Cardiovascular System
12%of exam
Endocrine System
8%of exam
Gastrointestinal System
12%of exam
Hematopoietic System
6%of exam
Immunological System
8%of exam
Integumentary System
6%of exam
Musculoskeletal System
10%of exam
Neurological System
10%of exam
Pulmonary System + Upper Respiratory Tract
8%of exam
Reproductive System
10%of exam
Urinary System
10%of exam
Quick Facts
- Exam
- Part I Biomedical Science
- Administrator
- NABNE
- Items
- 200 multiple-choice questions
- Case clusters
- 50 clusters; four questions each
- Sections
- Two sections; 100 each
- Section time
- 150 minutes each
- Standard break
- 60 minutes
- Delivery
- In-person Prometric
- Calculator
- Not available
- Structure/Function
- Approximately 60%
- Disease/Dysfunction
- Approximately 40%
- Passing
- Pass both GEAs
- Cut score
- Administration-specific Angoff
Structure vs Dysfunction
Structure/Function
- Approximately 60%
- Three SEAs
Disease/Dysfunction
- Approximately 40%
- Two SEAs
Both GEAs must pass
Physiology Formula Picker
- Need cardiac output→HR × SV
- Need ejection fraction→SV ÷ EDV × 100%
- Need vascular flow→Pressure gradient ÷ resistance
- Need vascular resistance→Pressure gradient ÷ flow
- Need mean pressure→DBP + one-third pulse pressure
- Need renal clearance→Ux × V ÷ Px
- Need alveolar ventilation→(VT−VD) × rate
- Need filtration fraction→GFR ÷ renal plasma flow
Cardiac Flow + Hemodynamics
- Venae cavae
- Systemic blood → right atrium
- Tricuspid valve
- Right atrium → right ventricle
- Pulmonic valve
- Right ventricle → pulmonary trunk
- Pulmonary veins
- Lungs → left atrium
- Mitral valve
- Left atrium → left ventricle
- Aortic valve
- Left ventricle → aorta
- Cardiac output
- Heart rate × stroke volume
- Mean arterial pressure
- DBP + one-third pulse pressure
- Left coronary perfusion
- Mainly during diastole
- Frank-Starling
- Higher preload raises stroke volume
Cardiac Development
- Truncus arteriosus
- Aorta + pulmonary trunk
- Bulbus cordis
- Trabeculated right ventricle
- Primitive ventricle
- Trabeculated left ventricle
- Primitive atrium
- Trabeculated atria
- Right sinus horn
- Smooth right atrium
- Pulmonary veins
- Smooth left atrium
- Endocardial cushions
- AV septation + valves
- Neural crest
- Conotruncal septum
- Ductus arteriosus
- Ligamentum arteriosum
- Foramen ovale
- Fossa ovalis
Pharyngeal Pouches
One ear, two tonsil, three thymus, four parathyroid
1: middle ear2: palatine tonsil3: thymus + inferior4: superior parathyroids
Primary vs Secondary Failure
Primary
- Target gland problem
- Trophic hormone compensates
Secondary
- Pituitary problem
- Trophic hormone deficient
Gland vs controller
Hormone Feedback Picker
- Low target; high trophic→Primary gland failure
- Low target; low trophic→Secondary failure
- High target; low trophic→Primary hyperfunction
- High target; high trophic→Secondary hyperfunction
- Hypercalcemia→Check PTH
- Thyroid screen→TSH first
- Central diabetes insipidus→ADH deficiency
- Nephrogenic diabetes insipidus→ADH resistance
Endocrine Axes + Origins
- Thyroid axis
- TRH → TSH → T3/T4
- Adrenal axis
- CRH → ACTH → cortisol
- Gonadal axis
- GnRH → LH/FSH
- PTH
- Calcium rises; phosphate falls
- Insulin
- Lowers blood glucose
- Glucagon
- Raises blood glucose
- Anterior pituitary
- Oral ectoderm
- Posterior pituitary
- Neuroectoderm
- Adrenal cortex
- Mesoderm
- Adrenal medulla
- Neural crest
- Inferior parathyroids
- Third pharyngeal pouch
- Superior parathyroids
- Fourth pharyngeal pouch
GI Map + Absorption
- Foregut artery
- Celiac trunk
- Midgut artery
- Superior mesenteric artery
- Hindgut artery
- Inferior mesenteric artery
- Iron absorption
- Duodenum
- Folate absorption
- Jejunum
- B12 absorption
- Terminal ileum
- Bile salt absorption
- Terminal ileum
- Secretin
- Pancreatic bicarbonate secretion
- CCK
- Enzymes + gallbladder contraction
- Parietal cells
- Acid + intrinsic factor
- Chief cells
- Pepsinogen
- Midgut rotation
- 270° counterclockwise around SMA
- Meckel diverticulum
- Persistent vitelline duct
- Enteric ganglia
- Neural crest
Coagulation Tests
PT is extrinsic; PTT is intrinsic
