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NBME CBSE Summary
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  • NBME CBSE

NBME CBSE Type II pneumocytes - ANSW surfactant (*lecithin*) Proliferate after injury Type I progenitors *Neonatal Respiratory Distress Syndrome* Polio live v killed vaccine - ANSW Killed = Salk = IgG Live = Sabin = IgG + IgA - can be shed in feces

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  • February 15, 2024
  • 144
  • 2023/2024
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NBME CBSE

Type II pneumocytes - ANSW surfactant (*lecithin*)
Proliferate after injury
Type I progenitors
*Neonatal Respiratory Distress Syndrome*

Polio live v killed vaccine - ANSW Killed = Salk = IgG

Live = Sabin = IgG + IgA
- can be shed in feces

Neonatal Respiratory Distress:
Etiology + Tx - ANSW Maternal DM (*high insulin*)
or C-section (*low cortisol*)
TX: *dexamethasone* before birth

Lung maturity determined with - ANSW Amniocentesis of Phospholipids (*type II
pneumocytes)
L >> S

Type I pneumocytes - ANSW Squamous gas diffusion

Elastase in lungs - ANSW macrophage: *lysosomes*
PMN: *azuronphilic granules*

Elastin stretches and recoils due to - ANSW Lysine interchain crosslinks

air pressure and
intrapleural pressure at FRC - ANSW Air pressure = 0
Intrapleural pressure = -5

Pulm Vasc Resistance is lowest during - ANSW Exhale of Tidal Volume

Lung Compliance is decreased by - ANSW LHF, pulmonary edema,
pulmonary fibrosis

Lung Compliance is increased by - ANSW emphysema, age

Obesity affects ERV and FRC - ANSW DECREASE
ERV & FRC

,Blood flow/min (pulmonary v systemic) - ANSW pulmonary = systemic

Anatomic pulmonary shunting - ANSW Bronchial circulation causes
*decreased PO2 in LA/LV*
than in pulmonary capillaries

More ventilation is at the - ANSW BASE

O2-Hgb dissociation LEFT shift - ANSW basic, cold, low 2,3 BPG
low pO2 (compensatory erythrocytosis)

O2-Hgb dissociation RIGHT shift - ANSW low pH, high 2,3BPG, high T
HOT, ACIDIC

CO2 transport to lungs - ANSW *carbonic anhydrase*
Cl shift
*Haldane*: CO2 released to lung
(*Bohr*: O2 release to tissue)

CO poisoning causes - ANSW carboxyhemoglobin
no affect on PaO2

Cyanide poisoning causes - ANSW lactic acidosis

How to treat cyanide poisoning - ANSW *Amyl nitrite* --> Methemoglobin
THEN *Thiosulfate* (hydroxycobalamin)

Normal A-a gradient - ANSW 5-15

Hypoventilation: Heroin OD or high altitude

Increased A-a gradient - ANSW *Diffusion impairment* (fibrosis)
*R-L shunt* (aspiration, ARDS)
*V/Q mismatch* (pulmonary edema

AT --> AT II
where and how - ANSW ACE
(- high in sarcoidosis)
In small pulmonary bV

C5a induces what - ANSW PMN influx (ie: in lungs)

Korotkoff sound - ANSW BP cuff - appear and disappear
in inflation/deflation

Pulsus Paradoxus - ANSW 10mmHg difference in

,Korotkoff sound

Pulsus Paradoxus occurs in - ANSW Cardiac Tamponade

Kussmaul sign - ANSW JVP rises *during inspiration*
Constrictive Pericardiditis

Restrictive/Interstitial Lung Disease:
A-a, FVC, FEV1, EFR - ANSW Airway widening due to *radial traction* from fibrosis
*increase Aa*
decreased FVC & FEV1
*Increased EFR*

Sarcoidosis - ANSW *Th1 *noncaseating granulmona
bilateral hilar adenopathy
increased *ACE*
increased IL2, IFNg
1-a-hydroxylase in macrophages: vit D --> *HyperCa*

Hyper Ca causes - ANSW stones, thrones, groans, psych overtones

1-a-hydroxylase in macrophages - ANSW PTH independent conversion of
Calcifediol to *calcitriol* (bioactive Vit D)

Vit D --> Hyper Ca

Idiopathic pulmonary fibrosis - ANSW *Honeycomb* pattern
loss of Type 1 pneumocytes
*hyperplasia Type II* pneumocytes

Goodpasture - ANSW HS II
Auto-Ab against BM destroys lung alveoli (*restrictive*) and renal glomeruli

Obstructive Lung Disease - ANSW DECREASED FEV1, Decreased FVC
increased RV, FRC, TLC
**different shape

COPD - ANSW PMN, mo, CD8

*V/Q mismatch:* O2 induced hypercapnia;
physio dead space

Myeloperoxidase causes - ANSW Green sputum/pus

Do not give O2 supplement to - ANSW COPD patient
Decreased stimulation of

, *carotid bodies* = decreased RR

TX COPD with - ANSW *Fluticasone* (glucocorticoid)
inhibit cellular reaction

a1-antitrypsin deficiency - ANSW Serine protease inhibitor

*LIVER*
*LUNG*: inc PMN elastase --> emphysema

Asthma dx - ANSW *Methacholine* (maCh) challenge
= induce bronchoconstriction
to reduce FEV1
+ test = Airways ARE reactive

B2 agonist MOA - ANSW B2 (Gs) --> AC --> increase *cAMP*

Corticosteroid MOA - ANSW inhibit cytokine synthesis
suppress T lymphocyte

mACh Antagonist ("tropium") MOA - ANSW *inhibit Vagal* via ACh
--> decreased Ca

OSA causes - ANSW pulmonary HTN and RHF
increases EPO which worsens HTN

EPO can do what
on Cardiovascular - ANSW worsen HTN

Pulmonary Arterial HTN - ANSW *BMPR2*
High *endothelin*, Low NO
SMC hypertophy, fibrosis, narrow lumen
*P2 louder* than A2

When is P2 louder than A2 - ANSW Pulmonary Artherial Hypertension

TX pulmonary arterial hypertension - ANSW Endothelin-R antagonist:
- Bo*sentan*, Ambi*sentan*
PGEi (inc cGMP):
- Silden*afil*

Pulmonary Embolism - ANSW *perfusion defect* (V/Q mismatch)
sudden SOB + calf swelling
Hypoxemia --> *Hyperventilate *
--> *Respiratory Alkalosis *
--> Metabolic compensation in 2 days

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