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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 has a getar certiup

/j0-f8/ens/1ln/:to1S0w.t7o6rwi-e2.di1pg9p4h0at/lca6)69ric3(w

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kamilia20  hdyclaoipmahl c?pist?ait +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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serntipteysHviyi ionidepexmusmn—ti yetp III/IV vinhyeeyitpritss naorecti to ltoinemannvre ganie.nt sCaseu eypd,sna hocu,g echst ,gtseshnit eahce.hda tOfne sene in fraemrs and ehsto odexpes ot s.ridb ievRerselb ni laeyr etssga fi uiumltss si doadi.ev

'Ist a type fo rveciiertst ulng edsis.ae

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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 eht hteor wanres scchoei 'nerat cctoerr

A - tNo na napayihclatc oaeticrn yanmli due ot hyioinctrc onmpotniuc(s fo s,yo wihch sah oytlosicngrep thta polepe aym eahv resellaig ras)wtdo

B - oNt smahat cazcet(hrderia by oerm cauet eidpeoss of nhibrtn,ntococcsorio eiwezhn)g

D - aeimAn (,6B B,9 ,)B21 or byeam a ymlnauopr moebimls ued to 9B or B21 ceeidifycn t-;g-& deetalev iohtcsnmoyee levlse ;--tg& shsirotbom -;tg&- V?TD

E - umlrPoany rtnxh;aa eTh itme eucrso wludo be cmhu rome uae,ct adn dwluo laso penrset hwti ysmotpms fo e-lkulfi pmsm.styo diRap dteha oto

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 +3  upvote downvote
submitted by ∗monoloco(155)
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Thsi paeittn si igniernpxcee nyshvresyiiiptte oinnsuiptme rmof hte kate.rsape I was tnnihigk M. Amiuv nhew I eeescdlt atkeraeps -- I kinht my oglic aws weladf ignev het scsciefip of the eansitt'p .toysr

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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owH udlwo oyu nwko htta ti ti'sn oowl rretsos e?sedsia

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cienfuegos  AF 8201 173: naiilhonat of sorsep aleds ot iellf-ku psmymots ttha seropgrs ciuylqk to ,erevf rluonpyam ereohmrhga, isneiimsaitdt dna ,kshco thiw ngmiiga ssloybip ogiswhn dneediw dieasimutmn +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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drancgico ot uowldr tvenpersisiyithy imsuipteonn si ude to tsud dan thta wsa loas na .io.o.pt.n

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amarousis  so 'ist ldeetnfiyi stdu tbu eht iepcifcs ptey fo tdsu aws the somt pirntmaot in htis useiq.not eth cfat that yeht enonmedit hte rsdbi si ornipmt.at eth ystud bkoso uldow eaucs ti tbu the rbdi dtsu is remo tmornptai -.- +
charcot_bouchard  vrsiteyyieHstipn omPiinnseut - rgnOica tuds klei( lodym umoiPncsaheniys)o - conIigran uonsn etd hlpe eher othuhg esecbau thbo will netsper hwit amse irritvsetec gnul ssdieea iuirtp ec. nktih seinc stud ni arilryb nrtae niteerh nracgio ro oraginnci nda saol u dton ees myan risanlbair thiw ngul deseais but ibdr nosiephwr is ailcyseciplf noemitden sa uesca of PH .sdaseei +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I salo wsa kngitnhi M. uviam heer, but tipieyvnstyiehsr unmisoipetn msese to tfi hitw the ralrriucgatonelu gshc.ean

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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who od we wnok kapeersat aeusc snhvyyepesirit nesomitpuin

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smc213  A18F 6p.57 bdri srpx;u-egeo&t- SNH pemiinotuns riesct(viert ungl sdeie)as nad F18A 214.p arsalmgnouuto eed:sissa frongei t;Hgae-mtaS&Nli-r mpneusii.nto I adh to make nesse of ti ceisn I in'ddt wnko it was HSN mesniuointp at sfrti. +5


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 +0  upvote downvote
submitted by ∗breis(56)
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coisaitPsst stesimme(o dalcel rsnostiohi ro raptro eeadiss ro rtopar vrfee) si an ticiefonn fo eth lgun um(aonenp)i uescad by teh cbmeutira lladiayhCohpm hid(ma)Clya cta.siipt

insgS adn f :uyogeo.cms,mhrt epvs uslauly utwoiht hucm . he pm.ehemuse .caasghhdllrca saeshchc te. sop. tnainserhs of rsr.taoehbe orh.tat

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charcot_bouchard  Uptead no ym revp mnomcte : esY hits si tsst.asiicpo ont itnysyhpvritiese in.nmiestopu How do u konw? oLpytycmeh nda rsPnecee fo aulGmnoar - spoeersn ot arelirutallcn iaay .lNwhcmdo SH anc lsao csaue oosel murlaonag oot and teh iacnlcli iertupc lltis meor ookl ilke uYoSH konw awth ......... cufk sith qsue +2
shemle  eerH .Pt endst'o heva eevf!r +9
shakakaka  oaaNcigntsne anl,ogruma ahytcp lopcmthiycy nliaotitf,rni nad sbfsorii rea enes ni vtieneHiitrpyyss isuipmetonn , drancicog ot odrwlU . +

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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