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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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gaeP 2 sha a tearg ieurcpt

d-.81eo34/6(1agorn/nwS2s)c61tfi-l9a6tppw0i/r9:t.i70hel/j/wc0

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kamilia20  oyldipahmhacl i?csi?ttpa +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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seitevrnpyitiHys ditenmuiexspionm— pyte IIVII/ pthsnetiyrviysei coianret to nimvalnnreteo tnag.nei asesuC enypdsa, cog,hu htecs ,estgniths eaahc.hde fnetO nese ni emrsafr and toseh eoxepsd to .brisd eibrlvRees ni reayl gtaess if sulitsmu si da.odeiv

Is't a pyet of iecisvttrre nugl .ieesasd

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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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Why the eroth rewnsa occsehi nre'at ctrroce

A - toN an yicalcthapna aiocrten lamiyn ued to ihrcnotyci monpnsi(cotu of y,so cwhih ash sltyciprengoo atht eppeol yma vhae slagielre as)wrodt

B - otN tmasah tcizehrr(daace yb rome actue opdesesi of ccnbcot,sohornoiitrn z)gwhenie

D - mAniea 6,B( ,B9 B)2,1 or mebya a moyparnlu olbmmeis due to B9 ro 2B1 iyccnfdeie g-;t-& leadveet ienmsyohocet esellv -&-;gt hsbomtsrio tg--;& TDV?

E - rluomanyP naxath;r eTh tmei ocsure wloud be mcuh more a,eutc nda odlwu lsao senrtep ihtw sytmspom of le-kfuil pytmso.ms iRdap ethda oto

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 +3  upvote downvote
submitted by ∗monoloco(155)
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Tihs tetanip si npeicxenegri vntiyeihsrseyitp toisunmepni morf het tpeakase.r I was hkngiitn M. uvAmi nehw I edetcels epaeskatr -- I ihktn ym icogl aws dleawf negiv teh pcsfcisei fo teh snteapti' y.tros

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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How wdolu uyo ownk ahtt it ntsi' olow rrostse sieaes?d

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cienfuegos  AF 1802 7:31 nnhaloaiti of orsesp lsdea ot eikllf-u ssomtypm htta esprrgso kcyqlui ot fvree, ylroapmnu ,mhoerhgrea sidtmtinaieis nda kc,hos wtih gmgiina ossiyplb igwonsh deinwed saduiemnitm +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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cnidgaocr to ldowru eyineirsiytvhpts nntpieisoum si eud ot tdus and atht saw losa na o...po.int

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amarousis  so t'si eilytenfdi dtsu tbu het spcieicf epty of utds swa hte msto pntimtoar ni siht it.nqeosu het fact ahtt ythe eenmdtoin eht dsrib is rmtiontpa. eht ytsud sbkoo uldow cesua it btu hte rdbi usdt is roem noraittpm .-- +
charcot_bouchard  vtreietiiysynpsH soentmPiuin - cniaOrg dsut e(kli ydlmo conPnsou)i myesiha - acInrnogi usendnot phle heer gohhut secbaue hbto wlli enspter iwth aems tstvereicri ugln sdsaeie t .ircpeui kntih nseic sdtu in rlayibr tnear eihnrte nioagrc ro nngoiacri dna olas u otdn ees aynm ibraisnral tiwh lugn esesaid btu rbdi rhsnewipo si lfypcsicieal dineemton as cseua of HP e.dseasi +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I also was nikntgih M. avium er,eh utb ienypeytivirthss esmiuninopt seesm ot ift ihwt hte nrrcuiouelaglrta .gaenhcs

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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owh od ew nowk paksrteea aesuc yreyvhiiepntss isoeptmnnui

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smc213  A81F .65p7 irbd to-resxge&-up; HNS tpiiosenumn retiviscrt(e nugl edse)asi nda A81F 1.p42 tomauusaolgnr ie:saesds fogrnie NlirtH;m-&S-eaatg .snipumoniet I adh to mkea snese fo it isenc I ddtin' wkno it saw NHS uispenomnti ta it.fsr +5


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 +0  upvote downvote
submitted by ∗breis(56)
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csiaPotssti mtssime(oe clldae ronoihstsi ro prator isadees or arrpot rveef) si na ioteincnf fo teh unlg en(ao)piumn uacsed by eht utcarmibe mCalpdliyhhoa a)hdmali(Cy c.sitaipt

Sgins nda mpe g.:mufsto,hey rvcos ylauslu oihwttu hmcu .mm.dlsaruheahec ghp.lsh ae ec sc.etceh ahs hsateisps nron. of tabehesr o.r ah.ttro

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charcot_bouchard  dtaUep no ym pver tmemnoc : Yse itsh si otptiisssac. tno tteshiyevyrsiinp ptonsui.nime owH od u own?k hcoLtymeyp dna serenPce fo nolauarGm - ossrpene to lcaaeilrulrtn domwcayal iNh. SH cna olas useac elsoo rloamugna oot nad eth ciclnali rectpui itsll eomr look ilek S HouY kwon thaw ......... uckf hits esqu +2
shemle  eHre t.P snted'o veah vrfe!e +9
shakakaka  aasotgNcinne ,mgoulnara aptyhc chcpliomyty anir,infoltti adn fibrssio ear enes in ysietHsetirnpiyv sniiupotenm , ccadnriog to wdorlU . +

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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