NBME CBSE LATEST 2026 EXAM QUESTIONS AND
SOLUTIONS GUARANTEE A+
✔✔CO poisoning causes - ✔✔carboxyhemoglobin
no affect on PaO2
✔✔Cyanide poisoning causes - ✔✔lactic acidosis
✔✔How to treat cyanide poisoning - ✔✔*Amyl nitrite* --> Methemoglobin
THEN *Thiosulfate* (hydroxycobalamin)
✔✔Normal A-a gradient - ✔✔5-15
Hypoventilation: Heroin OD or high altitude
✔✔Increased A-a gradient - ✔✔*Diffusion impairment* (fibrosis)
*R-L shunt* (aspiration, ARDS)
*V/Q mismatch* (pulmonary edema
✔✔AT --> AT II
where and how - ✔✔ACE
(- high in sarcoidosis)
In small pulmonary bV
✔✔C5a induces what - ✔✔PMN influx (ie: in lungs)
✔✔Korotkoff sound - ✔✔BP cuff - appear and disappear
in inflation/deflation
✔✔Pulsus Paradoxus - ✔✔10mmHg difference in
Korotkoff sound
✔✔Pulsus Paradoxus occurs in - ✔✔Cardiac Tamponade
✔✔Kussmaul sign - ✔✔JVP rises *during inspiration*
Constrictive Pericardiditis
✔✔Restrictive/Interstitial Lung Disease:
A-a, FVC, FEV1, EFR - ✔✔Airway widening due to *radial traction* from fibrosis
*increase Aa*
decreased FVC & FEV1
*Increased EFR*
✔✔Sarcoidosis - ✔✔*Th1 *noncaseating granulmona
,bilateral hilar adenopathy
increased *ACE*
increased IL2, IFNg
1-a-hydroxylase in macrophages: vit D --> *HyperCa*
✔✔Hyper Ca causes - ✔✔stones, thrones, groans, psych overtones
✔✔1-a-hydroxylase in macrophages - ✔✔PTH independent conversion of
Calcifediol to *calcitriol* (bioactive Vit D)
Vit D --> Hyper Ca
✔✔Idiopathic pulmonary fibrosis - ✔✔*Honeycomb* pattern
loss of Type 1 pneumocytes
*hyperplasia Type II* pneumocytes
✔✔Goodpasture - ✔✔HS II
Auto-Ab against BM destroys lung alveoli (*restrictive*) and renal glomeruli
✔✔Obstructive Lung Disease - ✔✔DECREASED FEV1, Decreased FVC
increased RV, FRC, TLC
**different shape
✔✔COPD - ✔✔PMN, mo, CD8
*V/Q mismatch:* O2 induced hypercapnia;
physio dead space
✔✔Myeloperoxidase causes - ✔✔Green sputum/pus
✔✔Do not give O2 supplement to - ✔✔COPD patient
Decreased stimulation of
*carotid bodies* = decreased RR
✔✔TX COPD with - ✔✔*Fluticasone* (glucocorticoid)
inhibit cellular reaction
✔✔a1-antitrypsin deficiency - ✔✔Serine protease inhibitor
*LIVER*
*LUNG*: inc PMN elastase --> emphysema
✔✔Asthma dx - ✔✔*Methacholine* (maCh) challenge
= induce bronchoconstriction
to reduce FEV1
,+ test = Airways ARE reactive
✔✔B2 agonist MOA - ✔✔B2 (Gs) --> AC --> increase *cAMP*
✔✔Corticosteroid MOA - ✔✔inhibit cytokine synthesis
suppress T lymphocyte
✔✔mACh Antagonist ("tropium") MOA - ✔✔*inhibit Vagal* via ACh
--> decreased Ca
✔✔OSA causes - ✔✔pulmonary HTN and RHF
increases EPO which worsens HTN
✔✔EPO can do what
on Cardiovascular - ✔✔worsen HTN
✔✔Pulmonary Arterial HTN - ✔✔*BMPR2*
High *endothelin*, Low NO
SMC hypertophy, fibrosis, narrow lumen
*P2 louder* than A2
✔✔When is P2 louder than A2 - ✔✔Pulmonary Artherial Hypertension
✔✔TX pulmonary arterial hypertension - ✔✔Endothelin-R antagonist:
