Lorena
10-21-2004, 08:06 PM
20:04:11 [ninadnashua] hi
20:04:44 [ninadnashua] how come no show up
20:05:04 [hutals] people usually show up late
20:05:31 [ninadnashua] ok
20:05:41 [ninadnashua] ll be right back in a while
20:05:49 [hutals] ok
20:11:50 mle1 enters this room
20:12:37 [hutals] hey mle
20:13:19 [hutals] seems empty tonight....i guess its must see thursday or something??
20:13:22 [mle1] hey hutals
20:15:00 [mle1] are we continuing rbc&lymphoprolifertaive sysyem?
20:15:25 [hutals] tonight i think is coagulation and bllod
20:15:28 [mle1] or moving on to coagulation?
20:15:35 [mle1] oh,o.k
20:16:50 [mle1] oh, by the way hutals have you finished studying entire pathology?
20:17:05 [mle1] hope you don't mind me asking this Q
20:17:23 [hutals] not yet....i've been reading along as per the schedule
20:17:38 [mle1] oh,o.k
20:17:54 Lorena enters this room
20:17:55 >[Lorena] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite.
20:18:00 [hutals] i'm actually a little behind and hope to catch up this weekend.....how bout you?
20:18:11 [mle1] you guys are reading the <a target=new HREF=http://www.amazon.com/exec/obidos/external-search?tag=valuetheplace-20&keyword=Goljan&mode=books>Goljan</A> review book right?
20:18:23 [mle1] oh,even i'm alot behind.
20:18:31 [Lorena] hi !!
20:18:40 [mle1] takes alot of time to read <a target=new HREF=http://www.amazon.com/exec/obidos/external-search?tag=valuetheplace-20&keyword=Goljan&mode=books>Goljan</A> pathology.
20:18:45 [hutals] hey lor
20:18:58 [mle1] hey lorena
20:18:59 [Lorena] hi guys
20:19:03 [hutals] cant type golijan or it will give a link
20:19:23 [Lorena] jwls cannot make it for today
20:19:27 [hutals] yes, you should try to get your hands on the audio
20:19:28 [mle1] oh,o.k, i was startled for asec.
20:19:47 [hutals] i wont be able to make it tomorrow
20:19:50 [mle1] thanks hutals.
20:20:15 [Lorena] me neither , i have a wedding
20:20:24 [hutals] the audios help alooooottt.....he makes it much easier to follow
20:21:07 [hutals] lucky you lor....love going to weddings
20:21:11 [mle1] oh,o.k.so you guys read the review book along with listening to the audio?
20:21:29 [Lorena] yes, they are nice
20:21:46 [mle1] i downloaded them just afew days back.
20:22:19 [hutals] i personally use the lecture notes that go along with the audio lectures, but the book is very similar.....just a different format
20:23:19 [hutals] then for all the other subjects i'm using the kap notes
20:23:21 [mle1] oh,o.k
20:23:37 [mle1] yes, same here too.
20:24:43 [hutals] i guess we can probably breeze thru some of the coagulation chapter since its not that long and not many of us here....want to get started and try to finish early?
20:25:13 [Lorena] yes
20:25:14 [hutals] nina is here but said she will be back
20:25:38 [Lorena] ok
20:26:00 [Lorena] difference between hemophilia A and B?
20:26:07 [ninadnashua] ya im back
20:26:08 [mle1] o.k
20:26:30 [hutals] factor 8 for A and 9 for B
20:27:11 [Lorena] yes, and with von willebrand disease? clinical not laboratory
20:27:53 [hutals] increased BT in VWD, but normal in hemophilia
20:28:11 [Lorena] yes
20:28:40 [hutals] hmmm, thats labs
20:28:41 [Lorena] also in Von willebrand they rarely have hemarthrosis
20:29:19 [hutals] i didnt know that one lor....thanks'
20:29:42 [Lorena] bleeding time is increased yes , so they bleed from gums or other mucosae
20:30:20 [hutals] ok, after listening to golijan, i think i finally understand the main difference between the extrinsic and intrinsic system. extrinsic has which factor which is not in intrinsic?
