NBME CBSE REAL EXAM 200 QUESTIONS AND ANSWERS LATEST
2023-2024 (usmle step 1)MEDICAL EXAMINATION
Type II pneumocystis - answers surfactant (*lecithin*)
Proliferate after injury
Type I progenitors
*Neonatal Respiratory Distress Syndrome*
Polio live v killed vaccine - answersKilled = Salk = IgG
Live = Sabin = IgG + IgA
- can be shed in feces
Neonatal Respiratory Distress:
Etiology + TX - answersMaternal DM (*high insulin*)
or C-section (*low cortisol*)
TX: *dexamethasone* before birth
Lung maturity determined with - answersAmniocentesis of Phospholipids (*type II
pneumocytes)
L >> S
Type I pneumocytes - answersSquamous gas diffusion
Elastase in lungs - answersmacrophage: *lysosomes*
PMN: *azuronphilic granules*
Elastin stretches and recoils due to - answersLysine interchain crosslinks
air pressure and
intrapleural pressure at FRC - answersAir pressure = 0
Intrapleural pressure = -5
Pulm Vasc Resistance is lowest during - answersExhale of Tidal Volume
Lung Compliance is decreased by - answersLHF, pulmonary edema,
pulmonary fibrosis
Lung Compliance is increased by - answersemphysema, age
Obesity affects ERV and FRC - answersDECREASE
ERV & FRC
Blood flow/min (pulmonary v systemic) - answerspulmonary = systemic
Anatomic pulmonary shunting - answersBronchial circulation causes
,*decreased PO2 in LA/LV*
than in pulmonary capillaries
More ventilation is at the - answersBASE
O2-Hgb dissociation LEFT shift - answersbasic, cold, low 2,3 BPG
low pO2 (compensatory erythrocytosis)
O2-Hgb dissociation RIGHT shift - answerslow pH, high 2,3BPG, high T
HOT, ACIDIC
CO2 transport to lungs - answers*carbonic anhydrase*
Cl shift
*Haldane*: CO2 released to lung
(*Bohr*: O2 release to tissue)
CO poisoning causes - answerscarboxyhemoglobin
no affect on PaO2
Cyanide poisoning causes - answerslactic acidosis
How to treat cyanide poisoning - answers*Amyl nitrite* --> Methemoglobin
THEN *Thiosulfate* (hydroxycobalamin)
Normal A-a gradient - answers5-15
Hypoventilation: Heroin OD or high altitude
Increased A-a gradient - answers*Diffusion impairment* (fibrosis)
*R-L shunt* (aspiration, ARDS)
*V/Q mismatch* (pulmonary edema
AT --> AT II
where and how - answersACE
(- high in sarcoidosis)
In small pulmonary bV
C5a induces what - answersPMN influx (ie: in lungs)
Korotkoff sound - answersBP cuff - appear and disappear
in inflation/deflation
Pulsus Paradoxus - answers10mmHg difference in
Korotkoff sound
Pulsus Paradoxus occurs in - answersCardiac Tamponade
,Kussmaul sign - answersJVP rises *during inspiration*
Constrictive Pericardiditis
Restrictive/Interstitial Lung Disease:
A-a, FVC, FEV1, EFR - answersAirway widening due to *radial traction* from fibrosis
*increase Aa*
decreased FVC & FEV1
*Increased EFR*
Sarcoidosis - answers*Th1 *noncaseating granulmona
bilateral hilar adenopathy
increased *ACE*
increased IL2, IFNg
1-a-hydroxylase in macrophages: vit D --> *HyperCa*
Hyper Ca causes - answersstones, thrones, groans, psych overtones
1-a-hydroxylase in macrophages - answersPTH independent conversion of
Calcifediol to *calcitriol* (bioactive Vit D)
Vit D --> Hyper Ca
Idiopathic pulmonary fibrosis - answers*Honeycomb* pattern
loss of Type 1 pneumocytes
*hyperplasia Type II* pneumocytes
Goodpasture - answersHS II
