Anonymous
06-23-2004, 10:59 PM
21:07:30 [Step_1] i think that roxanita posted a detailed schedule of path topics
21:07:39 [Lorena] yes, we usually say that in the chat , but i will post whatever we agree to discuss
21:07:51 [nne] where/
21:08:21 [zeda] please tell me which is the best material available if i want to chhose one?
21:08:42 jwls29 enters this room
21:08:44 [Step_1] http://www.valuemd.com/viewtopic.php?p=97486#97486
21:08:46 [zeda] k a p or g o l j a n
21:08:46 [crusher] goljian if you can grasp..
21:09:01 [crusher] if not than brs is fine
21:09:10 [neurodoctor_75] think goljan and <a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10002441&type=3&subid=0 >Kaplan</a><IMG border=0 width=1 height=1 src=http://ad.linksynergy.com/fs-bin/show?id=c97WUMRO5hY&bids=47491.10002441&type=3&subid=0 >
21:09:25 [jwls29] Hi. Is this the path discussion?
21:09:32 [zeda] k a p has no rating?
21:09:45 [Step_1] hi jwls
21:09:46 [Lorena] yes jwls, welcome
21:10:16 [Step_1] yes today is path, including cardio, resp, neoplasia, etc. sat will be remainder of path
21:10:24 [Step_1] ready to get started
21:10:30 [jwls29] Lol
21:10:32 [jwls29] soory
21:10:32 [Lorena] yes
21:10:50 [jwls29] i was looking at the bottom of the screen and couldn't see where i was posting
21:10:52 [jwls29] hello all
21:11:06 [Step_1] you hear fixed splitting in s2...is this normal or pathologic
21:11:07 [crusher] ok lets get started
21:11:30 [zeda] which topic we will finish first?
21:11:32 [Lorena] you can change the color of your letters for a more easy one to see on the rainbow on the left
21:11:33 [Step_1] jwls, you might want to pick a brighter color on the rainbow to the right
21:11:34 [crusher] pathologic commonly on ASD
21:11:44 [jwls29] how's this
21:11:59 [Step_1] oops sorry, i assumed cardiac....but whatever you prefer.
21:12:01 [Lorena] sorry ..right (always do the same mistake)
21:12:06 [Step_1] much better jwls
21:12:27 [jwls29] ok
21:13:20 [Step_1] thats right crusher.
21:13:39 [Step_1] what about s3?
21:13:58 [Step_1] is it normal to hear or abnormal?
21:14:12 [jwls29] isn't s3 pathologic too and should only be heard in children and elderly?
21:14:21 [crusher] S3 is normal is old age but pathologic in vol overload
21:14:24 merjo13 enters this room
21:14:33 [Lorena] abnormal
21:14:35 [merjo13] Hi all
21:14:51 [Step_1] normal in children and young adults, but abnormal after 40 yo....first sign of chf....good
21:15:01 [zeda] vasculitis of the elderly,presenting as headache,facial pain and impaired vision...Dx?
21:15:12 [jwls29] what about in elderly?
21:15:14 [Lorena] temporal arteritis
21:15:19 [crusher] temporal arteritis
21:15:25 [Step_1] temporal arteritis
21:15:35 [zeda] right
21:15:42 [neurodoctor_75] temporal arteritis
21:16:01 [Lorena] what vessels are involved ?
21:16:16 [Step_1] elderly should not have s3 because indicates volume overloaded right heart
21:16:18 [Lorena] besides temporal artery
21:16:27 [Step_1] but most probably do
21:16:32 [jwls29] ok
21:16:41 [jwls29] opthalmic art?
21:17:19 [Step_1] extracranial branches of carotid artery
21:17:21 [crusher] opthalmic also risk for blindness
21:17:43 [zeda] which art. are associated in Buerger dis.?
21:17:44 [Lorena] yes! good job
21:17:58 [Step_1] what is the treatment of temporal arteritis....give immediately to prevent blindness?
21:18:11 [jwls29] steroids
21:18:15 [crusher] corticosteroids
21:18:16 [neurodoctor_75] some problem in my computer.
21:18:26 [Lorena] small and medium size arteries and veins mostly in inf extremities
21:18:38 [Lorena] agree steroids
21:18:49 [crusher] med size vessels for Buerger dis
21:18:51 [jwls29] i thought it was in upper arteries
21:18:59 [jwls29] i mean upper extremities
21:19:01 [Step_1] agree with lorena and crusher for buerger.
21:19:10 [zeda] tibial and radial art.
21:19:11 [jwls29] this is the one associated with heavy smokers, right?
21:19:14 [Step_1] and yes corticosteroids....good job everyone
21:19:18 [Lorena] for buerger is inf extremities
21:19:42 [zeda] yes,assoc. with cigarette smoking
21:20:01 [zeda] also called thromboangitis obliterans
21:20:18 [jwls29] ok
21:20:23 [crusher] what is the most suspetible site in liver for Free radical injury??
21:20:38 [zeda] around central V.
21:20:41 [jwls29] i just checked my <a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10002441&type=3&subid=0 >Kaplan</a><IMG border=0 width=1 height=1 src=http://ad.linksynergy.com/fs-bin/show?id=c97WUMRO5hY&bids=47491.10002441&type=3&subid=0 > and it does not say which extremities. just says extremities
21:20:55 [Lorena] around central vein , zone 1
21:20:58 [jwls29] yikes
21:21:03 [jwls29] what is all that?
21:21:15 [crusher] buerger can also gluteal with gangrene of foot
21:21:25 [Step_1] jwls, try not to post the word kap lan, or first aid, amaxon, etc
21:21:31 [Lorena] jwls , they present with claudication....because inf extremities
21:21:33 [crusher] good.its in central vein zone 1
21:21:33 [jwls29] i don't know what i did
21:21:34 [zeda] yes
21:21:43 [Step_1] it will auto convert into a link like above
21:22:03 [jwls29] what are all those links?
21:22:30 [zeda] don't type book's or course's name here
21:22:37 [crusher] what are the free radicals for O2 and H20?
21:22:38 [zeda] t will go to direct links
21:22:40 [jwls29] ok
21:22:42 [jwls29] i won't
21:22:45 [jwls29] thanks
21:22:51 [Step_1] during game, young basketball player collapses and dies immediately. what type of cardiac disease likely?
21:22:56 [zeda] superoxide
21:23:08 [crusher] IHDS
21:23:21 [Lorena] superoxid anoin, hydroxyl radicals
21:23:24 [jwls29] hypertrophic cardiomyopathy
21:23:34 [Lorena] hypertrophic cardiomyopathy
21:23:41 [Step_1] hypertrophic cardiomyopathy.....there is a good post with pics about it. i'll try to find it and post the link tommorrow. good job
21:24:00 [zeda] hypertrophic cardiomyopathy and its rare
21:24:26 [Step_1] its rare, but often tested for some reason....dont ask me why?
21:24:32 [jwls29] what type of coarctation is associated with Turner's sdme? preductal or postductal?
21:24:46 [Lorena] preductal
21:24:50 [crusher] what are the neutrolizers of free radicals and how they work?
21:24:57 [Step_1] preductal
21:25:00 [jwls29] yup
21:25:02 [zeda] jwls...please change your color
21:25:07 [nne] preducta
21:25:21 [jwls29] lighter or darker?
21:25:38 [Lorena] superoxide dismutase, glutathione peroxidase
21:25:42 [zeda] purple is hard to read
21:25:50 [jwls29] is this better?
21:25:59 [zeda] yes..thanks
21:26:08 [Lorena] much better jwls, thanx
21:26:14 [jwls29] no prob
21:26:29 [Step_1] asian woman 33 yo presents with absent upper extremity pulse, but high bp in lower extremity. also has visual disturbances. Most likely diagnosis.
21:26:50 [jwls29] takayasu's arteritis
21:26:56 [Lorena] takayasu
21:27:18 [zeda] name one cong. abnormality which predisposes to aortic stenosis?
21:27:21 [Step_1] takayasu disease is correct. "can't taka yoy pulse"
21:27:25 [crusher] yes lorena superoxide dismutase ,glutathione ,N.acetylcystein,antioxidant like VIT E,C and selenium
21:27:33 [nne] takayasu
21:27:41 [crusher] coraction of aorta
21:28:04 [Lorena] i dont remember EXACtly how they work though
21:28:09 [zeda] bicuspid aortic valve
21:28:11 [jwls29] me neither
21:28:51 [nne] i think its coarctation of aorta that is right
21:29:16 [nne] takayasu is usually pulseless
21:30:01 [Step_1] microangiopathic hemolytic anemia with schistocuytes is associated with aortic stenosis
21:30:02 [crusher] they neutralizes the Fr and prevent the damGE OF cell membrane by LIPID PEROXIDATION ,in which FR combine with molecular O2
21:30:06 [nne] with asian there takayasu is correct
21:30:30 [Lorena] thank you crusher
21:30:41 [Step_1]>[nne] yes, the asian woman was takayasu
21:30:43 [jwls29] thank you
21:31:41 [Step_1] mneumonic is "can't taka ya pulse" because can't take pulse = takayasu
21:31:45 [crusher] free radicals r usmle fav topic
21:31:47 [Lorena] what coagulation path & factor you test with prothrombin time test?
21:31:59 [zeda] upper extremity hypertension with lower extre. hypotension..Dx?
21:32:18 [Step_1]>[zeda] coarctation of aorta
21:32:21 [jwls29] coarctation of the aorta
21:32:35 [crusher] coarction of aorta
21:32:35 [zeda] postductal...right
21:32:46 [Step_1]>[Lorena] extrinsic path
21:32:49 [Lorena] coarctatuion of aorta post ductal
21:32:51 [jwls29] intrinsic path don't know the factor
21:32:56 [zeda] how will u detect it on x-ray?
21:33:11 [jwls29] notching of the ribs
21:33:17 [crusher] what does n.acetylcystein do for poisioning with acetaminophan
21:33:20 [Lorena] yes step 1 , extrinsic path
21:33:34 [zeda] right
21:34:04 [jwls29] so prothromin is for extrinsic?
21:34:10 [jwls29] i always get that confused
21:34:20 [Step_1] I remember that because PeT and PiTT both make words. PT extrinsic and PTT is intrinsic
21:34:32 [jwls29] cool
21:34:40 [jwls29] now i'll remember
21:34:48 [Lorena] yes, prothrombin for extrinsic path
21:34:55 [Lorena] and common
21:35:02 sanya enters this room
21:35:24 [Step_1] hi sanya
21:35:29 [jwls29] what about crusher's question about the n acetylcystein?
21:35:38 [zeda] hi sanya
21:35:41 [sanya] Hi step_1
21:35:51 [Lorena] i dont remember ...
21:35:51 [zeda] crusher pl. ans
21:35:52 [sanya] Hi to all of you!
21:35:52 [Step_1] i didnt see crushers question
21:35:56 [jwls29] thanx lorena
21:36:06 [Step_1] now i see it
21:36:28 [Lorena] hi sanya
21:36:46 [Step_1] you give it for GSH or something. that is aka mucomyst which is used in CF and other pulmonary diseases too
21:36:50 [jwls29] hi sanya
21:38:06 [crusher] replenish gulathione..
21:38:42 [sanya] n-acetyl cysteine increases production of glutathione which is depleted in acetaminophen poisoning
21:38:51 [crusher] i,m sorry i was away,,my lill one askin something
21:39:06 [crusher] yes right sanya
21:39:52 [Lorena] for glutathione peroxidase?
21:40:30 [Step_1] printzmetals angina. stress ECG will show what? increase or decrease of what?
21:40:45 [sanya] what are we doing now I mean which chapter
21:40:51 GABA enters this room
21:40:52 [crusher] inc St seg elevation
21:41:03 [sanya] St elevation
21:41:04 [Lorena] ST elevation
21:41:06 [Step_1] still cardia path
21:41:27 [Lorena] we are jumping around sanya....from cell injury to cardiac and back
21:41:30 [sanya] OK Thankyou!
21:41:33 [Step_1] printzmetals will show elevated ST....where is ischemia....transmural or subendocardial
21:41:56 [Lorena] transmural
21:42:20 [Step_1] should we be on cell injury? we can ask those questions instead?
