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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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ageP 2 ash a argte treuicp

tn/-/9w0S/tas0g6n9j./d-irc2p1ti3e/6loolfw086:h1e4w)a1pi.r7(c

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kamilia20  hidmclpyolaha tiiatcp??s +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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petiHsniysrtyvie ep—eoixdiuitsnmmn type III/IV hintteepviysisyr traeinoc ot toimnarnnlvee tinnae.g easCsu ,pedsyna h,guoc ctshe gh,ttssnei .caaehdhe fetnO sene in asrermf nda shoet edospex to r.dsbi sieRerbevl in yarle gsesat fi smlutsui si oe.ddiav

stI' a yetp fo etirscritev unlg .esesdia

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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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hyW the tohre aesrnw chsocie 'taner rtcocre

A - Not na ailyaccphatn rcinaeto ianmyl ued ot tnircyhico onpsimuncot( of s,oy hichw sha rypgtsiocelno ttha lpoepe may ahev seiallgre t)rsawdo

B - tNo aamths rhdaae(teirccz by orme uacet epsdsieo fo bncocoosottincinrh,r gzenhewi)

D - eAniam B,6( ,9B B2)1, or amyeb a lnypaormu bmieosml due ot B9 or 21B yicdciefne g--;&t aeveetdl yeheoimscotn vllese -t;-g& timssoobrh &-tg-; DVT?

E - mnyoularP anharxt; ehT tmei eouscr wlduo eb umch mreo c,uate nda uwlod also reetpns ithw smyspotm of kieluf-l m.opysmst Ripad htead oot

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 +3  upvote downvote
submitted by ∗monoloco(155)
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This ttpeian is xicpeeirgenn tsyhernysiiptevi enipismunto rmfo hte reesapa.tk I saw hnkniitg .M umAvi nweh I etsedcel preseaakt -- I nikht my giloc was elafdw envig hte fipcisesc fo the paeinst't r.oyst

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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woH wuold ouy kwon tath ti s'itn lwoo retross eed?sisa

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cienfuegos  FA 1208 1:73 ihaanltoin fo oepsrs aldse to uk-lilef somyptms that sresprgo iukcqly ot r,eefv nrulyopma m,hregehrao istdimsnatiei dan ,skohc hwti gganiim osisybpl isnghwo dinedwe miumstdniea +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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cindcgora to uorlwd trisiintvehypesy neunimoispt is deu ot dtus and ahtt swa salo na .o.i.tnpo.

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amarousis  so sit' deiiftlney sudt tub the cecifpsi ytep of usdt was teh tmso irtnmatpo in shti uieq.otns het ftca ttha tehy dnenmoiet hte bdsri is toip.nmart het dtsuy ooksb duwlo eusca it tub teh rdib duts si roem ptitamonr --. +
charcot_bouchard  Heypyitstrsievin Pteouiismnn - ingOrac sdtu elik( dylom unh aoesicm)osiPny - nogairInc u noesdnt phle rhee ughtoh ecebsua bhot illw pnteser htwi mesa eicitvrrets glun seadsei .re ticiup tnkhi nsiec udts ni yrabrli artne ehnerti incaogr or gircanoin adn lsao u dnot ese aymn lsriaibnar thwi ungl sisadee ubt rbdi isorwenph si leacspiflyci emeitnodn sa asecu of HP idss.eae +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I osal swa gnktnihi M. viuam ,hree tbu vstinrytpehiisye npsonmiieut mssee ot fti htiw the ucatnrlauogrielr cgsa.hne

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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woh do we know arpeakest seuca nerethipyyivss niptseuoinm

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smc213  F8A1 76p5. rdbi -tpeeuorxsg-;& HSN emtosiunpin itvrcie(rtse nugl iesaeds) and 18AF 12p4. gturaomuosanl iesesas:d gneoifr S&t;rN-aal-gietHm o.iuninepstm I hda ot akem seesn fo ti sicne I 'nditd konw ti asw SNH uinnptsoemi ta f.irst +5


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 +0  upvote downvote
submitted by ∗breis(56)
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istsioPatcs tmeo(msies edllac htirssonoi ro atorpr eadsesi or prtroa fveer) is an tnenicfio of het unlg m)euno(ainp acdsue by the reuibmcta iylmalhaChodp hlimaaCdy)( c.atipsit

nsgSi dan et:veysmmgroufs,coh. p uayllus ithtwuo uhcm eehr.epmauhale. shhcadcm gls. c hehses.atc erano.st iphssn of t.oesbarerh orth.ta

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charcot_bouchard  aUdpet on my verp monmtec : esY iths is ota.spcssiit ont nttyieyhisspevir .ietnompnuis owH do u o?nkw tyyLeocphm nad ernesceP fo Gunaoalrm - possnere to altrlrnlicaeu ycdaaomwlhN. i SH cna asol asecu osoel alorungam oto nad eht nccilali terpuci tisll rmoe oklo eilk YuoHS onwk wtah ......... uckf isht esuq +2
shemle  eHer .tP 'otdesn ahev e!fevr +9
shakakaka  teisgoNcnaan narla,gmuo yptcah oyhmcycltip nitliof,nrita nad fiiosbsr era esen ni tiysynseiHevptri uonmnsetpii , oacrgincd ot woUrld . +

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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