaettirli tratsfil,ien tsrepsen w/ tliryveeal diml puerp pres ssptmymo ainlm(im sutmpu ;mpa& olw ),evfer nda is osmt ftneo saeduc by uesi,vrs tbu can be ar.leacitb wHvr,eoe itsh oisnqteu is epgnsreitn a corcnhi cae,s so 'Im mgaisuns htta eht sroviepu aitlntrities eiapnnomu euascd a itbfoicr renposes ni teh lnug.




 +4 
submitted by usmleuser007(370),
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lIalf else lsf:ai etno taht rteoh neraws cseohci era DCPO seytp

dragon3  (except sarcoidosis) +2  
leaf_house  I got hung up on why this couldn't be sarcoid, and I think no lymphadenopathy is one of the reasons you wouldn't pick it here. (Though it seems like it can cause alveolar septal thickening: https://pubs.rsna.org/doi/full/10.1148/rg.306105512) +  
lovebug  Restrictive VS Obstructive ! very good point! THX! +  
schep  if it were sarcoid, wouldn't the biopsy show noncaseating granulomas? +1  



 +3 
submitted by sweetmed(138),
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aUlsu iisttreilant uepannmio UIP)( is a rmof of nlgu aseidse rirtdazeheacc yb osrisgrpeev srcngari of ohtb l1gun]s.[ hTe grsacnri sorfbs()ii lionevvs het stouiprngp rfkwroaem tsrneti(mit)iu of teh un.lg UIP is uhts clfdasiise as a mofr fo tsriintitael lung seasdie. The metr uu"a"sl rfeers to het tcfa ttha PUI is eth omst common fmor of tneisiliatrt isf.irobs iPn"eu"omna iiteandcs ulgn" yaml"btior,an wchhi snuledci fsoisirb and natommili.naf A mtre lpiovseruy dseu ofr IUP in eht Bshitri eariturtel si pgcycioernt bnrgsofii lvsaeoilit ,)(CAF a tmer htat hsa efnall tuo fo oavfr ecnsi the bacis guylnridne ylaopgoht is onw hohgtut ot be ,bsirsiof ont foaialnmti.nm hTe rmet uulas itteasltrini moespuiintn U(PI) ash laso oftne eebn udes, utb ,ngaai het i-ist prat fo ttha maen amy seveaipzomerh a.inlmnmtiofa thBo UPI adn CFA hvae eenb bsedeircd sa nyssuonmyo htwi iapihoidct yuanrlpom srfsoib.i




 +0 
submitted by niboonsh(336),
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my suginnreaddtn of isth is mfro hmaptao - rtnesitItila )pl(aatciy uaopnimen - udcase yb siffedu letitanriits .frintatelsi naC be acusde yb saocplMyma me,uonp RV,S cmyaailhd eun,mpo nie,fzluan oeallixc uiitrben

athenathefirst  Yeah but how does that help you choose Usual interstital pneumonia? +