21:42:58 [jwls29] transmural
21:43:03 [zeda] associated factors with dilated cardiomyopathy?
21:43:09 [Lorena] i dont mind jumping or following by chapters , whatever you prefer
21:43:17 [Step_1] yes, its transmural because increase st. so what gives depressed ST and subendocardial ischemia?
21:43:39 [crusher] angina
21:43:42 [Lorena] alcohol, drugs, virus, parasites
21:43:50 [jwls29] stable angina
21:43:55 [Lorena] subendocardial
21:44:04 [GABA] angina
21:44:10 [Step_1] exertional (classical) angina gives depressed ST. relieved by nitoglycerin
21:44:40 [Step_1] hi gaba
21:44:59 [Lorena] yes, classical angina is a subendocardial ischemia = ST depression
21:45:12 [zeda] right lorena.......also pregnancy,can also be idipathic
21:45:22 [crusher] what is cause of met.Hb .nemia
21:46:00 [Lorena] carbo monoxide intoxication
21:46:23 [sanya] water with nitrites?
21:46:50 [zeda] oxidizing agents ..like nitrite or sulfur containig drugs
21:47:02 [Lorena] dapsone too
21:47:12 [Step_1] o2 content decreased. can be caused by tmp-smx treatment (i.e. tx of PCP in Aids pt...real test question)
21:47:27 [zeda] and defi. of metHb reductase
21:48:15 [Step_1] heme is stuck in iron + state so cannot bind O2
21:48:18 [crusher] Fe in Ferric state instead of ferrous state.(Fe sholud be in ferrous state to bind O2) result in dec O2 content dec Saturation of O2.person seems to be blue
21:48:23 [Lorena] thanks step
21:48:30 [Step_1] oops iron +3 state
21:49:00 [zeda] thanks step1 and crusher
21:49:09 [Step_1] treatment is IV meth blue and ascorbic acid (vit c)
21:49:19 [crusher] Tx of choice is methylene blue ,which inhances the conversion of Fe to ferrous state
21:49:28 [Step_1] real test question....best marker within 10 hrs of MI? choices were CKMB, troponin, LDH
21:49:43 [zeda] what are the mitochondrial toxins?
21:49:50 [crusher] tro[ponin
21:49:56 [sanya] troponin
21:49:56 [Lorena] troponin
21:50:01 [merjo13] Troponin
21:50:02 [zeda] CKMB
21:50:20 [crusher] what does ascorbic acid role?
21:50:20 [jwls29] troponin
21:50:36 [merjo13] Ascorbic- reducing agent
21:50:40 [Step_1] i dont have the ans because it is a recall, but i think it is ck mb according to goljan....not sure
21:50:47 [Lorena] agre with merjo
21:51:04 [Lorena] tricky
21:51:08 [crusher] i think troponin is more specific
21:51:15 [zeda] thanks step1...i thought i am wrong...but as i remeber this too
21:51:21 [Lorena] me too
21:51:35 [zeda] but need to check again
21:52:07 [zeda] i checked.....it is CK-MB
21:52:17 [nne] ist 24 hrs CK MB ACCORDING TO F A
21:52:18 [merjo13] Oh thanks
21:52:41 [jwls29] in the path book by cap ihave ck mb elevated by 4-8 hrs
21:52:41 [Lorena] ic
21:52:54 [nne] TROPONIN I IS IST 4 HRS TILL 7 - 10 DAYS
21:52:56 [crusher] oh ok
21:53:32 [nne] LDH1 IS FROM 2-7 DAYS
21:53:50 [Lorena] then why not troponin? if it is from4 hrs to 10 days ....confusing
21:54:02 [nne] IST 4 HRS ECG IS MOST APPROPRIATE
21:54:05 [jwls29] and troponin 3-6 hours
21:54:16 [jwls29] so which would be right?
21:54:35 [Step_1] that one really had me. goljan mentioned it in his audios, but not so clear in his notes. still confused about answer.... but real question
21:54:35 [sanya] Goljan notes says CK-MB increases 4-8hrs peaks in 24hrs disappears in 1.5 to 3 3days.
21:54:59 [nne] TEST OF CHOICE FOR 1SY 24 HRS IS CK- MB AS IT IS WRITTEN IN F A
21:55:10 [Lorena] at 10 hours post MI both are elevated.... but the questions is which one is the best marker?
21:55:27 [jwls29] wouldn't it be troponin?
21:55:39 [jwls29] i've always understood that that one is more specific
21:55:50 [sanya] both types of troponin increase in 3 to 12 hrs, since they all increase by 12hrs I think CK-MB is the RIGHT one
21:56:25 [Lorena] why?
21:56:54 [Step_1] i'll try to listen to that section of goljan again and provide some feedback in the forum hopefully tomorrow
21:57:17 [sanya] what I meant is since troponins only increase but does not peak CKMB is right
21:57:33 [Step_1] sorry for the question, but better to figure it out now that in the test
21:57:54 [jwls29] i have that the troponins peak at 16 hours
21:58:00 [Lorena] troponins do peak (at 16 hrs)
21:58:10 [nne] NO DON'T APOLOGISE FOR HELPING EVERYONE LEARN
21:58:24 [Lorena] yes step, excellent question
21:58:43 [Lorena] jus trying to figure out which one and why
21:58:45 [jwls29] exactly...i rather know for sure know than be staring at my computer the day of the exam
21:58:48 [sanya] goljan notes says T peks in 24hrs
21:59:00 [sanya] sorry peaks
21:59:31 [Step_1] i usually have the correct answers to the questions prepared...this one just had me stumped
21:59:32 [jwls29] yeah the guy from kap says that they are all going to say different times but they are all about in the same range
21:59:59 [jwls29] meaning different books will say differnt times
22:00:14 [Lorena] i see
22:00:50 [Lorena] ok, lets move on and look for that in dif sources
22:00:58 [jwls29] ok
22:01:11 [crusher] which IHD is most common
22:01:42 [nne] MI
22:01:52 [neurodoctor_75] angina
22:01:53 [sanya] angina pectoris
22:02:17 [Lorena] angina agree
22:02:20 [crusher] yes its angina pectoris
22:03:27 [Lorena] what are lines of zahn?
22:04:52 [jwls29] platelets and wbc's?
22:05:25 [jwls29] found in thrombus
22:05:40 [Lorena] close...platelets and RBC so they lookm like alternating pink bands
22:05:55 [jwls29] thanks
22:06:02 [sanya] what is Ejection fraction in systolic dysfuntion & in diastolic dysfuntion
22:06:05 [Lorena] yes, thats the difn witha blood clot - no platelets in blood clot
22:06:17 [Step_1] http://www-medlib.med.utah.edu/WebPath/jpeg1/LUNG117.jpg
22:06:18 [crusher] ok good to know lorena.tx\
22:06:25 [Step_1] oops...that didnt work
22:06:53 [Lorena] ejection fraction is decreased in systolic dysfunction
22:07:57 [sanya] right lorena
22:08:13 [Lorena] and in diastolic dysfunction is... ..... could be normal?
22:09:04 [jwls29] don't know this one
22:09:08 [Step_1] that one makes sense because ejection fraction is the fraction of blood pumped out of heart. blood is pumped out during systole....makes sense
22:09:39 [Step_1] i think??
22:09:57 [crusher] in diastolic dysfunction its inc
22:09:59 [Lorena] yes step
22:10:49 [Lorena] how is in dyastolic dysfunction sanya?
22:11:01 [neurodoctor_75] during diastole,inc why
22:11:04 [sanya] yes its normal that's one way to differentiate whether the cause is sys or dia dysfunction, pretty important in step2
22:11:15 zeda enters this room
22:11:32 [Step_1] thanks
22:11:34 [crusher] why its normal in diastole
22:11:40 [Lorena] thanks sanya
22:12:00 [Step_1] what gives a high pitched blowing murmur directly after S2?
22:13:47 [Lorena] mitral stenosis?
22:13:58 [Step_1] AV/PV regurg because of volume overload of ventricles (hypertropy/dialation) is the correct answer.
22:14:50 [Step_1] what gives a machinery murmur?
22:14:57 [sanya] PDA
22:15:01 [Lorena] ok
22:15:05 [Lorena] PDA
22:15:08 [merjo13] PDA
22:15:19 [jwls29] pda
22:15:22 [zeda] most common valvular heart dis. in U.S.?
22:15:28 [crusher] ok good step1....do you after S2 means (aotic and pul valves involve)
22:15:38 [Step_1] yes a PDA gives machinery murmur....mneumonic is a "PDA (palm pilot) is a machine"
22:15:39 [sanya] What direction is the flow of blood in PDA
22:15:43 [crusher] vsd
22:15:54 [merjo13] VSD
22:15:55 [Lorena] agree with crusher
22:15:58 [zeda] mitral valve prolapse
22:16:04 [merjo13] Aorta to pulm
22:16:15 [jwls29] agree with lorena and crusher
22:16:16 [zeda] especially in young women
22:16:17 [sanya] VSD you get a holosystolic or pan sys murmur
22:16:34 [Lorena] ops, you said valvular
22:16:35 [crusher] holosystolic
22:17:07 [merjo13] PSM
22:17:22 [sanya] merjo you're right
22:17:30 [zeda] middiastolic click followed by a late sys. murmur...Dx?
22:17:37 [merjo13] Thanks
22:17:46 [crusher] MVP
22:18:01 [zeda] right....mitral valve prolapse
22:18:29 [Step_1] MVP...agree
22:18:43 [Lorena] yes
22:18:55 [Step_1] what about opening snap?
22:19:14 [Lorena] mitras stenosis
22:19:19 [crusher] MS??
22:19:22 [merjo13] Occurs in MS
22:19:30 [Step_1] S-nap is S-tenosis
22:19:44 [zeda] what is nonbacterial thrombotic endocarditis?
22:20:05 [sanya] What will happen to the murmur in idopathic hypertropic subaortic stenosis when the patient is lying down
22:20:10 [jwls29] a mnemonic that helps me remember what is where is mr gluteal
22:20:11 [merjo13] occurs in SLE
22:20:36 [jwls29] mitral regurg aortic stenosis in systole
22:21:07 [Step_1] Liebman sack vegs in SLE
22:21:14 [zeda] friable,sterile emboli c/by hypercoagulable states
22:21:28 [merjo13] OOps...sorry
22:21:48 [zeda] gluteal. with DIC and adenoCA of pancreas
22:21:50 kokushubila enters this room
22:22:10 [crusher] hi koku
22:22:12 [Lorena] hi koku
22:22:15 [kokushubila] Hellooo everybody!
22:22:23 [Step_1] hi kiku
22:22:31 [zeda] hi koku
22:22:32 [jwls29] hi
22:22:34 [sanya] Hi Koks
22:23:14 [crusher] i gotta go>>guys
22:23:28 [crusher] see u later..may be
22:23:34 [jwls29] bye crusher
22:23:38 [sanya] why so soon crusher?
22:23:39 [Lorena] thank you crush
22:23:43 [zeda] which kind of murmur present in PDA?
22:23:53 [Step_1] bye crusher...thanks for the great questions
22:23:54 [Lorena] what do you mean maybe?
22:24:04 [merjo13] machinery murmur
22:24:13 [crusher] my movers r coming t.m so have piles of clothes n stuff to set
22:24:14 [Lorena] described as a machinery murmur
22:24:24 [zeda] YES...HARSH WAXING AND WANING
22:24:28 [crusher] anyone live in dallas???
22:24:29 [Step_1] machinery murmur in PDA because a "PDA (handheld) is a machine"
22:24:36 [zeda] MACHINERY MURMUR
22:24:46 [zeda] NICE STEP1
22:24:53 [sanya] Oh Ok bye see ya next week!
22:25:00 [Step_1]
22:25:08 [Step_1] abrupt onset of severe back pain, hypotension and pusatile mass are triad for what?
22:25:12 [Lorena] see you crush next week crush, bye
22:25:40 [zeda] bye crusher
22:25:41 [merjo13] Aneurysm rupture
22:25:44 [jwls29] aortic aneurysm?
22:26:01 [Step_1] thats the rupture triad for abdominal aortic aneurism....good job
22:26:16 [sanya] abdominal aortic anuerysm rupture
22:26:43 [Step_1] MI in a child is the buzz word for what dz?
