NBME CBSE REAL EXAM QUESTIONS AND ANSWERS
LATEST 2025
/.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
/.Type I pneumocytes - Answer-Squamous gas diffusion
/.Elastase in lungs - Answer-macrophage: *lysosomes*
PMN: *azuronphilic granules*
/.Elastin stretches and recoils due to - Answer-Lysine interchain crosslinks
/.air pressure and
intrapleural pressure at FRC - Answer-Air pressure = 0
Intrapleural pressure = -5
/.Pulm Vasc Resistance is lowest during - Answer-Exhale of Tidal Volume
/.Lung Compliance is decreased by - Answer-LHF, pulmonary edema,
pulmonary fibrosis
/.Lung Compliance is increased by - Answer-emphysema, age
/.Obesity affects ERV and FRC - Answer-DECREASE
ERV & FRC
,/.Blood flow/min (pulmonary v systemic) - Answer-pulmonary = systemic
/.Anatomic pulmonary shunting - Answer-Bronchial circulation causes
*decreased PO2 in LA/LV*
than in pulmonary capillaries
/.More ventilation is at the - Answer-BASE
/.O2-Hgb dissociation LEFT shift - Answer-basic, cold, low 2,3 BPG
low pO2 (compensatory erythrocytosis)
/.O2-Hgb dissociation RIGHT shift - Answer-low pH, high 2,3BPG, high T
HOT, ACIDIC
/.CO2 transport to lungs - Answer-*carbonic anhydrase*
Cl shift
*Haldane*: CO2 released to lung
(*Bohr*: O2 release to tissue)
/.CO poisoning causes - Answer-carboxyhemoglobin
no affect on PaO2
/.Cyanide poisoning causes - Answer-lactic acidosis
/.How to treat cyanide poisoning - Answer-*Amyl nitrite* --> Methemoglobin
THEN *Thiosulfate* (hydroxycobalamin)
/.Normal A-a gradient - Answer-5-15
Hypoventilation: Heroin OD or high altitude
/.Increased A-a gradient - Answer-*Diffusion impairment* (fibrosis)
*R-L shunt* (aspiration, ARDS)
*V/Q mismatch* (pulmonary edema
/.AT --> AT II
where and how - Answer-ACE
(- high in sarcoidosis)
In small pulmonary bV
/.C5a induces what - Answer-PMN influx (ie: in lungs)
/.Korotkoff sound - Answer-BP cuff - appear and disappear
in inflation/deflation
,/.Pulsus Paradoxus - Answer-10mmHg difference in
Korotkoff sound
/.Pulsus Paradoxus occurs in - Answer-Cardiac Tamponade
/.Kussmaul sign - Answer-JVP rises *during inspiration*
Constrictive Pericardiditis
/.Restrictive/Interstitial Lung Disease:
A-a, FVC, FEV1, EFR - Answer-Airway widening due to *radial traction* from fibrosis
*increase Aa*
decreased FVC & FEV1
*Increased EFR*
/.Sarcoidosis - Answer-*Th1 *noncaseating granulmona
bilateral hilar adenopathy
increased *ACE*
increased IL2, IFNg
1-a-hydroxylase in macrophages: vit D --> *HyperCa*
/.Hyper Ca causes - Answer-stones, thrones, groans, psych overtones
/.1-a-hydroxylase in macrophages - Answer-PTH independent conversion of
Calcifediol to *calcitriol* (bioactive Vit D)
Vit D --> Hyper Ca
/.Idiopathic pulmonary fibrosis - Answer-*Honeycomb* pattern
loss of Type 1 pneumocytes
*hyperplasia Type II* pneumocytes
/.Goodpasture - Answer-HS II
Auto-Ab against BM destroys lung alveoli (*restrictive*) and renal glomeruli
/.Obstructive Lung Disease - Answer-DECREASED FEV1, Decreased FVC
increased RV, FRC, TLC
**different shape
/.COPD - Answer-PMN, mo, CD8
*V/Q mismatch:* O2 induced hypercapnia;
physio dead space
/.Myeloperoxidase causes - Answer-Green sputum/pus
/.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 *