Auto-Ab against BM destroys lung alveoli (*restrictive*) and renal glomeruli
Obstructive Lung Disease - answersDECREASED FEV1, Decreased FVC
increased RV, FRC, TLC
**different shape
COPD - answersPMN, mo, CD8
*V/Q mismatch:* O2 induced hypercapnia;
physio dead space
Myeloperoxidase causes - answersGreen sputum/pus
Do not give O2 supplement to - answersCOPD patient
Decreased stimulation of
*carotid bodies* = decreased RR
TX COPD with - answers*Fluticasone* (glucocorticoid)
, inhibit cellular reaction
a1-antitrypsin deficiency - answersSerine protease inhibitor
*LIVER*
*LUNG*: inc PMN elastase --> emphysema
Asthma dx - answers*Methacholine* (maCh) challenge
= induce bronchoconstriction
to reduce FEV1
+ test = Airways ARE reactive
B2 agonist MOA - answersB2 (Gs) --> AC --> increase *cAMP*
Corticosteroid MOA - answersinhibit cytokine synthesis
suppress T lymphocyte
mACh Antagonist ("tropium") MOA - answers*inhibit Vagal* via ACh
--> decreased Ca
OSA causes - answerspulmonary HTN and RHF
increases EPO which worsens HTN
EPO can do what
on Cardiovascular - answersworsen HTN
Pulmonary Arterial HTN - answers*BMPR2*
High *endothelin*, Low NO
SMC hypertophy, fibrosis, narrow lumen
*P2 louder* than A2
When is P2 louder than A2 - answersPulmonary Artherial Hypertension
TX pulmonary arterial hypertension - answersEndothelin-R antagonist:
- Bo*sentan*, Ambi*sentan*
PGEi (inc cGMP):
- Silden*afil*
Pulmonary Embolism - answers*perfusion defect* (V/Q mismatch)
sudden SOB + calf swelling
Hypoxemia --> *Hyperventilate *
--> *Respiratory Alkalosis *
--> Metabolic compensation in 2 days
dx pulmonary embolism - answers*D-dimer* test
CT angiogram
2023-2024 (usmle step 1)MEDICAL EXAMINATION
Type II pneumocystis - answers surfactant (*lecithin*)
Proliferate after injury
Type I progenitors
*Neonatal Respiratory Distress Syndrome*
Polio live v killed vaccine - answersKilled = Salk = IgG
Live = Sabin = IgG + IgA
- can be shed in feces
Neonatal Respiratory Distress:
Etiology + TX - answersMaternal DM (*high insulin*)
or C-section (*low cortisol*)
TX: *dexamethasone* before birth
Lung maturity determined with - answersAmniocentesis of Phospholipids (*type II
pneumocytes)
L >> S
Type I pneumocytes - answersSquamous gas diffusion
Elastase in lungs - answersmacrophage: *lysosomes*
PMN: *azuronphilic granules*
Elastin stretches and recoils due to - answersLysine interchain crosslinks
air pressure and
intrapleural pressure at FRC - answersAir pressure = 0
Intrapleural pressure = -5
Pulm Vasc Resistance is lowest during - answersExhale of Tidal Volume
Lung Compliance is decreased by - answersLHF, pulmonary edema,
pulmonary fibrosis
Lung Compliance is increased by - answersemphysema, age
Obesity affects ERV and FRC - answersDECREASE
ERV & FRC
Blood flow/min (pulmonary v systemic) - answerspulmonary = systemic
Anatomic pulmonary shunting - answersBronchial circulation causes
,*decreased PO2 in LA/LV*
than in pulmonary capillaries
More ventilation is at the - answersBASE
O2-Hgb dissociation LEFT shift - answersbasic, cold, low 2,3 BPG
low pO2 (compensatory erythrocytosis)
O2-Hgb dissociation RIGHT shift - answerslow pH, high 2,3BPG, high T
HOT, ACIDIC
CO2 transport to lungs - answers*carbonic anhydrase*
Cl shift