PT: factor VIIPTT: VIII, IX, XI, XIIBoth: common pathway
PT vs PTT
PT
- Extrinsic pathway
- Factor VII sensitive
PTT
- Intrinsic pathway
- Factors VIII and IX
External vs internal initiation
Lab Pattern Picker
- Low MCV anemia→Iron studies first
- High MCV anemia→B12 + folate
- Hemolysis suspected→Retic + LDH + haptoglobin
- Isolated PT prolongation→Extrinsic pathway
- Isolated PTT prolongation→Intrinsic pathway
- Pancytopenia→Assess marrow production
- Neutrophilia→Bacterial or inflammatory pattern
- Eosinophilia→Allergy or parasite pattern
Blood + Coagulation
- Microcytic pattern
- Iron, thalassemia, chronic disease
- Macrocytic pattern
- B12 or folate deficiency
- Hemolysis pattern
- LDH↑ bilirubin↑ haptoglobin↓
- Reticulocyte count
- Marrow response marker
- PT
- Extrinsic + common pathways
- PTT
- Intrinsic + common pathways
- von Willebrand factor
- Platelet adhesion; carries VIII
- Thrombin
- Fibrinogen → fibrin
- Vitamin K factors
- II, VII, IX, X
- Erythropoietin
- Renal hypoxia response
Innate vs Adaptive
Innate
- Rapid nonspecific
- No classic memory
Adaptive
- Antigen specific
- Memory improves response
Immediate barrier vs learned specificity
Immune Mechanisms
- MHC I
- Nucleated cells → CD8
- MHC II
- APCs → CD4
- IgM
- First primary-response antibody
- IgG
- Secondary response; crosses placenta
- IgA
- Mucosal secretions
- IgE
- Allergy + parasite defense
- C3b
- Opsonization
- C5a
- Neutrophil chemotaxis
- C5b-9
- Membrane attack complex
- Type I
- IgE; immediate
- Type II
- IgG/IgM targets cells or matrix
- Type III
- Immune-complex deposition
- Type IV
- T-cell delayed response
Epidermis vs Dermis
Epidermis
- Keratinized epithelium
- Avascular
Dermis
- Connective tissue
- Vascular
Barrier vs support
Skin + Tissue
- Epidermis
- Surface ectoderm
- Most dermis
- Mesoderm
- Melanocytes
- Neural crest
- Keratinocytes
- Barrier + keratin
- Langerhans cells
- Antigen presentation
- Merkel cells
- Light-touch receptors
- Eccrine glands
- Thermoregulatory sweat
- Eccrine innervation
- Sympathetic cholinergic
Somite Map
Sclerotome skeleton, myotome muscle, dermatome dermis
Sclero: vertebrae + ribsMyo: skeletal muscleDerma: dorsal dermis
Bone + Muscle
- Osteoblast
- Builds bone; mesenchymal origin
- Osteoclast
- Resorbs bone; monocyte origin
- RANKL
- Promotes osteoclast maturation
- Bone collagen
- Type I
- Cartilage collagen
- Type II
- Skeletal contraction
- Calcium binds troponin C
- Smooth contraction
- Calcium binds calmodulin
- Intramembranous bone
- Many flat bones
- Endochondral bone
- Long bones
- Sclerotome
- Vertebrae + ribs
- Myotome
- Skeletal muscle
- Dermatome
- Dorsal dermis
UMN vs LMN
UMN
- Spastic weakness
- Hyperreflexia + Babinski
LMN
- Flaccid weakness
- Atrophy + fasciculations
Central tract vs final neuron
Neuro Pathways
- Dorsal columns
- Vibration + proprioception
- Dorsal-column crossing
- Medulla
- Spinothalamic tract
- Pain + temperature
- Spinothalamic crossing
- Spinal cord
- Corticospinal crossing
- Caudal medulla
- Dorsal root
- Sensory input
- Ventral root
- Motor output
- Sympathetic outflow
- T1–L2
- Parasympathetic outflow
- Craniosacral
- Broca area
- Motor speech
- Wernicke area
- Language comprehension
- Blood-brain barrier
- Endothelial tight junctions
- Microglia
- Mesoderm-derived macrophages
Acid-Base ROME
Respiratory Opposite, Metabolic Equal
Respiratory: pH opposes CO2Metabolic: pH follows bicarbonate
Obstructive vs Restrictive
Obstructive
- Expiratory flow limited
- FEV1/FVC reduced
Restrictive
- Lung volumes reduced
- Ratio preserved or high
Flow problem vs volume problem
Acid-Base Picker
- Low pH; high CO2→Respiratory acidosis
- Low pH; low bicarbonate→Metabolic acidosis
- High pH; low CO2→Respiratory alkalosis
- High pH; high bicarbonate→Metabolic alkalosis
- High anion gap→Unmeasured acid accumulation
- Normal-gap acidosis→Bicarbonate loss
- Metabolic acidosis compensation→Winter formula
- Compensation mismatches→Mixed disorder
Pulmonary Physiology
- Type I pneumocytes
- Gas exchange
- Type II pneumocytes
- Surfactant production
- Surfactant
- Lowers surface tension
- Obstruction
