NBME CBSE REAL EXAM QUESTIONS AND ANSWERS LATEST 2025

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 * --> 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