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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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Pgea 2 ahs a rgeta prceuti

h-i1nsd0r/9cS76-le:9t1fo)6aatiwpj20p18eoctrwl0./g/4/i3.w/6n(

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kamilia20  olamhypdlhcai siptit??ca +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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espsnityeyitrviH eouenixsidip—mtnm ytpe IVI/II ehetyypsirtivsni tcienrao ot tleoneirvnnam nteina.g uassCe y,epdasn ,ocugh scteh ttssgn,ihe caee.dhah netfO esne ni safmrre nad hstoe sexdpeo ot di.bsr beserilRve ni eaylr stgsea fi tulumsis si voeda.di

sIt' a epty fo tivreescirt lgnu ees.dais

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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 eth thore rasenw seihcco 'terna ecrtocr

A - Nto na hipacclnyaat centorai liymna edu ot iohniyrcct sotnu(omnpci fo oys, whhci sha nctyoielrgops that eplpeo aym veha ellegrsia )wrosdat

B - Nto staahm r(zcceadreatih yb eomr ecuat sieedspo fo ctc,nooisrohnobrtcni wgehn)eiz

D - iAamne ,6(B 9B, ),2B1 ro abmey a mpayronlu msmbileo edu ot 9B ro 12B edicinfyce g&-;-t veeeltda etonoichemsy elvesl -t-&;g boormhists tg-;&- DVT?

E - ramunoPly rtn;xaah heT tmie sueroc dlwuo eb humc rome utc,ae and owldu osla esprten hwit ypmmsost of -luekfil sms.ymotp dRpai dhate oto

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 +3  upvote downvote
submitted by ∗monoloco(155)
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hTsi ettipan is cnixeirpeeng ypnershveysiitit nopuimeitns mrof hte es.arkaept I swa ntikhing M. Auivm whne I tdeleesc rptaeesak -- I knhti ym cgoli asw edfwal gveni eht psescifci fo teh a'tspinte sy.ort

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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woH dlouw you kwon htat it 'snti oolw rorsest ?dsaiees

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cienfuegos  AF 0218 71:3 laitnnoahi of sprsoe sdela to lk-liuef tmposmsy thta rogserps cyuliqk to rfe,ve opumrnaly egaheo,mrrh iisintsadetmi dan o,hkcs thiw miiggna pblisoys oingswh eedwidn dmaitniemus +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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rgdncaico ot luodrw spiyihneesitryvt innsutpieom is eud to utds and tath asw laso na n..pi.o.ot

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amarousis  os s'ti ytefindeli tsdu but hte fseicpci tpye of dstu wsa eht tsom tropinatm in iths soune.tiq teh atfc taht yeth emoeinntd the isdrb si .notipmtra hte utysd kosob wloud ueacs ti tbu the bdir sdut is orem tnpoirtma -.- +
charcot_bouchard  seivenyyriHsptit iusPmnnteio - niOgcar sudt ek(li mdyol syn)asuhiiPe nomoc - ngaciIrno e tnsudno phel eher thuhgo bsaeecu othb liwl petesrn hwti asem icriretetvs guln aeseids eutci.ip r tinhk nisec tdsu ni ryabrli ertan etrnhie agnroic ro nricoinga dan saol u ntdo ese amyn rabairnlis hwit guln essaied but dbri wrnoihpes is siycicafllpe ndeineomt sa caseu fo PH seasdie. +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I salo was htinngik M. mviua he,er tub ttseieiyrinsyhpv iptsmeunnio sseem to fti htwi hte rrualuirlactogen cgnseah.

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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ohw do we kown apeserakt suace hnievtipsyrsye oneptmniuis

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smc213  81AF 6p75. rdib &;teeruspgx--o NSH utmnipnisoe tctrrees(ivi lnug ae)sisde nad F18A 4p12. agnlmsuoturao sdssi:eae ieogfnr -l-tNerSat;&iaHmg esiunoinmt.p I dha ot akme nesse fo it nseci I ddin't nwok ti swa SHN iiuntnmpseo at fisrt. +5


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 +0  upvote downvote
submitted by ∗breis(56)
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Pssstaociti om(esimste edlalc iisoonsthr or tpoarr eeaidss ro rptrao er)evf is na tnneiofci of the gunl noe(a)mnuip uedacs by hte icrmeautb Cimapdoayhhll C)(dhylmaia c.aiitstp

Snsig dna me.o:, e scstufhvyprmgo aylluus oihuttw mhcu rhah uclepdgeac sm hsme..ahe.l e seahhctsc. ios .nrtehnpass of hrtreesb.oa otrh.ta

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charcot_bouchard  dptaUe no ym rvep entcomm : seY shit si .assiipcotst otn yiteypsisrntvieh ospmu.tnenii owH od u k?nwo cyypmethoL nda erenPsce fo mlranuoGa - snpeerso ot irulcalelntra amc.ydiwh oaNl HS cna sola saecu eloos ugornaaml oto nad hte ialnccli crieupt lilts ermo oolk ekli S HuYo onkw thwa ......... cufk hits qsue +2
shemle  Here P.t esnotd' aevh veerf! +9
shakakaka  neatsNaiocng ,aagornulm ptahyc mlhyoyciptc ifalitrt,onni adn osbfiris aer nsee in prsniettyieviHsy nieunmtipos , irdgocacn ot lwUrdo . +

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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