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Now entering USMLE_Step_2 subroom.
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[dua_frank] back
[dua_frank] finally
[samantha] wc
[dua_frank] thanks sammy
[megs] ok start
[lanny] ok guys start
[lanny] rubella lets discuss
[megs] what are BP CHANGES during pregnancy???
[megs] ok lanny u r q first
[lanny] BP increase
[samantha] it dec during the 1st trimes
[lanny] right
[lanny] but inc later
[megs] yes sammy right
[lanny] diastolic dec more than syst
[samantha] and diastolic dec by 15mmhg
[megs] but never icr up to prepregnant levels
[samantha] yes megs
[lanny] ya
[megs] what is congenital rubella syndrome??/
[uniteus] hi everyone ..sorry for being late
[lanny] hi uni
[megs] hi uni
[dua_frank] hi uni
[lanny] deafness cataract heart dz
[megs] congenital deafness cardiac anomalies
[megs] yeah lanny
[uniteus] blueberry muffin rash too
[samantha] cong deafness cataracts thrombocytopenia and hepatospleenomegaly
[lanny] mental retardation too
[dua_frank] its called as a triad right?
[dua_frank] or not?
[lanny] yes dua the triad is the deafness cataract and heart dz
[dua_frank] oh that was hutchinson triad, sorry
[dua_frank] what triad is this?
[dua_frank] any name to it lanny?
[lanny] dont think so
[megs] yes as dua said hepatosplenomegaly ln pathy and thrombocytopenia is always accompany cong infectious disease
[dua_frank] sammy said that megs
[megs] dua u said this in peds chat
[megs] lol
[dua_frank] oh
[megs] i remember it ...good old
[lanny] if a preg woman is infrected in 2 mths what to do?
[megs] terminate pregnacy lanny
[dua_frank] yeah those are common triats of all
[lanny] its not an indication
[lanny] the risk is still small
[uniteus] so do nothing then lanny..just managed expentantly?
[megs] but still lanny termination is adviced...
[lanny] right uni megs
[megs] who is right lanny
[lanny] both are
[lanny] megs term is not an indication so dont terminate
[samantha] transplacental spread is 90% in the 1st trimes
[megs] infected in 2 months is what lanny???
[uniteus] which trimester is fetur prone to most serious infection to toxoplasmosis?
[lanny] if woman gets inf before 3 mths of preg then term is not an indication
[lanny] after 3 mths not sure???
[samantha] 3rd trim lanny
[samantha] sorry uni
[megs] ok
[uniteus] oh...its is first trimester sammy
[lanny] no if woman gets infected and gets preg within the first 3 mths i mean
[uniteus] but 3rd trimester has high risk to toxo
[megs] yes uni
[uniteus] yeah...i remember u megs..wen i was reading this
[megs] lol
[samantha] ok uni
[dua_frank] lol
[megs] what isrx of toxoplasma in prg???
[megs] rx??
[uniteus] pyrimethamine n sulfadiazine
[megs] yes
[lanny] megs same as non preg
[megs] yes lanny
[uniteus] what is the toxoplasmosis triad clin feature?
[uniteus] to fetus/infant
[dua_frank] hydrocephalus, periventricular calns and something else
[lanny] choriretinitis intra cr calcify IUGR
[lanny] dua its intra not peri
[megs] microcephaly intracr calcification and mr uni
[dua_frank] oh
[megs] not hydrocephalous dua
[lanny] peri is CMV
[dua_frank] right sorry microcephaly
[uniteus] yeah..it is hydrocephalus, INTRA cranial calcification n Chorioretinitis
[megs] it hydrops fetalis
[dua_frank] its hydro
[uniteus] TOXO = INTRAcranial n CMV = PeriVentricular calcification
[dua_frank] thanks uni
[uniteus] urw
[megs] its FETAL HYDROPS=HYDROPS FETALIS
[lanny] yes toxo is periventricular
[lanny] there is no hydroceph in toxo dua
[uniteus] yeah
[dua_frank] what will happen to cholesterol in pregnancy?
[lanny] sorry perivent is CMV
[uniteus] rt lanny..opposite...