20:31:28 [Lorena] thromblopplastin?
20:32:02 [hutals] extrinsic has factor 7 which is unique, so that is the magic number to know
20:32:28 [hutals] intrinsic has 12, 11,9,8 unique
20:32:29 [Lorena] oh ok, the lucky number
20:33:06 [hutals] yes, i meant lucky, not magic...sorry
20:34:17 [Lorena] what factors are affected by heparin?
20:34:17 [hutals] so in hemophilia A which pathway?
20:34:39 [Lorena] intrinsic because it is VIII factor
20:34:57 [hutals] exactly, same would be true for hemophila B
20:35:20 [hutals] now here is a tricky concept
20:35:37 [hutals] they both share 10, 5, 2, 1
20:36:25 [Lorena] ok
20:36:26 [hutals] warfarin and heparin will effect factors in BOTH systems, but one more than other
20:37:09 [hutals] so knowing that, what would be affected with those....extrinsic or intrinsic
20:37:32 [Lorena] heparin affects more factors than warfarin right?
20:37:58 [hutals] yes thats correct
20:38:35 [hutals] heparin will effect intrinsic more uniquely, but also extrinsic
20:38:46 [hutals] opposite for warfarin
20:39:01 [hutals] PT goes with extrinsic and PTT with intrinsic
20:39:10 [Lorena] yes
20:39:16 [hutals] so here is the trick question that might be asked
20:39:21 [Lorena] which extrinsic affects heparin?
20:39:50 [hutals] what would you expect as far PT and PTT for heparin, what about warfarin?
20:40:25 [hutals] the shared ones.....2
20:41:06 [hutals] shared factors are 10, 5, 2, 1. the factors for heparin are 2, 7, 9, 10
20:41:15 [Lorena] warfarin prolonged PT , heparin prolonged PT and PTT?
20:41:18 Betty31 enters this room
20:41:39 [hutals] so 2 and 10 will affect both extrinsic and intrinsic
20:41:44 [hutals] hey betty
20:42:03 [Lorena] hi betty
20:42:06 [Betty31] hi
20:42:42 [hutals] actually, both will have an increased PT and PTT. But PT better indicator for warfarin and PTT better for heparin.
20:43:05 [Lorena] ok, thanx
20:43:57 [hutals] that always threw me off because when i would see an increase in both, i would exlude those two causes.....but i was wrong.....but now i finally figured it out thanks to papi
20:44:43 [Lorena] and me thanks to you
20:44:54 [hutals]
20:45:40 [hutals] what a common cause of HUS?
20:46:05 [hutals] hint-round in undercooked meat
20:46:15 [hutals] not round....found
20:46:25 [Lorena] escherichia coli Enterohemorragica
20:46:47 [hutals] yep E coli 0157:H7
20:46:59 [hutals] another one is shigella
20:47:17 [hutals] what the most common cause of an inc BT
20:47:41 [hutals] hint - you can buy it over the counter
20:48:31 [hutals] another hint is that its used for headaches and causes ulcers
20:48:34 [Lorena] it would be aspirin
20:48:49 [hutals] yep
20:49:21 [Lorena] what does bleeding time test?
20:49:42 [hutals] PLT function
20:49:52 [Lorena] yes
20:50:11 [hutals] what is a common cause of vit k def?
20:50:38 [Lorena] broad spectrum antibiotics, malabsorption
20:51:04 [hutals] antibx, newborns, warfarin, malabsorption......good job!
20:51:26 [hutals] in preg pt, would you give heparin or warfarin?
20:51:51 [Lorena] heparin
20:52:17 [hutals] yep....."war is bad"
20:53:10 [Lorena] why baby can have a def in vit K?
