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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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gaPe 2 sah a tegra tpurice

p608e4n9-1ls/(/Saanr627/o.t/6rthigeoi90wd3ci:1w.pw1j/t0)-cfl

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kamilia20  hydamphoiclla c?sta?piti +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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ynttsriHivpseeiy ismeontixui—pemdn tpey IIVII/ itsypryvihiesetn ncriaoet to nrlnienevtoma itn.gaen auCses yen,dasp chgo,u htecs tgeins,hts eehdcah.a ftneO nsee ni rfreasm dan htose xpeedos ot brds.i lrievebeRs in yarel atsges if slsutmui si oead.vid

stI' a ytpe of strveretici lngu dsei.esa

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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 hte oterh newrsa hcsiceo 'etanr retoccr

A - tNo na cpathaiacnyl rcntieao inlamy ude ot ntoycrhcii oucptins(onm of ys,o ihcwh has nrloitcogsype atht ppleeo yma heav lirleeasg )tosawdr

B - oNt ahtams hcrdta(aeeczri yb omre cueat espoedis of hcrooncroiic,nobtnts zgeiwhe)n

D - Aeaimn (6B, B9, ,2B1) ro mabye a ramuopnly oiemmsbl ued ot B9 or 21B iciecefydn -t-;g& dtlaeeev oyetemsnihoc eelslv t&;--g ihmoostrsb ;&-gt- TV?D

E - lmynaruoP thnxraa; Teh emti ocesru owudl be chmu rome utcae, adn wduol osla rsetnpe iwth pmsosmty of lulki-fe .ssmopytm pdiRa taedh oot

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 +3  upvote downvote
submitted by ∗monoloco(155)
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hiTs aepntit si negeieicxpnr tyrenpvsstiieyih iotinempnsu fmro teh eepaar.skt I was gntiiknh M. umAiv enwh I dsceltee esearpatk -- I nhkit ym ilocg wsa wefdla inveg eht fcpsiecis fo eht tnaiespt' r.yots

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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owH dluwo uoy konw htat ti t'ins wloo osrtres sadeei?s

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cienfuegos  FA 1280 3:17 ioiltnhaan fo sepsro aseld ot k-uiflle ssommytp ahtt rgposres yliuckq ot r,efve mypualrno mergrh,eaoh emtnsaisitdii dna kcos,h ihwt iginmga bpoysils soghwin eiwednd dnisteuamim +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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iocgrnacd ot dwruol pseyrivtyetnihsi imnosepiunt si deu ot dtus nda hatt was osal na otni...p.o

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amarousis  so s'ti ifneyidtel stdu utb the sicpiecf yetp fo ustd swa het somt ntopmtria ni htis sqniteo.u hte ctaf ttah tyhe eioetmnnd hte irdbs is ait.otpnmr eth dusty okosb lowdu scaue it utb eth drib utsd is orme itnotrapm .-- +
charcot_bouchard  tyeyvitinssHeirp ePmontinius - rancOig tdus il(ke odmyl aoesnyucPsn) ioimh - gnaIrcnoi u eonstdn hlep reeh hthoug subacee otbh wlli eptsren twih aems vstcirretei lngu sdaseei picte iru. hintk cnies udts ni aibylrr nerta nriheet rgoanic or iaoicrgnn and loas u dton see amny iiaaslnrrb ihtw ulgn eiassde tub idbr pehowsrin is sclypacielif omntdenie as suaec fo PH s.seadie +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I lsao saw tkniihgn M. ivuma eer,h tub ithyripnisvystee pitnenouims mssee to fit hwti hte ueuntcgralraloir ncaehg.s

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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woh od ew nkwo askaperet sceua ieseyhtspvynir nespnoiimtu

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smc213  8FA1 .675p rbdi &e;er-supgxo-t NSH nneouitspim e(vcsirtiret nugl se)sadie nda F1A8 21p.4 rgsnuutoolama deaes:iss ngroief S-tNeig&lmr-at;aH ontunie.mpsi I dha to akem sseen fo it scnie I td'nid konw it asw NHS misnuetnpoi at rsf.it +5


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 +0  upvote downvote
submitted by ∗breis(56)
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tPatiscsosi omemsist(e dlcela sntsirohio or aporrt dsasiee ro tarpro fer)ev si an iceionntf of teh lung npmonaie(u) dceuas by hte tamcrubie lmhlaCpdyaoih (aCl)dyimah aciitpt.s

nigsS nad v,ysopefmrm uo s:etgch. ulyslau ithtowu umhc herhc.uehm ac.seag.lp mehdsla h ees.ccahts npe.arnosshts i fo .osbr tareeh rah.tto

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charcot_bouchard  dpateU no ym perv otmcnem : sYe hist si iposs.scttai ont iriseynvhityepst i.sutpnmoien How od u nwko? mpctLyheyo dan Pneeserc of uroaaGmnl - enresosp to uraitecrllanl .awyhod Ncimal SH cna asol cseau seool aomragnul oto dan het niccalli cpurite tills reom okol lkei uYHSo know athw ......... cfku tihs sueq +2
shemle  Hree .tP dtneso' evha ee!frv +9
shakakaka  Ninotagasnec nmglraao,u htapcy ctpymlhoyic of,inlittnrai adn isorbsfi era enes in petrsysiHtnyiiev mnuonspiiet , cacidrgno ot dUowrl . +

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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