22:27:05 [sanya] Kawasaki's
22:27:18 [zeda] Aschoff bodies in the myocardium are pathognomic for what?
22:27:28 [Lorena] agree
22:27:34 [Step_1] Kawasaki dz is MCC of acute MI in children....great sanya
22:27:36 [merjo13] Rheumatic fever
22:27:39 [sanya] Rheumatic carditis
22:27:41 [Lorena] aschoff bodies are dx for rheumatic fever
22:27:47 [jwls29] rheumatic fever
22:27:51 [zeda] right sanya
22:27:52 [Step_1] rheumatic fever
22:28:05 [sanya] thanks step1
22:28:08 [zeda] s/s?
22:28:33 [Lorena] jones criteria
22:28:55 [jwls29] arthralgia
22:28:57 [merjo13] 2 major 1 minor or vice versa
22:28:58 [jwls29] carditis
22:29:00 [sanya] subcutanoeus nodules, pericarditis, arthritis, chorea, erythema marginatum
22:29:03 [Lorena] arthritis, carditis, rheumatic nodules, erythema marginatum amd chorea are the major ones
22:29:16 [jwls29] nodules
22:29:16 [sanya] SPACE
22:29:19 [jwls29] sydenhan chorea
22:29:26 [Step_1] arthralgias, fever, elevated ESR or c reative protein, prolonged PR interval, erythema marginatum
22:29:52 [zeda] migratory polyarthritis,erythma margi.,subcut. nodules,pancreatitis
22:29:56 [Step_1] polyarthritis
22:30:05 [Lorena] minor are leukocytosis, fever, ESR?CRP increased, raised PR, arthralgia
22:30:41 [zeda] right
22:30:52 [sanya] What will happen to the murmur in idopathic hypertropic subaortic stenosis when the patient is lying down
22:31:35 [zeda] sequela of ac. rheumatic fever?
22:31:58 [jwls29] mitral valve stenosis
22:32:11 [Lorena] mitral stenosis and CHF , endocarditis
22:32:32 [Lorena] what is the answer to your q's sanya?
22:32:43 [merjo13] MS ,IE
22:32:54 [zeda] also..fish mouth deformity
22:33:07 [sanya] normally the other murmurs like MS or AS will increase because of increase return of blood to the heart on lying down so flow across the stenotic valve but in IHSS the murmur intensity decreases
22:33:32 [Lorena] thank you
22:33:35 [Step_1] sinusitis, saddle nose deformity, recurrent pneumonia, c-ANCA.....what dz?
22:34:00 [merjo13] Cong sypilis
22:34:02 [sanya] Wegenes granulomatosis
22:34:03 [kokushubila] Didn't know that Sanya Thank you
22:34:09 [Lorena] wegener disease
22:34:27 [sanya] you're welcome
22:34:45 [Step_1] wegeners granulomatosis is correct. anytime you see kidney and resp with c-anca is a dead give away....good sanya
22:34:52 [Step_1] and lorena
22:35:07 [jwls29] saddle nose is in wegener's?
22:35:08 [Step_1] treatment?
22:35:25 [Lorena] cyclophosphamide
22:35:29 [sanya] cause destruction of nasal cartilage
22:35:38 [Step_1] wegeners is the MCC of saddle nose deformity according to goljan
22:36:02 [jwls29] ok
22:36:08 [Step_1] cyclophospahmide is correct. bonus...what side effect and how to prevent?
22:36:11 [jwls29] i thought saddle nose was syphyllis
22:36:19 [jwls29] i guess i need to listen to his lectures
22:36:29 [sanya] hemorrhagic cystitis
22:36:55 [Lorena] dont know
22:37:01 [jwls29] agree with sanya
22:37:12 [Step_1]>[jwls29] i think syphillis too
22:37:19 [Step_1] cyclophosphamide causes hemorragic cystitis and prevented with Mesna....good
22:37:46 [Lorena] what is chrug strauss syndrome?
22:37:58 [jwls29] so in both?
22:38:00 [Lorena] Churg Strauss ..sorry
22:38:21 [jwls29] vasculitis with granulomas and eosinophilia
22:38:22 [sanya] its associated with asthma
22:38:36 [jwls29] assoc with asthma
22:38:41 [kokushubila] Vasculitis, Esinophilia , Asthma a combination of these-Churg ...
22:38:43 [Step_1] C-yclophoshamide remembered because of C-ANCA. the P-ANCA on the other hand is P-olyarteritis nodosa
22:38:49 [Lorena] v good
22:38:54 [zeda] small vess. vasculitis involving skin,lung,heart vess
22:39:11 [Step_1] agree
22:39:17 [sanya] I will be back in 10 minutes guys
22:39:29 [Step_1] ok sanya
22:39:30 [Lorena] mean dif between Churg and PAN?
22:39:49 [zeda] p-ANCA antibod. r present
22:40:04 [jwls29] pan does not involve lung
22:40:16 [jwls29] and p-anca instead of c-anca
22:40:18 [kokushubila] In Churg -you have Asthma
22:40:29 [Lorena] yes!
22:40:47 [Lorena] PAN involves any organ EXCEPT lung
22:41:13 [Lorena] and in Churg , meanly the lung is involved: asthma, etc
22:41:27 [Lorena] and the abs...good job
22:41:45 [jwls29] what antigen is positive in 30%
22:41:45 [Step_1] we should probably move to respiratory soon
22:42:00 [zeda] what r X-Linked bleeding disorders?
22:42:02 [Step_1] HBV
22:42:14 [jwls29] HBsAg
22:42:15 [jwls29] yes
22:42:16 [Lorena] HBs ag
22:42:26 [jwls29] hemophilia
22:42:28 [Step_1] hemophilia
22:42:35 [Lorena] hemophilia
22:42:49 [zeda] right..factor 8 and 9 defi.
22:43:24 [Step_1] which one for hemophilia A or B, 8 or 9?
22:43:25 [Lorena] lab in hemophilia A ?
22:43:47 [Lorena] hemophilia A is 8 , B is 9
22:43:52 [zeda] prolong pyy but normal bt,plt. count and pt in both
22:44:00 [jwls29] agree with lorena
22:44:12 [Step_1] 8=A and 9=B ....thankfully in order
22:44:13 [zeda] prolonged ptt
22:44:36 [Step_1] prolonged PTT normal PT and BT
22:44:54 [jwls29] agree
22:44:57 [zeda] right
22:45:02 [Lorena] yes
22:45:06 [Lorena]
22:45:41 [Lorena] and in VOn Willebrand disease?
22:46:34 [Step_1] increase BT, normal PT, increased PTT, low ristocetin cofactor assay
22:47:02 [Lorena] excellent
22:47:16 [Step_1] inc PT, PTT with low PLTs and D-Dimer present....what dx? that treatment?
22:47:31 [zeda] its a most common hereditary bleeding disorder
22:47:40 neurodoctor_75 exits from this room
22:47:45 neurodoctor_75 enters this room
22:48:16 [Lorena] DIC?
22:48:34 [Step_1] DIC, treatment is heparin because prevents consumption of coagulation factors
22:48:36 [Lorena] life support and treat underlying condition
22:48:42 [jwls29] DIC
22:48:46 [zeda] DIC
22:48:51 [jwls29] tx underlying condition
22:49:36 [Step_1] D-dimer is the buzz word, but also might see oozing of blood maybe post delivery
22:50:03 [Lorena] ok
22:50:15 [zeda] Histological presentation of ARDS?
22:50:16 [Step_1] should we do some respiratory path?
22:51:10 [jwls29] loss of pneumocytes
22:51:15 [Lorena] edema, inflamation
22:51:16 [zeda] characterized by intra-alveolar hyaline membranes
22:51:17 [Step_1] neutropil related injury with destruction of type 2 pneumocytes
22:51:19 [jwls29] inflammation
22:51:28 [Lorena] hyaline mebrane
22:51:33 [jwls29] i was missing edema
22:52:14 [Step_1] most commont cause of ARDS?
22:52:30 [jwls29] shock?
22:52:37 [Lorena] septic shock
22:52:50 [Step_1] endotoxic shock is MCC....good job
22:53:14 [zeda] sepsis,infection,aspiration and trauma
22:54:03 [Step_1] according to goljan, any child on exam with nasal polyps is assumed to have what dz?
22:54:51 [Step_1] wasn't actually in notes, but mentioned a couple of times in audio...the ans is CF
22:55:16 [jwls29] really????
22:55:29 [neurodoctor_75] why cf with the nasal polyps.
22:55:42 [Lorena] interessting
22:55:50 [Step_1] just for test.....not real life.
22:55:55 [neurodoctor_75] mean the pathogenesis
22:55:57 [Step_1] at least according to him
22:56:15 [zeda] what is Reid Index?
22:57:01 [Step_1] The ratio of the thickness of the mucous gland layer to the thickness of the wall between the epithelium and cartilage
22:57:01 [jwls29] it is the ratio of the mucus glands in the lungs
22:57:30 [zeda] Reid index is a ratio of the thickness of mucous gland to the thickness of bronchial wall
22:57:50 [zeda] increased Reid Index suggestive of what?
22:58:04 [Step_1] chronic bronchitis
22:58:08 [jwls29] chronic bronchitis
22:58:16 [zeda] yes
22:58:21 [zeda] s/s?
22:58:24 [Step_1] obstructive diseases
22:58:33 [Lorena] makes sence
22:59:15 [Lorena] cough, dyspnea, increased risk for infections
22:59:36 [Step_1] Blue Bloater, so cyanotic due to resp acidosis, obese
23:00:02 [Lorena] i wonder why they gain weight...
23:00:19 [Step_1] B-lue B-loater is B-ronchitis
23:00:25 [zeda] this is cyanosis resulting from severe hypoxia
23:01:20 [zeda] chronic bronchitis
23:02:01 [kokushubila] Pink Puffers?
23:02:14 [zeda] emphysema
23:02:23 [Step_1] cant find the reason for the obesity, but they seem to usually be obese and cyanotic vs the pink puffers that have emphsema and are typically think
23:02:57 [Lorena] ok thanks
23:03:03 [zeda] pink puffers overventilates
23:03:51 [Step_1] alpha 1 antitrypsin deficiency gives what type of emphysema? centrilobular or panacinar?
23:04:21 [Lorena] panacinar
23:04:31 [jwls29] panacinar
23:04:36 [Step_1] panacinar...that was a q.bank question....good job
23:04:41 [zeda] pan
23:04:57 [Lorena] centrilobular si asso with smoking
23:05:25 [Step_1] yes, agree
23:05:51 [jwls29] what is the only cancer of the lung treated with chemo instead of with surgery?
23:06:42 [Lorena] small cell ca?
23:06:49 [jwls29] yes
23:06:54 [zeda] small cell?
23:07:26 [Lorena] 2 ca associated with smoking?
23:07:43 [jwls29] small and squamous
23:07:49 [zeda] What is Ghon complex?
23:07:49 [Step_1] squamous and small cell cancers
23:08:01 [Lorena] yes
23:08:09 [Step_1]>[jwls29] what is the answer?
23:08:15 [kokushubila] Adeno not associated with smoking
23:08:27 [Step_1]>[zeda] seen in primary TB
23:08:38 [zeda] yes
23:08:44 [zeda] and in sec.?
23:08:48 [kokushubila] ????? I think I am wrong!
23:09:04 [jwls29] small cell cancer treated with chemo the rest are treated with surgery
23:09:06 [zeda] cavitary lesions in lung apices
23:09:15 [Lorena] you are right koku
23:09:20 [Step_1] adeno is the MC primary lung cancer in both smokers and nonsmokers
23:09:48 [Step_1] i think she meant which is exclusively seen in smokers....right?
23:10:33 [Lorena] yes, and adeno is less associated than squamous and small cell
23:10:37 [kokushubila] Ok got u, And Bronchioalveolar Ca is the only one which is not asso.with smoke , Right?
23:10:53 [Lorena] exactly
23:10:53 [Step_1] i agree
23:10:59 [Step_1] roofer for 15 yrs and smoker for 10 yrs greatest risk for what? primary lung cancer or mesothelioma?