[dua_frank] *)
[lanny] no uni chk it toxo is intra
[uniteus] oh sorry..dua..i mean...he corrected himself..n i am agreein to it
[dua_frank] lol
[uniteus]
[lanny] i have a mnemonic for that uni
[uniteus] tell me
[uniteus] megs dey r same for fetal hydrops
[lanny] difficulu its a weird way i remeber it
[samantha] it will inc dua
[lanny] difficult to explain here
[dua_frank] sammy it remains same
[uniteus] oh ok..
[dua_frank] no effect thus, no atherosclerosis
[uniteus] i just remeber : cmV = periVentricular calcif
[lanny] FINALLY UNI AGREES LOL
[dua_frank] nice
[samantha] what about HDL and LDL?
[megs] UNI SINCE BIGINING WAS TELLING THAT ONLY..LOL
[dua_frank] what happens to tidal volume ?
[megs] icr dua
[lanny] increase
[uniteus] increase tidal vol
[dua_frank] right
[dua_frank] they are not affected sammy
[samantha] ok dua
[samantha] inc in the 3rd trim
[dua_frank] they have increased risk of DVT and PE not MI or atherosclerosis
[lanny] which murmurs is normal in preg
[dua_frank] systolic
[uniteus] systolic?
[megs] systolic
[lanny] right both
[samantha] systolic
[uniteus] why do pregnant dont get thyroid problem despite increase t4?
[dua_frank] when does quickening begin?
[dua_frank] TBG inc too uni
[uniteus] 16-20week gest
[lanny] cause its inc TBG
[dua_frank] right
[megs] total t4 increse...
[uniteus] rt all yeah..due to increase TBG
[megs] not free t4
[uniteus] thx megs
[samantha] only total T$ inc free T4 is normal uni
[samantha] 16 weeks/
[uniteus] thx sammy
[megs] quickening at16 in multigravida and at 20 wks in prii
[megs] primi
[dua_frank] thanks megs
[lanny] whats quickenieng??
[uniteus] fetal movement first time
[uniteus] felt by mom
[lanny] oh yes thanks
[uniteus] urw
[dua_frank] little buggers start kicking then
[dua_frank] mc cause of abortion in second trimester is?
[megs] uterine anomalies
[megs] prob in uterus
[lanny] incompete cervix
[dua_frank] not cervix megs?
[samantha] cervical incom
[dua_frank] cervical structural abnormalities yes
[dua_frank] usually incompetant cervix
[megs] cx is part of uterus...i said in general
[dua_frank] ok
[megs] true incompitent cx
[dua_frank] when does lightening happen?
[lanny] at what time is cerclage placed
[megs] commomest cause of 1 st trimester abortions??/
[samantha] 36 weeks
[dua_frank] chro abs
[lanny] no sam i mean placed
[dua_frank] third trimester sammy
[dua_frank] 14 weeks lanny
[dua_frank] removed at 32
[lanny] 12 -16 wks right dua
[lanny] removed at 34
[megs] 14 wks lanny ideally
[samantha] 36 is for lightening lanny dua's q
[dua_frank] lightening is flattening of upper abdomen and increased prominence of lower abdomen
[megs] or 2 weeks priar to previous abortions
[dua_frank] baby comes down
[lanny] os sorry sam
[samantha] no prob lanny
[dua_frank] average weight gain during pregnany and what is average baby weight?
[megs] 11 to 12 kg
[megs] noraml baby wt is 3 kg
[lanny] use lbs guys american system
[dua_frank] yes
[dua_frank] 28 lbs and 7-8 lbs
[lanny] dua i thought 20 lbs
[lanny] youre right 7 lbs average
[dua_frank] 12 kgs is 28 lbs lanny
[uniteus] no maths please
[dua_frank] lol
[samantha] lol
[dua_frank] what does g2p1002 mean?
[dua_frank] math uni :P
[uniteus] eck
[samantha] gravida 2 para 4
[samantha] dua
[megs] *)
[lanny] dua forgotten
[uniteus] term 1, preterm 0, abortion ?
[dua_frank] means this is her second pregnancy, previous pregnancy with twins
[dua_frank] whats triple scan?
[megs] b hcg ,esriol ,alfa fetoprt levle
[lanny] screen you mean dua
[dua_frank] oops
[dua_frank] screen
[dua_frank] yes
[lanny] megs got it
[dua_frank] what are their abnormal values?
[uniteus] dua d p1002 is term=1, preterm=0, abortion=0, living = 2
[dua_frank] tell me the conditions which change them
[megs] all trisomies dua
[dua_frank] right
[uniteus] inc afp= ntd
[dua_frank] the last 4 numbers are flap uni
[uniteus] ok...thx
[dua_frank] full term pregnancy, premature pregnancy, abortions, living children
[lanny] ventral abdom wall def
[dua_frank] this is for parity
[dua_frank] 1002 would mean one full term pregnancy with twins
[dua_frank] parity should previous prenancies
[uniteus] ok..got it ..thx dua
[dua_frank] welcome
[dua_frank] afp decreased iN?
[megs] dua can u explain seperately
[megs] what is 1002
[dua_frank] G2P1002
[lanny] inc a FP ?
[dua_frank] this was the equation
[uniteus] NTD lanny
[megs] ok
[lanny] what else uni
[dua_frank] G2 is gravida 2, just shows how many times she has become pregnany, including present one
[uniteus] low afp, hcg, estriol is trisomy 18
[megs] agree uni
[dua_frank] P shows viable pregnancies, not number of fetetus deliverd, just pregnancies that have reached viability
[lanny] i mean inc a FP seen in??
[megs] yes dua
[uniteus] NTD lanny..
[lanny] what else uni
[uniteus] dunno
[megs] neural tube defects, germ cell tumors
[dua_frank] in parity we have 4 numbers which denote full term pregnancies, premature pregnancies, abortions, living children (FLAP)
[lanny] fetal death uni
[megs] thanx dua
[dua_frank] in our case lady had previously one full term pregnancy, no premature pregs no abortions and 2 live babies (twinS)
[dua_frank] welcome megs
[samantha] thanx dua
[dua_frank] how about gastrorhesiS?
[dua_frank] AFP in this?
[lanny] inc dua
[dua_frank] right lanny
[dua_frank] what tests do you do on first visit?
[lanny] OH DUA I JUST WAS GONNA ASK????
[megs] lanny do u mean to say FP INCR IN FETAL DEATH???
[dua_frank] lol telepathy lanny
[lanny] yes
[lanny] right dua
[lanny] blood group
[lanny] rubella titre
[lanny] syph hiv hepB
[dua_frank] rh cbc pap and gc for chlamydia too
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[dua_frank] if family history of DM, 1 hr glucola
[lanny] yes dua
[lanny] if no fam hx then at 24 wks
[dua_frank] triple screen too
[dua_frank] yes
[dua_frank] so many tests
[lanny] ok second visit
[lanny] at 16 -20 wks
[lanny] what do we do???
[dua_frank] sickle cell screen, hb
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[lanny] aFP U sound for fetal age
[dua_frank] but you do that at first visit
[dua_frank] the triple screen
[dua_frank] usg also at first visit
[dua_frank] 28 weeks?
[lanny] triple screen is done from 15 wks dua
[lanny] between 15 -20 wks
[megs] AGREE LANNY
[lanny] so thats second visit
[dua_frank] oh
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[dua_frank] shouldn't we be going month wise then? instead of visit wise
[lanny] 28 wks diab screen
[dua_frank] lady can come at even 16 weeks for first visit
[dua_frank] we never know
[lanny] repeat RH
[lanny] CBC
[dua_frank] yes lanny
[lanny] give rhogam
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[dua_frank] what if rh is positive lanny?
[lanny] give rhogam if RH neg
[dua_frank] positive?
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[lanny] no need
[dua_frank] you should do amniocentesis, prepare for transfusion and delivery of baby
[dua_frank] whats lyle curve?
[lanny] so what if you have a rh pos at 8 weeks first visit?/
[dua_frank] you dont do it then lanny
[dua_frank] you do
[dua_frank] dunno lanny
[lanny] yes you do you do blood grp and RH
[dua_frank] ask megs
[megs] DURING MANAGING RH NEGATIVE PREG THERE IS CERTAIN PROTOCOL
[megs] if mother is rh negative do husbands blood gr firs
[megs] if husbands blood gr is negative...no need of rhogum
[megs] if mother is negative....
