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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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geaP 2 ash a rtaeg pturiec

9it/o/n72(/wjl/1-na:iia06S0cd84rc)hpt6l3/ewo1.6er1-ft9s.pw0g

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kamilia20  ohmadllycaiph csti?aip?t +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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sptirevyHiintsey eiptniexn—mdsmuoi pyte VIII/I esyvrtyhpitsinei rtniaeoc to norlatnnievme ine.gant seaCsu yna,dspe c,houg ehsct hse,nisttg cha.hedea eftOn esne ni ramsfre dan otehs oepxesd ot r.ibds evirlRebes in lyare gessat if ultissum si d.ieadvo

tI's a tpye fo tisrreitevc glnu ase.dies

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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 het horte sewnra ocichse a'trne corrcte

A - oNt na ctipnaaclyha tiraneco anylmi deu to nthiyioccr npitu(moncos of yo,s chiwh sha olnortsypegci atht leoepp aym ehva lirgleeas daot)srw

B - tNo tasmah cza(tidahrcere by remo uctae psiodsee fo cncort,iorinstohocbn zwgiheen)

D - eAamni (B,6 B,9 12,B) ro aeymb a lynuaopmr iblmmose edu ot 9B ro B21 eiccnedify --;g&t tdealvee eomyiocthnes vllees tg-;-& omsbotsirh -gt-&; T?DV

E - muyrnPaol taaxrnh; hTe mtei eoscru wuldo eb mchu omre e,auct dna louwd lsao trpsene hiwt ommtssyp of -klfliue tmpsm.yso aidRp dheta too

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 +3  upvote downvote
submitted by ∗monoloco(155)
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iThs enpaitt si cnpeeigrexni eyvhiyintessrpit nieunomspit mfro het tpesrakae. I saw ihignktn .M mvAui ewhn I deescelt sateeaprk -- I ntkih ym ogicl aws wldefa iegvn het siecicspf of teh pnsitat'e yors.t

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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owH dowul uyo wnok taht ti nsti' oolw stesror esseia?d

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cienfuegos  FA 0128 :713 atahlinion fo rossep aesld ot lukfie-l ypmtssom thta grrsopes ikcluqy ot vee,rf ulpnmyroa gomhe,ahrer mniieatsidsti nad cko,hs twhi ignmgai osslpiyb wsingoh iwdneed uemintsmida +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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dnicagrco ot uorldw rsiheyitesvtypin oinpsiutemn si due to stdu nda atth swa laso na oon.p.i.t.

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amarousis  os 'sti iyeidnleft dsut btu het cipcsfie epty of tsud asw eth msto matrtnpio in tsih eoni.qtsu teh ftca atht ehty tnmeeindo het sdibr si mnoat.iptr teh tdyus obkso uoldw saeuc ti tub the dibr tuds is emor onmtpairt -.- +
charcot_bouchard  Hipsetyeinrvtyis ietPsmnunio - ngrcOia dstu kel(i mloyd coniisn) ahePuoysm - Iangoincr nu stdone lehp rhee hgthuo usbeaec ohtb lliw sepetrn wthi eams tertscveiri nlug seieasd c.iuper ti khitn esinc dstu in lrbayri teanr hineret caingor ro ingciaonr dna sola u odnt see yanm siinlbrraa hwti lgun eessadi ubt rbdi hisnwerop si cipaysecifll denoientm as asceu fo PH eesdas.i +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I olsa wsa knigtinh M. imauv eer,h but nhivtstesipeyriy iimeponutsn emess ot tif hitw eht iaanrrctleuglrou nga.echs

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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hwo do we wkon satreaekp escau nsvpethsiieryy tnpieounsmi

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smc213  1F8A p675. ibdr -r&oxs;-etugpe SNH epnonimtsui esitc(rtervi lnug ss)ieaed adn A18F 41p2. ngasruoluatmo disss:aee rginofe a-iNr;al&tgHSe-mt .inespitumon I adh ot kmae snsee fo it icesn I nd'tid wkon it aws HSN npoutmeinis at .sirft +5


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 +0  upvote downvote
submitted by ∗breis(56)
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isscisoPtat (ssmtmoeei adlelc onssothrii ro toarpr sdaiese or aroprt vref)e si na nctofniei fo the guln o(enim)anpu ceadsu yb eth tmcuibear lalCpaodhihym h(Cmilya)da it.pacist

sginS adn v syohpefetcs,roumgm :. syaulul ttiwhou muhc aarlaceclu mhsheheh. .e. mspdg .sheacshtc e spnts reshn.aoi of et hore.bsra rhta.ot

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charcot_bouchard  atpUed no ym vper ntemocm : esY ihts is tao.cstspsii ont ytniivrysseiethp moeintunip.s How do u kw?on cptyehymLo nda rPescnee fo omalraGnu - seesrpno ot lrcalaiterlun dalhNi oac.mwy HS can olas ceuas eoslo nlguaramo oot nad eth lclnacii prteiuc lstil oemr oolk ilek Y uHSo owkn thwa ......... fcuk this euqs +2
shemle  eHer .tP 'teosdn ahev re!vef +9
shakakaka  eacNngsotian lunora,mga pchyat hilocypmcty lifittrainno, nad brsfoiis are nese in ytintperiisvyHes uminoeipstn , nrcoagidc ot Udowlr . +

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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