23:11:12 [zeda] risk factors for CA colon?
23:11:17 [kokushubila] Lung Cancer?
23:11:21 [jwls29] lung cancer?
23:11:48 [Lorena] lung ca
23:11:50 [jwls29] fatty diet,low fiber
23:11:56 [Step_1] mesothelioma has no smoking relationship, but pt would die from primary lung cancer before getting mesothelioma because takes 20 to 30 yrs to develop
23:12:21 [jwls29] good question,step_1
23:12:21 [Lorena] adenomatous poliposis of the colon
23:12:48 [Step_1] thanks
23:13:01 [Step_1] from goljan so i cant take credit
23:13:16 [jwls29] lol
23:13:27 [Step_1]
23:13:31 [kokushubila] Main complications of Lung Ca ?
23:13:36 [Lorena] also when they give you a patient with exposure to asbestos and ask what cancer...dont jump tommesothelioma
23:13:50 [jwls29] why?
23:13:59 [Lorena] bronchogenic cancer is more frequent
23:14:17 [jwls29] ok
23:14:36 [Step_1] interesting....thanks
23:14:45 [jwls29] complications of lung cancer would be mets
23:15:01 [Lorena] unless yo donta have bronchogenic ca as a choice
23:15:05 [jwls29] to the adrenals in 50%
23:16:51 [sanya] Which Ca metastasizes most commonly to the liver
23:17:58 [Step_1] colorectal?
23:18:22 [Step_1] no never mind that answer
23:18:32 [kokushubila] SPHERE of Complications-Superior vena cava syndrome,Pancoats tumor,Horner's syndrome,Endocrine(paraneoplastic),Recurrent Laryngeal Syndrome(hoarseness).Effusions(Pleural, Pericardial) MUST KNOW these complications of Lung Ca
23:18:38 [sanya] 1st lung then colon
23:18:42 [jwls29] i don't know this one
23:18:59 [Lorena] thanks kokush
23:19:01 [jwls29] thank you
23:19:20 [Step_1] thanks kokush
23:19:34 [Step_1] and thanks sanya
23:19:44 [Step_1] tall thin male (or scuba diver) presents with sudden onset of pleuritic type chest pain, tympanitic percussion not, absent breath sounds, elevation of diaphram, trachea shifted. what dx?
23:20:02 [kokushubila] Thanks to F A !!
23:20:07 [Lorena] pneumothorax
23:20:14 [sanya] pnuemothorax
23:20:21 [jwls29] pneumothorax
23:20:36 [Lorena] spontaneous in thin, tall people
23:20:46 [kokushubila] U r welcome!
23:20:55 [Step_1] spontaneous pneumothorax often caused by rupture of subpleural bullae in apex of lung. seen in marfans and scuba.
23:21:02 [Step_1] good job
23:21:26 [Step_1] so i guess we'll do some neoplasia
23:21:53 [Lorena] yes
23:22:01 [jwls29] ok
23:22:17 [jwls29] i have a hard time with the oncogenes
23:22:28 [kokushubila] Wht's the Treatment of Neonatal Respiratory Distress Syndrome?
23:22:34 [jwls29] can't remember any except for the most obvious ones
23:22:40 [Lorena] did you check the neumonic i posted to remember them?
23:22:55 [jwls29] no
23:23:00 [jwls29] haven't seen it
23:23:04 [jwls29] on the forum?
23:23:11 [Step_1] real question (and q.bank too) asked about pt described with B cell follicular lyphoma and asked what caused it> choices were t8,14 , bcl-2 overexpression, and more?
23:23:19 [sanya] surfactant
23:23:46 [Lorena] t8, 14?
23:23:50 [jwls29] and oxygen
23:23:52 [Step_1] PEEP and O2
23:24:07 [sanya] bcl2 causing the apoptosis gene to be inactivated
23:24:16 [jwls29] i'm with lorena on that one
23:25:15 [sanya] t8,14 is Burkkits lymphoma, right
23:25:18 [Step_1] this one got me because I always mix up t 8;14 and t 14;18. the former is Burkitts and the latter is B cell follicular. since t 14;18 was not an option, it is the overexpression of bcl 2
23:25:39 [Lorena] wow
23:25:43 [jwls29] i always confuse them
23:26:03 [Lorena] me too
23:26:13 [Step_1] i think the boards know that we confuse them often, so be prepared
23:26:21 [jwls29] yup
23:26:23 [Lorena] thanks step
23:27:53 [Step_1] bilateral hearing loss dealing with inactivation of NF1....is this with chrom 17 or 22 and why
23:28:14 [Lorena] 17
23:28:14 [jwls29] 17
23:28:23 [sanya] 17
23:28:24 [jwls29] schwanomma
23:28:42 [jwls29] or is it bilateral acoustic neuroma
23:28:44 [Lorena] neurofibromas
23:28:46 [Step_1] Bi-lateral (2 sides) will be NF-2, so chom 22
23:29:01 [Step_1] another tricky one
23:29:03 Parmish enters this room
23:29:30 [Step_1] but good mneumoic is the 2 for BI lateral and 22
23:29:32 [sanya] retinoblastoma gene is it a tumor supressor gene or proto oncogene
23:29:48 [Lorena] tumor supresro gene
23:29:52 [Step_1] oops, i put NF1 in the question....my mistake
23:30:03 [jwls29] yeah i was confused
23:30:03 [Step_1] that would be 17....sorry
23:30:11 [jwls29] that's why i said 17
23:30:24 [sanya] that's OK
23:30:26 [jwls29] but i knew that nf2 was on chrom 22
23:30:28 [Lorena] yes, i understand now
23:30:35 [Step_1] i meant to put NF gene....sorry...
23:30:36 [jwls29] bilat hearing loss
23:30:42 [jwls29] cool
23:30:59 [jwls29] it's ok
23:31:40 [Step_1] long day of studying will have strange effects
23:31:45 [jwls29] lol
23:32:02 [Lorena] lol
23:32:56 [Step_1]>[sanya] is it a suppressor gene?
23:33:06 [Lorena] i have to go guys
23:33:08 [jwls29] how long do you guys usually stay?
23:33:13 [sanya] yes step1
23:33:33 [Step_1] thanks for the great chat again lorena
23:33:46 [Lorena] i wont be able to attend next chat so i will see you on wednesday
23:34:10 [jwls29] bye lorena...thanks
23:34:11 [sanya] bye lorena
23:34:22 [Lorena] bye
23:34:25 [kokushubila] Bye Lor , Enjoy your studies
23:34:35 [Step_1] bye lorena...we'll miss ya
23:35:29 [Step_1]>[jwls29] usually no longer than about 12 eastern (3 hrs). i think we're just about rapping things up with neoplasia
23:35:53 [jwls29] ok
23:36:07 [jwls29] so we meet again on saturday at the same time
23:36:15 [jwls29] ?
23:36:26 [Step_1] every wed and sat at 9pm eastern
23:36:56 [Step_1] just a couple more high yield things and we'll wrap up in next 10 mins....what do you say?
23:37:11 [jwls29] wonderful...so glad i found this group. Since I study alone I never know how much I'm retaining
23:37:17 [jwls29] that would be fine
23:37:22 [sanya] fine with me
23:37:50 [sanya] setp1 when is your exam
23:38:01 [Step_1] most of the benefit is that you want to prepare and stay on schedule with the group....i love that i found this group too
23:38:02 [sanya] sorry step1
23:38:17 [Step_1] mine is coming up next week
23:38:26 [jwls29] i've missed alot though
23:38:32 [jwls29] that makes me sad
23:38:37 [neurodoctor_75] good luck
23:38:47 [sanya] Wow , I'm sure you're going to ace it
23:38:50 [jwls29] oh wow
23:38:56 [jwls29] you'll do great
23:39:00 [Step_1] if things go as planned, the group can recycle the schedule and get newcomers all the time
23:39:21 [neurodoctor_75] good idea
23:39:22 [jwls29] oh good
23:39:30 [jwls29] that would be wonderful
23:39:31 [Step_1] i dont know about that....i'm very nervous about it...but i'll never feel ready so i'm just going to go for it
23:40:03 [sanya] yeah i felt the same for step2 don't worry!
23:40:53 [Step_1] i'll make sure to give a good experience for you all afterwards that will hopefully help
23:41:19 [Step_1] most common cancers in decreasing order. first list incidence in males (top 3)
23:41:23 [sanya] Thanks so much!
23:41:43 [sanya] prostate, lung colon
23:41:56 [jwls29] prostate, lung,colon
23:42:12 [Step_1] by the way, i hope that everyone got the 100 pg goljan hy notes in the download area
23:42:13 [sanya] brast, lung , colon females
23:42:27 [Step_1] prostate, lung, colorectal is right. what about females
23:42:31 [jwls29] agree with sanya
23:42:42 [jwls29] i just downloaded it yesterday
23:42:52 [Step_1] sanya is correct....good
23:42:55 [jwls29] i'm going to have to listen to his lectures
23:43:15 [Step_1] what about mortalities for men and women separately?
23:43:22 [sanya] Oh yes, that was so kind
23:43:22 kokushubila enters this room
23:43:35 [Step_1]>[jwls29] highly recommended....i love his lectures
23:43:42 [jwls29]
23:43:51 [sanya] lung, prostate, colon men
23:43:58 [jwls29] mortalities are lung in both
23:44:07 [sanya] lung, breast, colon women
23:44:18 [jwls29] breast in women prostate in men
23:44:27 [jwls29] colon third in both
23:44:48 [jwls29] thank u very very much
23:45:04 [jwls29] its hard for me to listen to his lectures since i don't have his notes
23:45:15 [jwls29] my mind wanders
23:45:18 [Step_1] now what about the 2nd most common cause of cancer death in total population....trick question
23:45:25 [sanya] Really nice of you guys to do it
23:45:52 [Step_1] i think the notes are important for his lectures, although he doesn't follw the order
23:46:20 [jwls29] would the 100 pgs be good to listen to with the lectures?
23:46:38 [jwls29] would the 2d most common be colon?
23:47:04 [Step_1] colorectal is the 2nd most common in both men and women combined because men dont get breat cancer very often and women dont have prostates....trick question
23:47:47 [Step_1] the 100 pgs are a summary and not really related too much for the lectures. good high yield info for studying after his lectures
23:48:42 [Step_1] another real question described a SE china person most likely to have what type of cancer secondary to EBV?
23:49:14 [neurodoctor_75] lung?
23:49:29 [kokushubila] Nasopharyngeal Ca
23:49:30 [sanya] nasopharyngeal ca
23:49:43 [jwls29] nasopharyngeal??
23:49:46 [Step_1] the answer is nasopharyngeal carcinoma for SE China secondary to EBV.....good job....one more from me
23:50:00 [Step_1] MC cancer in Japan? why?
23:50:13 [jwls29] gastric
23:50:13 [sanya] gastric adeno CA
23:50:13 [neurodoctor_75] gastric
23:50:26 [jwls29] lots of smoked food
23:50:29 [sanya] eating smoked foods, nitrosamines
23:50:33 [jwls29] nitrites
23:50:51 [Step_1] stomach carcinoma due to smoked products and preservatives....excellent!
23:51:17 [Step_1] ok, i think i'll call it a night....we went over alot
23:51:35 [jwls29] yeah me too
23:51:38 [jwls29] i'm tired
23:51:48 [jwls29] thank you all so much for making me feel welcomed
23:51:49 [sanya] Ok then see you all on Saturday, Bye!
23:51:54 [jwls29] and for the great questions
23:52:03 [jwls29] see you all on saturday
23:52:06 [kokushubila] Guys I have to go,THANK YOU
23:52:10 [jwls29] have a great night
23:52:12 [Step_1] so the remainder of path for sat night. i'll see everyone on sat and maybe some of you in the forum in between
23:52:26 [neurodoctor_75] see u all
23:52:35 [kokushubila] Have a nice study , God bless you
23:52:39 [jwls29] what are the topics for sat?