[uniteus] but if not husband but other? *)
[lanny] correct megs
[megs] and babies blood gr is suspected to be positive then as lanny said
[dua_frank] uni lol
[lanny] if father is pos and mum is neg give RHIGAM
[lanny] if previous preg mum got rhogam do you give in this preg??
[uniteus] yeah...collegeu of mine asked me dat...i was bit blank at that point..basically i learned to do grp n rh to all pregnant woman...n baby too no matter wat...husband not too reliable
[megs] yes lanny u will give
[dua_frank] right i agree uni lol
[uniteus] lol
[lanny] agree megs just wanted to let all know
[uniteus] thx lanny
[dua_frank] what do you look for in amniocentesis?
[lanny] in short always give rhogam if mum is rh neg
[dua_frank] of this rh pos mom
[uniteus] if mom blood test is HBsAg,wat u give to baby just born?
[dua_frank] right lanny
[lanny] regardless of fathers status
[dua_frank] ig uni
[dua_frank] and vaccine
[lanny] vacc and IG
[megs] immunoglobulins and vaccination both
[lanny] right megs
[uniteus] rt dua n lanny...need to give both ..n rt megs
[lanny] immed after birth and 6 wks later
[dua_frank] bilirubin
[dua_frank] how will you rx chlamydia inf in preg ldy?
[lanny] doxycycline
[lanny] oh sorry
[uniteus] no lanny tetra
[uniteus] teratogenic
[lanny] no uni
[dua_frank] ceph or erythro
[lanny] erythro
[megs] erythro dua
[uniteus] erythromycin
[dua_frank] can give both
[lanny] doxy and tetra are contra in preg
[dua_frank] yes lanny
[dua_frank] what test at 37 weeks?
[lanny] Grb B strep
[lanny] chlamydia culture
[lanny] GC
[dua_frank] good lanny, if positive?
[lanny] treat
[dua_frank] drug
Unrecognized Command or Action.
[dua_frank] ?
[uniteus] give intrapartum antibiotics
[dua_frank] iv amp yes
[uniteus] pcn
[lanny] pen
[dua_frank] uti rx/
[dua_frank] ?
[uniteus] amp n gent??
[dua_frank] yep
[lanny] amp gent clinda???
[dua_frank] when do you give nitrofurantoin?
[uniteus] allergic to PCN
[lanny] agree
[megs] uti dua..when alleric to pen
[uniteus] or stable patient? as outpatient?
[dua_frank] i thought you desensitize and give pens
[dua_frank] you might be right though, thanks
[lanny] thats in syphillis
[megs] desensitization of pencillin..i know only for syphilis
[dua_frank] yes syphillis, thanks
[megs] for other disess we have alternate antobiotic..eqally effective
[uniteus] Cocaine mother is at risk of what problem?
[lanny] heart dz
[megs] abruption uni
[uniteus] rt megs
[lanny] teratofens
[lanny] lithium>??
[uniteus] difference between placenta abruption n previa?
[dua_frank] ebstein
[megs] ebstiens anomaly lanny
[uniteus] Ebstein
[uniteus] triscupis valve mainly affected in ebstein
[lanny] right
[lanny] tetra/??
[megs] previa painles bleeding due to malposition of placenta...
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[lanny] abrupt is painful
[megs] abruption painful..bleeding ..cause is premature seperation of normally situated placenta
[uniteus] rt megs n lanny
[megs] placental location is imp
[megs] abnormal location...its previa...
[megs] normal location its abruption
[lanny] management of abruption??
[samantha] delliver lanny
[megs] amniotomy and termination...lanny
[lanny] right all
[lanny] C section
[uniteus] speculum exam, USS, bed rest , if <34weeks give steroid for lung maturity...but if not stable allow v-deliver or Csection
[lanny] if mother and child in jeopardy
[uniteus] csection
[uniteus] complication of abruption?
[megs] DIC
[lanny] DIC
[uniteus] rt n?
