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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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ePga 2 sha a aetgr erctpiu

ws/10/pt)rj7nc1t9-Sdt-9io/if1n:iapclahwe6g3.r4w/(60o.l/208e6

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kamilia20  laldhopahmyic tcptisia?? +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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nrivyHteessiityp imoemdsx—nitnpiue peyt /IIIVI vnyisieitsrehpty actoenri to inmvorenlntae eg.inant eusCas eysdapn, guo,hc hcste thignes,st .aehdceah tfnOe nese ni efrrasm adn eoths xopeesd ot irs.bd beiselrveR ni yearl tassge if muuistsl is aiodd.ve

I'st a epyt of rteciistrve nugl d.iseesa

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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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hWy het toehr aenwsr osccihe ta'nre torrecc

A - tNo an aychatlaicnp nacetoir lymina deu ot cinhrtiocy (onstpmioucn of ,soy chhwi sha nsiecogotlyrp htta eppeol amy evah raeligels trad)wso

B - Nto athmas ircactde(rehza by mero aucet diesoesp of hicirconcntbtooos,nr egwh)znie

D - miaAen B,6( ,B9 ),B12 or ambey a uarplmoyn sbilmoem deu to 9B or B21 icfdiecyne ;-gt-& teevelad eisceotmynho vseell -t;&-g omthsobisr g-t;-& VDT?

E - Pryuolmna rhta;xna hTe meit soruec wdlou be uhmc rmoe cu,aet and dlouw salo nsrpete hwit mspotysm of k-ellfui .smpytoms Rdipa ehadt oto

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 +3  upvote downvote
submitted by ∗monoloco(155)
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hisT apttein si ecpeneiixgrn iriistepysnethvy smuepionnit ofmr eth eaert.apsk I asw nnitkhgi M. mivuA enhw I cldeeste seataperk -- I intkh ym gcoli was dfleaw negvi the epcisfcsi of hte t'painste s.yotr

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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oHw doluw ouy wnko htat ti in'st lwoo trresso ses?deia

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cienfuegos  FA 8012 73:1 ioalnahnit fo sopres sldea to eiklflu- potmmsys atht sesorpgr cuklqyi to e,rvef praluyonm ee,ghrarohm tssitimeaiind adn ksc,ho ihtw iimggna yolpbssi hogisnw wdeedin atndmiemisu +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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ogcrdicna ot urlwdo nyieithptsseiryv iomstnnpeui is eud to sutd dna taht was lsoa na ..io.npt.o

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amarousis  so 'its eednfliity dsut but eth pfsiceci tepy fo tdsu wsa teh otsm potitrnma ni ihts tesoiuq.n het fatc tath ythe neintmeod het dbisr si tpnatmir.o teh tudsy sobok ulwdo aecus ti tub het ribd ustd is rome monirttpa --. +
charcot_bouchard  Hisetypeytiirsvn Psuntnomeii - agcirnO ustd lei(k omldy asP nschymeinoui)o - niIanrcog uenosd nt lhep hree hgouth eesuabc thbo llwi ertpesn iwth msea etevtcrirsi ugln adieses ieupr cit. nkthi secni dtus ni bylirar ertan hternei rcnoagi ro gnoicrnia dna loas u ondt ees yman isrialrbna ihwt ulng aiesdse utb irbd rwoniseph is pilfcyisclae eodenmint sa ucesa fo PH siae.esd +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I also asw ngktinhi .M aumiv rhe,e but isnyitspteyvhrie sitmuponein meses to ift ihtw the acgolrnaetluirur .ecshang

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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hwo od ew oknw akpsaeter cusae yypteniehsrvis nptnimisoue

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smc213  AF81 6.5p7 bdir xrgpeot;&-s-eu SHN tsnienopimu vi(ecrrietst ungl ssi)edae dan 81AF 142p. onauorgastulm esads:ise roeigfn agmr-&aeitS-H;ltN stnoniim.upe I adh ot mkea ensse fo it sinec I 'tddin nkow ti asw HSN tesnnipomui at rtfi.s +5


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 +0  upvote downvote
submitted by ∗breis(56)
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sPsitsiatco o(msmseeit cdllae niosrohits ro taoprr eeasdsi ro raoptr e)verf is an finietonc of the ugln )eoaminup(n deasuc yb teh maeibtcru hmpiaallodhyC amdhy)Cai(l t.astiipc

ginSs dan such ymmg.etps,rovef: o slauylu ttohiuw umch .h el.gcdhcmepu ah earhaes.lms echtesasch. tnossrnepi.a hs fo .reeots rhab ho.trat

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charcot_bouchard  taepUd on ym pevr cmetnmo : seY htsi is ic.topisstsa tno tessytrhnyiiveip itespnnmou.i How do u on?kw optyhLmyce dan sncerPee fo namaoGlru - onsrpese ot uraialercnltl aaoNd w.imlhcy SH cna olas seacu sloeo ogrnmalau oot dna eth nicliacl pciutre ltisl oerm olok klei uS YoH knwo whta ......... ufkc hist qesu +2
shemle  Here t.P 'destno hvae rfe!ve +9
shakakaka  asncgtoaiNen alngra,omu catyhp ctmycyphloi tf,traininlio dan iibssrfo era nese in etsyHipityiesvnr metiinsuonp , cdaroginc ot olwUdr . +

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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