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:
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:
