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NBME 20 Answers

nbme20/Block 4/Question#21 (62.6 difficulty score)
A 47-year-old woman comes to the physician ...
Contact with parakeets🔍

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submitted by masonkingcobra(242),
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Peag 2 sha a aetrg tuecipr


kamilia20  chlamydophila psittaci?? +  

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.

+5/- lilyo(55),

submitted by hayayah(996),
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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

+1/- alexp1101(2),

submitted by neovanilla(30),

Why the other answer choices aren't correct

A - Not an anaphylactic reaction mainly due to chronicity (consumption of soy, which has glycoproteins that people may have allergies towards)

B - Not asthma (characterized by more acute episodes of bronchoconstriction, wheezing)

D - Anemia (B6, B9, B12), or maybe a pulmonary embolism due to B9 or B12 deficiency --> elevated homocysteine levels --> thrombosis --> DVT?

E - Pulmonary anthrax; The time course would be much more acute, and would also present with symptoms of flu-like symptoms. Rapid death too

submitted by monoloco(125),
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submitted by imnotarobotbut(139),
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woH odwlu uoy knwo htta it its'n wloo rsrtsoe eesd?asi

cienfuegos  FA 2018 137: inhalation of spores leads to flu-like symptoms that progress quickly to fever, pulmonary hemorrhage, mediastinitis and shock, with imaging possibly showing widened mediastinum +4  

submitted by endochondral1(12),
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dcaircngo ot owdulr irsseytniivyhpte omtnnesiuip is edu ot ustd nda tath asw aols an .o...oitpn

amarousis  so it's definitely dust but the specific type of dust was the most important in this question. the fact that they mentioned the birds is important. the dusty books would cause it but the bird dust is more important -.- +  
charcot_bouchard  Hypersensitivity Pneumonitis - Organic dust (like moldy hay) Pneumocniosis - Inorganic dust none help here though because both will present with same restrictive lung disease picture. i think since dust in library arent neither organic or inorganic and also u dont see many librarians with lung disease but bird ownership is specifically mentioned as cause of HP disease. +  

submitted by beeip(118),
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I laso swa nnkihgti M. mvuia here, btu itetisyhvpesnryi pomusnineti semes to itf thiw hte iturrolauelgrnca csga.hen

submitted by endochondral1(12),
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woh do we owkn earkpteas cusae eiprhisneysytv setnomiinup

smc213  FA18 p.657 bird exposure--> HSN pneumonitis (restrictive lung disease) and FA18 p.214 granulomatous diseases: foreign material-->HSN pneumonitis. I had to make sense of it since I didn't know it was HSN pneumonitis at first. +5  

submitted by breis(35),
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iSsgn and ct f gym,oomsv.p:resuhe yusaull iuwttoh cuhm gelushm.sp.ahecalhhreadm e.c scehact protnss h.sinea fo tesbae roh.r ohrtta.

charcot_bouchard  Update on my prev comment : Yes this is psittacosis. not hypersensitivity pneumonitis. How do u know? Lymphocyte and Presence of Granuloma - response to intracellular chlamydia. Now HS can also cause loose granuloma too and the clinical picture still more look like HS You know what ......... fuck this ques +  
shemle  Here Pt. doesn't have fever! +6