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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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gePa 2 hsa a atreg rpitcue

afw1ho).r/1d/.egwwl006n6:p(/r9//9tict3-teo401isSc68pan7-2lji

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kamilia20  clhyaldahiomp ?tast?iicp +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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tieinsvsHrteipyy dounmipnmes—txeii ytep IVII/I seyinvrypitsieth aiertcon to entlvnienmroa .gtneani sesCua dan,yesp ghcuo, hestc hsgitten,s a.eachdhe ntfOe nese in arsemfr dan hsote esxpdoe ot rdsib. lrseeiRvbe in aryle tesags fi ilumstsu si avde.iod

t'sI a eypt fo icertsrivet nlug sda.seei

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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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hWy teh reoht wnaers eioscch tarn'e ercotrc

A - Not an incaapyhtlca itcanore iyalnm edu ot tyriihoncc sopmnito(nuc fo soy, hwhci ash olysicegtnrop htat leoppe may ahve lgslraeei at)oswrd

B - tNo amthas (dhcezeiaartrc yb oemr caute depiosse fo sntrotroccbhnoni,ioc z)eewghin

D - Ainaem B6,( 9B, B12), or maybe a alynoumpr omelibms ued ot 9B or 2B1 ficeidecyn g--&t; elveetad ntseicooyhme lesvle tg--;& itsbrmohso &;t-g- TVD?

E - nraulmPyo hanx;tra eTh mtie eorscu lwoud eb uchm eomr eatc,u and wlduo saol eneptrs ithw omsmtpsy of iukefl-l mt.spysom Rpadi eadth oot

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 +3  upvote downvote
submitted by ∗monoloco(155)
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Thsi aiteptn is enerpinecixg eyiynsvsitperthi ismuponiten fomr hte esark.ptea I wsa ithgnkin M. mAiuv ehwn I tlseeedc erpstakea -- I kntih ym ilocg swa efldaw vgine eth sfpseiicc fo eht tstneipa' ytros.

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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wHo dowul yuo wkno atht it si'tn lwoo sosrtre di?aeess

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cienfuegos  AF 1802 17:3 alaoithnni fo orpsse lseda to lu-ilefk mymtspos htta spgesrro ilkuycq to ,rfeev uypnomalr aehorg,rmhe iieaiidtnsmts dna csk,oh wtih niimgga ypoilssb oiwsghn edewdni eiisdnummat +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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cingodacr to lwurod vitrspyieehytnsi epunsitoimn is eud to sudt dna that asw sloa an oo.p..i.tn

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amarousis  os sti' elnifityed sdtu tbu eht scpecfii ytpe of duts was eth sotm onpmiratt in ihts uesoqi.tn het actf that yteh doenetmni teh ibdrs is rt.maoptin eht usdyt bkoso uowld caseu ti btu the ibrd ustd is mero armtotinp --. +
charcot_bouchard  stiirsteiypnHyev Psmintueoin - rgniOac dust (ikel mloyd iPcanoui smosen)yh - rogIannci notnseu d phel eerh ohthgu eebacus hobt illw peesrnt whit aesm crvtterisie lgnu sadeeis triep.uic inkht isecn dstu ni alyrbri rtnae etrnhei noigrca ro ginniorca nad lsao u tndo see nyam risalnraib iwth ulng diseaes ubt bidr whrnseoip is fiecicayslpl detmoinen as scaeu of HP as.sidee +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I lsao wsa hitngnik .M mviau ,ehre utb rhtyssetviyinpei iueinnotmsp sseem to fti iwth teh lltirnoeruagurca hsnca.eg

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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owh do ew kwno aasteprek usace prseyntiyieshv tmoiensipun

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smc213  A81F .p567 rdib &s-;u-epogtrxe HSN pmiuientons eie(tcvristr ugnl siedsea) nad 1FA8 142.p olougnarmtsau sdease:is rfgoein aaS&-eitHmtrglN-; usint.onmpie I hda ot emak esens of it eisnc I indd't nwko it swa HSN opntismeniu at .sitfr +5


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 +0  upvote downvote
submitted by ∗breis(56)
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cPstsaioist eeommits(s ledcal orshiniots ro prarto disaees or poatrr ee)vrf is an oneftiinc of hte ugln pomin(ae)un dacues by eht abcmetiur lhhmydlpCiaoa aaClh)d(imy sitp.tiac

Snsig nad rvmc: he.t,oefmosyspg u uuylasl iwhtout hmuc h.hselaehdmm.re sahpu cclgea. seh.ctch esa rh.o teinspsnsa of erorehat b.s thaort.

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charcot_bouchard  pedtaU on ym rpve ntmemco : eYs this is s.itaiscptso not ityshreneiiyvstp ioet.unpnism wHo od u nowk? htcoyyLemp nad rcePeesn of urGanloma - sronpsee ot arciellnalrtu yld No.wamchai HS nca aslo esuac sleoo onmaulgra too adn het inicacll iecuptr illst oerm olko eilk oSY Hu nkow thwa ......... ckfu siht seuq +2
shemle  reeH P.t tdeno's veha vre!ef +9
shakakaka  tsoananceNgi rumlong,aa pchaty cylhopctimy rnifittinlao, dna ioisrsbf rae nees in yisvsyepietintrH neistnopium , oinrcdagc ot Urlwod . +

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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