23:53:32 [Step_1] there is an announcement posted on the step 1 forum, but it is the remainder of path (gi, cns, etc)
23:53:41 [jwls29] thanks
23:53:49 [jwls29] have a good night, everybody
23:53:50 [Step_1] :flyaway
23:54:06 [Step_1] oops
21:07:39 [Lorena] yes, we usually say that in the chat , but i will post whatever we agree to discuss
21:07:51 [nne] where/
21:08:21 [zeda] please tell me which is the best material available if i want to chhose one?
21:08:42 jwls29 enters this room
21:08:44 [Step_1] http://www.valuemd.com/viewtopic.php?p=97486#97486
21:08:46 [zeda] k a p or g o l j a n
21:08:46 [crusher] goljian if you can grasp..
21:09:01 [crusher] if not than brs is fine
21:09:10 [neurodoctor_75] think goljan and <a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10002441&type=3&subid=0 >Kaplan</a><IMG border=0 width=1 height=1 src=http://ad.linksynergy.com/fs-bin/show?id=c97WUMRO5hY&bids=47491.10002441&type=3&subid=0 >
21:09:25 [jwls29] Hi. Is this the path discussion?
21:09:32 [zeda] k a p has no rating?
21:09:45 [Step_1] hi jwls
21:09:46 [Lorena] yes jwls, welcome
21:10:16 [Step_1] yes today is path, including cardio, resp, neoplasia, etc. sat will be remainder of path
21:10:24 [Step_1] ready to get started
21:10:30 [jwls29] Lol
21:10:32 [jwls29] soory
21:10:32 [Lorena] yes
21:10:50 [jwls29] i was looking at the bottom of the screen and couldn't see where i was posting
21:10:52 [jwls29] hello all
21:11:06 [Step_1] you hear fixed splitting in s2...is this normal or pathologic
21:11:07 [crusher] ok lets get started
21:11:30 [zeda] which topic we will finish first?
21:11:32 [Lorena] you can change the color of your letters for a more easy one to see on the rainbow on the left
21:11:33 [Step_1] jwls, you might want to pick a brighter color on the rainbow to the right
21:11:34 [crusher] pathologic commonly on ASD
21:11:44 [jwls29] how's this
21:11:59 [Step_1] oops sorry, i assumed cardiac....but whatever you prefer.
21:12:01 [Lorena] sorry ..right (always do the same mistake)
21:12:06 [Step_1] much better jwls
21:12:27 [jwls29] ok
21:13:20 [Step_1] thats right crusher.
21:13:39 [Step_1] what about s3?
21:13:58 [Step_1] is it normal to hear or abnormal?
21:14:12 [jwls29] isn't s3 pathologic too and should only be heard in children and elderly?
21:14:21 [crusher] S3 is normal is old age but pathologic in vol overload
21:14:24 merjo13 enters this room
21:14:33 [Lorena] abnormal
21:14:35 [merjo13] Hi all
21:14:51 [Step_1] normal in children and young adults, but abnormal after 40 yo....first sign of chf....good
21:15:01 [zeda] vasculitis of the elderly,presenting as headache,facial pain and impaired vision...Dx?
21:15:12 [jwls29] what about in elderly?
21:15:14 [Lorena] temporal arteritis
21:15:19 [crusher] temporal arteritis
21:15:25 [Step_1] temporal arteritis
21:15:35 [zeda] right
21:15:42 [neurodoctor_75] temporal arteritis
21:16:01 [Lorena] what vessels are involved ?
21:16:16 [Step_1] elderly should not have s3 because indicates volume overloaded right heart
21:16:18 [Lorena] besides temporal artery
21:16:27 [Step_1] but most probably do
21:16:32 [jwls29] ok
21:16:41 [jwls29] opthalmic art?
21:17:19 [Step_1] extracranial branches of carotid artery
21:17:21 [crusher] opthalmic also risk for blindness
21:17:43 [zeda] which art. are associated in Buerger dis.?
21:17:44 [Lorena] yes! good job
21:17:58 [Step_1] what is the treatment of temporal arteritis....give immediately to prevent blindness?
21:18:11 [jwls29] steroids
21:18:15 [crusher] corticosteroids
21:18:16 [neurodoctor_75] some problem in my computer.
21:18:26 [Lorena] small and medium size arteries and veins mostly in inf extremities
21:18:38 [Lorena] agree steroids
21:18:49 [crusher] med size vessels for Buerger dis
21:18:51 [jwls29] i thought it was in upper arteries
21:18:59 [jwls29] i mean upper extremities
21:19:01 [Step_1] agree with lorena and crusher for buerger.
21:19:10 [zeda] tibial and radial art.
21:19:11 [jwls29] this is the one associated with heavy smokers, right?
21:19:14 [Step_1] and yes corticosteroids....good job everyone
21:19:18 [Lorena] for buerger is inf extremities
21:19:42 [zeda] yes,assoc. with cigarette smoking
21:20:01 [zeda] also called thromboangitis obliterans
21:20:18 [jwls29] ok
21:20:23 [crusher] what is the most suspetible site in liver for Free radical injury??
21:20:38 [zeda] around central V.
21:20:41 [jwls29] i just checked my <a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10002441&type=3&subid=0 >Kaplan</a><IMG border=0 width=1 height=1 src=http://ad.linksynergy.com/fs-bin/show?id=c97WUMRO5hY&bids=47491.10002441&type=3&subid=0 > and it does not say which extremities. just says extremities
21:20:55 [Lorena] around central vein , zone 1
21:20:58 [jwls29] yikes
21:21:03 [jwls29] what is all that?
21:21:15 [crusher] buerger can also gluteal with gangrene of foot
21:21:25 [Step_1] jwls, try not to post the word kap lan, or first aid, amaxon, etc
21:21:31 [Lorena] jwls , they present with claudication....because inf extremities
21:21:33 [crusher] good.its in central vein zone 1
21:21:33 [jwls29] i don't know what i did
21:21:34 [zeda] yes
21:21:43 [Step_1] it will auto convert into a link like above
21:22:03 [jwls29] what are all those links?
21:22:30 [zeda] don't type book's or course's name here
21:22:37 [crusher] what are the free radicals for O2 and H20?
21:22:38 [zeda] t will go to direct links
21:22:40 [jwls29] ok
21:22:42 [jwls29] i won't
21:22:45 [jwls29] thanks
21:22:51 [Step_1] during game, young basketball player collapses and dies immediately. what type of cardiac disease likely?
21:22:56 [zeda] superoxide
21:23:08 [crusher] IHDS
21:23:21 [Lorena] superoxid anoin, hydroxyl radicals
21:23:24 [jwls29] hypertrophic cardiomyopathy
21:23:34 [Lorena] hypertrophic cardiomyopathy
21:23:41 [Step_1] hypertrophic cardiomyopathy.....there is a good post with pics about it. i'll try to find it and post the link tommorrow. good job
21:24:00 [zeda] hypertrophic cardiomyopathy and its rare
21:24:26 [Step_1] its rare, but often tested for some reason....dont ask me why?
21:24:32 [jwls29] what type of coarctation is associated with Turner's sdme? preductal or postductal?
21:24:46 [Lorena] preductal
21:24:50 [crusher] what are the neutrolizers of free radicals and how they work?
21:24:57 [Step_1] preductal
21:25:00 [jwls29] yup
21:25:02 [zeda] jwls...please change your color
21:25:07 [nne] preducta
21:25:21 [jwls29] lighter or darker?
21:25:38 [Lorena] superoxide dismutase, glutathione peroxidase
21:25:42 [zeda] purple is hard to read
21:25:50 [jwls29] is this better?
21:25:59 [zeda] yes..thanks
21:26:08 [Lorena] much better jwls, thanx
21:26:14 [jwls29] no prob
21:26:29 [Step_1] asian woman 33 yo presents with absent upper extremity pulse, but high bp in lower extremity. also has visual disturbances. Most likely diagnosis.
21:26:50 [jwls29] takayasu's arteritis
21:26:56 [Lorena] takayasu
21:27:18 [zeda] name one cong. abnormality which predisposes to aortic stenosis?
21:27:21 [Step_1] takayasu disease is correct. "can't taka yoy pulse"
21:27:25 [crusher] yes lorena superoxide dismutase ,glutathione ,N.acetylcystein,antioxidant like VIT E,C and selenium
21:27:33 [nne] takayasu
21:27:41 [crusher] coraction of aorta
21:28:04 [Lorena] i dont remember EXACtly how they work though
21:28:09 [zeda] bicuspid aortic valve
21:28:11 [jwls29] me neither
21:28:51 [nne] i think its coarctation of aorta that is right
21:29:16 [nne] takayasu is usually pulseless
21:30:01 [Step_1] microangiopathic hemolytic anemia with schistocuytes is associated with aortic stenosis
21:30:02 [crusher] they neutralizes the Fr and prevent the damGE OF cell membrane by LIPID PEROXIDATION ,in which FR combine with molecular O2
21:30:06 [nne] with asian there takayasu is correct
21:30:30 [Lorena] thank you crusher
21:30:41 [Step_1]>[nne] yes, the asian woman was takayasu
21:30:43 [jwls29] thank you
21:31:41 [Step_1] mneumonic is "can't taka ya pulse" because can't take pulse = takayasu
21:31:45 [crusher] free radicals r usmle fav topic
21:31:47 [Lorena] what coagulation path & factor you test with prothrombin time test?
21:31:59 [zeda] upper extremity hypertension with lower extre. hypotension..Dx?
21:32:18 [Step_1]>[zeda] coarctation of aorta
21:32:21 [jwls29] coarctation of the aorta
21:32:35 [crusher] coarction of aorta
21:32:35 [zeda] postductal...right
21:32:46 [Step_1]>[Lorena] extrinsic path
21:32:49 [Lorena] coarctatuion of aorta post ductal
21:32:51 [jwls29] intrinsic path don't know the factor
21:32:56 [zeda] how will u detect it on x-ray?
21:33:11 [jwls29] notching of the ribs
21:33:17 [crusher] what does n.acetylcystein do for poisioning with acetaminophan
21:33:20 [Lorena] yes step 1 , extrinsic path
21:33:34 [zeda] right
21:34:04 [jwls29] so prothromin is for extrinsic?
21:34:10 [jwls29] i always get that confused
21:34:20 [Step_1] I remember that because PeT and PiTT both make words. PT extrinsic and PTT is intrinsic
21:34:32 [jwls29] cool
21:34:40 [jwls29] now i'll remember
21:34:48 [Lorena] yes, prothrombin for extrinsic path
21:34:55 [Lorena] and common
21:35:02 sanya enters this room
21:35:24 [Step_1] hi sanya
21:35:29 [jwls29] what about crusher's question about the n acetylcystein?
21:35:38 [zeda] hi sanya
21:35:41 [sanya] Hi step_1
21:35:51 [Lorena] i dont remember ...
21:35:51 [zeda] crusher pl. ans
21:35:52 [sanya] Hi to all of you!
21:35:52 [Step_1] i didnt see crushers question
21:35:56 [jwls29] thanx lorena
21:36:06 [Step_1] now i see it
21:36:28 [Lorena] hi sanya
21:36:46 [Step_1] you give it for GSH or something. that is aka mucomyst which is used in CF and other pulmonary diseases too
21:36:50 [jwls29] hi sanya
21:38:06 [crusher] replenish gulathione..
21:38:42 [sanya] n-acetyl cysteine increases production of glutathione which is depleted in acetaminophen poisoning
21:38:51 [crusher] i,m sorry i was away,,my lill one askin something
21:39:06 [crusher] yes right sanya
21:39:52 [Lorena] for glutathione peroxidase?
21:40:30 [Step_1] printzmetals angina. stress ECG will show what? increase or decrease of what?
21:40:45 [sanya] what are we doing now I mean which chapter
21:40:51 GABA enters this room
21:40:52 [crusher] inc St seg elevation
21:41:03 [sanya] St elevation
21:41:04 [Lorena] ST elevation
21:41:06 [Step_1] still cardia path
21:41:27 [Lorena] we are jumping around sanya....from cell injury to cardiac and back
21:41:30 [sanya] OK Thankyou!
21:41:33 [Step_1] printzmetals will show elevated ST....where is ischemia....transmural or subendocardial
21:41:56 [Lorena] transmural
21:42:20 [Step_1] should we be on cell injury? we can ask those questions instead?
