NBME CBSE LATEST UPDATED EXAM
2026/2027ALL 100 QUESTIONS WITH
CORRECT ANSWERS
1. Pulsus Paradoxus - CORRECT ANSWER - 10mmhg difference in
Korotkoff sound
Rationale: Pulsus paradoxus is defined as an exaggerated fall in systolic
blood pressure (>10 mmHg) during inspiration. Normal fall is ≤10
mmHg. Measurement is made by inflating the BP cuff and slowly
deflating while listening for Korotkoff sounds during expiration, then
noting when sounds are heard throughout the respiratory cycle.
2. Pulsus Paradoxus occurs in - CORRECT ANSWER - Cardiac
Tamponade
Rationale: Pulsus paradoxus is a classic finding in cardiac tamponade
due to increased intrapericardial pressure. Mechanism: increased right
ventricular filling during inspiration pushes the interventricular septum
leftward, decreasing left ventricular filling and stroke volume. Other
causes: constrictive pericarditis, severe asthma, tension pneumothorax.
3. Kussmaul sign - CORRECT ANSWER - JVP rises during inspiration
| Constrictive Pericarditis
1
,Rationale: Kussmaul sign is a paradoxical rise in jugular venous
pressure during inspiration (normally JVP decreases with inspiration).
Indicates impaired right ventricular filling. Classic for constrictive
pericarditis. Other causes: right heart failure, restrictive cardiomyopathy.
4. Restrictive/Interstitial Lung Disease: A-a, FVC, FEV1, FER -
CORRECT ANSWER - Airway widening due to radial traction from
fibrosis; increase Aa gradient; Decreased FVC and FEV1; Increased
FER (FEV1/FVC)
Rationale: In restrictive lung disease, fibrosis causes radial traction on
airways, actually widening them. FEV1/FVC ratio preserved or
increased (>80%). Both FVC and FEV1 decreased proportionally. A-a
gradient increased due to V/Q mismatch and diffusion impairment.
5. Sarcoidosis - CORRECT ANSWER - Th1 noncaseating granuloma;
Bilateral hilar adenopathy; Increased ACE; Increased IL2, IFNγ; 1-α-
hydroxylase in macrophages: Vit D to hypercalcemia
Rationale: Sarcoidosis is a multisystem granulomatous disorder.
Alveolar macrophages produce 1-α-hydroxylase converting 25-OH
vitamin D to 1,25-(OH)2 vitamin D (calcitriol), causing hypercalcemia.
CD4+ T cells produce Th1 cytokines. Elevated ACE from granulomas.
6. Hypercalcemia causes - CORRECT ANSWER - stones, thrones,
groans, psych overtones
2
, Rationale: "Stones" = nephrolithiasis. "Thrones" = constipation and
polyuria. "Groans" = abdominal pain, nausea, vomiting, peptic ulcer
disease. "Psych overtones" = depression, confusion, cognitive changes.
7. 1-α-hydroxylase in macrophages - CORRECT ANSWER - PTH
independent conversion of Calcifediol to calcitriol (bioactive Vit D) →
Vit D → Hypercalcemia
Rationale: Normally, 1-α-hydroxylase is in the kidney regulated by
PTH. In sarcoidosis, activated macrophages express this enzyme
constitutively, leading to unregulated calcitriol production and PTH-
independent hypercalcemia. Suppressed by glucocorticoids.
8. Idiopathic pulmonary fibrosis - CORRECT ANSWER - Honeycomb
pattern; Loss of Type 1 pneumocytes; hyperplasia Type II pneumocytes
Rationale: IPF shows usual interstitial pneumonia (UIP) pattern with
temporal heterogeneity. Honeycombing = end-stage fibrotic cysts. Type
II pneumocytes proliferate attempting to repair damaged alveolar
epithelium.
