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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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Paeg 2 sah a aergt eiucrpt

p-t8s-oSi00/6cdr/e.e/3tw//2n1i4liwro(9aa667:w)fc1jp1ng.lht90

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kamilia20  mhadciolhylap pi?sia?tct +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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erpnsttyiHiiysev ixumpdoninmee—tsi pyet VIII/I siineveyhttipsry ecoatirn to vmnrnaoetlnei igtnen.a Cuseas esdnya,p gc,uoh cshte sgieth,tsn ea.edhhac etOnf nsee in rrfaesm nad thsoe dpsxeoe to d.isrb rseeviebRl in yaelr astesg if lumistsu is iedoa.vd

tsI' a epyt of vetiscreitr lgun esase.di

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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 rhote eawrns coscehi n'tear rccrote

A - Nto an yacanlcthipa orinteca nyailm eud ot cirnycohti (minotusonpc of ,soy cihhw sah gosoiycptrenl that epleop yma have legsliear wsdrat)o

B - tNo astham ccie(eazhrartd yb roem eatuc oiepsdes of ntsiohooctn,rcrioncb ein)hzgwe

D - Amiane B6(, ,9B 1,2B) ro ayemb a nouyamprl omsemilb eud to B9 or 21B yeiincefcd ;-g&t- teeavedl eohcnimesyot lelesv ;&tg-- hsbrmtoios -&;tg- ?TVD

E - nouPrylam aant;rxh The emti soeruc dulow eb mhuc erom ecut,a dan lowud slao nspeert htiw psyosmtm of l-lkufei msp.otsym aipRd atdeh oot

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 +3  upvote downvote
submitted by ∗monoloco(155)
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ishT nttepia si cgnxrpeeieni eyyresisvithptni iinneouptms rfmo het rktesea.ap I saw ktnhiign .M vmuiA hwne I setelced spaeakter -- I nhtik ym colig aws aledfw ievng the cpieifcss of eth 'tenptias y.trso

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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oHw udlwo ouy wkon that it 'nits wolo rerstos sdeasi?e

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cienfuegos  FA 2810 137: onnliaaith fo erpsos ledsa to l-fkielu smtposym thta sgproers ylcqiuk ot f,veer upraolnmy moahhe,egrr asnmiteistdii and kohs,c tiwh igimgna solypibs nsghwio niddeew nduseimmita +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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cirdocgan to ouwdrl vihtyntreyesiips pisnimuotne is ued to dtus dan thta aws olsa na o.tnpi..o.

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amarousis  so it's dieyiflten utsd tub hte icepscfi eytp fo dust aws het osmt nmptiarot in iths qiotsue.n eth acft ttah they tednmoine the srdib is tarpi.notm het yutsd sboko wuold ucase it ubt hte dirb dstu is orme ramnpoitt -.- +
charcot_bouchard  vstierynyspetHii etPiisuomnn - rnagciO tsdu e(kil ylmdo io)aehinsPnmyuc so - Ignncroia tnosndeu ehlp erhe hguoth ueaebsc bhto ilwl tnpesre whit seam iscvertetir lgnu sisdeae eitu crp.i tkhni scein sutd in lrayirb neart nireteh igraocn or grcninoai dna sola u dnto ees aymn irbnailsar whit lngu aseisde utb drbi eiwrspnho is lcyipisfecal tmdioeenn sa seuca of HP ss.eiade +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I olsa aws tighknin M. aiuvm e,erh but hiestyrnipytsiev epimsnotniu seesm to fti whti eht iolnurraeucraltg egnh.csa

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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owh od ew konw eekrtasap cuase hieniystevsrpy tsoieupminn

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smc213  F18A .7p65 dibr ge;&-xtoe-rsup HNS oumesipintn etirv(tesicr lnug )eessdai dan 81FA 12.p4 ltomagnorsuua dsi:aeses orinegf eHmga&rlNit-;-tSa sie.mnoiuptn I had ot kmae ssene fo ti scnie I tnd'di nowk ti asw NHS noeumiinstp at .ritfs +5


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 +0  upvote downvote
submitted by ∗breis(56)
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icPtsasoits emmts(ioes laldce iissonhort or toprar adsseei or artpor ref)ve is an ntcfnieio of teh nlgu )iepmunao(n udscae by hte ribmtauce oyamdalihlphC aialm(yhd)C it.catpsi

isngS nad umfesvsoeycort,hmgp :. ululysa wtihout hmcu hecp. ueh seaca eh.algsrhlmd.m ahce.tce ssh aonesirptnhs.s fo bsree.arh ot th.raot

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charcot_bouchard  pUeatd no my eprv mmtenoc : Yes tsih si asocptti.iss tno stnrheyiistvepiy nptunois.ime Hwo do u knw?o pcymhtoyeL adn ePneercs fo lGamuraon - ssoenrpe to lraciutrllnea Nlc.a ahidymwo SH acn asol seuca oeslo ulmaoangr oto adn hte cllicina ruipetc sllti ermo loko like S YuHo okwn ahtw ......... ckuf ihts useq +2
shemle  erHe Pt. 'nosedt aveh !ferve +9
shakakaka  cianetnNagos ogm,anurla athcpy mplcyotihyc ilni,ofnitatr nad sirfisob aer eesn ni eyryniHispvtsite neniisopmut , oadnigcrc to rUldow . +

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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