21:42:58 [jwls29] transmural
21:43:03 [zeda] associated factors with dilated cardiomyopathy?
21:43:09 [Lorena] i dont mind jumping or following by chapters , whatever you prefer
21:43:17 [Step_1] yes, its transmural because increase st. so what gives depressed ST and subendocardial ischemia?
21:43:39 [crusher] angina
21:43:42 [Lorena] alcohol, drugs, virus, parasites
21:43:50 [jwls29] stable angina
21:43:55 [Lorena] subendocardial
21:44:04 [GABA] angina
21:44:10 [Step_1] exertional (classical) angina gives depressed ST. relieved by nitoglycerin
21:44:40 [Step_1] hi gaba
21:44:59 [Lorena] yes, classical angina is a subendocardial ischemia = ST depression
21:45:12 [zeda] right lorena.......also pregnancy,can also be idipathic
21:45:22 [crusher] what is cause of met.Hb .nemia
21:46:00 [Lorena] carbo monoxide intoxication
21:46:23 [sanya] water with nitrites?
21:46:50 [zeda] oxidizing agents ..like nitrite or sulfur containig drugs
21:47:02 [Lorena] dapsone too
21:47:12 [Step_1] o2 content decreased. can be caused by tmp-smx treatment (i.e. tx of PCP in Aids pt...real test question)
21:47:27 [zeda] and defi. of metHb reductase
21:48:15 [Step_1] heme is stuck in iron + state so cannot bind O2
21:48:18 [crusher] Fe in Ferric state instead of ferrous state.(Fe sholud be in ferrous state to bind O2) result in dec O2 content dec Saturation of O2.person seems to be blue
21:48:23 [Lorena] thanks step
21:48:30 [Step_1] oops iron +3 state
21:49:00 [zeda] thanks step1 and crusher
21:49:09 [Step_1] treatment is IV meth blue and ascorbic acid (vit c)
21:49:19 [crusher] Tx of choice is methylene blue ,which inhances the conversion of Fe to ferrous state
21:49:28 [Step_1] real test question....best marker within 10 hrs of MI? choices were CKMB, troponin, LDH
21:49:43 [zeda] what are the mitochondrial toxins?
21:49:50 [crusher] tro[ponin
21:49:56 [sanya] troponin
21:49:56 [Lorena] troponin
21:50:01 [merjo13] Troponin
21:50:02 [zeda] CKMB
21:50:20 [crusher] what does ascorbic acid role?
21:50:20 [jwls29] troponin
21:50:36 [merjo13] Ascorbic- reducing agent
21:50:40 [Step_1] i dont have the ans because it is a recall, but i think it is ck mb according to goljan....not sure
21:50:47 [Lorena] agre with merjo
21:51:04 [Lorena] tricky
21:51:08 [crusher] i think troponin is more specific
21:51:15 [zeda] thanks step1...i thought i am wrong...but as i remeber this too
21:51:21 [Lorena] me too
21:51:35 [zeda] but need to check again
21:52:07 [zeda] i checked.....it is CK-MB
21:52:17 [nne] ist 24 hrs CK MB ACCORDING TO F A
21:52:18 [merjo13] Oh thanks
21:52:41 [jwls29] in the path book by cap ihave ck mb elevated by 4-8 hrs
21:52:41 [Lorena] ic
21:52:54 [nne] TROPONIN I IS IST 4 HRS TILL 7 - 10 DAYS
21:52:56 [crusher] oh ok
21:53:32 [nne] LDH1 IS FROM 2-7 DAYS
21:53:50 [Lorena] then why not troponin? if it is from4 hrs to 10 days ....confusing
21:54:02 [nne] IST 4 HRS ECG IS MOST APPROPRIATE
21:54:05 [jwls29] and troponin 3-6 hours
21:54:16 [jwls29] so which would be right?
21:54:35 [Step_1] that one really had me. goljan mentioned it in his audios, but not so clear in his notes. still confused about answer.... but real question
21:54:35 [sanya] Goljan notes says CK-MB increases 4-8hrs peaks in 24hrs disappears in 1.5 to 3 3days.
21:54:59 [nne] TEST OF CHOICE FOR 1SY 24 HRS IS CK- MB AS IT IS WRITTEN IN F A
21:55:10 [Lorena] at 10 hours post MI both are elevated.... but the questions is which one is the best marker?
21:55:27 [jwls29] wouldn't it be troponin?
21:55:39 [jwls29] i've always understood that that one is more specific
21:55:50 [sanya] both types of troponin increase in 3 to 12 hrs, since they all increase by 12hrs I think CK-MB is the RIGHT one
21:56:25 [Lorena] why?
21:56:54 [Step_1] i'll try to listen to that section of goljan again and provide some feedback in the forum hopefully tomorrow
21:57:17 [sanya] what I meant is since troponins only increase but does not peak CKMB is right
21:57:33 [Step_1] sorry for the question, but better to figure it out now that in the test
21:57:54 [jwls29] i have that the troponins peak at 16 hours
21:58:00 [Lorena] troponins do peak (at 16 hrs)
21:58:10 [nne] NO DON'T APOLOGISE FOR HELPING EVERYONE LEARN
21:58:24 [Lorena] yes step, excellent question
21:58:43 [Lorena] jus trying to figure out which one and why
21:58:45 [jwls29] exactly...i rather know for sure know than be staring at my computer the day of the exam
21:58:48 [sanya] goljan notes says T peks in 24hrs
21:59:00 [sanya] sorry peaks
21:59:31 [Step_1] i usually have the correct answers to the questions prepared...this one just had me stumped
21:59:32 [jwls29] yeah the guy from kap says that they are all going to say different times but they are all about in the same range
21:59:59 [jwls29] meaning different books will say differnt times
22:00:14 [Lorena] i see
22:00:50 [Lorena] ok, lets move on and look for that in dif sources
22:00:58 [jwls29] ok
22:01:11 [crusher] which IHD is most common
22:01:42 [nne] MI
22:01:52 [neurodoctor_75] angina
22:01:53 [sanya] angina pectoris
22:02:17 [Lorena] angina agree
22:02:20 [crusher] yes its angina pectoris
22:03:27 [Lorena] what are lines of zahn?
22:04:52 [jwls29] platelets and wbc's?
22:05:25 [jwls29] found in thrombus
22:05:40 [Lorena] close...platelets and RBC so they lookm like alternating pink bands
22:05:55 [jwls29] thanks
22:06:02 [sanya] what is Ejection fraction in systolic dysfuntion & in diastolic dysfuntion
22:06:05 [Lorena] yes, thats the difn witha blood clot - no platelets in blood clot
22:06:17 [Step_1] http://www-medlib.med.utah.edu/WebPath/jpeg1/LUNG117.jpg
22:06:18 [crusher] ok good to know lorena.tx\
22:06:25 [Step_1] oops...that didnt work
22:06:53 [Lorena] ejection fraction is decreased in systolic dysfunction
22:07:57 [sanya] right lorena
22:08:13 [Lorena] and in diastolic dysfunction is... ..... could be normal?
22:09:04 [jwls29] don't know this one
22:09:08 [Step_1] that one makes sense because ejection fraction is the fraction of blood pumped out of heart. blood is pumped out during systole....makes sense
22:09:39 [Step_1] i think??
22:09:57 [crusher] in diastolic dysfunction its inc
22:09:59 [Lorena] yes step
22:10:49 [Lorena] how is in dyastolic dysfunction sanya?
22:11:01 [neurodoctor_75] during diastole,inc why
22:11:04 [sanya] yes its normal that's one way to differentiate whether the cause is sys or dia dysfunction, pretty important in step2
22:11:15 zeda enters this room
22:11:32 [Step_1] thanks
22:11:34 [crusher] why its normal in diastole
22:11:40 [Lorena] thanks sanya
22:12:00 [Step_1] what gives a high pitched blowing murmur directly after S2?
22:13:47 [Lorena] mitral stenosis?
22:13:58 [Step_1] AV/PV regurg because of volume overload of ventricles (hypertropy/dialation) is the correct answer.
22:14:50 [Step_1] what gives a machinery murmur?
22:14:57 [sanya] PDA
22:15:01 [Lorena] ok
22:15:05 [Lorena] PDA
22:15:08 [merjo13] PDA
22:15:19 [jwls29] pda
22:15:22 [zeda] most common valvular heart dis. in U.S.?
22:15:28 [crusher] ok good step1....do you after S2 means (aotic and pul valves involve)
22:15:38 [Step_1] yes a PDA gives machinery murmur....mneumonic is a "PDA (palm pilot) is a machine"
22:15:39 [sanya] What direction is the flow of blood in PDA
22:15:43 [crusher] vsd
22:15:54 [merjo13] VSD
22:15:55 [Lorena] agree with crusher
22:15:58 [zeda] mitral valve prolapse
22:16:04 [merjo13] Aorta to pulm
22:16:15 [jwls29] agree with lorena and crusher
22:16:16 [zeda] especially in young women
22:16:17 [sanya] VSD you get a holosystolic or pan sys murmur
22:16:34 [Lorena] ops, you said valvular
22:16:35 [crusher] holosystolic
22:17:07 [merjo13] PSM
22:17:22 [sanya] merjo you're right
22:17:30 [zeda] middiastolic click followed by a late sys. murmur...Dx?
22:17:37 [merjo13] Thanks
22:17:46 [crusher] MVP
22:18:01 [zeda] right....mitral valve prolapse
22:18:29 [Step_1] MVP...agree
22:18:43 [Lorena] yes
22:18:55 [Step_1] what about opening snap?
22:19:14 [Lorena] mitras stenosis
22:19:19 [crusher] MS??
22:19:22 [merjo13] Occurs in MS
22:19:30 [Step_1] S-nap is S-tenosis
22:19:44 [zeda] what is nonbacterial thrombotic endocarditis?
22:20:05 [sanya] What will happen to the murmur in idopathic hypertropic subaortic stenosis when the patient is lying down
22:20:10 [jwls29] a mnemonic that helps me remember what is where is mr gluteal
22:20:11 [merjo13] occurs in SLE
22:20:36 [jwls29] mitral regurg aortic stenosis in systole
22:21:07 [Step_1] Liebman sack vegs in SLE
22:21:14 [zeda] friable,sterile emboli c/by hypercoagulable states
22:21:28 [merjo13] OOps...sorry
22:21:48 [zeda] gluteal. with DIC and adenoCA of pancreas
22:21:50 kokushubila enters this room
22:22:10 [crusher] hi koku
22:22:12 [Lorena] hi koku
22:22:15 [kokushubila] Hellooo everybody!
22:22:23 [Step_1] hi kiku
22:22:31 [zeda] hi koku
22:22:32 [jwls29] hi
22:22:34 [sanya] Hi Koks
22:23:14 [crusher] i gotta go>>guys
22:23:28 [crusher] see u later..may be
22:23:34 [jwls29] bye crusher
22:23:38 [sanya] why so soon crusher?
22:23:39 [Lorena] thank you crush
22:23:43 [zeda] which kind of murmur present in PDA?
22:23:53 [Step_1] bye crusher...thanks for the great questions
22:23:54 [Lorena] what do you mean maybe?
22:24:04 [merjo13] machinery murmur
22:24:13 [crusher] my movers r coming t.m so have piles of clothes n stuff to set
22:24:14 [Lorena] described as a machinery murmur
22:24:24 [zeda] YES...HARSH WAXING AND WANING
22:24:28 [crusher] anyone live in dallas???
22:24:29 [Step_1] machinery murmur in PDA because a "PDA (handheld) is a machine"
22:24:36 [zeda] MACHINERY MURMUR
22:24:46 [zeda] NICE STEP1
22:24:53 [sanya] Oh Ok bye see ya next week!
22:25:00 [Step_1]
22:25:08 [Step_1] abrupt onset of severe back pain, hypotension and pusatile mass are triad for what?
22:25:12 [Lorena] see you crush next week crush, bye
22:25:40 [zeda] bye crusher
22:25:41 [merjo13] Aneurysm rupture
22:25:44 [jwls29] aortic aneurysm?
22:26:01 [Step_1] thats the rupture triad for abdominal aortic aneurism....good job
22:26:16 [sanya] abdominal aortic anuerysm rupture
22:26:43 [Step_1] MI in a child is the buzz word for what dz?
