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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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egaP 2 ash a ategr rtcueip

g6-0iSs/d/.e-wofan7:p/o6n01at/c841jt9hrw1t3i/i(r6lew2pc.)90l

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kamilia20  lhcyhodaapilm i?tat?ipcs +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)


 +9  upvote downvote
submitted by hayayah(1212)
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nyvtHsypieseirit imioeumxintsnp—de ytpe IVII/I ieneptyiitshyvsr cietoanr to ntolriemvnean eagnt.in aseusC dnyp,sea h,gouc hcest ,nsttgihse ehcd.aahe ftOne eens in earsmrf nad hoest exspdeo ot ris.bd rvilbReees in yaelr sgesta if ssuimlut is v.deioda

stI' a yept of ircevtsetri lngu a.isdees

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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)


 +6  upvote downvote
submitted by neovanilla(57)
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Wyh teh oerth wsrnea iccoehs ar'net ccrrote

A - tNo na tacnpahlycia tncoriea myainl due ot oiyntircch tosmnpoun(ic fo so,y chhwi sah rinceotlygosp ttah eeplpo may eavh easegrlil wt)daors

B - otN aahstm z(echriaredtac by oerm acteu pdiseeso fo onnott,scrcnbriioohc ehginew)z

D - Aieanm 6B(, 9B, 21B), or mbyae a olmaprnuy oliemmbs due to B9 ro 21B enefdcycii &;-g-t ltevedea ieecotsnhmoy vllese ;t-&-g bhooismrst t-g-&; T?DV

E - yulrPmnoa tnah;rax heT item ucsoer owdlu be hmuc mroe ceaut, dna wodlu osla eesrtnp with smmystpo of ll-uekif smmspt.oy paRid dhtae oto

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 +3  upvote downvote
submitted by monoloco(155)
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sihT ttiepan is eiginrxepnec petrtinsviiyhesy teunnsoiipm omrf hte .sraeteapk I wsa inhtknig M. uAvim ehnw I ecdtseel tkseaprea -- I tinkh my glcio swa aelfwd veing eht ifcecpiss fo eth 'tinespta o.sytr

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 +1  upvote downvote
submitted by imnotarobotbut(184)
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oHw udlow oyu nokw atht it tis'n oowl etrrsos siesead?

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cienfuegos  AF 0812 37:1 tlinoanhai of psroes elasd ot l-lifkue mmsosypt thta rsgrsope yciuqlk to e,erfv olramyunp eh,grmahoer itamdisseniti dan ko,shc ithw anmgiig yoislsbp iswngoh dnweedi aimtnuesdmi +10



 +0  upvote downvote
submitted by endochondral1(24)
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nocrgidca ot udlwor tihrsesnyepvyiti iispmnuntoe is edu ot stdu and that asw oasl na .pit.no..o

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amarousis  so i'st nefiidtlye dtus ubt eht iiscefcp ypet fo utds aws eht stmo rnittampo ni shit not.sqeiu eht atcf atht hyte eidmneont the sidrb si miotanrtp. teh sudyt bsoko wdlou auesc it but the ridb dsut si omer otnimptra -.- +
charcot_bouchard  rysnvittsiepeyHi smPiiunneot - rnacOgi dtus iek(l yldom Peooi hanyincsu)sm - cognarIni sedotnn u pleh here hohgtu saebuce boht wlli tpesenr htwi aesm ieirtcstrev nglu edsisae p.rie ctiu tkhni ecisn dsut in rbyarli rtane rinhtee rcgiano ro anngiorci dna alos u ntdo see myan lrirasniba thwi nglu saeeisd btu dbri nioehwspr si icalsfelpicy mnedtinoe sa aesuc fo PH se.sdiae +



 +0  upvote downvote
submitted by beeip(141)
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I olsa was ikgithnn M. auimv eer,h tbu hsiniyevrpytsite pmunsnotiie esesm to ift iwht the oaelrariculgtrnu e.hgnasc

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 +0  upvote downvote
submitted by endochondral1(24)
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who od ew nwko rtsaepake sucea vehyypnrsisite iepimntsoun

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smc213  FA81 p765. bidr pg-u;rse-t&exo SHN emsnntiioup tterr(seiivc lgnu eiasdse) nad F1A8 1p.42 rouuaomtgalns s:dseisae efgiron ttgr-mieSHa;al&N- nsnom.itepiu I hda to kmea essen fo it cneis I ind'dt onkw it swa SHN nmpuiiosent at fr.tsi +5



 +0  upvote downvote
submitted by breis(56)
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isPsatstcoi msimte(eso aellcd irsnosihto or poarrt asieesd or orpatr fver)e is na nteiofcni of hte lugn np(i)menoua csadue yb het tariecbum loyaCphaimhdl dhma(ya)iCl .tistaicp

Sngis adn ,.yosogupeevfh mtcsmr: ulsuayl uhwotit hmcu cc.eh .sgeuh spmaeamrlhhedl.a tcesseahc h. nitnos.hepssa r of bsrhe .traoe ahot.rt

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charcot_bouchard  edaptU no ym prve nmoctme : Yes siht si o.sistactpsi nto hyitepieyvsnsirt stuopniimne. How do u onkw? hmeoLctyyp dna Pernesec of unaGarolm - oeresspn to rtacellalirun diyhmlwc aNoa. HS nac lsao ucsea soelo omrlaugan too adn het anicillc iurcept lislt emor oolk eilk YHSou nokw tawh ......... ckfu tshi eqsu +2
shemle  ereH Pt. ostdne' hvea reve!f +9
shakakaka  ancseNigaont ,aagumolrn ptchay yophiycctlm ifolintn,aitr adn fbssrioi ear nsee in Htsisyiyeptervni utnnmoipise , iaroccgdn to lrdwoU . +

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