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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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Page 2 has a gerat uercipt

ejn:l36is0/-)-Sfw9rp6e1p2(1ogdnw//hwcio96.4t8t07acrilt0a.//1

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kamilia20  pyhlachmiadlo ti??pascit +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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evttiHrpeyisysni ni—ixosditnmeepmu ptye /IIVII teyyiieptsvsihnr einrtoca ot aeritlnmvnone gna.inte essCau ysa,dpne cu,hog shtec t,gesisnht .hdeechaa Otnfe esen ni asermfr dan tesoh eodxpes to irds.b veiesRrlbe ni eryal asgste fi tlssumui si edvoi.ad

stI' a type fo eistrvietcr glun ssd.eiea

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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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yhW het ohret enwars hseoicc n'arte erocrtc

A - otN na ptalyaaiccnh nroacite nmylai due to crioithycn pinuostmcn(o fo s,yo cihhw ahs gcolptinsroye htat olpepe mya heav eglilsear wd)aosrt

B - Nto htsama ehcae(cazdrirt by orem ecatu sdopesie fo rnosccct,nohbirnooit )iwhgneez

D - manAie B(,6 B,9 2),1B or beamy a noralumpy mobsimle eud ot B9 or 21B iycciedfen -gt;-& atvldeee oenhtemocyis veslle t--&;g motrsobihs -t-g;& DVT?

E - namPoruly rxnt;haa The emti esurco wdluo be mhuc remo ctuae, and uowld laos entpres thwi spysmtmo of -luefkil myspm.ots adpiR hdate oot

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 +3  upvote downvote
submitted by ∗monoloco(155)
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Tsih eiptnat si igenxenecpir yirthspyieeinvts nupismotnie romf hte ek.paestra I asw intkihng .M iAvmu hewn I eeesctld ptekaarse -- I tnhik my iolcg saw dwalef igenv eth ifpssccei of hte iatepsn't tors.y

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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wHo udolw oyu wkno htta ti i'nts oolw tsoserr e?sdeasi

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cienfuegos  AF 8012 713: onilaithan of espors ledas ot ilfuelk- otpsmmsy ttah srosrepg ykiqucl to er,fev nrupomayl aehrgrmohe, astieidistinm adn cshko, tihw gigmnai yipsolbs nhgsiow niedwed mseimtdianu +10



 +0  upvote downvote
submitted by ∗endochondral1(24)
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gcnodacri to wrdluo yshiniptevryitse ionumspinte is ude to dstu nad ttha aws sloa an ..nio..pto

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amarousis  so ist' ntydfeelii dtsu utb the eiscfcpi eypt of udts swa hte ostm anittpomr in isth .oietnsqu eht tcfa atht yeht ondimtnee hte sbidr si itr.mtapon hte uydst kosbo uwodl uaces ti but teh bdri sutd si mreo tnrpmoati --. +
charcot_bouchard  iiHtsysenevpriyt niumsontPie - anOicgr tuds lek(i yodlm si)uociomshPyne na - Iicnornag eonsnt ud eplh eher ugthoh ebuaecs bhot lilw eeprsnt with seam teretsrivic guln deesias c.i reptui khnti cisne tsud ni railrby raetn ethneri roacing ro gcrnonaii and osal u dton ees many raislrainb twih ugnl idseeas tbu rdib oesphwirn si laefiypcslic onmieednt as sauec fo HP ss.iedea +



 +0  upvote downvote
submitted by ∗beeip(141)
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I laso wsa nitkghin M. vuaim eh,er but yeythrpeivinisst pontmeuniis meses ot fit ihwt the rlaetulucirganro ehsng.ca

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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ohw od ew wnko pekaarest uecas iyteyspriehnsv ptsuinoiemn

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smc213  8FA1 75p.6 dibr -or-psx&;uteeg SHN insnmutepoi crseeir(titv nulg aeeds)is dan F18A 42p1. uutonalroamsg ssai:dsee ofngeir ;tmat&-g-HiNarleS msoiipt.neun I dah to ekma esens of it sienc I d'tidn knwo ti saw HSN nmetuiispon at .isrft +5



 +0  upvote downvote
submitted by ∗breis(56)
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tocsPiasist est(semomi lladce iisrstoohn ro rtopra sseadie ro rpoart eevrf) is an eotifncin of eht ungl an)nmeu(oip dcsuea yb teh rtumaeibc iaophllCdymha aha)(ilymCd sicip.tta

Ssign nad gpme:e ,vyrsoofumt. hcs uylusla tohtwiu chmu sh .gph.umhrc.daeeaeme lal hcs hs tec.cesha shntap. isneors of .sareb herto to.athr

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charcot_bouchard  atpdeU no ym eprv tmocnme : esY itsh si tsstcpa.sioi tno ypenishiiyettsrv mseti.ponuin woH do u w?kno mtpyhceLoy adn reensceP fo Gmolurnaa - esseponr ot lrcanliatlreu h.wNcdalm yaio HS nac laso ucsea lsooe rmnoaugal too dan eht ciicnlla eritpcu tlils omer oklo lkie SoY Hu wkon tawh ......... ckfu htsi sque +2
shemle  erHe .tP otsed'n ehva r!vfee +9
shakakaka  icanseoNtang om,aanlrug ahtcpy ihcplocyytm ,iinanlforitt adn fsirsbio ear nees in isinspHvtteeiyyr oitnimnuesp , rcangdcio to 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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