NBME CBSE REAL EXAM 200 QUESTIONS AND
ANSWERS LATEST (usmle step 1)MEDICAL
EXAMINATION
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 *
--> 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
ANSWERS LATEST (usmle step 1)MEDICAL
EXAMINATION
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 *
--> 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