LATEST 2025
/.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
/.Type I pneumocytes - Answer-Squamous gas diffusion
/.Elastase in lungs - Answer-macrophage: *lysosomes*
PMN: *azuronphilic granules*
/.Elastin stretches and recoils due to - Answer-Lysine interchain crosslinks
/.air pressure and
intrapleural pressure at FRC - Answer-Air pressure = 0
Intrapleural pressure = -5
/.Pulm Vasc Resistance is lowest during - Answer-Exhale of Tidal Volume
/.Lung Compliance is decreased by - Answer-LHF, pulmonary edema,
pulmonary fibrosis
/.Lung Compliance is increased by - Answer-emphysema, age
/.Obesity affects ERV and FRC - Answer-DECREASE
ERV & FRC
,/.Blood flow/min (pulmonary v systemic) - Answer-pulmonary = systemic
/.Anatomic pulmonary shunting - Answer-Bronchial circulation causes
*decreased PO2 in LA/LV*
than in pulmonary capillaries
/.More ventilation is at the - Answer-BASE
/.O2-Hgb dissociation LEFT shift - Answer-basic, cold, low 2,3 BPG
low pO2 (compensatory erythrocytosis)
/.O2-Hgb dissociation RIGHT shift - Answer-low pH, high 2,3BPG, high T
HOT, ACIDIC
/.CO2 transport to lungs - Answer-*carbonic anhydrase*
Cl shift
*Haldane*: CO2 released to lung
(*Bohr*: O2 release to tissue)
/.CO poisoning causes - Answer-carboxyhemoglobin
no affect on PaO2
/.Cyanide poisoning causes - Answer-lactic acidosis
/.How to treat cyanide poisoning - Answer-*Amyl nitrite* --> Methemoglobin
THEN *Thiosulfate* (hydroxycobalamin)
/.Normal A-a gradient - Answer-5-15
Hypoventilation: Heroin OD or high altitude
/.Increased A-a gradient - Answer-*Diffusion impairment* (fibrosis)
*R-L shunt* (aspiration, ARDS)
*V/Q mismatch* (pulmonary edema
/.AT --> AT II
where and how - Answer-ACE
(- high in sarcoidosis)
In small pulmonary bV
/.C5a induces what - Answer-PMN influx (ie: in lungs)
/.Korotkoff sound - Answer-BP cuff - appear and disappear
in inflation/deflation
,/.Pulsus Paradoxus - Answer-10mmHg difference in
Korotkoff sound
/.Pulsus Paradoxus occurs in - Answer-Cardiac Tamponade
/.Kussmaul sign - Answer-JVP rises *during inspiration*
Constrictive Pericardiditis
/.Restrictive/Interstitial Lung Disease:
A-a, FVC, FEV1, EFR - Answer-Airway widening due to *radial traction* from fibrosis
*increase Aa*
decreased FVC & FEV1
*Increased EFR*
/.Sarcoidosis - Answer-*Th1 *noncaseating granulmona
bilateral hilar adenopathy
increased *ACE*
increased IL2, IFNg
1-a-hydroxylase in macrophages: vit D --> *HyperCa*
/.Hyper Ca causes - Answer-stones, thrones, groans, psych overtones
/.1-a-hydroxylase in macrophages - Answer-PTH independent conversion of
Calcifediol to *calcitriol* (bioactive Vit D)
Vit D --> Hyper Ca
/.Idiopathic pulmonary fibrosis - Answer-*Honeycomb* pattern
loss of Type 1 pneumocytes
*hyperplasia Type II* pneumocytes
/.Goodpasture - Answer-HS II
Auto-Ab against BM destroys lung alveoli (*restrictive*) and renal glomeruli
/.Obstructive Lung Disease - Answer-DECREASED FEV1, Decreased FVC
increased RV, FRC, TLC
**different shape
/.COPD - Answer-PMN, mo, CD8
*V/Q mismatch:* O2 induced hypercapnia;
physio dead space
/.Myeloperoxidase causes - Answer-Green sputum/pus
/.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 *
