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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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Pgea 2 hsa a rgate erupitc

oit0g1traa//6wi641rsh0c9)6pfclo:/2w7/leewji-83./dnnp(.19-S0t

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kamilia20  alyhhcdimpaol it?paist?c +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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iHnstirypveyiset tsximoend—umnpiei yept I/IIVI ytsienyithsivpre cirteaon to nvoimantlerne eaingn.t Cseusa ,nsdypae cough, hscte gethtis,sn hed.aehac tnOef seen ni amrresf dan thoes xesdpeo to .rdisb evsrelibeR in ayelr esgsat if ituussml si o.adevid

sIt' a eypt fo iterertvcsi nugl asiedse.

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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 het rhteo arwens cehsoic 'traen tccrero

A - Nto na tcncyalihapa ointrcae ayimnl ude ot cithyonrci mosnpu(ciotn fo os,y hhiwc ahs insleopgtocry hatt oelepp yma aehv risegllae rat)sdwo

B - tNo atamsh c(zerciaahertd yb roem tcuea iseedpso of tocobc,rntnocirosnih igw)nheze

D - eimnaA (,B6 9,B ,B12) or mybea a uloarmynp slommibe deu to 9B or 2B1 idcfnceeiy -g&;t- eltevdae yonhstocieem llvese &;-g-t oshitsrbom -g&t;- ?TVD

E - yorlamuPn ta;hxnra eTh item uoserc wuold eb mhcu remo auec,t dan ldwuo aols etsnerp wtih stpsmyom fo flil-uek soymt.psm daRip taedh too

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 +3  upvote downvote
submitted by monoloco(155)
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Thsi ntiepta si inpgiecxeren ysyetviiprehsnti stninuiomep mrfo het ark.eetpsa I aws nkghniit .M Auvmi wenh I sctedlee eratasekp -- I nktih my gloic saw lwdfae engvi eth ieipcfssc of the n'sttpaei .otsyr

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 +1  upvote downvote
submitted by imnotarobotbut(184)
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Hwo oduwl you okwn atht it n'sti lowo sersort esasd?ei

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cienfuegos  AF 1082 31:7 anaothlini of esosrp dleas ot u-ikllef ysmpmtso ttah rsregops ulcqkiy to er,efv umnoyrlap ohgemhare,r sstdtnieimaii dna hscok, thiw iimgnga silyobps swgnhoi deienwd tmnsaiuiemd +10


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 +0  upvote downvote
submitted by endochondral1(24)
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cngcradio to dlrwou ihtveiytinsysrpe iispnnmteou is eud to dtus adn thta saw lsoa na it.o.pn..o

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amarousis  so sti' eiidteyfnl dstu utb teh cicpiesf eytp fo utds swa hte tmos pattmorni in sith eos.itunq the atcf htat they dneieomtn eth rdisb si ipoa.ttmnr eth sudyt osobk lwuod sceua it ubt eth irdb utds is orme tiratmpon --. +
charcot_bouchard  rssteyiivtnHeipy enusiimoPtn - nrgOica dtus (keil dolym asioh enuPyo)sinmc - onnriIacg eu snndto ehpl reeh ougthh aceseub btoh illw resnetp hwti emas ecvrrettsii gnlu seieads puiric .et tihkn icesn tsud in birlayr aetrn hreinet gorianc ro rognnciai dna sola u otnd ees ynma anrilsrabi thwi unlg deassei ubt idbr epwhonris is siayclpfiecl neenotidm sa sucae of PH dea.eiss +


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submitted by beeip(141)
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I laso saw hgiikntn .M vaium hree, btu eytprniviisthesy onmsiunpeti emess ot fit hwit teh alrierrnlutaoucg esac.ngh

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 +0  upvote downvote
submitted by endochondral1(24)
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woh od ew wkno eparketsa uesac eiiyepssrvtnyh umoetsipnni

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smc213  8AF1 756.p dbri &o-xetp;ue-rsg SHN nmeptinsuoi tritcre(vesi ngul d)seisea and 81FA 24.1p nursmgoaoautl des:asise ifegnor t-e-Hitl&rmg;aaNS .ieupnoistmn I hda to make essen of it sicne I dd'itn knwo ti swa SNH teusmnionip ta fsi.tr +5


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submitted by breis(56)
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saiotisPsct soi(steemm daecll isioorthsn ro rproat sieased ro otarpr fee)vr si an enoftniic of eth lung opiumeann() saecud by eht ueiabrmtc loCyamahhdlip ai()aydhClm spaiitt.c

sgSni adn f. s:,srm oheeumgpovtcy syluaul tiwuhot cmuh cd.mahhe .alrghc.emeeluashs p aec.ecsshht ies.rn nosahspt fo boae.set hrr tthora.

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charcot_bouchard  aUpdte no ym evpr tmmceno : sYe tihs si tssptosac.ii ton vestpthreyisyiin imopu.nitesn owH do u kown? hLymeopcty adn renesPce fo Gmnoulraa - npesrose to cleaatllrurin aay.oNlmh wcid HS acn oasl escua esloo rnalmouga too and eth licnclia ecrputi litsl mero oolk klie oHS Yu nwko tawh ......... fuck hsit qsue +2
shemle  reeH t.P dt'seno vhea vfree! +9
shakakaka  ntgciaoensaN amua,glron cyhpat hplyoctycmi ttnailiofr,in nad fsbsorii era seen ni ytipeieyHtrsvsni ipioutnenms , crconaidg ot rdUwol . +

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