NBME CBSE Actual exam
COMPREHENSIVE QUESTIONS AND
VERIFIED ANSWERS 2026(GRADED A+)
DETAILED ANSWERS!!
Type II pneumocytes - Answer-surfactant (*lecithin*)
Proliferate after injury
Type I progenitors
*Neonatal Respiratory Distress Syndrome*
Polio live v killed vaccine - Answer-Killed = Salk = IgG
Live = Sabin = IgG + IgA
- can be shed in feces
Neonatal Respiratory Distress:
Etiology + Tx - Answer-Maternal DM (*high insulin*)
or C-section (*low cortisol*)
TX: *dexamethasone* before birth
Lung maturity determined with - Answer-Amniocentesis of
Phospholipids (*type II pneumocytes)
L >> S
Do not give O2 supplement to - Answer-COPD patient
Decreased stimulation of
*carotid bodies* = decreased RR
TX COPD with - Answer-*Fluticasone* (glucocorticoid)
inhibit cellular reaction
a1-antitrypsin deficiency - Answer-Serine protease inhibitor
*LIVER*
*LUNG*: inc PMN elastase --> emphysema
,Asthma dx - Answer-*Methacholine* (maCh) challenge
= induce bronchoconstriction
to reduce FEV1
+ test = Airways ARE reactive
B2 agonist MOA - Answer-B2 (Gs) --> AC --> increase *cAMP*
Corticosteroid MOA - Answer-inhibit cytokine synthesis
suppress T lymphocyte
mACh Antagonist ("tropium") MOA - Answer-*inhibit Vagal* via ACh
--> decreased Ca
OSA causes - Answer-pulmonary HTN and RHF
increases EPO which worsens HTN
EPO can do what
on Cardiovascular - Answer-worsen HTN
Pulmonary Arterial HTN - Answer-*BMPR2*
High *endothelin*, Low NO
SMC hypertophy, fibrosis, narrow lumen
*P2 louder* than A2
When is P2 louder than A2 - Answer-Pulmonary Artherial Hypertension
TX pulmonary arterial hypertension - Answer-Endothelin-R antagonist:
- Bo*sentan*, Ambi*sentan*
PGEi (inc cGMP):
- Silden*afil*
Pulmonary Embolism - Answer-*perfusion defect* (V/Q mismatch)
sudden SOB + calf swelling
Hypoxemia --> *Hyperventilate *
--> *Respiratory Alkalosis *
--> Metabolic compensation in 2 days
dx pulmonary embolism - Answer-*D-dimer* test
CT angiogram
,Lines of Zahn
*Homan's sign* (DVT calf pain on dorsiflex)
TX pulmonary embolism - Answer-Heparin/LMWH
THEN
Warfarin
Fat embolism syndrome - Answer-Long bone/pelvic fracture
--> neuro, hypoxemia, rash
Fat microglobules in *pulmonary arterioles*
Spontaenous pneumothorax - Answer-nontraumatic* rupture of
subpleural blebs*
**20 yo thin TALL man who smokes
*DECREASED PRELOAD*
Tension pneumothorax - Answer-Treachea deviates
REQUIRES INTUBATION
ARDS - Answer-bilateral infiltrate
**PANCREATITIS RISK
1. *EXUDATIVE* (capillary permeability)
2. *Proliferative* (collagen)
3. *Fibrotic* (pulmonary fiborsis + HTN)
What are the risks from ARDS - Answer-Sepsis
Pancreatitis
Pneumo
cystic fibrosis genetics - Answer-*dF508 frameshift*
CFT protein - post-tln
HypoNa
Cystic Fibrosis complications - Answer-Dec *Vit A* --> Pancreatic
(squamous metaplasia)
Def *Vit E* --> Neuromuscular, hemolytic anemia
Def *Vit K *--> Intracranial hemorrhage
Meconium Ileus; No Vas deferns; Digital clubbing
DEATH FROM PNEUMO
, Hemorrhagic infarct is what color and why - Answer-RED
Dual blood supply
Empyema - Answer-Infected *exudative* pleural effusion
Meniscus opacity
Increased LDH
COMPLICATES PNEUMO
Lobar pneumonia - Answer-*consolidation*
Ex: strep, legionella
--> Red (3-4 d)
--> Grey hepatization (5-7d)
--> Resolution (*Type II regen* in 8 d)
Broncho Pneumonia - Answer-*Patchy*
ex: Staph, Strep, Kleb, H flu
Interstitial Pneumonia - Answer-Alveolar walls
Ex: Mycoplasma, Chlamydia,
Legionella,
RSV/CMV/flu/adeno
Tuberculosis - Answer-Th1: IFNg --> activates
Macrophage (CD14): TNF-a
Lung Harmatoma - Answer-hyaline cartilage, fat, SMC
lined by respiratory
pneumoepithelium
Pancoast syndrome - Answer-*NSCLC* at lung apex (superior sulcus)
compression of *brachial plexus *
--> Shoulder pain, *Horner, *
Upper edema, paraplegia
Asbestos #1 cancer - Answer-Bronchiogenic carcinoma
(Adenocarcinoma in situ)
Asbestos change in lung - Answer-*pleural thickening, calcifications* of
posterolateral midlung and diaphragm
COMPREHENSIVE QUESTIONS AND
VERIFIED ANSWERS 2026(GRADED A+)
DETAILED ANSWERS!!
