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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 has a rgtea rticpeu

e.r/1-lgtcn7iwt0ho6p)149iol0a/s931/c.j-dn/pf60:aSei28/(w6wtr

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kamilia20  amchhpoldilay ips?t?ctia +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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tpitvreniiseyyHs tx—mpseinuioimedn ypte I/IIIV pyhyssvteniitrei iocaertn to rmalitevnnneo ngn.taei eCuass a,sdnepy ,ouchg chste estghnt,si eae.adchh Ofnet nees ni rsfmrae nad ohste sedeoxp ot rsd.ib Rbileeervs in raely gasest fi lmuiutss si iva.oedd

Its' a etpy of evrcritiset lgun saeeid.s

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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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hWy the oehrt nrawse ehsocic 'eartn trecocr

A - oNt na aacctilhnapy croinate myalin edu to oycncihtir i(nscmuotpon fo ,osy hhwci hsa rstgoplncoyei htta ppeole mya vaeh eeigllsar tsroa)dw

B - otN atsmah tecacezia(rrhd by orme aucet spiodsee fo t,itrocoocncohnibrsn ewenh)zig

D - nmieAa B6(, ,B9 )B12, ro beyam a plunoryam ibmoemsl edu ot B9 or 2B1 eeincdycfi &-t-g; edletvae sctimoeeynoh levsle -t&;g- omthsribso g&t--; VD?T

E - aymonPrlu ;arxahtn hTe emit rueocs odlwu be hcmu emro tcea,u dna wudlo aosl snetpre iwht mossypmt of iulfel-k posmtsym. iapRd htdae oot

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 +3  upvote downvote
submitted by ∗monoloco(155)
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hTis aneitpt si nirxpieeecgn tsneiyrviestyhip ntuoisnimep omfr eth srpkteaae. I saw hnkgitni M. imvuA newh I ectedlse krpaeetsa -- I tkinh my cgilo asw wdlefa nvige teh ciipsfesc fo teh tn'eatisp otrys.

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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oHw wduol yuo kown atth it nits' olwo eostrsr ?iaedess

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cienfuegos  FA 8102 13:7 niahonatil of opessr dales ot uelikl-f tssmmpoy atht sperrgos ykqiluc to ferev, lyrunaomp eohrmherga, diistseitnaim and khs,oc twhi mganigi ybopssli nwhgios wdeeind midteiumnsa +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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idangrcco to wodlru iehiyttvreinpssy upesnnimtio is eud ot sutd adn atht was losa an tnp.oio...

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amarousis  so s'ti deeyntlfii tsdu tbu teh csiiepcf eytp of usdt swa hte omts pmnriatto in sith ntqe.uiso eth atfc ahtt yhte ntienedom eht dsbir is noimtrp.ta teh stuyd obkso uwold ausce it btu hte irdb duts is mero nattprmio --. +
charcot_bouchard  yiirtHetyvissenp nmsntiioePu - giracOn tsdu lik(e ylodm ncPuesyihaoosm ni) - giracnIno etsdn oun ephl erhe ghouth ecaesbu hobt will setprne ihwt asem evittirrcse lugn ssdieea i. ceitupr ktnhi escin tdus in byairrl eartn ehntier aiorgcn or rcnoginai dan lsoa u ndto ees myan sabiarlrin hwti gnlu ssdaeie utb drbi eipowhsrn si clpflaciysei menondite sa sauce fo PH dseea.si +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I also saw thnkgini .M mivua ,eehr tbu tievsnrtiseiyphy tnospiuiemn sseme to ift wthi teh irulaerluocgntra ca.gsneh

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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how od ew nokw terkeaspa cusea eethvynrpisyis umsetpnnioi

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smc213  AF18 7p5.6 dbri --;stg&opuxeer HNS ntsinpmeuoi ir(ervttcsei guln ssea)eid nad 8AF1 .14p2 arugoamlnotus :edasesis eroifgn tt;igNmea-a&SHl-r topnni.mseui I hda to kame esnse of it isnec I 'idtnd wkno it asw HSN mstienipuno ta sfit.r +5


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 +0  upvote downvote
submitted by ∗breis(56)
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sotPsisatic eiemsms(ot cldlea shonirotis or orprat esedsai ro trparo efrve) si an onnicfeit of eht nulg on)muap(nie aeudcs by eht aeucmirtb lpayimaohChld mhd)Ca(alyi .pitatcis

iSgsn and grmtcp.hy suf:moosee ,v lauusly uhwitot uchm rug..hshaaheeheleclmmcps da. hc shte.aces nhartis o.sspen fo oberas et.hr hor.tat

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charcot_bouchard  Utaepd on my vpre nocemtm : eYs tsih is sp.scatiotsi nto iysshipievettyrn ntuiosnipme. Hwo do u ?onwk ptecyomyLh dan rcPnseee fo olmunaraG - esonpser to llrtlcruaeina aNy mcdhawo.il SH can salo uasec eolos anlmaougr oto nad eht iccailln uepcrti llist orme kool eilk So HuY wkon twha ......... cukf tish eqsu +2
shemle  erHe .tP 'stodne have ervf!e +9
shakakaka  Nsatnaenoicg lunogaarm, hyctpa ymolcyiphtc nliat,iinroft adn sfsborii ear seen ni ysvyesHpieittrin suinnmotiep , cnigrdaco ot lrodUw . +

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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