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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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Page 2 ahs a etrag tcpueri

2.s-adt19/twn10.(i/c6)weha1pc//t9-ro/84iroSnle6:iwf63p7jgl00

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kamilia20  idhahllocapym tatp??iics +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)

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 +9  upvote downvote
submitted by ∗hayayah(1212)
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esnyHietyritvpis ptiuixnnmodisee—m ptye /IIIIV ivtsyiehytsrpine intarceo ot nitoveeannmlr i.tngnea seauCs andsep,y c,ugoh sthce stseng,thi ca.hahdee nOfet esen ni easrmrf and tseoh sdpexoe ot .bdris eerielvbsR in ryael tgsase fi stsumlui is od.devai

s'tI a tpye of iriettvrces ngul sse.deia

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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)

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 +6  upvote downvote
submitted by ∗neovanilla(57)
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Wyh the horte ernaws chseoci rtea'n rocrtec

A - tNo na ypnlaaatichc tonciear ymnila ude to hctinoiryc ms(nnoptciuo of o,sy cwihh has lritoneyogpsc ttha poeepl yam haev sllgaeeri )radtswo

B - toN amstha ahteazercrdi(c yb rome ecuta pieoseds of tshcbcr,nnitooconior e)wnhzeig

D - eiAnma 6B(, B9, ,2)B1 ro aebmy a poumlanyr ebomimsl edu to 9B ro B21 cniyifdece &;--tg edtavele ocnytemhoeis eelvls &;gt-- shsotroimb -;g&-t VT?D

E - monPayulr at;rnhxa ehT temi soecur ulodw eb cmhu roem eact,u dna lwdou laso eetrpsn whit mtmspsyo fo fl-eikul .tmpsymso adipR hedat oot

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 +3  upvote downvote
submitted by ∗monoloco(155)
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ihTs nitepat is inreeigecnpx hitersyyiivtnpse munespioint mofr the arpetks.ea I saw gtnhkini .M ivumA ewnh I eectlsde aktperesa -- I khnit ym licgo swa wedafl eingv teh essfciicp of het eta'pstni ts.roy

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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wHo dowlu ouy nkwo that ti 'tsni owlo rstoser e?ssieda

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cienfuegos  AF 1802 31:7 iinoaanlht fo respso alsde to fi-lekul mosmpyts ttha rsreopsg qykluci ot eer,vf plyrnoaum ,orhrhgeema sstiiinmdiaet dan hokc,s twih agimgni bisosypl ngwhois weddnie uantmidmsie +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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dgocanirc to lrwoud tyhrinstpyviiese omniietnpsu si ude ot utsd nda atth saw lsao an o.ip..nt.o

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amarousis  os tis' fdleyitnei dsut tbu het cfecispi pety fo dsut wsa het omts mrnpaitto ni isth o.nutiqse het tfca thta yhet intnemdoe eth sidbr is taiprotmn. the ustyd ooskb lduow seuca ti but hte dibr dtus si emor aptrtnmoi -.- +
charcot_bouchard  psvtHeniiisyrtye inmuesPinot - icnOrag ustd (ilke ldyom noan)yuchs Pmiieso - onIiagrnc usndot en elph eher hgohut caebsue bhot ilwl ernstpe wtih mesa ivtrceerist lnug sdiaees ipe curti. itnhk incse tusd ni rbrilya trean ereniht cgoiarn ro gnarnicio dan slao u dnto ees mnya anrsrilbai wiht ugnl dssieea btu drib phswernio si syciaielfpcl ednitmneo as eucsa fo PH s.idesae +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I osla was hnnikitg M. muaiv he,re btu hepiyesinisttrvy pniimsuoetn eessm ot tif iwth eht ernraaugrillocut hengs.ca

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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how do ew wonk eaesrpatk aecsu ihsserenypiyvt otuipsmnein

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smc213  81FA 57.p6 rdib u;ps&-xegt-ero NHS npuesniomit irstr(ivetec lugn ea)dsesi dna F1A8 .4p12 gtrluaasnmuoo :dsseseai grenifo -&arlgi-t;eaNtmSH senoiipnum.t I adh to amek nesse of ti cisne I n'didt kwno ti was SHN tousinnpiem ta s.rfti +5


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 +0  upvote downvote
submitted by ∗breis(56)
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itsiaoPcsts emieos(mts acedll snhotisrio or optarr sieesda ro raport )rveef si an ntonfieci fo the ugln )uipo(aennm cdseua by hte bceatmiru ahaCilhodmypl yi(aalCm)dh ca.ipitts

igsSn nad peucshoe sfr,vtmo mgy.: yaslluu htwtiou much dcpeeaes. .cmaghrhh .sua lhlem es c.hahcest isapsernsno t.h fo a .brtshoree .trtaho

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charcot_bouchard  adUetp on my rpev momcetn : Yse tshi is icsoispta.st not nityyrspeshiietv .mpniotsunei owH od u kown? Loehmypyct adn eseePcrn of aGlranoum - eorpessn to lnartlaeciurl ohdNl.y awiamc HS cna slao ausec oosle auoalrgmn oto nad hte ciilnlac pecirtu siltl mroe look ekil YoS uH wokn htaw ......... ukfc sthi uesq +2
shemle  eeHr .tP t'snoed eahv fveer! +9
shakakaka  tieNocgnaans ru,anomlag yhapct ohtmpiclycy nnotrat,ifiil and ibrisfso aer sene in psiyHyenrvteitsi mnuntopieis , cnodiarcg ot Urlwod . +

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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