22:27:05 [sanya] Kawasaki's
22:27:18 [zeda] Aschoff bodies in the myocardium are pathognomic for what?
22:27:28 [Lorena] agree
22:27:34 [Step_1] Kawasaki dz is MCC of acute MI in children....great sanya
22:27:36 [merjo13] Rheumatic fever
22:27:39 [sanya] Rheumatic carditis
22:27:41 [Lorena] aschoff bodies are dx for rheumatic fever
22:27:47 [jwls29] rheumatic fever
22:27:51 [zeda] right sanya
22:27:52 [Step_1] rheumatic fever
22:28:05 [sanya] thanks step1
22:28:08 [zeda] s/s?
22:28:33 [Lorena] jones criteria
22:28:55 [jwls29] arthralgia
22:28:57 [merjo13] 2 major 1 minor or vice versa
22:28:58 [jwls29] carditis
22:29:00 [sanya] subcutanoeus nodules, pericarditis, arthritis, chorea, erythema marginatum
22:29:03 [Lorena] arthritis, carditis, rheumatic nodules, erythema marginatum amd chorea are the major ones
22:29:16 [jwls29] nodules
22:29:16 [sanya] SPACE
22:29:19 [jwls29] sydenhan chorea
22:29:26 [Step_1] arthralgias, fever, elevated ESR or c reative protein, prolonged PR interval, erythema marginatum
22:29:52 [zeda] migratory polyarthritis,erythma margi.,subcut. nodules,pancreatitis
22:29:56 [Step_1] polyarthritis
22:30:05 [Lorena] minor are leukocytosis, fever, ESR?CRP increased, raised PR, arthralgia
22:30:41 [zeda] right
22:30:52 [sanya] What will happen to the murmur in idopathic hypertropic subaortic stenosis when the patient is lying down
22:31:35 [zeda] sequela of ac. rheumatic fever?
22:31:58 [jwls29] mitral valve stenosis
22:32:11 [Lorena] mitral stenosis and CHF , endocarditis
22:32:32 [Lorena] what is the answer to your q's sanya?
22:32:43 [merjo13] MS ,IE
22:32:54 [zeda] also..fish mouth deformity
22:33:07 [sanya] normally the other murmurs like MS or AS will increase because of increase return of blood to the heart on lying down so flow across the stenotic valve but in IHSS the murmur intensity decreases
22:33:32 [Lorena] thank you
22:33:35 [Step_1] sinusitis, saddle nose deformity, recurrent pneumonia, c-ANCA.....what dz?
22:34:00 [merjo13] Cong sypilis
22:34:02 [sanya] Wegenes granulomatosis
22:34:03 [kokushubila] Didn't know that Sanya Thank you
22:34:09 [Lorena] wegener disease
22:34:27 [sanya] you're welcome
22:34:45 [Step_1] wegeners granulomatosis is correct. anytime you see kidney and resp with c-anca is a dead give away....good sanya
22:34:52 [Step_1] and lorena
22:35:07 [jwls29] saddle nose is in wegener's?
22:35:08 [Step_1] treatment?
22:35:25 [Lorena] cyclophosphamide
22:35:29 [sanya] cause destruction of nasal cartilage
22:35:38 [Step_1] wegeners is the MCC of saddle nose deformity according to goljan
22:36:02 [jwls29] ok
22:36:08 [Step_1] cyclophospahmide is correct. bonus...what side effect and how to prevent?
22:36:11 [jwls29] i thought saddle nose was syphyllis
22:36:19 [jwls29] i guess i need to listen to his lectures
22:36:29 [sanya] hemorrhagic cystitis
22:36:55 [Lorena] dont know
22:37:01 [jwls29] agree with sanya
22:37:12 [Step_1]>[jwls29] i think syphillis too
22:37:19 [Step_1] cyclophosphamide causes hemorragic cystitis and prevented with Mesna....good
22:37:46 [Lorena] what is chrug strauss syndrome?
22:37:58 [jwls29] so in both?
22:38:00 [Lorena] Churg Strauss ..sorry
22:38:21 [jwls29] vasculitis with granulomas and eosinophilia
22:38:22 [sanya] its associated with asthma
22:38:36 [jwls29] assoc with asthma
22:38:41 [kokushubila] Vasculitis, Esinophilia , Asthma a combination of these-Churg ...
22:38:43 [Step_1] C-yclophoshamide remembered because of C-ANCA. the P-ANCA on the other hand is P-olyarteritis nodosa
22:38:49 [Lorena] v good
22:38:54 [zeda] small vess. vasculitis involving skin,lung,heart vess
22:39:11 [Step_1] agree
22:39:17 [sanya] I will be back in 10 minutes guys
22:39:29 [Step_1] ok sanya
22:39:30 [Lorena] mean dif between Churg and PAN?
22:39:49 [zeda] p-ANCA antibod. r present
22:40:04 [jwls29] pan does not involve lung
22:40:16 [jwls29] and p-anca instead of c-anca
22:40:18 [kokushubila] In Churg -you have Asthma
22:40:29 [Lorena] yes!
22:40:47 [Lorena] PAN involves any organ EXCEPT lung
22:41:13 [Lorena] and in Churg , meanly the lung is involved: asthma, etc
22:41:27 [Lorena] and the abs...good job
22:41:45 [jwls29] what antigen is positive in 30%
22:41:45 [Step_1] we should probably move to respiratory soon
22:42:00 [zeda] what r X-Linked bleeding disorders?
22:42:02 [Step_1] HBV
22:42:14 [jwls29] HBsAg
22:42:15 [jwls29] yes
22:42:16 [Lorena] HBs ag
22:42:26 [jwls29] hemophilia
22:42:28 [Step_1] hemophilia
22:42:35 [Lorena] hemophilia
22:42:49 [zeda] right..factor 8 and 9 defi.
22:43:24 [Step_1] which one for hemophilia A or B, 8 or 9?
22:43:25 [Lorena] lab in hemophilia A ?
22:43:47 [Lorena] hemophilia A is 8 , B is 9
22:43:52 [zeda] prolong pyy but normal bt,plt. count and pt in both
22:44:00 [jwls29] agree with lorena
22:44:12 [Step_1] 8=A and 9=B ....thankfully in order
22:44:13 [zeda] prolonged ptt
22:44:36 [Step_1] prolonged PTT normal PT and BT
22:44:54 [jwls29] agree
22:44:57 [zeda] right
22:45:02 [Lorena] yes
22:45:06 [Lorena]
22:45:41 [Lorena] and in VOn Willebrand disease?
22:46:34 [Step_1] increase BT, normal PT, increased PTT, low ristocetin cofactor assay
22:47:02 [Lorena] excellent
22:47:16 [Step_1] inc PT, PTT with low PLTs and D-Dimer present....what dx? that treatment?
22:47:31 [zeda] its a most common hereditary bleeding disorder
22:47:40 neurodoctor_75 exits from this room
22:47:45 neurodoctor_75 enters this room
22:48:16 [Lorena] DIC?
22:48:34 [Step_1] DIC, treatment is heparin because prevents consumption of coagulation factors
22:48:36 [Lorena] life support and treat underlying condition
22:48:42 [jwls29] DIC
22:48:46 [zeda] DIC
22:48:51 [jwls29] tx underlying condition
22:49:36 [Step_1] D-dimer is the buzz word, but also might see oozing of blood maybe post delivery
22:50:03 [Lorena] ok
22:50:15 [zeda] Histological presentation of ARDS?
22:50:16 [Step_1] should we do some respiratory path?
22:51:10 [jwls29] loss of pneumocytes
22:51:15 [Lorena] edema, inflamation
22:51:16 [zeda] characterized by intra-alveolar hyaline membranes
22:51:17 [Step_1] neutropil related injury with destruction of type 2 pneumocytes
22:51:19 [jwls29] inflammation
22:51:28 [Lorena] hyaline mebrane
22:51:33 [jwls29] i was missing edema
22:52:14 [Step_1] most commont cause of ARDS?
22:52:30 [jwls29] shock?
22:52:37 [Lorena] septic shock
22:52:50 [Step_1] endotoxic shock is MCC....good job
22:53:14 [zeda] sepsis,infection,aspiration and trauma
22:54:03 [Step_1] according to goljan, any child on exam with nasal polyps is assumed to have what dz?
22:54:51 [Step_1] wasn't actually in notes, but mentioned a couple of times in audio...the ans is CF
22:55:16 [jwls29] really????
22:55:29 [neurodoctor_75] why cf with the nasal polyps.
22:55:42 [Lorena] interessting
22:55:50 [Step_1] just for test.....not real life.
22:55:55 [neurodoctor_75] mean the pathogenesis
22:55:57 [Step_1] at least according to him
22:56:15 [zeda] what is Reid Index?
22:57:01 [Step_1] The ratio of the thickness of the mucous gland layer to the thickness of the wall between the epithelium and cartilage
22:57:01 [jwls29] it is the ratio of the mucus glands in the lungs
22:57:30 [zeda] Reid index is a ratio of the thickness of mucous gland to the thickness of bronchial wall
22:57:50 [zeda] increased Reid Index suggestive of what?
22:58:04 [Step_1] chronic bronchitis
22:58:08 [jwls29] chronic bronchitis
22:58:16 [zeda] yes
22:58:21 [zeda] s/s?
22:58:24 [Step_1] obstructive diseases
22:58:33 [Lorena] makes sence
22:59:15 [Lorena] cough, dyspnea, increased risk for infections
22:59:36 [Step_1] Blue Bloater, so cyanotic due to resp acidosis, obese
23:00:02 [Lorena] i wonder why they gain weight...
23:00:19 [Step_1] B-lue B-loater is B-ronchitis
23:00:25 [zeda] this is cyanosis resulting from severe hypoxia
23:01:20 [zeda] chronic bronchitis
23:02:01 [kokushubila] Pink Puffers?
23:02:14 [zeda] emphysema
23:02:23 [Step_1] cant find the reason for the obesity, but they seem to usually be obese and cyanotic vs the pink puffers that have emphsema and are typically think
23:02:57 [Lorena] ok thanks
23:03:03 [zeda] pink puffers overventilates
23:03:51 [Step_1] alpha 1 antitrypsin deficiency gives what type of emphysema? centrilobular or panacinar?
23:04:21 [Lorena] panacinar
23:04:31 [jwls29] panacinar
23:04:36 [Step_1] panacinar...that was a q.bank question....good job
23:04:41 [zeda] pan
23:04:57 [Lorena] centrilobular si asso with smoking
23:05:25 [Step_1] yes, agree
23:05:51 [jwls29] what is the only cancer of the lung treated with chemo instead of with surgery?
23:06:42 [Lorena] small cell ca?
23:06:49 [jwls29] yes
23:06:54 [zeda] small cell?
23:07:26 [Lorena] 2 ca associated with smoking?
23:07:43 [jwls29] small and squamous
23:07:49 [zeda] What is Ghon complex?
23:07:49 [Step_1] squamous and small cell cancers
23:08:01 [Lorena] yes
23:08:09 [Step_1]>[jwls29] what is the answer?
23:08:15 [kokushubila] Adeno not associated with smoking
23:08:27 [Step_1]>[zeda] seen in primary TB
23:08:38 [zeda] yes
23:08:44 [zeda] and in sec.?
23:08:48 [kokushubila] ????? I think I am wrong!
23:09:04 [jwls29] small cell cancer treated with chemo the rest are treated with surgery
23:09:06 [zeda] cavitary lesions in lung apices
23:09:15 [Lorena] you are right koku
23:09:20 [Step_1] adeno is the MC primary lung cancer in both smokers and nonsmokers
23:09:48 [Step_1] i think she meant which is exclusively seen in smokers....right?
23:10:33 [Lorena] yes, and adeno is less associated than squamous and small cell
23:10:37 [kokushubila] Ok got u, And Bronchioalveolar Ca is the only one which is not asso.with smoke , Right?
23:10:53 [Lorena] exactly
23:10:53 [Step_1] i agree
23:10:59 [Step_1] roofer for 15 yrs and smoker for 10 yrs greatest risk for what? primary lung cancer or mesothelioma?
23:11:12 [zeda] risk factors for CA colon?