20:53:42 [hutals] no normal flora so require IM vit K at birth
20:53:57 [Lorena] yes
20:54:05 [ninadnashua] no vit k in breast milk
20:54:07 [hutals] look for newborn born at home as hint on exam
20:54:11 [hutals]
20:54:27 [hutals] good point nina
20:54:28 [ninadnashua] so require im vitk
20:55:00 [ninadnashua] thanks
20:55:20 [hutals] pt has diffuse oozing of blood from all breaks in skin shortly after delievery. labs detect inc D-dimers, inc PT and PTT, dec PLTs, shistocytes seen....diagnosis
20:55:52 [Lorena] ICD
20:56:29 [hutals] i know it as DIC, but probably the same thing.....right?
20:56:48 [Lorena] ops, sorry i meant DIC
20:56:53 [Lorena] lol
20:57:10 [hutals] no prob....i figured that
20:57:34 [hutals] the pt probably had an amniotic fluid embolism
20:57:44 [Lorena] yes
20:58:05 [hutals] the D dimer is typically known for detecting PE's, but also known for DIC
20:58:21 [hutals] treatment?
20:59:09 [Lorena] treat the underline pathology, heparin
20:59:20 [hutals] yep, very good
20:59:34 [Lorena] to avoid consumption of coagulation factors and plasma
21:00:27 [Lorena] what are other causes of DIC?
21:00:38 [hutals] seems crazy to give heparin to someone who is already bleeding, so that is a board favorite because it goes against logic unless you understand the process
21:00:54 [hutals] endotoxic shock
21:01:08 [hutals] snake bites
21:01:20 [Lorena] yes very good
21:01:58 [hutals] i think we actually covered most of coagulation....that was a short chapter
21:02:15 [Lorena] yes
21:02:51 [hutals] wanna call it quits early since we covered the material and not to many showed up tonight?
21:03:14 [Lorena] yes, good idea
21:03:37 [Lorena] i'll see you all on monday
21:03:44 [hutals] ok, well have a great time at the wedding and have a great weekend!
21:04:06 [Lorena] thank you hutals you too!
21:04:06 [hutals] nite everyone....bye
21:04:17 hutals exits from this room
21:04:39 [Lorena] bye ninad
21:04:43 [Lorena] and betty
21:04:56 [ninadnashua] bye lorena
21:05:11 [ninadnashua] meet u allnextweek
20:04:44 [ninadnashua] how come no show up
20:05:04 [hutals] people usually show up late
20:05:31 [ninadnashua] ok
20:05:41 [ninadnashua] ll be right back in a while
20:05:49 [hutals] ok
20:11:50 mle1 enters this room
20:12:37 [hutals] hey mle
20:13:19 [hutals] seems empty tonight....i guess its must see thursday or something??
20:13:22 [mle1] hey hutals
20:15:00 [mle1] are we continuing rbc&lymphoprolifertaive sysyem?
20:15:25 [hutals] tonight i think is coagulation and bllod
20:15:28 [mle1] or moving on to coagulation?
20:15:35 [mle1] oh,o.k
20:16:50 [mle1] oh, by the way hutals have you finished studying entire pathology?
20:17:05 [mle1] hope you don't mind me asking this Q
20:17:23 [hutals] not yet....i've been reading along as per the schedule
20:17:38 [mle1] oh,o.k
20:17:54 Lorena enters this room
20:17:55 >[Lorena] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite.
20:18:00 [hutals] i'm actually a little behind and hope to catch up this weekend.....how bout you?
20:18:11 [mle1] you guys are reading the <a target=new HREF=http://www.amazon.com/exec/obidos/external-search?tag=valuetheplace-20&keyword=Goljan&mode=books>Goljan</A> review book right?
20:18:23 [mle1] oh,even i'm alot behind.
20:18:31 [Lorena] hi !!
20:18:40 [mle1] takes alot of time to read <a target=new HREF=http://www.amazon.com/exec/obidos/external-search?tag=valuetheplace-20&keyword=Goljan&mode=books>Goljan</A> pathology.
20:18:45 [hutals] hey lor
20:18:58 [mle1] hey lorena
20:18:59 [Lorena] hi guys
20:19:03 [hutals] cant type golijan or it will give a link
20:19:23 [Lorena] jwls cannot make it for today
20:19:27 [hutals] yes, you should try to get your hands on the audio
20:19:28 [mle1] oh,o.k, i was startled for asec.
