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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 has a tegar creupit

nesp//itpc4w(Sh-0t.t768ilg/r)e:ar0a9w1/2.d11/lo6-w30o6fji9cn

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kamilia20  moylldcahphia p??scaitit +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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sniHtersiepyvyit siemtxeinndou—pim tpey IVIII/ phtieyssntvyiier ctinareo ot entlnrinaevmo eatngn.i eCsaus aspen,yd uhg,oc ctehs snhgestt,i cahe.ehad entfO seen in samrefr dna etsoh doxepse ot rdsib. eReveislrb in lyera teagss fi imusstul si dvodae.i

I'st a ypet of tercriviste lgun asie.dse

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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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Why the htoer rwnase iocechs a'nert ercctor

A - Nto an cacahpaytnil tenicora ylnaim ued to tniorhicyc pinson(tumoc of sy,o hhcwi sha gpoonietcrsyl that peolep aym veha saeriegll atw)rsdo

B - Nto amshat echadcaz(trire by mroe cteau diseoeps fo tnoniriobcocshctor,n ghn)wezei

D - eamniA (6B, 9,B 2B1), or ymaeb a aynmrlopu mesblmio eud to B9 or 12B eifydnecic g--;t& ldveteea yetoceimnhso lvlsee &;-gt- hboortissm &;-gt- DTV?

E - Puamrlyno hxanrt;a The tmei rocesu ldwuo eb mchu mreo tca,ue nda lowud losa etrsnpe hitw pomtssym fo l-felkiu s.yomstpm adiRp dahte too

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 +3  upvote downvote
submitted by ∗monoloco(155)
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ihTs tiapten is neixegrcipen evehiinsstyrtpiy niitnsuemop fomr teh ak.rsepaet I wsa hnigkint .M mAiuv ewhn I dclseete askpertae -- I hknit my ocgli swa faledw gevni teh pcsifecsi fo teh tpnisat'e yrs.to

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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Hwo duwlo oyu onwk taht ti 'nits owol sstrero s?sadeei

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cienfuegos  FA 0281 17:3 iolhaitnan of esrops dsale ot -lukfiel smsptomy that posrergs liqycku to er,fve muprlonya eg,rerhhmao iitstmidieasn dan c,khso htwi imganig iyposbls ignwsoh idnwede sduieimtnma +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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cdnioagrc ot uowldr svtieyseiiypntrh muennispoit si deu to utsd nad tath wsa aols na onp...ot.i

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amarousis  so t'si iftdiylene stdu utb eht secicifp pyte fo tusd saw hte smto iapmtrtno in tihs ieqtuson. het tcaf ttha eyht deinnoetm teh dsibr is iatr.nmtop het ysdut kobso wudol esuac ti but teh brid stud is eorm paonmtitr --. +
charcot_bouchard  tesivteriHyiynsp iuneoinstmP - cnigaOr tsud ie(kl doylm ouPeic)ysnan shiom - oinrgIcna une notds lehp erhe ghthuo aeusbec obht lwil senrpet wthi asme vtreiestcri lugn siedase uirt. pice khnti esnci dstu ni bryairl nerta ienhetr rgacoin or giaoinrcn nda olsa u odtn ees ynma airrainsbl wthi glnu edsseai btu ridb pihsnrowe si caepsciyllif dtemnoeni as sauce of HP .seeiads +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I aosl swa nghinitk M. vamui r,hee ubt npiteseyhitvsiry metnonupiis semse to fit hitw teh roaaleurnigluctr gc.hsnea

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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how do ew konw taspkaere cuesa syyhinerspitev poiiustnenm

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smc213  FA18 7.6p5 brdi pe;gr--oesut&x SNH onsepmituin itevrci(sert nglu idses)ea nda 8FA1 2.p14 oarnugumtaosl ess:daesi nreigfo i-l-Hgm;atraeS&tN nit.oesiupnm I had ot akme essne of ti ncesi I ti'ddn wkno ti was NSH tmsonepiiun at fi.str +5


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 +0  upvote downvote
submitted by ∗breis(56)
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stsaosciitP sm(moeetsi laledc onhssroiti or arrtop sieeads ro rtopar eer)fv si na ctniieonf of the lnug (iaon)epumn ecsadu by eth tbauicemr lmdihaChpaylo mClahai)dy( tpaitisc.

giSsn nda :cm ,e ogopymssrfu.vhet ulylusa tiwtuoh mhcu hcd ecsge..ahl.amhe maeuplhs r h sechatc.se itnea hrnsssp.o fo s.tehr oarbe o.ahtrt

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charcot_bouchard  padtUe no ym vrpe tmoencm : esY itsh is issctsao.pit otn tsihseypintvyrei i.uesnpmitno owH od u nkow? pohmytecyL adn rePecsen fo maGrluano - rseospen ot urceallaniltr .i hcmywdoaaNl SH acn aslo csaue osleo ulroaangm oot dan eht ccinlila ictreup iltsl remo look elki YHSuo konw hwat ......... ukcf hits usqe +2
shemle  eHer .tP 'sdnote hvea eevrf! +9
shakakaka  nagtoeNnscai ,lmouragan pytcha lyoipcmythc ailnt,tnrifoi nda isfrsbio are enes ni iviepyistneyrHst intpsioenum , gdaniorcc ot rlUodw . +

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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