Anonymous
10-25-2004, 09:28 PM
20:17:39 [hutals] so, should we get started for tonight. we can start with GI till about 9 and then go onto hepato/pancreas....sound good?
20:18:18 [Roxanita] good
20:18:48 [hutals] what is the most common cause of sqaumous caner in mouth?
20:19:03 [Roxanita] Lorena I put a CT Scan for chronic pancreatitis, check it I like imagens
20:19:13 [Lorena] smoking
20:19:21 [Lorena] yes i saw it, thanks
20:19:47 [Lorena] i am so bad to interpret CT scans
20:19:52 [hutals] smoking is MCC, then alcohol.....very good lorena
20:20:17 [Roxanita] so modest Lorena
20:20:38 [Lorena] if cancer above upper lip then it is basal, right?
20:20:42 [hutals] what type of cancer is most common on upper lip? what about lower lip?
20:20:54 [Roxanita] yes, first cause is smoking and then OH
20:21:01 [hutals] you read my mind lor
20:21:26 [Roxanita] right Lorena
20:21:26 [Lorena] it is true but they say many times you can guess withput looking at the images because of the clinical background...i really hops that will be the case in my exam
20:22:28 [hutals] upper lip = basal and lower lip = squamous. "** comes from your lips" (top to bottom)
20:23:00 [Lorena] lol
20:23:24 [Roxanita] so the base (basal) is on the top (upper)
20:24:18 [hutals] how can you tell if dyspagia is due to mechanical obstruction vs peristalsis problem?
20:25:05 [Lorena] mechanical is dysphagia to solids ....and a peristalsis problem is to both
20:25:54 [Roxanita] right
20:26:06 [hutals] dysphagia for solids NOT liquids is mechanical obstruction whereas dysphagia for solids AND liquids is peristalsis problem......very good lor! what is most common cause if dyspagia to solids and liquids?
20:27:03 [ninadnashua] achalasia
20:27:20 [Lorena] achalasia
20:27:39 [hutals] achalasia is most common cause, then comes things like progressive systemic sclerosis, MG, etc.....good job lor and nina
20:27:43 [jwls29] agree
20:28:01 [hutals] and jwls
20:28:50 [hutals] how to distinguish achalasia from hisrchprungs?
20:28:51 [Roxanita] where do we see the "bird beak" sign?
20:28:57 [Lorena] patient from suth america and has achalasia?
20:29:18 [jwls29] chaga's disease for pt from south america
20:29:23 [Roxanita] CHAGAS
20:29:33 [Lorena] when Lower esophageal sphincter doesnt relax
20:29:51 [jwls29] achalasia is bird beak
20:29:55 [Roxanita] Achalasia
20:30:07 [hutals] chagas
20:30:13 [Lorena] yes, very good ...name oF THE BUG?
20:30:16 [Roxanita] what is the cause for achalasia?
20:30:23 [jwls29] reduvid bug
20:30:47 [hutals] in hirschprungs the proximal bowel is dialated, but there is peristalisis
20:31:05 [hutals] failure of relaxation of the LES sphincter
20:31:06 [jwls29] failure of relaxation of LES due to absent myenteric ganglion cells
20:31:27 [Roxanita] Trypanosoma Cruzi
20:31:48 [hutals] Trypanasoma cruzi
20:32:38 [Lorena] yes, you are all right , reduviv bug is the vector and the causal is T cruzi
20:32:44 [ninadnashua] leishmania
20:32:48 [Roxanita] the insect who spread belongs to the family of Reduviidae
20:33:06 [hutals] what can cause espophagitis in AIDS?
20:33:24 [Lorena] candida
20:33:31 [ninadnashua] fungus candida
20:33:34 [jwls29] candida
20:33:50 [hutals] Candida is MCC, others include Herpes and CMV...very good everyone
20:34:43 [hutals] what vessels are involved with esophageal varices?
20:35:04 [ninadnashua] left gastric vein
20:35:10 [jwls29] left gastric and azygous vein
20:35:17 [Lorena] left gastric vein and azygous
20:35:22 [ninadnashua] azygous vein
20:35:30 [hutals] left gastric and azygous vein....excellent!
