NBME CBSE LATEST 2026 EXAM STUDY QUESTIONS AND
SOLUTIONS GUARANTEE A+
✔✔Vit B6 - ✔✔Pyridoxine
synthesis of heme, histamine, 5HT, Epi, NE, DA, GABA
*Transamination*
✔✔vit B6 deficiency - ✔✔*Pyroxidine*
peripheral neuropathy
seizure
sideroblastic anemia
✔✔vit b7 - ✔✔*Biotin*
pyruvate --> OAA
Acetyl coA --> malonyl coA
propionyl coA --> methylmanonyl coA
✔✔Vit B9 - ✔✔folate
synthesis of purine/pyrimidine
✔✔vit B9 deficiency - ✔✔*folate*
elevated homocysteine
megaloblastic anemia
glossitis
✔✔Vit b12 - ✔✔*cobalamin*
DNA synthesis
✔✔Vit B12 deficiency - ✔✔increased *homocysteine + MMA*
megaloblastic anemia
demyelination of *dorsal* (touch) +
*lateral corticospinal* (motor)
✔✔Respiratory Acidosis - ✔✔asthma
pneumonia
hypoventialtion (heroin OD)
✔✔Respiratory Alkalosis - ✔✔Hyperventialtion
high Altitude
,ASPIRIN (compensation - normal pH)
✔✔Metabolic acidosis - ✔✔*DKA *- anion gap!!!! >11
*Lactic acidosis *
*Alcohol *
Aspirin (compensation - normal pH)
✔✔Metabolic alkalosis - ✔✔Severe Vomitting
Loss of K
Cl in urine**
✔✔Cause of lactic acidosis - ✔✔Seizure, Exercise,
Tissue ischemia, Cyanide,
*Mt myopathy*
Failure: Hepatic/CV/pulmonary
✔✔Hyperacute transplant rejection - ✔✔*preformed Ab* = HS II *complement*
-Transfusion reaction
✔✔what chelates Ca to cause
paresthesia during transfusion reaction - ✔✔Citrate
✔✔Acute transplant rejection - ✔✔<6 mo
Cellular = *HS IV* CD8/4
Humoral = *HS II* complement
✔✔*Cellular* Acute Transplant rejection - ✔✔*lymphocytic* endothelitis
✔✔Humoral Acute Transplant rejection - ✔✔PMN necrotizing vasculitis
HS II: Complement
✔✔Chronic transplant rejection - ✔✔Cellular IV
Humoral II
*Arteriosclerosis:* fibrosis of SMALL airways
✔✔GvHD - ✔✔*HS IV *
bone marrow, liver
✔✔Tryptophan forms what with what cofact - ✔✔1. *Niacin*
2. *5HT* --> Melatonin
cofactor = BH4
,✔✔Phenylalanine forms what with what cofactor - ✔✔cofactor = BH4
-->Tyrosine
✔✔What does Tyrosine form - ✔✔1. Homogentisic acid
-->*Fumarate* (TCA)
2. DOPA
--> *DA* --> NE --> Epi
3. *Melanin*
✔✔Dopa conversion - ✔✔Tyrosine --> DOPA
(*D-decarb*, B6) --> DA
(*D-B-H*, Vit C) --> NE
(*PMNT*, cortisol) --> Epi
✔✔Ethanol --> Acetaldehyde - ✔✔via Alc-dH and NAD
*Fomepizole* = OD antidote
ex: Ethylene glycol; Methanol
✔✔Fomepizole - ✔✔Alcohol *OD antidote*
(ethylene glycol or methanol)
inhibit ethanol --> acetaldehyde (Alc-DH)
✔✔Acetaldehyde --> Acetate - ✔✔Acetaldehyde-dH
Disulfram (discourage)
✔✔Disulfram - ✔✔*discourage* alcohol use by
inhibiting acetaldehyde --> acetate
✔✔FA synthesis + FA degradation cofactors - ✔✔SYNTHESIS= citrate
DEGRADATION = Carnitine
✔✔Tay Sachs - ✔✔*Hexoaminase A* deficiency
increased *GM2 ganglioside*
neuro, cherry red macula, blind
✔✔increased GM2 Ganglioside - ✔✔*Tay Sachs*
hexoaminase a def
neuro, cherry red macula, blind
, ✔✔Fabry - ✔✔*a-galactosidase A *
increased Ceramide trihexoside & Gb3
peripheral neuro, angiokeratoma
RISK = *HCM, CVA, CKD*
✔✔Which lysosomal storage disorder risks serious organ damage (heart, renal, brain) -
✔✔*Fabry* (a-galactosidase A def)
✔✔Krabbe Disease - ✔✔high *galactocerebroside*
neuro, peripheral, OPTIC
degeneration
✔✔Gaucher Disease - ✔✔high *glucocerebroside*
neuro, cherry red macula
hepatosplenomegaly
✔✔Niemman Pick - ✔✔high sphingomyelin
neuro, cherry red macula, *hypotonia*
✔✔What lysosomal storage disease causes *optic* manifestations - ✔✔Krabbe (high
galactocerebroside)
✔✔What lysosomal storage disease causes hypotonia - ✔✔*Niemman Pick*
(high sphingomyeline)
✔✔Which ion channels decrease Ca - ✔✔Na/Ca exchanger
SERCA
✔✔Which ion channels increase Ca - ✔✔L-type
Ryanodine
✔✔Ionotropic receptor - ✔✔IMMEDIATE flux of Na, Ca, K
*nAChR*
✔✔1-3 d starve causes - ✔✔*FFA* (hormone sensitive lipase)
- *epi* stimulates
*Gluconeogensis *(Cortisol; OAA --> PEP)