20:19:47 [hutals] i wont be able to make it tomorrow
20:19:50 [mle1] thanks hutals.
20:20:15 [Lorena] me neither , i have a wedding
20:20:24 [hutals] the audios help alooooottt.....he makes it much easier to follow
20:21:07 [hutals] lucky you lor....love going to weddings
20:21:11 [mle1] oh,o.k.so you guys read the review book along with listening to the audio?
20:21:29 [Lorena] yes, they are nice
20:21:46 [mle1] i downloaded them just afew days back.
20:22:19 [hutals] i personally use the lecture notes that go along with the audio lectures, but the book is very similar.....just a different format
20:23:19 [hutals] then for all the other subjects i'm using the kap notes
20:23:21 [mle1] oh,o.k
20:23:37 [mle1] yes, same here too.
20:24:43 [hutals] i guess we can probably breeze thru some of the coagulation chapter since its not that long and not many of us here....want to get started and try to finish early?
20:25:13 [Lorena] yes
20:25:14 [hutals] nina is here but said she will be back
20:25:38 [Lorena] ok
20:26:00 [Lorena] difference between hemophilia A and B?
20:26:07 [ninadnashua] ya im back
20:26:08 [mle1] o.k
20:26:30 [hutals] factor 8 for A and 9 for B
20:27:11 [Lorena] yes, and with von willebrand disease? clinical not laboratory
20:27:53 [hutals] increased BT in VWD, but normal in hemophilia
20:28:11 [Lorena] yes
20:28:40 [hutals] hmmm, thats labs
20:28:41 [Lorena] also in Von willebrand they rarely have hemarthrosis
20:29:19 [hutals] i didnt know that one lor....thanks'
20:29:42 [Lorena] bleeding time is increased yes , so they bleed from gums or other mucosae
20:30:20 [hutals] ok, after listening to golijan, i think i finally understand the main difference between the extrinsic and intrinsic system. extrinsic has which factor which is not in intrinsic?
20:31:28 [Lorena] thromblopplastin?
20:32:02 [hutals] extrinsic has factor 7 which is unique, so that is the magic number to know
20:32:28 [hutals] intrinsic has 12, 11,9,8 unique
20:32:29 [Lorena] oh ok, the lucky number
20:33:06 [hutals] yes, i meant lucky, not magic...sorry
20:34:17 [Lorena] what factors are affected by heparin?
20:34:17 [hutals] so in hemophilia A which pathway?
20:34:39 [Lorena] intrinsic because it is VIII factor
20:34:57 [hutals] exactly, same would be true for hemophila B
20:35:20 [hutals] now here is a tricky concept
20:35:37 [hutals] they both share 10, 5, 2, 1
20:36:25 [Lorena] ok
20:36:26 [hutals] warfarin and heparin will effect factors in BOTH systems, but one more than other
20:37:09 [hutals] so knowing that, what would be affected with those....extrinsic or intrinsic
20:37:32 [Lorena] heparin affects more factors than warfarin right?
20:37:58 [hutals] yes thats correct
20:38:35 [hutals] heparin will effect intrinsic more uniquely, but also extrinsic
20:38:46 [hutals] opposite for warfarin
20:39:01 [hutals] PT goes with extrinsic and PTT with intrinsic
20:39:10 [Lorena] yes
20:39:16 [hutals] so here is the trick question that might be asked
20:39:21 [Lorena] which extrinsic affects heparin?
20:39:50 [hutals] what would you expect as far PT and PTT for heparin, what about warfarin?
20:40:25 [hutals] the shared ones.....2
20:41:06 [hutals] shared factors are 10, 5, 2, 1. the factors for heparin are 2, 7, 9, 10
20:41:15 [Lorena] warfarin prolonged PT , heparin prolonged PT and PTT?