- Bo*sentan*, Ambi*sentan*
PGEi (inc cGMP):
- Silden*afil*
✔✔Pulmonary Embolism - ✔✔*perfusion defect* (V/Q mismatch)
sudden SOB + calf swelling
Hypoxemia --> *Hyperventilate *
--> *Respiratory Alkalosis *
--> Metabolic compensation in 2 days
✔✔dx pulmonary embolism - ✔✔*D-dimer* test
CT angiogram
Lines of Zahn
*Homan's sign* (DVT calf pain on dorsiflex)
✔✔TX pulmonary embolism - ✔✔Heparin/LMWH
THEN
Warfarin
✔✔Fat embolism syndrome - ✔✔Long bone/pelvic fracture
, --> neuro, hypoxemia, rash
Fat microglobules in *pulmonary arterioles*
✔✔Spontaenous pneumothorax - ✔✔nontraumatic* rupture of subpleural blebs*
**20 yo thin TALL man who smokes
*DECREASED PRELOAD*
✔✔Tension pneumothorax - ✔✔Treachea deviates
REQUIRES INTUBATION
✔✔ARDS - ✔✔bilateral infiltrate
**PANCREATITIS RISK
1. *EXUDATIVE* (capillary permeability)
2. *Proliferative* (collagen)
3. *Fibrotic* (pulmonary fiborsis + HTN)
✔✔What are the risks from ARDS - ✔✔Sepsis
Pancreatitis
Pneumo
✔✔cystic fibrosis genetics - ✔✔*dF508 frameshift*
CFT protein - post-tln
HypoNa
✔✔Cystic Fibrosis complications - ✔✔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 - ✔✔RED
Dual blood supply
✔✔Empyema - ✔✔Infected *exudative* pleural effusion
Meniscus opacity
Increased LDH
COMPLICATES PNEUMO
✔✔Lobar pneumonia - ✔✔*consolidation*
Ex: strep, legionella
--> Red (3-4 d)
--> Grey hepatization (5-7d)
--> Resolution (*Type II regen* in 8 d)
SOLUTIONS GUARANTEE A+
✔✔CO poisoning causes - ✔✔carboxyhemoglobin
no affect on PaO2
✔✔Cyanide poisoning causes - ✔✔lactic acidosis
✔✔How to treat cyanide poisoning - ✔✔*Amyl nitrite* --> Methemoglobin
THEN *Thiosulfate* (hydroxycobalamin)
✔✔Normal A-a gradient - ✔✔5-15
Hypoventilation: Heroin OD or high altitude
✔✔Increased A-a gradient - ✔✔*Diffusion impairment* (fibrosis)
*R-L shunt* (aspiration, ARDS)
*V/Q mismatch* (pulmonary edema
✔✔AT --> AT II
where and how - ✔✔ACE
(- high in sarcoidosis)
In small pulmonary bV
✔✔C5a induces what - ✔✔PMN influx (ie: in lungs)
✔✔Korotkoff sound - ✔✔BP cuff - appear and disappear
in inflation/deflation
✔✔Pulsus Paradoxus - ✔✔10mmHg difference in
Korotkoff sound
✔✔Pulsus Paradoxus occurs in - ✔✔Cardiac Tamponade
✔✔Kussmaul sign - ✔✔JVP rises *during inspiration*
Constrictive Pericardiditis
✔✔Restrictive/Interstitial Lung Disease:
A-a, FVC, FEV1, EFR - ✔✔Airway widening due to *radial traction* from fibrosis
*increase Aa*
decreased FVC & FEV1
*Increased EFR*
✔✔Sarcoidosis - ✔✔*Th1 *noncaseating granulmona
,bilateral hilar adenopathy
increased *ACE*
increased IL2, IFNg
1-a-hydroxylase in macrophages: vit D --> *HyperCa*
✔✔Hyper Ca causes - ✔✔stones, thrones, groans, psych overtones
✔✔1-a-hydroxylase in macrophages - ✔✔PTH independent conversion of
Calcifediol to *calcitriol* (bioactive Vit D)
Vit D --> Hyper Ca
