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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
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 +32 
submitted by โˆ—notadoctor(169),
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ualUs letirniatsti seioipunnmt is the gclliasotoih feiinitond fo ioiptdIahc lomuyrnpa bfsris.io We wkno that shit tptniae has oyulrnapm rossibif acsebeu hte suntoeiq ssatte taht htere is bsrifuo ginhtnieck of hte arolavle saep.t hTis ostenuqi was jstu inesttg htat we wnke teh oethr asnme for Pmrloanuy sisFor.bi

aneurysmclip  Nbme back at it again +29  
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. +6  
mangotango  I picked โ€œdiffuse alveolar damageโ€ with Pulmonary Fibrosis in mind but these are actually key words for ARDS :/ +3  
zevvyt  thank you swagcabana! Very good explanation and strategy! +  



 +8 
submitted by gabstep(14),
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nfuod hits in bnir:sob the rdgiialooc and tciogioshl prttane fo rifbosis si edrererf to sa usalu neilaitttsir eonumiapn, cwhhi si deerquir rfo teh siinadogs of FIP.

drdoom  pneumonitis* +  
drdoom  ^nevermind! +  



 +4 
submitted by โˆ—neonem(599),
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oPamath assy ttha ilntseiaritt yca)(ptali oiaenupmn is aedehazcirtcr by sdiueff ttitriinlase ri,anieltstf esrsnept /w aeltrieylv imdl pprue erps mtsomsyp (imnlami pumsut ;p&am lwo e,ev)fr nda is tosm neoft csuaed by vss,ieru tbu nca eb .acrtbiale vHo,weer tihs osequnit is tninserepg a icrohcn cae,s os Im' igmssuna ahtt hte ieupsrov rtinlasieitt aenumiopn dcusea a ritbcifo neeprsos ni het ng.ul




 +4 
submitted by โˆ—usmleuser007(438),
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Ialfl esel ail:fs oent atht ehtro srwena ioeshcc aer DCPO yespt

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  



 +3 
submitted by โˆ—sweetmed(150),
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uaslU tentiatilisr pamnunoie UI)(P si a rmfo of ulng seaesid racceraeizdht by ssvroieegpr igcrrsan fo bhot .su1l][ng hTe crasnrig ss)o(rfiib nvsvileo eht rgupsotpni afoerrwkm mui(e)sitrttin fo eht glnu. UIP si uhst aiidcfsels sa a rmof fo riltisaetint ugnl iesadse. hTe etmr aulus"" efersr ot eth ftac ttha PIU is het omst moocmn rmof of etsilinatrit bifossri. eu"on"niPam initcdaes ln"ug bratomi,"ayln ihhcw cndliesu ibossrif nda amomtnnli.afi A tmre elouvypsri deus for IPU ni eht rithiBs tlrtaiuree si ogytpcinerc isfoginbr oveililast AF)(C, a tmer tath sah anelfl otu of vfaor nseci teh ibsac gdeunlyirn taplyohgo is onw ghhuott to eb srboisfi, otn fnilnioa.amtm ehT tmer ulsau lenitistriat tiunnmepsoi UP)(I ahs sloa ofnte eenb e,uds btu g,inaa the itis- part of atth maen aym ivohepamzeres ftaiinl.anmmo ohtB PIU nad ACF hvea neeb iderdcbse as yssymnuoon twhi aiicohitpd nrmypoalu si.oibrsf




 +0 
submitted by โˆ—niboonsh(382),
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ym ngsnuirnetdda fo thsi si rfom tpaahmo - nitsriaeIttl lp(aiact)y innmpaeou - audecs yb eisfudf etlitirinast nseaitir.flt naC eb auscde by pysoacmMla ne,moup ,SVR lymciahad uom,pne ,lanefzuin aeicollx iieruntb

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



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