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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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gPae 2 ash a etagr rupitec

4)/tog-.2wl/96hp.:c3eSast/o(/cafd-twnlj0e01i61i6w97rrn8/i1p0

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kamilia20  ihaoclapldmhy ?sca?ipitt +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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tnsvepsieyyriiHt im—iexdtoenimupns teyp IIVI/I svehisinripyeytt orctaine to noirlmvnentea .tgnneai sseuCa as,pyden ugo,ch chtse isth,tseng chhea.ead fnOet enes in rfamser dna osteh pdoeexs ot rsidb. sRbeevelir ni aylre tgesas fi lsmustui si .aoviedd

'sIt a tpye of eriirevctst glun .dsaesei

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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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yhW het roeth wensar schcieo aren't etrrocc

A - oNt na ynpclaacatih iotrncea lanimy deu ot iioyhtncrc poncso(iumtn fo o,ys hwhci hsa scryooeiptlng htta ppeole mya vaeh raelglies asw)rotd

B - otN amhast etaiz(rdrchaec yb rmeo etcau dpeoseis of ohcsbroionocttncirn, zngehwie)

D - ieamAn B6,( ,9B 1)2,B ro ymaeb a rnmpluayo elimmbso ude to B9 or B21 ciecenidfy t-;g&- vateleed hycetiesomno eleslv g-t-&; bomssiroth tg-&-; TDV?

E - mnryuoalP nax;atrh heT ietm srueco luwdo be mchu rmeo ut,aec adn luowd aslo tpenrse ihwt pmmytsso of kef-ulil .tompsysm piRad dtahe oot

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 +3  upvote downvote
submitted by ∗monoloco(155)
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hTis tpantei si eeprneginxic ytsnviiresyietph pnnsioumite fmro eth rsetaea.kp I saw ghitknin .M uvAmi hwne I desceetl eaetakrps -- I nhikt my cilog saw fadlew evnig the sfsecipci fo het te'apnist tyosr.

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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woH luwdo uyo nwko htta ti 'ints olow etrossr esedai?s

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cienfuegos  AF 1802 17:3 haatniilon of eospsr ldase ot -killuef msoympts tath gesprsor ulyikcq to vfree, ouynarlmp rgoreheh,ma eidtitamsisin nda shkc,o htiw giigman lbpoyiss oigwshn dewnedi maiunesdimt +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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rcdcngaoi to lwurdo nehiiytepvstsriy msotieuinnp is ude ot dtus dna taht saw aosl na oni.op..t.

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amarousis  os t'is fiedtenily udst tub eth psiecifc ypte fo stdu was eth sotm tpmanotir ni tihs e.utnioqs teh cfat atht hyet mionnetde hte sbrid si tompnrat.i het ytsud kboos olwdu cueas it tub eht ribd usdt is erom pmoitrtna .-- +
charcot_bouchard  snpyHtvtisiiyeer netmuisonPi - igOnacr dstu ke(li ymold yi)Piocnsh aesounm - ncnorIagi nu edsont lphe rhee uthohg eabusce tohb liwl ernstpe thiw msae eitrsritcev ulng easdise peiiut c.r hktin insce sudt ni blyarir ratne ehientr coaingr ro nncgoiari and lsao u dotn see namy bilsraairn tihw ugln seasdie ubt bdir iowphrnse is icycelalpsfi edtmeinon as aceus fo PH s.edaesi +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I laos swa nknhgiit M. uavim re,eh but ytrsinvyitphseie miueoptsinn eessm to itf wthi eht teurnogualilacrr caes.hng

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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woh od ew know serakteap saeuc yretevsnspyihi utmposinine

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smc213  AF18 756p. ridb xu-ores&t-;peg SHN sieomtnpinu icetitevrs(r glun adi)sese nad A1F8 .142p oulaurgsnamto ides:aess rgoefin Ni-gtSr&tea-a;Hml tnepoisum.ni I dha to kmae esnse fo ti esnci I tin'dd onwk ti aws HNS punmnsitieo at tis.fr +5


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 +0  upvote downvote
submitted by ∗breis(56)
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tisssctaPio sisemome(t lldace srhotoinsi or rptrao ssaeedi ro orrtpa ee)rvf si an cneoinift fo the glun epi)mou(nna dasceu by het umcabreti doaipalhlhCym liaamCd)(hy asititcp.

Snsig dna umvgse :t.yfcspm oo,erh uuyslla tihtouw mhcu cpesamghldl.. eaershhahu e.mc schs.hce ate r .snsothsenapi fo o.sbhraetr e rhota.t

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charcot_bouchard  peUtda on my vpre otnmecm : esY hist is .tsasptciios ton tensiyertphviysi .ouspnieitnm owH od u ?wkon Lycyemthpo nad ecsnePer of unolmGara - sepseron ot arcuirlelltna molcaiw. hyNad SH can oasl uscea sleoo lnguraaom too nad hte acinicll utciepr illst mreo kool elik H uSYo nowk htwa ......... kufc stih usqe +2
shemle  ereH .tP neto'ds haev vefer! +9
shakakaka  gnNoatesicna gr,lnmuoaa cytahp chtiocpymyl ntitonifrl,ai adn isfribos rea enes in iyvterHtseipinsy inuspnteoim , dniorcgca ot Urwdlo . +

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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