✔✔Idiopathic pulmonary fibrosis - ✔✔*Honeycomb* pattern
loss of Type 1 pneumocytes
*hyperplasia Type II* pneumocytes
✔✔Goodpasture - ✔✔HS II
Auto-Ab against BM destroys lung alveoli (*restrictive*) and renal glomeruli
✔✔Obstructive Lung Disease - ✔✔DECREASED FEV1, Decreased FVC
increased RV, FRC, TLC
**different shape
✔✔COPD - ✔✔PMN, mo, CD8
*V/Q mismatch:* O2 induced hypercapnia;
physio dead space
✔✔Myeloperoxidase causes - ✔✔Green sputum/pus
✔✔Do not give O2 supplement to - ✔✔COPD patient
Decreased stimulation of
*carotid bodies* = decreased RR
✔✔TX COPD with - ✔✔*Fluticasone* (glucocorticoid)
inhibit cellular reaction
✔✔a1-antitrypsin deficiency - ✔✔Serine protease inhibitor
*LIVER*
*LUNG*: inc PMN elastase --> emphysema
✔✔Asthma dx - ✔✔*Methacholine* (maCh) challenge
= induce bronchoconstriction
to reduce FEV1
,+ test = Airways ARE reactive
✔✔B2 agonist MOA - ✔✔B2 (Gs) --> AC --> increase *cAMP*
✔✔Corticosteroid MOA - ✔✔inhibit cytokine synthesis
suppress T lymphocyte
✔✔mACh Antagonist ("tropium") MOA - ✔✔*inhibit Vagal* via ACh
--> decreased Ca
✔✔OSA causes - ✔✔pulmonary HTN and RHF
increases EPO which worsens HTN
✔✔EPO can do what
on Cardiovascular - ✔✔worsen HTN
✔✔Pulmonary Arterial HTN - ✔✔*BMPR2*
High *endothelin*, Low NO
SMC hypertophy, fibrosis, narrow lumen
*P2 louder* than A2
✔✔When is P2 louder than A2 - ✔✔Pulmonary Artherial Hypertension
✔✔TX pulmonary arterial hypertension - ✔✔Endothelin-R antagonist:
- Bo*sentan*, Ambi*sentan*
PGEi (inc cGMP):
- Silden*afil*
✔✔Pulmonary Embolism - ✔✔*perfusion defect* (V/Q mismatch)
sudden SOB + calf swelling
Hypoxemia --> *Hyperventilate *
--> *Respiratory Alkalosis *
--> Metabolic compensation in 2 days
✔✔dx pulmonary embolism - ✔✔*D-dimer* test
CT angiogram
Lines of Zahn
*Homan's sign* (DVT calf pain on dorsiflex)
✔✔TX pulmonary embolism - ✔✔Heparin/LMWH
THEN
Warfarin
✔✔Fat embolism syndrome - ✔✔Long bone/pelvic fracture
, --> neuro, hypoxemia, rash
Fat microglobules in *pulmonary arterioles*
✔✔Spontaenous pneumothorax - ✔✔nontraumatic* rupture of subpleural blebs*
**20 yo thin TALL man who smokes
*DECREASED PRELOAD*
✔✔Tension pneumothorax - ✔✔Treachea deviates
REQUIRES INTUBATION
✔✔ARDS - ✔✔bilateral infiltrate
**PANCREATITIS RISK
1. *EXUDATIVE* (capillary permeability)
2. *Proliferative* (collagen)
3. *Fibrotic* (pulmonary fiborsis + HTN)
✔✔What are the risks from ARDS - ✔✔Sepsis
Pancreatitis
Pneumo
✔✔cystic fibrosis genetics - ✔✔*dF508 frameshift*
CFT protein - post-tln
HypoNa
✔✔Cystic Fibrosis complications - ✔✔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 - ✔✔RED
Dual blood supply
✔✔Empyema - ✔✔Infected *exudative* pleural effusion
Meniscus opacity
Increased LDH
COMPLICATES PNEUMO
✔✔Lobar pneumonia - ✔✔*consolidation*
Ex: strep, legionella
--> Red (3-4 d)
--> Grey hepatization (5-7d)
--> Resolution (*Type II regen* in 8 d)