- FEV1/FVC decreases
- Restriction
- FEV1/FVC preserved or rises
- Shunt
- Perfusion without ventilation
- Dead space
- Ventilation without perfusion
- Apex V/Q
- Higher than base
- Hypoventilation
- PaCO2 rises
- Right oxygen shift
- Acid, heat, CO2, 2,3-BPG
- Fetal lung epithelium
- Foregut endoderm
Shunt vs Dead Space
Shunt
- Perfused not ventilated
- Low V/Q
Dead space
- Ventilated not perfused
- High V/Q
Blood without air vs reverse
Germ Layers
Ecto outside, meso middle, endo lining
Ecto: skin + neuralMeso: muscle + urogenitalEndo: gut + lung
Anatomy vs Embryology
Anatomy
- Current structure
- Location and relationships
Embryology
- Developmental origin
- Folding and derivatives
Present form vs formation
Developmental Origin Picker
- Brain or spinal cord→Neural tube
- Peripheral ganglia→Neural crest
- Epidermis→Surface ectoderm
- Muscle or bone→Mesoderm
- Kidney or gonad→Intermediate mesoderm
- Gut epithelial lining→Endoderm
- Respiratory epithelial lining→Endoderm
- Melanocyte or adrenal medulla→Neural crest
Reproductive Physiology
- Male LH
- Leydig testosterone
- Male FSH
- Sertoli spermatogenesis
- Female LH
- Theca androgen
- Female FSH
- Granulosa aromatase
- hCG
- Maintains corpus luteum
- Prolactin
- Milk production
- Oxytocin
- Milk ejection
- AMH
- Müllerian regression
- Testosterone
- Wolffian differentiation
- DHT
- External male differentiation
- Müllerian ducts
- Upper female tract
- Urogenital sinus
- Lower vagina
General Embryology
- Gastrulation
- Epiblast forms three layers
- Notochord
- Induces neural plate
- Ectoderm
- Epidermis + nervous system
- Mesoderm
- Muscle, bone, vessels, urogenital
- Endoderm
- GI + respiratory epithelium
- Neural tube
- Central nervous system
- Neural crest
- PNS, melanocytes, adrenal medulla
- Lateral folding
- Closes ventral body wall
- Embryonic period
- Weeks three through eight
- Major structural risk
- Organogenesis exposure
Nephritic vs Nephrotic
Nephritic
- Hematuria + inflammation
- RBC casts
Nephrotic
- Heavy proteinuria
- Edema + lipiduria
Inflammation vs protein loss
Renal Physiology
- Clearance
- Ux × V ÷ Px
- Inulin clearance
- Measures GFR
- PAH clearance
- Estimates renal plasma flow
- Proximal tubule
- Bulk iso-osmotic reabsorption
- Descending limb
- Water permeable
- Thick ascending limb
- Salt reabsorption; water impermeable
- Distal tubule
- PTH raises calcium reabsorption
- Collecting duct
- ADH raises water permeability
- Aldosterone
- Sodium retention; potassium secretion
- Renin trigger
- Low renal perfusion
- Ureteric bud
- Collecting system
- Metanephric mesenchyme
- Nephrons
- Bladder epithelium
- Urogenital sinus endoderm
- Bladder trigone
- Mesoderm
Common Traps
System vs SEA weights
Eleven systems carry percentages ≠ Five SEAs about 40 items each
GEA labels
Structure/Function is 60% ≠ Disease/Dysfunction is 40%
Passing score
No predetermined percentage ≠ Angoff cut varies
Part I vs Part II
Part I tests biomedical foundations ≠ Part II tests clinical readiness
Calculator access
Prometric demo has calculator ≠ NPLEX exam does not
Neural tube vs crest
Tube forms CNS ≠ Crest forms much PNS
Primary vs secondary
Primary means target gland ≠ Secondary means pituitary
PT vs PTT
PT tests extrinsic ≠ PTT tests intrinsic
Shunt vs dead space
Shunt lacks ventilation ≠ Dead space lacks perfusion
Nephritic vs nephrotic
Nephritic has RBC casts ≠ Nephrotic has heavy proteinuria
Unanswered questions
Blank scores incorrect ≠ Mark one best answer
Last Minute
- 1.Use current eleven-system blueprint
- 2.Structure/Function = 60%
- 3.Disease/Dysfunction = 40%
- 4.Both GEAs must pass
- 5.No predetermined passing percentage
- 6.Two sections; 100 questions each
- 7.Each section allows 150 minutes
- 8.No calculator during NPLEX
- 9.Mark every question
- 10.Trace structure before mechanism
- 11.Separate adult anatomy from origin
- 12.Check feedback direction twice
- 13.Localize neural tract crossing
- 14.Match lab pattern before disease
- 15.Distinguish shunt from dead space
- 16.Check PT versus PTT
- 17.Use mechanism, not treatment
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