20:41:18 Betty31 enters this room
20:41:39 [hutals] so 2 and 10 will affect both extrinsic and intrinsic
20:41:44 [hutals] hey betty
20:42:03 [Lorena] hi betty
20:42:06 [Betty31] hi
20:42:42 [hutals] actually, both will have an increased PT and PTT. But PT better indicator for warfarin and PTT better for heparin.
20:43:05 [Lorena] ok, thanx
20:43:57 [hutals] that always threw me off because when i would see an increase in both, i would exlude those two causes.....but i was wrong.....but now i finally figured it out thanks to papi
20:44:43 [Lorena] and me thanks to you
20:44:54 [hutals]
20:45:40 [hutals] what a common cause of HUS?
20:46:05 [hutals] hint-round in undercooked meat
20:46:15 [hutals] not round....found
20:46:25 [Lorena] escherichia coli Enterohemorragica
20:46:47 [hutals] yep E coli 0157:H7
20:46:59 [hutals] another one is shigella
20:47:17 [hutals] what the most common cause of an inc BT
20:47:41 [hutals] hint - you can buy it over the counter
20:48:31 [hutals] another hint is that its used for headaches and causes ulcers
20:48:34 [Lorena] it would be aspirin
20:48:49 [hutals] yep
20:49:21 [Lorena] what does bleeding time test?
20:49:42 [hutals] PLT function
20:49:52 [Lorena] yes
20:50:11 [hutals] what is a common cause of vit k def?
20:50:38 [Lorena] broad spectrum antibiotics, malabsorption
20:51:04 [hutals] antibx, newborns, warfarin, malabsorption......good job!
20:51:26 [hutals] in preg pt, would you give heparin or warfarin?
20:51:51 [Lorena] heparin
20:52:17 [hutals] yep....."war is bad"
20:53:10 [Lorena] why baby can have a def in vit K?
20:53:42 [hutals] no normal flora so require IM vit K at birth
20:53:57 [Lorena] yes
20:54:05 [ninadnashua] no vit k in breast milk
20:54:07 [hutals] look for newborn born at home as hint on exam
20:54:11 [hutals]
20:54:27 [hutals] good point nina
20:54:28 [ninadnashua] so require im vitk
20:55:00 [ninadnashua] thanks
20:55:20 [hutals] pt has diffuse oozing of blood from all breaks in skin shortly after delievery. labs detect inc D-dimers, inc PT and PTT, dec PLTs, shistocytes seen....diagnosis
20:55:52 [Lorena] ICD
20:56:29 [hutals] i know it as DIC, but probably the same thing.....right?
20:56:48 [Lorena] ops, sorry i meant DIC
20:56:53 [Lorena] lol
20:57:10 [hutals] no prob....i figured that
20:57:34 [hutals] the pt probably had an amniotic fluid embolism
20:57:44 [Lorena] yes
20:58:05 [hutals] the D dimer is typically known for detecting PE's, but also known for DIC
20:58:21 [hutals] treatment?
20:59:09 [Lorena] treat the underline pathology, heparin
20:59:20 [hutals] yep, very good
20:59:34 [Lorena] to avoid consumption of coagulation factors and plasma
21:00:27 [Lorena] what are other causes of DIC?
21:00:38 [hutals] seems crazy to give heparin to someone who is already bleeding, so that is a board favorite because it goes against logic unless you understand the process
21:00:54 [hutals] endotoxic shock
21:01:08 [hutals] snake bites
21:01:20 [Lorena] yes very good
21:01:58 [hutals] i think we actually covered most of coagulation....that was a short chapter
21:02:15 [Lorena] yes
21:02:51 [hutals] wanna call it quits early since we covered the material and not to many showed up tonight?
21:03:14 [Lorena] yes, good idea
21:03:37 [Lorena] i'll see you all on monday
21:03:44 [hutals] ok, well have a great time at the wedding and have a great weekend!
21:04:06 [Lorena] thank you hutals you too!
21:04:06 [hutals] nite everyone....bye
21:04:17 hutals exits from this room
21:04:39 [Lorena] bye ninad
21:04:43 [Lorena] and betty
21:04:56 [ninadnashua] bye lorena
21:05:11 [ninadnashua] meet u allnextweek