Type II pneumocytes - Answer-surfactant (*lecithin*)
Proliferate after injury
Type I progenitors
*Neonatal Respiratory Distress Syndrome*
Polio live v killed vaccine - Answer-Killed = Salk = IgG
Live = Sabin = IgG + IgA
- can be shed in feces
Neonatal Respiratory Distress:
Etiology + Tx - Answer-Maternal DM (*high insulin*)
or C-section (*low cortisol*)
TX: *dexamethasone* before birth
Lung maturity determined with - Answer-Amniocentesis of
Phospholipids (*type II pneumocytes)
L >> S
Do not give O2 supplement to - Answer-COPD patient
Decreased stimulation of
*carotid bodies* = decreased RR
TX COPD with - Answer-*Fluticasone* (glucocorticoid)
inhibit cellular reaction
a1-antitrypsin deficiency - Answer-Serine protease inhibitor
*LIVER*
*LUNG*: inc PMN elastase --> emphysema
,Asthma dx - Answer-*Methacholine* (maCh) challenge
= induce bronchoconstriction
to reduce FEV1
+ test = Airways ARE reactive
B2 agonist MOA - Answer-B2 (Gs) --> AC --> increase *cAMP*
Corticosteroid MOA - Answer-inhibit cytokine synthesis
suppress T lymphocyte
mACh Antagonist ("tropium") MOA - Answer-*inhibit Vagal* via ACh
--> decreased Ca
OSA causes - Answer-pulmonary HTN and RHF
increases EPO which worsens HTN
EPO can do what
on Cardiovascular - Answer-worsen HTN
Pulmonary Arterial HTN - Answer-*BMPR2*
High *endothelin*, Low NO
SMC hypertophy, fibrosis, narrow lumen
*P2 louder* than A2
When is P2 louder than A2 - Answer-Pulmonary Artherial Hypertension
TX pulmonary arterial hypertension - Answer-Endothelin-R antagonist:
- Bo*sentan*, Ambi*sentan*
PGEi (inc cGMP):
- Silden*afil*
Pulmonary Embolism - Answer-*perfusion defect* (V/Q mismatch)
sudden SOB + calf swelling
Hypoxemia --> *Hyperventilate *
--> *Respiratory Alkalosis *
--> Metabolic compensation in 2 days
dx pulmonary embolism - Answer-*D-dimer* test
CT angiogram
,Lines of Zahn
*Homan's sign* (DVT calf pain on dorsiflex)
TX pulmonary embolism - Answer-Heparin/LMWH
THEN
Warfarin
Fat embolism syndrome - Answer-Long bone/pelvic fracture
--> neuro, hypoxemia, rash
Fat microglobules in *pulmonary arterioles*
Spontaenous pneumothorax - Answer-nontraumatic* rupture of
subpleural blebs*
**20 yo thin TALL man who smokes
*DECREASED PRELOAD*
Tension pneumothorax - Answer-Treachea deviates
REQUIRES INTUBATION
ARDS - Answer-bilateral infiltrate
**PANCREATITIS RISK
1. *EXUDATIVE* (capillary permeability)
2. *Proliferative* (collagen)
3. *Fibrotic* (pulmonary fiborsis + HTN)
What are the risks from ARDS - Answer-Sepsis
Pancreatitis
Pneumo
cystic fibrosis genetics - Answer-*dF508 frameshift*
CFT protein - post-tln
HypoNa
Cystic Fibrosis complications - Answer-Dec *Vit A* --> Pancreatic
(squamous metaplasia)
Def *Vit E* --> Neuromuscular, hemolytic anemia
Def *Vit K *--> Intracranial hemorrhage
Meconium Ileus; No Vas deferns; Digital clubbing
DEATH FROM PNEUMO
, Hemorrhagic infarct is what color and why - Answer-RED
Dual blood supply
Empyema - Answer-Infected *exudative* pleural effusion
Meniscus opacity
Increased LDH
COMPLICATES PNEUMO
Lobar pneumonia - Answer-*consolidation*
Ex: strep, legionella
--> Red (3-4 d)
--> Grey hepatization (5-7d)
--> Resolution (*Type II regen* in 8 d)
Broncho Pneumonia - Answer-*Patchy*
ex: Staph, Strep, Kleb, H flu
Interstitial Pneumonia - Answer-Alveolar walls
Ex: Mycoplasma, Chlamydia,
Legionella,
RSV/CMV/flu/adeno
Tuberculosis - Answer-Th1: IFNg --> activates
Macrophage (CD14): TNF-a
Lung Harmatoma - Answer-hyaline cartilage, fat, SMC
lined by respiratory
pneumoepithelium
Pancoast syndrome - Answer-*NSCLC* at lung apex (superior sulcus)
compression of *brachial plexus *
--> Shoulder pain, *Horner, *
Upper edema, paraplegia
Asbestos #1 cancer - Answer-Bronchiogenic carcinoma
(Adenocarcinoma in situ)
Asbestos change in lung - Answer-*pleural thickening, calcifications* of
posterolateral midlung and diaphragm
