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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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gaPe 2 hsa a raegt ruiecpt

:twiocrd.-l39l/(17S)p/-tan0ire1n4s1/./0wet98fwagic6p6j20/6oh

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kamilia20  pyohdcaimllah t?ac?iptsi +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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iHviinsstyeyretp pi—nmdiuemneisxot ptey IIIVI/ piyiesnhteiyrvts toicnrea ot eortmavenlnin taeg.nin uCases a,pnseyd ohcu,g hcste nht,sgtesi haeahec.d Oneft eens ni rmrasfe adn eosth eexdpso to brsd.i esrievlReb ni yaelr tgsaes if luuisstm si .aeiodvd

sI't a epyt of rittevirecs nlug dsesa.ie

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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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hyW hte trheo wrensa ihccose 'taern rtroecc

A - oNt na pcalacinahyt roeacnit iynlam ued to rnihccitoy (nnicotsmupo fo yso, hcwih ash yscotlneigrop atht epopel amy veha ieegsallr )ratdsow

B - tNo mstaha iced(caarehzrt yb orem eutca iesoepds of ncsncbttrhooo,nirioc ewen)zhig

D - inaeAm B,(6 B,9 ,B)21 or maybe a mnorlpyau mebolims eud ot 9B or 2B1 iifcyeendc t--;&g aleetedv eotcesnhoymi evlels -g&;t- mhotossibr g;t-&- ?DVT

E - olnaPrymu x;hntraa Teh eimt scuero uldwo eb hcum rmoe teca,u nda lduow slao tprsene tihw sopymstm fo llufke-i .ommsytsp Rapid htdae too

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 +3  upvote downvote
submitted by ∗monoloco(155)
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iTsh ttenpai si cerinxiepgne iptresnyveyhsiti iiomnutpesn form eth easeprakt. I saw kthignin .M vumAi enwh I ecedselt sraetekap -- I ntkih ym loigc saw afdwle vgnie het spfccisie of het itsaetp'n .sryot

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 +1  upvote downvote
submitted by ∗imnotarobotbut(184)
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oHw owlud ouy onkw taht it st'in wloo serrsot sdaeie?s

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cienfuegos  FA 1028 73:1 iahoalnnit fo sepsor delsa to ek-lulif moytpssm ttha gersorsp lckyiqu ot rvee,f mupnyaolr rmheh,rogea dsimtanteisii dan ckoh,s thwi iaggmin ospsblyi gwisnoh nedwied amtusiedmni +10


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 +0  upvote downvote
submitted by ∗endochondral1(24)
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codaigcrn to rulodw vesythiiietnpyrs monitnusipe si due ot sdtu adn thta saw oasl an p.io.n.to.

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amarousis  so i'st eidftyenil tsdu ubt eht ccfseiip pety fo stud swa teh tmos ompnitatr ni htsi o.qsueitn the actf hatt teyh edimonnte teh rdibs is pao.trntim hte utdsy bosok odlwu useca ti but the ibrd tdsu si eorm ntmtiorap --. +
charcot_bouchard  ytvssHeyitperiin nPmniioestu - rOiancg dsut lei(k dyolm eimoo)isnayh cPnus - cIagrnnoi ndtensou plhe ehre gouhht scaeeub tobh will rseepnt hwti same vieitcstrre lgun asdseie uci.t eirp nkhti nicse stdu in riylabr rtean rieehtn oagricn ro aniinocgr dan alos u tndo ese naym rabrnsilai hwti ungl eeasisd but bdir enhiswopr is ilcpyfsecali itnemneod as aecsu of HP .esaised +


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 +0  upvote downvote
submitted by ∗beeip(141)
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I salo saw hknntiig M. auimv heer, tub shvttepiyrsiniye topueinnims semes to tif ihtw het lrrgcnaaueuiltro anhs.ecg

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 +0  upvote downvote
submitted by ∗endochondral1(24)
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hwo do ew onkw etapekasr esauc sripvsehnyiyet neiimnpusot

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smc213  8A1F 5.6p7 bidr prtso--;&geexu NHS ponieinmstu ercve(itsirt lngu d)esiaes dan A18F .2p14 sltoaoumugnar as:essdie eiforng &i-rmt;gNltae-SHa npsum.tenioi I dha to eamk sesen of it ciesn I ndd'it owkn it aws NHS tponniiemsu ta is.tfr +5


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 +0  upvote downvote
submitted by ∗breis(56)
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toissscitPa msm(ieoest llcdea thissirono ro prraot iesseda ro aotrpr evf)re is na eonntcifi fo eth gunl n(iuonmp)ae ucsdae by teh mctrbaeui hlhdioaaypCml )amylh(diaC tctsa.ipi

Ssing nad hcm: ygsfro.se,ovtue pm lluaysu ttoihwu mhcu cmrhahe hsl.ae d .pmgesu.echal hhs.sccate e epaihnrsotsn. s fo srr.ato eehb th.oart

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charcot_bouchard  tpedaU no my ervp enctmmo : seY tshi is csiatpioss.t ont yitetervpysiihsn nmointpeu.si owH od u nw?ok emhytyLcpo nad Pecsenre fo onGmlarua - sonepres ot rcuanltelliar a.oilhcdayNm w SH nca osla aucse oosel gurmoanal oot adn the alclciin epurtic litls mreo look ilke u oYSH onkw ahtw ......... fkuc hsit sueq +2
shemle  ereH t.P 'ndseto ehav eref!v +9
shakakaka  antiegaNocns ,orgnamlau tachpy cyciolpmyht lin,titafnoir nda firsbsio ear eesn ni eevypsitHisyrnti pnemnuiotsi , ogradcnic to Urdowl . +

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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