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NBME 21 Answers

nbme21/Block 1/Question#32 (reveal difficulty score)
A 50-year-old man has had progressive dyspnea ...
Usual interstitial pneumonitis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +35 
submitted by โˆ—notadoctor(175)
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Ulaus eniitaitrlts unemoisnpit si eth lotigalcisoh itinnfdieo fo acdiohipIt ryumonpla fsisb.iro eW onkw ttha ihts ntapiet sah aropumlny ibsroisf besecua eht equoisnt assett atth ehetr is iorbufs nigetnhcik fo het laaveorl psae.t ishT quieostn swa tusj tinestg ttah ew kwne het rheot maesn orf uPonamyrl irFsb.sio

aneurysmclip  Nbme back at it again +37
pg32  Is it still considered idiopathic pulmonary fibrosis is it appears to have been caused by an atypical pneumonia? +1
zevvyt  Why not Sarcoidosis? Wouldn't Sarcodosis also be a chronic inflamation with fibrous thickening? +2
swagcabana  UIP is a better answer. Sarcoid is a leap in logic, usual interstitial pneumonitis is textbook histological definition of idiopathic pulmonary fibrosis. The biopsy has no mention of noncaseating granulomas and the clinical picture is not consistent with an inflammatory process. You have to focus on the better answers, try not to get caught up in the "why nots?" Calling this sarcoidosis is like someone coming in with prototypical asthma and jumping to eosinophilic granulomatous with polyangiitis. Sure its a possibility but its definitely not likely. +7
mangotango  I picked โ€œdiffuse alveolar damageโ€ with Pulmonary Fibrosis in mind but these are actually key words for ARDS :/ +5
zevvyt  thank you swagcabana! Very good explanation and strategy! +



 +9 
submitted by gabstep(15)
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onudf itsh in bb:inors het ioirgacdlo dan ictoishglo tratenp fo brsfisoi is feerdrre ot sa lusua ealrntitiist mpeauonni, hiwhc is qedrieru for teh igssndioa of IF.P

drdoom  pneumonitis* +
drdoom  ^nevermind! +



 +4 
submitted by โˆ—sweetmed(157)
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lUusa aitiiltrnest nenuiompa (UP)I si a romf fo ungl sisedea zertccaraeihd yb oprgisesvre cgairnrs of tohb ]s1ugn.[l hTe ircnsarg sfr)boii(s eosvvnli eth nstgoiprpu werfraokm item)i(inrtsut of teh nlgu. IUP is uths iseiaclfds sa a ofmr fo srilitttanie ulgn deisa.se ehT metr u""saul esefrr ot the cfat thta PUI is eht msto cmonmo fmro fo arlttsiieint sirsibof. ePmai"nuo"n siatecnid gnu"l yn,latirabm"o ihwch ceiudlns irifbsos nda toiniafl.amnm A mert rvuolepiys esud for IPU in teh tihsiBr riurttelea si gcircteonpy grsifbion islivaetol ,)FCA( a rmet thta ahs lfnlae otu fo fraov ncies hte iscab rlgdeynuni ypagoohlt is now utthohg ot eb s,irsofib ton fn.moinalamit eTh mter uusla lneitstrtiia mutnieionps P)U(I hsa olsa otfen eenb usd,e tub ia,ang het stii- prta of tath mnea may hpavoriesezem mantn.lmfaioi htBo PIU dan AFC ehav eneb bcersdide as uyyonmnsso ihtw iapthdcoii orynaupml .osrbifis




 +4 
submitted by โˆ—neonem(629)
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mPotaha yssa taht trliiitesant y)acipalt( epomniuna is crrazcetdieah yb sffediu ttesnaitiril tnrsfile,tai sptresen w/ eleivalrty limd puper espr pmsmtsyo (ainlimm usmput &p;ma low eev)rf, dan si tsom toefn seaucd yb srusev,i but acn eb ticebr.laa erw,Hvoe hits tesnouqi is igtennserp a rncciho as,ce so 'mI ngiasmsu hatt the uviopser sntiliraitet omuenapin educsa a cbitorif srseenop in eht lg.nu




 +4 
submitted by โˆ—usmleuser007(462)
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lIlfa esel lsi:fa oten thta ohret swnera iosecch rae CODP ptesy

dragon3  (except sarcoidosis) +2
leaf_house  I got hung up on why this couldn't be sarcoid, and I think no lymphadenopathy is one of the reasons you wouldn't pick it here. (Though it seems like it can cause alveolar septal thickening: https://pubs.rsna.org/doi/full/10.1148/rg.306105512) +
lovebug  Restrictive VS Obstructive ! very good point! THX! +
schep  if it were sarcoid, wouldn't the biopsy show noncaseating granulomas? +1



 +0 
submitted by โˆ—niboonsh(409)
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my unneagsrintdd of sthi si ofrm pomhtaa - lntretiasIit t(lapca)iy naoueipnm - ceudas yb ifedufs tarenlsitiit ef.ritnalsit anC eb aucsed yb oaMlypscma ,omnupe V,RS cayhadlim ,uempno enifzlun,a xlloeaci uteiirnb

athenathefirst  Yeah but how does that help you choose Usual interstital pneumonia? +



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