✔✔>3 d starve uses - ✔✔Adipose
SOLUTIONS GUARANTEE A+
✔✔Vit B6 - ✔✔Pyridoxine
synthesis of heme, histamine, 5HT, Epi, NE, DA, GABA
*Transamination*
✔✔vit B6 deficiency - ✔✔*Pyroxidine*
peripheral neuropathy
seizure
sideroblastic anemia
✔✔vit b7 - ✔✔*Biotin*
pyruvate --> OAA
Acetyl coA --> malonyl coA
propionyl coA --> methylmanonyl coA
✔✔Vit B9 - ✔✔folate
synthesis of purine/pyrimidine
✔✔vit B9 deficiency - ✔✔*folate*
elevated homocysteine
megaloblastic anemia
glossitis
✔✔Vit b12 - ✔✔*cobalamin*
DNA synthesis
✔✔Vit B12 deficiency - ✔✔increased *homocysteine + MMA*
megaloblastic anemia
demyelination of *dorsal* (touch) +
*lateral corticospinal* (motor)
✔✔Respiratory Acidosis - ✔✔asthma
pneumonia
hypoventialtion (heroin OD)
✔✔Respiratory Alkalosis - ✔✔Hyperventialtion
high Altitude
,ASPIRIN (compensation - normal pH)
✔✔Metabolic acidosis - ✔✔*DKA *- anion gap!!!! >11
*Lactic acidosis *
*Alcohol *
Aspirin (compensation - normal pH)
✔✔Metabolic alkalosis - ✔✔Severe Vomitting
Loss of K
Cl in urine**
✔✔Cause of lactic acidosis - ✔✔Seizure, Exercise,
Tissue ischemia, Cyanide,
*Mt myopathy*
Failure: Hepatic/CV/pulmonary
✔✔Hyperacute transplant rejection - ✔✔*preformed Ab* = HS II *complement*
-Transfusion reaction
✔✔what chelates Ca to cause
paresthesia during transfusion reaction - ✔✔Citrate
✔✔Acute transplant rejection - ✔✔<6 mo
Cellular = *HS IV* CD8/4
Humoral = *HS II* complement
✔✔*Cellular* Acute Transplant rejection - ✔✔*lymphocytic* endothelitis
✔✔Humoral Acute Transplant rejection - ✔✔PMN necrotizing vasculitis
HS II: Complement
✔✔Chronic transplant rejection - ✔✔Cellular IV
Humoral II
*Arteriosclerosis:* fibrosis of SMALL airways
✔✔GvHD - ✔✔*HS IV *
bone marrow, liver
✔✔Tryptophan forms what with what cofact - ✔✔1. *Niacin*
2. *5HT* --> Melatonin
cofactor = BH4
,✔✔Phenylalanine forms what with what cofactor - ✔✔cofactor = BH4
-->Tyrosine
✔✔What does Tyrosine form - ✔✔1. Homogentisic acid
-->*Fumarate* (TCA)
2. DOPA
--> *DA* --> NE --> Epi
3. *Melanin*
✔✔Dopa conversion - ✔✔Tyrosine --> DOPA
(*D-decarb*, B6) --> DA
(*D-B-H*, Vit C) --> NE
(*PMNT*, cortisol) --> Epi
✔✔Ethanol --> Acetaldehyde - ✔✔via Alc-dH and NAD
*Fomepizole* = OD antidote
ex: Ethylene glycol; Methanol
✔✔Fomepizole - ✔✔Alcohol *OD antidote*
(ethylene glycol or methanol)
inhibit ethanol --> acetaldehyde (Alc-DH)
✔✔Acetaldehyde --> Acetate - ✔✔Acetaldehyde-dH
Disulfram (discourage)
✔✔Disulfram - ✔✔*discourage* alcohol use by
inhibiting acetaldehyde --> acetate
✔✔FA synthesis + FA degradation cofactors - ✔✔SYNTHESIS= citrate
DEGRADATION = Carnitine
✔✔Tay Sachs - ✔✔*Hexoaminase A* deficiency
increased *GM2 ganglioside*
neuro, cherry red macula, blind
✔✔increased GM2 Ganglioside - ✔✔*Tay Sachs*
hexoaminase a def
neuro, cherry red macula, blind
, ✔✔Fabry - ✔✔*a-galactosidase A *
increased Ceramide trihexoside & Gb3
peripheral neuro, angiokeratoma
RISK = *HCM, CVA, CKD*
✔✔Which lysosomal storage disorder risks serious organ damage (heart, renal, brain) -
✔✔*Fabry* (a-galactosidase A def)
✔✔Krabbe Disease - ✔✔high *galactocerebroside*
neuro, peripheral, OPTIC
degeneration
✔✔Gaucher Disease - ✔✔high *glucocerebroside*
neuro, cherry red macula
hepatosplenomegaly
✔✔Niemman Pick - ✔✔high sphingomyelin
neuro, cherry red macula, *hypotonia*
✔✔What lysosomal storage disease causes *optic* manifestations - ✔✔Krabbe (high
galactocerebroside)
✔✔What lysosomal storage disease causes hypotonia - ✔✔*Niemman Pick*
(high sphingomyeline)
✔✔Which ion channels decrease Ca - ✔✔Na/Ca exchanger
SERCA
✔✔Which ion channels increase Ca - ✔✔L-type
Ryanodine
✔✔Ionotropic receptor - ✔✔IMMEDIATE flux of Na, Ca, K
*nAChR*
✔✔1-3 d starve causes - ✔✔*FFA* (hormone sensitive lipase)
- *epi* stimulates
*Gluconeogensis *(Cortisol; OAA --> PEP)
✔✔>3 d starve uses - ✔✔Adipose
