Fun facts learned from Kaplan

Question 1

What germ layer do teratomas typically arise from?

Answer 1

primitive streak!

*they can contain derivatives of all 3 germ layers ectoderm, mesoderm and endoderm so they are thought to derive from the primitive streak*

primitive streak occurs in the 3rd week of development and is a groove in the midline of the caudal half of the epiblast of the 2 layer embryo

Question 2

Carpopedal spasms, tetany, muscle and abdominal cramps, and tingling of the lips and hands are symptoms of what disorder?

Answer 2

Hypocalcemia and hypophosphatemia due to hypoparathyroidism hypoparathyroidism

often occurs due to injury of the parathyroid glands during neck surgery

Question 3

What are 3 symptoms of Autism spectrum disorder? What is a common treatment?

Answer 3

• withdrawal from actions with others
• limited communication (verbal and nonverbal)
• need for sameness/restrictive repetitive behaviors, interests and activities (RRBs)
• **often treated with behavioral therapy- especially shaping

Question 4

What is mean systemic filling pressure? MSFP How do we increase it? What is a normal MSFP?

Answer 4

point at which the vascular function curve intersects the x-axis (at zero CO)

it is the pressure that exists in all parts of the circulation when the heart has been stopped and pressures have come into equilibrium.

It increases as blood volume increases normal is +7mmHg

Question 5

What is the half life equation including Volume of distribution and clearnce?

Answer 5

t1/2= (0.7 * Vd)/Clearance

Question 6

Which arteries in the kidney are often occluded by sickle cell nephropathy and cause renal necrosis?

Answer 6

the vasa recta

the glomerulus can be occluded as well but that will lead to glomerular disease instead of renal necrosis

Question 7

How do we best culture Haemophilu influenzae?

Answer 7

It requires factors V and X on chocolate agar

so you either need gentle heat to lyse the RBCs, or use staph aureus which is beta hemolytic

Question 8

what 3 features characterize body dysmorphic disorder?

Answer 8

• preoccupation with an unrealistic negative self evaluation of personal appearance or attractiveness
• preoccupation disrupts day to day life
• may seek multiple surgeries or other interventions

Question 9

What is acanthosis nigricans and when is ti seen?

Answer 9

a skin condition characterized by dark, thick, velvety skin in body folds and creases

it can be seen in patients with underying cancers, and also in obese and diabetic patients

Question 10

WHat is JVP used to estimate? What value is considered normal? What does it suggest?

Answer 10

central venous pressure

less than 8 cm H20 is normal!

It suggests right heart failure (most likely due to left heart failure)

Question 11

• The thumb extensors are innervated by the _____ nerve
• The thenar muscles are innervated by the _____ nerve which allows the thumb to ______
• adduction of thumb is enable by the _____ muscle which is innervated by the ______ nerve

Answer 11

• thumb extensors are innervated by the radial nerve
• the thenar muscles are innervted by the median nerve which allows the thumb to opose, flex, and abduct
• adduction of the thumb is innervated by the adductor pollicis which is innervated by the ulnar nerve

Question 12

What are the key features of aortic insufficiency? 3

Answer 12

• increased pulse presure ( caused by retrograde flow from the aorta to the left ventricle)
• diastolic murmur best heard at left lower sternal border
• often occurs due to valvular vegitations produced by bacterial endocarditis

Question 13

Rheumatoid arthritis is a chronic multisystem disorder associated with what 4 things?

What is a distinguishing factor of rheumatoid arthritis compared to non-immunologic arthritis?

What drug is a good anti-inflammatory agent for RA?

Answer 13

• persistent inflammatory synovitis
• lymphadenopathy
• splenomegaly
• and subcutaneous nodules

Morning stiffness that lasts over an hour is specific for inflammatory arthritis as opposed to non-inflammatory arthritis

Celecoxib (iireversible COX2 inhibitor) is a good antiinflammatory

Question 14

Dos a positive net filtration pressure (calculated according to starling) mean into the capillary or out of the capillary?

Answer 14

Positive means out of the capillary and into the interstitium

Question 15

WHat shoul dyou suspect in a patient who has a red, swollen knee with limited motion days after a joint injury?

Answer 15

septic joint!

once started sever infection may develop because cartilage is avasculure so inflammatory cells cant access it

Question 16

What is associated with Polycystic kidney disease?