23:11:17 [kokushubila] Lung Cancer?
23:11:21 [jwls29] lung cancer?
23:11:48 [Lorena] lung ca
23:11:50 [jwls29] fatty diet,low fiber
23:11:56 [Step_1] mesothelioma has no smoking relationship, but pt would die from primary lung cancer before getting mesothelioma because takes 20 to 30 yrs to develop
23:12:21 [jwls29] good question,step_1
23:12:21 [Lorena] adenomatous poliposis of the colon
23:12:48 [Step_1] thanks
23:13:01 [Step_1] from goljan so i cant take credit
23:13:16 [jwls29] lol
23:13:27 [Step_1]
23:13:31 [kokushubila] Main complications of Lung Ca ?
23:13:36 [Lorena] also when they give you a patient with exposure to asbestos and ask what cancer...dont jump tommesothelioma
23:13:50 [jwls29] why?
23:13:59 [Lorena] bronchogenic cancer is more frequent
23:14:17 [jwls29] ok
23:14:36 [Step_1] interesting....thanks
23:14:45 [jwls29] complications of lung cancer would be mets
23:15:01 [Lorena] unless yo donta have bronchogenic ca as a choice
23:15:05 [jwls29] to the adrenals in 50%
23:16:51 [sanya] Which Ca metastasizes most commonly to the liver
23:17:58 [Step_1] colorectal?
23:18:22 [Step_1] no never mind that answer
23:18:32 [kokushubila] SPHERE of Complications-Superior vena cava syndrome,Pancoats tumor,Horner's syndrome,Endocrine(paraneoplastic),Recurrent Laryngeal Syndrome(hoarseness).Effusions(Pleural, Pericardial) MUST KNOW these complications of Lung Ca
23:18:38 [sanya] 1st lung then colon
23:18:42 [jwls29] i don't know this one
23:18:59 [Lorena] thanks kokush
23:19:01 [jwls29] thank you
23:19:20 [Step_1] thanks kokush
23:19:34 [Step_1] and thanks sanya
23:19:44 [Step_1] tall thin male (or scuba diver) presents with sudden onset of pleuritic type chest pain, tympanitic percussion not, absent breath sounds, elevation of diaphram, trachea shifted. what dx?
23:20:02 [kokushubila] Thanks to F A !!
23:20:07 [Lorena] pneumothorax
23:20:14 [sanya] pnuemothorax
23:20:21 [jwls29] pneumothorax
23:20:36 [Lorena] spontaneous in thin, tall people
23:20:46 [kokushubila] U r welcome!
23:20:55 [Step_1] spontaneous pneumothorax often caused by rupture of subpleural bullae in apex of lung. seen in marfans and scuba.
23:21:02 [Step_1] good job
23:21:26 [Step_1] so i guess we'll do some neoplasia
23:21:53 [Lorena] yes
23:22:01 [jwls29] ok
23:22:17 [jwls29] i have a hard time with the oncogenes
23:22:28 [kokushubila] Wht's the Treatment of Neonatal Respiratory Distress Syndrome?
23:22:34 [jwls29] can't remember any except for the most obvious ones
23:22:40 [Lorena] did you check the neumonic i posted to remember them?
23:22:55 [jwls29] no
23:23:00 [jwls29] haven't seen it
23:23:04 [jwls29] on the forum?
23:23:11 [Step_1] real question (and q.bank too) asked about pt described with B cell follicular lyphoma and asked what caused it> choices were t8,14 , bcl-2 overexpression, and more?
23:23:19 [sanya] surfactant
23:23:46 [Lorena] t8, 14?
23:23:50 [jwls29] and oxygen
23:23:52 [Step_1] PEEP and O2
23:24:07 [sanya] bcl2 causing the apoptosis gene to be inactivated
23:24:16 [jwls29] i'm with lorena on that one
23:25:15 [sanya] t8,14 is Burkkits lymphoma, right
23:25:18 [Step_1] this one got me because I always mix up t 8;14 and t 14;18. the former is Burkitts and the latter is B cell follicular. since t 14;18 was not an option, it is the overexpression of bcl 2
23:25:39 [Lorena] wow
23:25:43 [jwls29] i always confuse them
23:26:03 [Lorena] me too
23:26:13 [Step_1] i think the boards know that we confuse them often, so be prepared
23:26:21 [jwls29] yup
23:26:23 [Lorena] thanks step
23:27:53 [Step_1] bilateral hearing loss dealing with inactivation of NF1....is this with chrom 17 or 22 and why
23:28:14 [Lorena] 17
23:28:14 [jwls29] 17
23:28:23 [sanya] 17
23:28:24 [jwls29] schwanomma
23:28:42 [jwls29] or is it bilateral acoustic neuroma
23:28:44 [Lorena] neurofibromas
23:28:46 [Step_1] Bi-lateral (2 sides) will be NF-2, so chom 22
23:29:01 [Step_1] another tricky one
23:29:03 Parmish enters this room
23:29:30 [Step_1] but good mneumoic is the 2 for BI lateral and 22
23:29:32 [sanya] retinoblastoma gene is it a tumor supressor gene or proto oncogene
23:29:48 [Lorena] tumor supresro gene
23:29:52 [Step_1] oops, i put NF1 in the question....my mistake
23:30:03 [jwls29] yeah i was confused
23:30:03 [Step_1] that would be 17....sorry
23:30:11 [jwls29] that's why i said 17
23:30:24 [sanya] that's OK
23:30:26 [jwls29] but i knew that nf2 was on chrom 22
23:30:28 [Lorena] yes, i understand now
23:30:35 [Step_1] i meant to put NF gene....sorry...
23:30:36 [jwls29] bilat hearing loss
23:30:42 [jwls29] cool
23:30:59 [jwls29] it's ok
23:31:40 [Step_1] long day of studying will have strange effects
23:31:45 [jwls29] lol
23:32:02 [Lorena] lol
23:32:56 [Step_1]>[sanya] is it a suppressor gene?
23:33:06 [Lorena] i have to go guys
23:33:08 [jwls29] how long do you guys usually stay?
23:33:13 [sanya] yes step1
23:33:33 [Step_1] thanks for the great chat again lorena
23:33:46 [Lorena] i wont be able to attend next chat so i will see you on wednesday
23:34:10 [jwls29] bye lorena...thanks
23:34:11 [sanya] bye lorena
23:34:22 [Lorena] bye
23:34:25 [kokushubila] Bye Lor , Enjoy your studies
23:34:35 [Step_1] bye lorena...we'll miss ya
23:35:29 [Step_1]>[jwls29] usually no longer than about 12 eastern (3 hrs). i think we're just about rapping things up with neoplasia
23:35:53 [jwls29] ok
23:36:07 [jwls29] so we meet again on saturday at the same time
23:36:15 [jwls29] ?
23:36:26 [Step_1] every wed and sat at 9pm eastern
23:36:56 [Step_1] just a couple more high yield things and we'll wrap up in next 10 mins....what do you say?
23:37:11 [jwls29] wonderful...so glad i found this group. Since I study alone I never know how much I'm retaining
23:37:17 [jwls29] that would be fine
23:37:22 [sanya] fine with me
23:37:50 [sanya] setp1 when is your exam
23:38:01 [Step_1] most of the benefit is that you want to prepare and stay on schedule with the group....i love that i found this group too
23:38:02 [sanya] sorry step1
23:38:17 [Step_1] mine is coming up next week
23:38:26 [jwls29] i've missed alot though
23:38:32 [jwls29] that makes me sad
23:38:37 [neurodoctor_75] good luck
23:38:47 [sanya] Wow , I'm sure you're going to ace it
23:38:50 [jwls29] oh wow
23:38:56 [jwls29] you'll do great
23:39:00 [Step_1] if things go as planned, the group can recycle the schedule and get newcomers all the time
23:39:21 [neurodoctor_75] good idea
23:39:22 [jwls29] oh good
23:39:30 [jwls29] that would be wonderful
23:39:31 [Step_1] i dont know about that....i'm very nervous about it...but i'll never feel ready so i'm just going to go for it
23:40:03 [sanya] yeah i felt the same for step2 don't worry!
23:40:53 [Step_1] i'll make sure to give a good experience for you all afterwards that will hopefully help
23:41:19 [Step_1] most common cancers in decreasing order. first list incidence in males (top 3)
23:41:23 [sanya] Thanks so much!
23:41:43 [sanya] prostate, lung colon
23:41:56 [jwls29] prostate, lung,colon
23:42:12 [Step_1] by the way, i hope that everyone got the 100 pg goljan hy notes in the download area
23:42:13 [sanya] brast, lung , colon females
23:42:27 [Step_1] prostate, lung, colorectal is right. what about females
23:42:31 [jwls29] agree with sanya
23:42:42 [jwls29] i just downloaded it yesterday
23:42:52 [Step_1] sanya is correct....good
23:42:55 [jwls29] i'm going to have to listen to his lectures
23:43:15 [Step_1] what about mortalities for men and women separately?
23:43:22 [sanya] Oh yes, that was so kind
23:43:22 kokushubila enters this room
23:43:35 [Step_1]>[jwls29] highly recommended....i love his lectures
23:43:42 [jwls29]
23:43:51 [sanya] lung, prostate, colon men
23:43:58 [jwls29] mortalities are lung in both
23:44:07 [sanya] lung, breast, colon women
23:44:18 [jwls29] breast in women prostate in men
23:44:27 [jwls29] colon third in both
23:44:48 [jwls29] thank u very very much
23:45:04 [jwls29] its hard for me to listen to his lectures since i don't have his notes
23:45:15 [jwls29] my mind wanders
23:45:18 [Step_1] now what about the 2nd most common cause of cancer death in total population....trick question
23:45:25 [sanya] Really nice of you guys to do it
23:45:52 [Step_1] i think the notes are important for his lectures, although he doesn't follw the order
23:46:20 [jwls29] would the 100 pgs be good to listen to with the lectures?
23:46:38 [jwls29] would the 2d most common be colon?
23:47:04 [Step_1] colorectal is the 2nd most common in both men and women combined because men dont get breat cancer very often and women dont have prostates....trick question
23:47:47 [Step_1] the 100 pgs are a summary and not really related too much for the lectures. good high yield info for studying after his lectures
23:48:42 [Step_1] another real question described a SE china person most likely to have what type of cancer secondary to EBV?
23:49:14 [neurodoctor_75] lung?
23:49:29 [kokushubila] Nasopharyngeal Ca
23:49:30 [sanya] nasopharyngeal ca
23:49:43 [jwls29] nasopharyngeal??
23:49:46 [Step_1] the answer is nasopharyngeal carcinoma for SE China secondary to EBV.....good job....one more from me
23:50:00 [Step_1] MC cancer in Japan? why?
23:50:13 [jwls29] gastric
23:50:13 [sanya] gastric adeno CA
23:50:13 [neurodoctor_75] gastric
23:50:26 [jwls29] lots of smoked food
23:50:29 [sanya] eating smoked foods, nitrosamines
23:50:33 [jwls29] nitrites
23:50:51 [Step_1] stomach carcinoma due to smoked products and preservatives....excellent!
23:51:17 [Step_1] ok, i think i'll call it a night....we went over alot
23:51:35 [jwls29] yeah me too
23:51:38 [jwls29] i'm tired
23:51:48 [jwls29] thank you all so much for making me feel welcomed
23:51:49 [sanya] Ok then see you all on Saturday, Bye!
23:51:54 [jwls29] and for the great questions
23:52:03 [jwls29] see you all on saturday
23:52:06 [kokushubila] Guys I have to go,THANK YOU
23:52:10 [jwls29] have a great night
23:52:12 [Step_1] so the remainder of path for sat night. i'll see everyone on sat and maybe some of you in the forum in between
23:52:26 [neurodoctor_75] see u all
23:52:35 [kokushubila] Have a nice study , God bless you
23:52:39 [jwls29] what are the topics for sat?
23:53:32 [Step_1] there is an announcement posted on the step 1 forum, but it is the remainder of path (gi, cns, etc)
23:53:41 [jwls29] thanks
23:53:49 [jwls29] have a good night, everybody
23:53:50 [Step_1] :flyaway
23:54:06 [Step_1] oops