*Haldane*: CO2 released to lung
(*Bohr*: O2 release to tissue)
CO poisoning causes - answerscarboxyhemoglobin
no affect on PaO2
Cyanide poisoning causes - answerslactic acidosis
How to treat cyanide poisoning - answers*Amyl nitrite* --> Methemoglobin
THEN *Thiosulfate* (hydroxycobalamin)
Normal A-a gradient - answers5-15
Hypoventilation: Heroin OD or high altitude
Increased A-a gradient - answers*Diffusion impairment* (fibrosis)
*R-L shunt* (aspiration, ARDS)
*V/Q mismatch* (pulmonary edema
AT --> AT II
where and how - answersACE
(- high in sarcoidosis)
In small pulmonary bV
C5a induces what - answersPMN influx (ie: in lungs)
Korotkoff sound - answersBP cuff - appear and disappear
in inflation/deflation
Pulsus Paradoxus - answers10mmHg difference in
Korotkoff sound
Pulsus Paradoxus occurs in - answersCardiac Tamponade
,Kussmaul sign - answersJVP rises *during inspiration*
Constrictive Pericardiditis
Restrictive/Interstitial Lung Disease:
A-a, FVC, FEV1, EFR - answersAirway widening due to *radial traction* from fibrosis
*increase Aa*
decreased FVC & FEV1
*Increased EFR*
Sarcoidosis - answers*Th1 *noncaseating granulmona
bilateral hilar adenopathy
increased *ACE*
increased IL2, IFNg
1-a-hydroxylase in macrophages: vit D --> *HyperCa*
Hyper Ca causes - answersstones, thrones, groans, psych overtones
1-a-hydroxylase in macrophages - answersPTH independent conversion of
Calcifediol to *calcitriol* (bioactive Vit D)
Vit D --> Hyper Ca
Idiopathic pulmonary fibrosis - answers*Honeycomb* pattern
loss of Type 1 pneumocytes
*hyperplasia Type II* pneumocytes
Goodpasture - answersHS II
Auto-Ab against BM destroys lung alveoli (*restrictive*) and renal glomeruli
Obstructive Lung Disease - answersDECREASED FEV1, Decreased FVC
increased RV, FRC, TLC
**different shape
COPD - answersPMN, mo, CD8
*V/Q mismatch:* O2 induced hypercapnia;
physio dead space
Myeloperoxidase causes - answersGreen sputum/pus
Do not give O2 supplement to - answersCOPD patient
Decreased stimulation of
*carotid bodies* = decreased RR
TX COPD with - answers*Fluticasone* (glucocorticoid)
, inhibit cellular reaction
a1-antitrypsin deficiency - answersSerine protease inhibitor
*LIVER*
*LUNG*: inc PMN elastase --> emphysema
Asthma dx - answers*Methacholine* (maCh) challenge
= induce bronchoconstriction
to reduce FEV1
+ test = Airways ARE reactive
B2 agonist MOA - answersB2 (Gs) --> AC --> increase *cAMP*
Corticosteroid MOA - answersinhibit cytokine synthesis
suppress T lymphocyte
mACh Antagonist ("tropium") MOA - answers*inhibit Vagal* via ACh
--> decreased Ca
OSA causes - answerspulmonary HTN and RHF
increases EPO which worsens HTN
EPO can do what
on Cardiovascular - answersworsen HTN
Pulmonary Arterial HTN - answers*BMPR2*
High *endothelin*, Low NO
SMC hypertophy, fibrosis, narrow lumen
*P2 louder* than A2
When is P2 louder than A2 - answersPulmonary Artherial Hypertension
TX pulmonary arterial hypertension - answersEndothelin-R antagonist:
- Bo*sentan*, Ambi*sentan*
PGEi (inc cGMP):
- Silden*afil*
Pulmonary Embolism - answers*perfusion defect* (V/Q mismatch)
sudden SOB + calf swelling
Hypoxemia --> *Hyperventilate *
--> *Respiratory Alkalosis *
--> Metabolic compensation in 2 days
dx pulmonary embolism - answers*D-dimer* test
CT angiogram