[samantha] dic
[lanny] ATN
[megs] RENAL FAILURE
[samantha] embolii
[uniteus] maternal shock n mother may get couvelair uterus
[uniteus] what is couvelair uterus?
[lanny] bleeding int uterine sall
[lanny] wall
[megs] BUT ITS BENIGN UNI..U DONT NEED TO DO ANYTHING FOR IT
[megs] it will resolve on its own...
[uniteus] couvelair uterus is bruised , purple appearnce of serosa...
[uniteus] agree megs..sorry for putting it as complication
[megs] covulier uterus is just a finding during c section in abruption
[lanny] its like a bruise on your skin
[lanny] but this is on the uterus
[megs] true lanny
[lanny] what is metabolic state in preg??
[dua_frank] when is amniocentesis done?
[megs] what is tr of planta previa with 30 weeks bleeding profusely???
[lanny] acidosis or alkao
[uniteus] second trimester dua
[uniteus] resp alkalosis in preg
[dua_frank] 15 to 17th week
[samantha] c section megs
[dua_frank] what do you use amniocentesis for?
[lanny] admit pt and give bed rest give steroid
[megs] yes sammy
[samantha] and iv fluids first
[megs] for triple screen, in rh negative pregnancy dua
[dua_frank] triple screen is done by blood megs
[megs] also some times for feta karyotyping
[megs] oh sorry dua..u r correct ..
[uniteus] karyotype dua
[dua_frank] we look for karyotyping, bilirubin in rh positive mom, blood, culture it and alpha feto protein
[uniteus] y bilirubin dua?
[dua_frank] you look for rh incompatibility uni
[uniteus] oh ok..thx
[dua_frank] if there is bilirubin it means hemolysis has begun already
[dua_frank] got to do immediate delivery
[dua_frank] or else hydrops fetalis
[megs] dua lily s charting???
[dua_frank] yes megs of bilirubin
[dua_frank] by amniocentesis
[dua_frank] when do we do CVS?
[uniteus] first trimester 9-12wk
[dua_frank] right
[uniteus] for karyotype
[dua_frank] just a little better than amniocentesis
[dua_frank] and can be done earlier
[uniteus] but has risk too..like miscarriae
[uniteus] miscarriage
[uniteus] most commonest cause of postpartum hemorrage?
[dua_frank] remannts of placenta
[megs] retained placenta pieces
[uniteus] nope
[dua_frank] no? :O
[uniteus] think again
[megs] atonic uni???
[samantha] atonic uterus
[uniteus] rt megs n samantha...uterine atony
[megs] but uni retained is more common
[dua_frank] so thats why you do massage?
[dua_frank] yeah megs
[uniteus] yup dua
[uniteus] nurses always massage the uterus..
[megs] in the era of PG AND ERGOMETRIN...ATONIC PPH IS ..NOT COMMON
[dua_frank] okie dokie obgynologist megs jee :P
[megs] dua lol
[megs] are u making funn
[uniteus] ur the boss megs...i only follow notes
[megs] of me lol
[dua_frank] no way megs, never
[uniteus] lol
[dua_frank] i would trust you more than kaplan on obgyn, i swear lol
[uniteus] agree dua
[megs] i do not worth that dua..
[dua_frank] megs i never learnt obgyn with as much interest as now with you, thanks a lot for all your inputs here
[megs] ok let it be...step 2 is a big ..big..topic..and obgy is a part of it
[samantha] why not megs
[uniteus] agree dua..thank u very much....
[megs] ok guys
[megs] move on next sub
[dua_frank] aww shes blushing now :P
[dua_frank] ok ok i'll stop teasing you noW :P
[uniteus] lol ...ok megs go hit us q
[megs] what is HELLP SYNDROME??/
[uniteus] hemolysis, elev liver enxymes, low platelets seen in sever preeclampsia
[megs] YES UNI
[samantha] agree uni
[dua_frank] megs can you please explain what normal triple screen is like?