9. Goodpasture syndrome - CORRECT ANSWER - Type II
Hypersensitivity; Auto-Ab against BM destroys lung alveoli (restrictive)
and renal glomeruli
Rationale: Caused by autoantibodies against α3 chain of type IV
collagen in basement membrane. Linear IgG deposits on
3
2026/2027ALL 100 QUESTIONS WITH
CORRECT ANSWERS
1. Pulsus Paradoxus - CORRECT ANSWER - 10mmhg difference in
Korotkoff sound
Rationale: Pulsus paradoxus is defined as an exaggerated fall in systolic
blood pressure (>10 mmHg) during inspiration. Normal fall is ≤10
mmHg. Measurement is made by inflating the BP cuff and slowly
deflating while listening for Korotkoff sounds during expiration, then
noting when sounds are heard throughout the respiratory cycle.
2. Pulsus Paradoxus occurs in - CORRECT ANSWER - Cardiac
Tamponade
Rationale: Pulsus paradoxus is a classic finding in cardiac tamponade
due to increased intrapericardial pressure. Mechanism: increased right
ventricular filling during inspiration pushes the interventricular septum
leftward, decreasing left ventricular filling and stroke volume. Other
causes: constrictive pericarditis, severe asthma, tension pneumothorax.
3. Kussmaul sign - CORRECT ANSWER - JVP rises during inspiration
| Constrictive Pericarditis
1
,Rationale: Kussmaul sign is a paradoxical rise in jugular venous
pressure during inspiration (normally JVP decreases with inspiration).
Indicates impaired right ventricular filling. Classic for constrictive
pericarditis. Other causes: right heart failure, restrictive cardiomyopathy.
4. Restrictive/Interstitial Lung Disease: A-a, FVC, FEV1, FER -
CORRECT ANSWER - Airway widening due to radial traction from
fibrosis; increase Aa gradient; Decreased FVC and FEV1; Increased
FER (FEV1/FVC)
Rationale: In restrictive lung disease, fibrosis causes radial traction on
airways, actually widening them. FEV1/FVC ratio preserved or
increased (>80%). Both FVC and FEV1 decreased proportionally. A-a
gradient increased due to V/Q mismatch and diffusion impairment.
5. Sarcoidosis - CORRECT ANSWER - Th1 noncaseating granuloma;
Bilateral hilar adenopathy; Increased ACE; Increased IL2, IFNγ; 1-α-
hydroxylase in macrophages: Vit D to hypercalcemia
Rationale: Sarcoidosis is a multisystem granulomatous disorder.
Alveolar macrophages produce 1-α-hydroxylase converting 25-OH
vitamin D to 1,25-(OH)2 vitamin D (calcitriol), causing hypercalcemia.
CD4+ T cells produce Th1 cytokines. Elevated ACE from granulomas.
6. Hypercalcemia causes - CORRECT ANSWER - stones, thrones,
groans, psych overtones
2
, Rationale: "Stones" = nephrolithiasis. "Thrones" = constipation and
polyuria. "Groans" = abdominal pain, nausea, vomiting, peptic ulcer
disease. "Psych overtones" = depression, confusion, cognitive changes.
7. 1-α-hydroxylase in macrophages - CORRECT ANSWER - PTH
independent conversion of Calcifediol to calcitriol (bioactive Vit D) →
Vit D → Hypercalcemia
Rationale: Normally, 1-α-hydroxylase is in the kidney regulated by
PTH. In sarcoidosis, activated macrophages express this enzyme
constitutively, leading to unregulated calcitriol production and PTH-
independent hypercalcemia. Suppressed by glucocorticoids.
8. Idiopathic pulmonary fibrosis - CORRECT ANSWER - Honeycomb
pattern; Loss of Type 1 pneumocytes; hyperplasia Type II pneumocytes
Rationale: IPF shows usual interstitial pneumonia (UIP) pattern with
temporal heterogeneity. Honeycombing = end-stage fibrotic cysts. Type
II pneumocytes proliferate attempting to repair damaged alveolar
epithelium.
9. Goodpasture syndrome - CORRECT ANSWER - Type II
Hypersensitivity; Auto-Ab against BM destroys lung alveoli (restrictive)
and renal glomeruli
Rationale: Caused by autoantibodies against α3 chain of type IV
collagen in basement membrane. Linear IgG deposits on
3
