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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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aegP 2 has a gaert eiutcrp

(ch6e97ewpi:01pl0o9t/l4n-8./rf1atsgj/r2cS0-1nwa/wi/6o)d.3t6i

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kamilia20  mhidhlalcyopa iast?pi?ct +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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eyrtitspyienHisv —dmpuenxeiintisom pety II/IVI nsvstphyyrieieit oiteracn to imtenraonvlen gan.itne uCsesa neps,yad ugoch, cseht tegst,inhs aedhhc.ae tnOfe esne ni raefsmr nad esoth dosexep ot .idsrb bleeesRvir ni ealry esgsta if itsusuml si oveia.dd

s'It a tpye fo tviretreisc guln edaess.i

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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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Wyh the heort snawre ccsohie r'tean crecrto

A - Nto na ntccphilyaaa tnerciao minlya deu to chiorcynit oincntmpu(so fo ,yos whhic has enrgioycostpl htta oppele may evha larleesig dwarsto)

B - toN amtsah cerzthdecir(aa yb mroe uetac isoepsde fo hno,cniobrsocncoitrt zweghein)

D - mnAiae B,(6 ,9B ,)B21 ro yaebm a amnypulro imblsome ude to 9B or 21B ifcedciney t&--;g avdeelet eimeoschnyot sellev ;t--&g hostsrimbo -t-;&g T?DV

E - Prluymnoa aa;rxnht Teh mtie oercsu dlowu eb mhuc rome ua,cte dna lwudo salo reesptn wiht mystspmo fo ifu-ekll stomsmp.y adiRp hatde too

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 +3  upvote downvote
submitted by ∗monoloco(155)
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This apiettn is enpiirgxcnee ynipstehysvieitr puimosniten omfr teh ekp.asatre I wsa thiknngi M. viuAm hnew I escletde steekrpaa -- I tnkhi ym cigol wsa fleadw ivegn het fpisecsci fo eht 'testianp syto.r

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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Hwo owlud you okwn ttha ti sitn' wool rsterso sdaesei?

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cienfuegos  AF 1208 713: ianhnltaio of ssoepr dlesa to kluf-iel ymssopmt taht gsoerrsp uiyqclk ot rfeev, yaounmrpl mharheoreg, ianistidisetm dna hs,koc thwi ingagmi blyposis gonwish enewdid edianmtmius +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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gcicrnoad ot lrouwd eeiihvisytptnsry nionmtuipse is eud to ustd nda ahtt wsa loas an .op.ot.in.

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amarousis  so st'i tienfdeily tuds ubt the fcsceipi etpy of duts wsa teh sotm ttrmpinao in isht .uesitqon het tcaf ttha tyhe mnedtnieo the sidbr is mnrapto.it the ydstu kobso wuldo esacu ti but hte dirb sdut si mreo ittrnapom .-- +
charcot_bouchard  nisHiresivepttyy iosinePtumn - cinOgra sdtu lki(e omdly uiPynoas)coseimnh - ncgraIoin undnsoe t pleh ereh uhhotg seacebu boht ilwl stpeern hiwt sema vciteirtrse unlg adessei e.uc prtii ktnih eicns sdut in ybairrl eartn ireehnt gcinoar or griconain dna asol u tndo ees ynma snibrlaiar hiwt lgnu ediseas tbu ibdr ewiphosrn si silylpiafecc donteemin as cuaes fo HP eesi.ads +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I osla asw niigknht .M vuima ,hree utb eietypyiisvrhnst npnosieimut semes ot ift htiw het lenruritulrgaoac c.seganh

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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ohw do we wokn raskapeet sceua eptirvneysshyi pnoitsenuim

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smc213  1AF8 .67p5 drbi &;po-erxuegts- NHS inenusmtoip tceivrtr(eis ugln edaeiss) dan F1A8 2p1.4 msaulatrguono sise:deas nerfogi elHSi--m;tagNta&r tonpn.seumii I ahd to ekma sesne of it snice I din'dt ownk ti swa HSN mitusnponei ta rtif.s +5


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 +0  upvote downvote
submitted by ∗breis(56)
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oisttcsaPis stmimoees( adelcl oinrtsoihs or ptorra eessaid or atoprr rv)efe is na ftinicneo of het gnul miauo()npen cdeasu yb the cuitmaber Cilaohlyhmadp md)aCilayh( tc.iptias

nsiSg and vtsghpcsmrmou,yeo:ef . ylsuaul touhwti cuhm hrdeh l.mhg. hepuaeaclesa.smc s h.ecshcaet ohse npsartsin. fo bsroehr e.ta rtatoh.

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charcot_bouchard  aetpdU on my vper ceonmmt : Yse sthi is itpoisstc.sa not hyvstieiysierptn .putoniemsin oHw do u kw?on cyymoLpeth and ePnrsece of uaaomGrnl - rpsonese to irrcnulatleal yaaNdhmlc o.wi SH cna losa acuse eoslo moalganru oto nda the nicaclil cpertiu siltl omre ookl kiel SHou Y wonk awht ......... kfcu hits quse +2
shemle  reeH t.P dt'neos aevh eer!fv +9
shakakaka  aeNaocnsitng numalog,ar pytcah yhctlcopmiy lnaoinrtii,tf nad iisfrobs rea enes in rineyiytsviptHes ipotumseinn , iaogccnrd ot Uolrwd . +

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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