[dua_frank] and whats MOM
[dua_frank] multiples of median
[megs] DUA I HAVE NEVER PERSONALLY DID IT
[megs] I KNOW JUST THEOROTICAL
[dua_frank] ok
[dua_frank] talks here about moms of afp
[dua_frank] was wondering what that was
[megs] just remember it MOM ..in downs screening
[dua_frank] ok teratogen,s me telling presentation you tell me teratogen
[dua_frank] yeah low mom there megs
[megs] ok dua
[dua_frank] cns defects, deafness, congenital heart defecs
[uniteus] cmv
[megs] rubella
[dua_frank] drug uni
[megs] ok
[dua_frank] sorry drugs please
[uniteus] oh...
[megs] streptomycin dua??
[megs] not sure
[dua_frank] isotretinoin
[uniteus] eck
[dua_frank] limb reduction?
[megs] ok
[megs] thalidomide
[dua_frank] right
[uniteus] warfarin or thalidomine
[dua_frank] fetal cytotoxicity?
[megs] tell us more dua
[dua_frank] streptomycin
[dua_frank] just that megs
[dua_frank] ebstein anomlay?
[megs] ok
[megs] lithium
[uniteus] li
[dua_frank] neural tube defects, cleft lip, renal defectS?
[uniteus] folic acid def...so phehytoin or valproic
[megs] valproate
[dua_frank] right valprioc
[uniteus] no phenytoin dua..dunno?
[dua_frank] stippling of uncalcified epiphysis, microcephaly, MR, optic atrophy?
[uniteus] lead
[samantha] lead
[megs] dunno
[dua_frank] uni i know of only valproate that is teratogenic in antiseizure medication
[dua_frank] warfarin
[megs] great dua
[uniteus] ok..thx dua
[dua_frank] yellow teeth?
[megs] tetra
[uniteus] tetracyclin
[dua_frank] easy
[dua_frank]
[samantha] i think uni is rt fetal hydantoin synd
[samantha] phenytoin is there
[uniteus] ok...just remembered..thx sammy
[dua_frank] iugr, short palpebral fissure, long philtrum?
[samantha] blocks folic acid
[uniteus] alcohol dua
[lanny] alcohol
[dua_frank] oh yeah, thanks sammy, but with neural tube defects? can you please tell me the features of fetal hydantoin syndrome?
[dua_frank] yes alcohol
[dua_frank] t shape uterus?
[megs] DEC
[lanny] DES
[megs] DE S
[uniteus] what is dec?
[uniteus] oh..got it megs
[dua_frank] as far as i know there is only microcephaly in FHS
[dua_frank] yes DES
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[dua_frank] IUGR, mr, microcephaly, inner epicanthal folds depressed nasal bridge, nail hypoplasia, oral clefts and heart defects?
[samantha] that's rt dua
[lanny] fetal alcohol??
[dua_frank] right
[dua_frank] thanks for reminding me about FHS uni and sammy
[lanny] is hydantioin same a sphenytoin
[dua_frank] yes lanny
[uniteus] yes
[lanny] thx
[dua_frank] when are igs given?
[dua_frank] name the infections
[uniteus] ok
[dua_frank] well? :P
[uniteus] oh..kawasaki u mean
[dua_frank] uni sleeping again lol wake up
[uniteus] yeah..
[uniteus]
[lanny] whats the q dua??
[dua_frank] kawasaki and ITP yes but in normal women
[dua_frank] i'm talking about igs for infections
[dua_frank] in pregnant women
[dua_frank] hepatitis, rabies, tetanus, varicella, hep a and measles
[uniteus] oh..ok..thx
[dua_frank] welcome
[dua_frank] ok i guess thats all from me today
[uniteus] ok..me too
[dua_frank] see you all tomorrow
[uniteus] bye lanny, dua, sammy n megs...n thx
[dua_frank] last day for obgyn tomorrow
[dua_frank] bye uni
[lanny] yes dua
[dua_frank] thanks too
[lanny] it went well
[dua_frank] it did lanny
[lanny] plz post todays dua
[dua_frank] i will be doing that now
[lanny] and thankyou as always
[dua_frank] welcome
[dua_frank] bye lanny and sammy
[lanny] see you all tom guys!!!
uniteus has left the chat.
lanny has left the chat.
[samantha] bye dua
samantha has left the chat.