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NBME 21 Answers

nbme21/Block 1/Question#32 (60.3 difficulty score)
A 50-year-old man has had progressive dyspnea ...
Usual interstitial pneumonitis🔍

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submitted by notadoctor(153),
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luUas sitietlntari oeiunsptmni is eth ilooalhsigtc dtfnieinio fo tphicaiIdo mrlopnauy isrifbso. eW nkwo tath this pattien ash nuaopmlyr rfoibiss scabuee teh quieotsn steast atht teerh is soirfbu gthincekni fo eth oealvral apts.e hiTs ntisueoq asw tujs itetngs htta ew ewnk eht reoht nmesa fro lrunymPao ibFir.oss

aneurysmclip  Nbme back at it again +24  
pg32  Is it still considered idiopathic pulmonary fibrosis is it appears to have been caused by an atypical pneumonia? +1  
zevvyt  Why not Sarcoidosis? Wouldn't Sarcodosis also be a chronic inflamation with fibrous thickening? +2  
swagcabana  UIP is a better answer. Sarcoid is a leap in logic, usual interstitial pneumonitis is textbook histological definition of idiopathic pulmonary fibrosis. The biopsy has no mention of noncaseating granulomas and the clinical picture is not consistent with an inflammatory process. You have to focus on the better answers, try not to get caught up in the "why nots?" Calling this sarcoidosis is like someone coming in with prototypical asthma and jumping to eosinophilic granulomatous with polyangiitis. Sure its a possibility but its definitely not likely. +6  
mangotango  I picked “diffuse alveolar damage” with Pulmonary Fibrosis in mind but these are actually key words for ARDS :/ +1  
zevvyt  thank you swagcabana! Very good explanation and strategy! +  

submitted by gabstep(14),
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oudfn iths ni orsinb:b het rciooldaig nda ilciootsgh tapnter fo iriosbsf is drferere ot as auuls lsntiriieatt peomniuan, chwhi is qereduir rof eth sdogasini of .PIF

drdoom  pneumonitis* +  
drdoom  ^nevermind! +  

submitted by neonem(556),
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Pahaotm assy that teiriitnsatl )ltca(iyap oeinpamun si rcterdehzaaci by dfsifue eailtnirtits nlieastifr,t ressetnp /w elvielrtay ldmi epupr sepr ystpmmso almi(min tsuupm map&; wlo efevr,) adn si otsm foetn cuaeds yb reus,siv tbu can eb raate.bcil eve,owrH sith esnqiuto is pngsenitre a ohrcicn ,csae so m'I mnuasigs tath hte pvseorui rtetsitiinal nuanpeimo eaudsc a trfibcoi neporses in het ng.ul

submitted by usmleuser007(377),
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fllaI esle ls:ifa teno that oreht snreaw seiccoh aer POCD septy

dragon3  (except sarcoidosis) +2  
leaf_house  I got hung up on why this couldn't be sarcoid, and I think no lymphadenopathy is one of the reasons you wouldn't pick it here. (Though it seems like it can cause alveolar septal thickening: +  
lovebug  Restrictive VS Obstructive ! very good point! THX! +  
schep  if it were sarcoid, wouldn't the biopsy show noncaseating granulomas? +1  

submitted by sweetmed(138),
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slUua atrlsitiniet umpnioaen (U)PI is a rofm of ungl edssaie crrdcetaiezha by oirespsvegr acirgnsr of obht s].gnu[1l ehT cgiasrrn i(srsob)if eslonivv eht gruptpinso ferwroakm tiu(seirnti)mt fo het u.ngl IUP si tsuh csdaesliif as a form fo ilritsettian gunl ssiaee.d ehT metr "uuasl" eersfr to hte ctaf ttha IUP is hte somt momocn omrf of nttiersiialt .fisbiros Peu""onamni etsnidcai nlgu" bmlrtn"a,ayio hciwh nscdeiul biosirsf nda ial.afionmmnt A rtme oysivpluer edsu rfo IUP in eth riBhsit irutlerate si ccipegornyt infsbgoir ltselvaiio ,(FC)A a etmr hatt sah laenlf uto fo forav nseic hte csiab dnnigluery hyoltapgo is onw htugtoh ot eb issrif,ob not ifan.tmanoilm ehT metr uulas nriaiittestl uesiptnmoin UIP)( ash also otenf eebn sdeu, tbu ,ingaa eht isi-t trpa of ttha name yam ahsmezoeerivp nnmtilo.imaaf hotB IUP and ACF veha eben ecrsbdedi sa soyoyumsnn hwit hiioapitdc napolurmy i.sirsobf

submitted by niboonsh(338),
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my sidetdnrnuang of tsih is mrof amoapth - itileInsrtta tlay)(paic ounneiapm - scdaue by eidusff tarsteinliti nifatersitl. nCa eb sdaecu yb aspcoaymMl eun,mop S,RV dmahalciy muo,pen en,zalufin lliaxoec unertibi

athenathefirst  Yeah but how does that help you choose Usual interstital pneumonia? +