Answer 16

saccular berry aneurysm in th ecircle of illis that may rupture and lead to subarachnoid hemorrhage

associated with cysts in other organs: liver, pancreas, spleen, lung

Question 17

The inflammatory process of syphyllis in the aorta can lead to____

Answer 17

obliteration of the vasa vasorum leading to ischemia and atrophy of the aortic media, this leads to wrinkling of the intimal layer and dilation of the aota and of the aortic valve ring

Question 18

Damage to what will lead to retrograde seminal flow and cloudy urine?

Answer 18

internal urethral sphincter which is comprised of smooth muscle at the bladder neck which is sympatheticall ycontrolled and contracts during ejactulation to prevent retrograde flow. it also contracts to maintain urinary continence and relaxes during voiding

Question 19

WHat causes varicose veins?

Answer 19

chronically high venous pressure in the legs

Question 20

What symptoms characterize chuurg strauss syndrome? What does the history usually have? What laboratory studies are usually done?

Answer 20

necrotizing vasculitis affecting multiple organ symptoms

history of asthma or allergic rhinitis

labs show eosinophilia and p-ANCA (perinuclear anti neutrophil cytoplasmic antibodies)

Question 21

What is the most common etiology of AAA

What on exam is suggestive and what is diagnostic?

Answer 21

atherosclerosis

pulsatile abdominal mass on physical exam

ltrasound or CT is diagnositc

Question 22

What color would the exudate from a thoracentesis from a bacterial pneumonia be? CHF? Nephrotic syndrome? TB? Lymphoma?

Answer 22

bacterial pneumonia- yellow green

CHF- celar yellow resembling serum

Nephrotic syndrome- clear yellow resembling serum

TB- straw colored, lymphocytic predominance

Lymphoma- chylous effusions are exudative effusions with a high lipid content, this they have a milky white appearane and originate from the lymph channels

Question 23

What are milky white chylous exudate effusions usually related to?

Answer 23

most commonly related to disruption or obstruction by trauma or malignancy (lymphoma, adjacent tumors)

Question 24

How does aminoglycoside resistance occur?

Answer 24

enzymatic inactivation of the drug by acetylation

Question 25

How do bacteria become resstant to penicillins and cephalosporins?

Answer 25

production of B-lactamase; cleavage of B-lactam rings

Question 26

How do bacteria become resstant to Chloramphenicol?

Answer 26

production of acetyltransferase; inactivation of drug by acetylation

Question 27

How do bacteria become resstant to tetracyclines?

Answer 27

Increased efflux out of the cell

Question 28

How do bacteria become resstant to Sulfonamides

Answer 28

active export out of the cell and lowered affinity of enzyme

Question 29

How do bacteria become resstant to Vancomycin?

Answer 29

ligase produces cell wall pentapeptides that terminate in D-alanine, D-lactate, which will not bind to drug

Question 30

When does LV pressure rise at its most rapid rate?

Answer 30

during isovolumetric contraction, a time when intraventricular blood volume remains constant

Question 31

What is genetic imprinting and what are 2 examples?

Answer 31

transmission of the trait and gene expression in a sex-specific manner ex: angelman syndrome and prader willi syndrome

Question 32

What is pleitropy? give an example?

Answer 32

a single gene affects numerous, seemingly unrelated phenotypes. ex: albinism is a single gene that affects pigmentation and causes visual problems

Question 33

what pneumonia is associated with a thick, bloody sputum (currant helly sputum) reddish

Answer 33

Klebsiella pnemonia

Question 34

What is Dressler Syndrome

Answer 34

post MI fibrinous pericarditis 2-0 wks after other causes of fibrinous pericarditis are uremia bc of renal failure, acute rheumatic fever, systemic lupus, erythematous and viral etiologies

Question 35

How dos exercise influence breathing?

Answer 35

it increases oxygen demand and therefore ventilation. increase in respiratory rate and tidal volume. also expiratory air flow rate so: increases respiratory rate tidal volume expiratory air flow rate

Question 36

Describe the locations of hematopoiesis throughout gestation

Answer 36

3rd week= yolk sac 1st month= liver 2-4 month= spleeen and lymph organs after 4 months= bone marrow

Question 37

What is injected itradermally during the PPD skin test? WHat type of hypersensitivity reaction does this cause?

