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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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ePag 2 sah a agrte ritpecu

j/93-nS02p//woia1t.ie()8gaiw94ndhe/017:rrf/ll6-0.sttwccp6o61

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kamilia20  yhachaopimldl a?sticpt?i +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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rpisevHseitnityy tin—meexpoumiisdn tepy II/VII tyiiesnsrvtypieh oiaernct ot nvenlteroanim ginae.tn esausC pye,nasd o,gcuh shect ttgeh,isns hecahd.ae tnOfe nsee in fsearrm nad steho esopedx to irds.b beRlsviree ni ayrel eagtss if lmitussu si do.eadvi

st'I a pyte of trsetireicv ulng se.isaed

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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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Wyh hte hrote arnwes cisheoc nat're reccotr

A - Nto na acyhcnaiatpl oeranitc ylainm ued to oincryicht osmopncni(ut fo ,osy ihhcw has sgentpylioorc atht elppeo yma ahve lgaerleis )dtrsowa

B - tNo ahsmat ahtcredc(iezra yb orem tcuae dpsioese of ooir,ttnnicncscoorbh zng)wiehe

D - Aneami B,6( B9, )21,B or yebma a lropyuanm lsoimbem deu ot 9B or B12 eefcyciidn --t&;g tdvaelee etnomysioceh levlse &g--;t obothsrsim -gt;-& DTV?

E - rPyuoanlm a;hntxar ehT temi rcusoe ouldw eb umch more ta,cue and luwod alos sretenp hwit mtoypmss fo ufilkel- yst.smmpo daiRp adeht oot

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 +3  upvote downvote
submitted by ∗monoloco(155)
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Tihs atpneti si eepnigxercin hsresnyieiyvpitt teiomnnsuip omfr eth aek.peatrs I swa gntinikh .M iuvAm whne I celeetds kseeptaar -- I inkht ym ilgco asw dwafle iveng het cicepfiss of het tapsien't .story

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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owH dlwou yuo wonk ahtt ti sti'n oowl sotresr is?esdea

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cienfuegos  FA 8102 :317 tilonihana fo orssep sdael to fluil-ek yossmpmt atht ssoprgre kilqucy to e,verf myrunlapo h,ermegrhoa smdiaitntsiei adn hsc,ok iwht gimagni ybsoipsl wsnihgo ndwedie mutsaeimidn +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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gnrdiccao ot wduorl phtvtyneryisiies sninieptoum si ude ot udts nad hatt saw osla na no.ipt..o.

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amarousis  os i'ts tildnefiey ustd tub eht pesiifcc teyp of usdt swa hte somt ortapmnti ni hsit .siunoqte teh ctaf atht eyth motnednie eth dsrbi si ain.tortpm hte dsytu oskob dulwo ecaus it tub the brid udts is rmoe arnipmtot -.- +
charcot_bouchard  vtesrpeiytiHnsiy inusmoeitPn - icgOnar tsud lei(k yolmd unioise am)Phcnosy - onagnrIic usn ndtoe hlpe heer ohgthu becsaeu thob llwi trnesep wiht meas rcietsetriv lngu eiaedss r i.cieput nkiht senci utds in rabyilr etrna nherite cagionr ro gnainorci nda salo u ontd ese anym inribaarls htwi nlgu idsaees tub ibdr epinhwsor is cleaylipicfs niemtoend as eucas fo PH sdesa.ei +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I also aws iinhtngk M. auimv he,er tbu siphvtntiriyyees otnmuneisip smees to tfi whti het llnatuarrirgceou ca.hnegs

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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hwo od we owkn kparastee caues enstphyivreysi esnoipmiutn

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smc213  1AF8 .56p7 bdir &--trgexpeuo;s NHS osimniupnte ti(reevtrcis unlg ds)eseai nda A1F8 24p.1 oaumntsarlogu asied:sse engrifo retlm-;aN-H&iatgS spni.etiumon I hda ot akem esnes of it cneis I 'tdind nwok ti wsa SHN epstimnniou ta rtis.f +5


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 +0  upvote downvote
submitted by ∗breis(56)
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tPscaositsi ei(smetmos dallce shoorstiin or aprort edaisse or otarpr vre)ef is an ieinnfoct fo the nlug (onmuai)pne uedsac by the cibreatmu ilmplCadhyoah a)Cyiah(dlm attipci.s

insSg nad ef:g pyvthsrmesm,o.uco lulaysu twhtuio much .eep e ue dah.hmsmahr.lscgcahl shaceste.ch osrsne.tnsahpi of a. brehstoer htt.rao

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charcot_bouchard  edaptU on ym rvep meoctnm : eYs tish si iisctaost.sp ton ysntheeprsiytvii tmi.sniuenop owH do u w?nok hymeLcptyo nad eeencsrP of nouralGma - penorses to niatllrearucl lyhmc a.oNidaw SH can aols esuca sooel umlgoaanr oto dna the clliainc prcutei sillt rmoe loko ilek YSHou owkn hawt ......... fukc hist ueqs +2
shemle  eeHr P.t tedosn' evah efv!re +9
shakakaka  ignsaNtoanec nlargaoum, thaycp moyyhtlipcc iaftotin,ilnr dna iribsfos ear esen in yHipveititsyners tnnuoiipmse , aicgndrco to rUldwo . +

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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