Answer 37

tuberculin which is the outer surface protein type IV delayed type (T cell mediated)

Question 38

What is actinic keratosis a precurosor for? What is it called when it is on the lip instead of the skin?

Answer 38

squamous cell carcinoma actinic chelitis

Question 39

How does pneumonia cause a V/Q mismatch

Answer 39

the lung is inflammaed which increases blood flow, but airflow into the lung is compromised (decrease V, increase Q)

Question 40

Where in te body is Fusobacterium a part of the normal flora?

Answer 40

oral cavity

Question 41

What is the treatment for oral candidiasis?

Answer 41

Nystatin

Question 42

What organism is the most common cause of secondary pneumonia?

Answer 42

Staphylococcus aureus is the most common cause of secondary pneumonia often complicated by abscess or empyema it is gram positive, catalase positive, coagulase positive

Question 43

What lung cancer is associated with Cushing symdrome?

Answer 43

Small cell carcinoma bc it is neuroendocrine and releases ACTH

Question 44

How do we treat whooping cough

Answer 44

erythromycin it is associated w hypoglycemia MOA is inhibition of Gi so increased cAMP

Question 45

Which cell plays a crucial role in the pathogenesis of ARDS

Answer 45

Neutrophils

Question 46

What condtions is Klebsiella pneumonia associated with? How do we treat it?

Answer 46

alcoholics, diabetics, COPD treat with 3rd generation cephalosporins which are cefotaxime, ceftriaxone, ceftazidime

Question 47

What 2 drugs are used to treat Legionella?

Answer 47

Fluoroquinolones Erythromycin (macrolide)

Question 48

What kind of bugs should NOT e treated with Vancomycin?

Answer 48

gram negatives!!!!!!! It is great for MRSA

Question 49

spherical bodies with sharply outlined walls when stained with methenamine silver what is this?

Answer 49

Pneumocystics jirovecii extraellular parasite

Question 50

What antibiotics are used to treat Pseudomonas aeruginosa?

Answer 50

* antipseudomonal B lactam * piperacillin-tazobactam, cefepime, ceftazidime * respiratory floroquinolone * levofloxacin, moxifloxacin, gemifloxacin * aminoglycosides * gentamycin, tobramycin

Question 51

Which lung volume cannot be measured on spirometry?

Answer 51

FRC

Question 52

What 2 lung diseases have noncaseating granulomas?

Answer 52

Berryliosis (pneumoconiosis) and sarcoidosis

Question 53

what is the most common cause of pneumonia is children less than 1?

Answer 53

Respiratory syncycial virus this is in the paramyxovirus family and is negative sense, single stranded RNA that are non-segmented, helical and enveloped

Question 54

How will exposing blood to air change the blood gas readings?

Answer 54

higher O2 lower CO2 HIgher pH (more basic)

Question 55

What does aspirin Salicylate acid poisoning do to acid base chemistry?

Answer 55

repisratory alkalosis due to direct effects on the respiratory centers sometimes with metabolic acidosis following

Question 56

What do we use to estimate ECF? WHat about plasma?

Answer 56

ECF-inulin plasma-RISA Interstitial=ECF-Plasma

Question 57

Where is the left recurrent laryngeal nerve located?

Answer 57

in the arch of the aorta arises as the left vagus crosses in front of the arch of the aorta

Question 58

What radiograph findings suggest spontaneous pneumothorax?

Answer 58

Radiolucency along the chest wall

Question 59

What does wedge shaped opacity on radiograph suggest?

Answer 59

pulmonary embolism

Question 60

What is the equation for clearance? What happens to the renal clearance of a substance if the plasma concentration increases?

Answer 60

Clearance= (Urinary concentration \* Urine Flow) / Plasma concentration therefore if the plasma concentration increases the clearance will decrease

Question 61

what is assciated with anti-mitochondrial autoantibodies

Answer 61

primary biliary cholangitis- chronic granulomatous inflammation leading to destruction of intrahepatic bile ducts the patient would be itchy due to increased circulating bile salts

Question 62

what component of hepatocytes does reye syndrome affect?

Answer 62

mitochondria

Question 63

what 2 locations of the colon are most susceptible to ischemic damage during ischemic bowel disease

Answer 63

splenic flexure and sigmoid colon (watershed)