20:36:47 [Lorena] MCC of hematemesis?
20:37:19 [ninadnashua] varices
20:37:45 acestep1 enters this room
20:37:56 [jwls29] hi ace
20:38:01 [hutals] hey ace
20:38:02 [ninadnashua] oh duodenal ulcer
20:38:13 [Lorena] hi ace
20:38:21 [hutals] ulcer
20:38:27 [jwls29] mc primary cancer of the esophagus?
20:38:41 [acestep1] hi lor , jwls n hutals
20:38:49 [hutals] duodenal ulcer most common than gastric
20:38:52 [Lorena] yes, duodenal ulcer then gastric ulcer and third is esophageal varices
20:39:07 [hutals] adenocarcinoma
20:39:13 [Lorena] adenocarcinoma
20:39:13 [ninadnashua] ya
20:39:22 [jwls29] yes
20:39:30 [jwls29] and in third world countries?
20:39:31 [hutals] pyloric stenosis vs duodenal atresia....which has bile stained fluid? which assoc with downs? which occurs at birth? which 2-4 weeks after birth? which has double bubble sign? which has polydyramnios?
20:39:46 [hutals] 3rd world would be squamous
20:40:01 [jwls29] yes hutals
20:40:04 [acestep1] k
20:40:27 [Lorena] duodenal atresia associated with downs ocuur right after birth , it has polyhidramnios
20:40:44 [acestep1] i think duodenalk atresia has bile stained
20:40:50 [jwls29] duodenal atresia is associated with down's, double bubble sign and has bile stained fluid and the mother had polyhydramnios
20:40:50 [Lorena] it has double bubble sign
20:41:01 [acestep1] agree with lor
20:41:11 [ninadnashua] agree
20:41:21 [Lorena] pyloric stenosis is soe weeks after birth , non bile stain
20:41:28 [jwls29] congenital pyloric stenosis is 2-4 wks after birth and is non bile stained with an epigastric mass
20:41:32 [acestep1] wht si double bubble sign
20:41:35 [hutals] D-uodenal atresia = D-ouble bubble, D-owns, "D-o have bile". it also happens at birth and causes polyhydramnios.....very good
20:42:01 [jwls29] good mnemonic,hutals...ty
20:42:04 [Lorena] great nemonic hutals
20:42:10 [hutals] double bubble sign on xray means air in stomach
20:42:36 [acestep1] oh yes! thnx hutals
20:42:36 [Lorena] and duodenum
20:42:38 [hutals] also air in prox duodenum....both air bubbles cause double bubble
20:43:01 [ninadnashua] air looks like bubbles
20:43:05 [acestep1] ok
20:43:50 [ninadnashua] pyloroplasty is treatment
20:44:27 [hutals] which should be biopsied....gastric or duodenal ulcer.....or both?
20:44:32 [Lorena] ok
20:44:33 [hutals] or neither
20:44:39 [Lorena] just gastric
20:44:49 [jwls29] gastric
20:45:00 [jwls29] duodenal doesn't need to be biopsied b/c not malignant
20:45:19 [Roxanita] Mallory Weiss syndrome mcc?
20:45:20 [hutals] very good....all correct!
20:45:36 [hutals] alcoholics
20:45:58 [Lorena] bulimia and alcoholics
20:46:02 [hutals] from vomitting
20:46:15 [jwls29] agree
20:46:28 [acestep1] agree
20:46:36 [Roxanita] MWS where is the lession located?
20:46:39 [hutals] an interesting one is the MCC of Boerhaave's?
20:46:56 [hutals] distal esophagus
20:47:09 [acestep1] sgree
20:47:12 [jwls29] tear of distal esophagus
20:47:13 [Lorena] yes, endoscopy ...yikes
20:47:22 [acestep1] agree imean
20:47:41 [hutals] some causes also include alcoholics and bulemia, but MCC is endoscopy....wow. good job
20:48:03 [acestep1] ic
20:48:31 [Roxanita] Boerhaave's, is in distal or proximal esophagus?
20:48:42 [jwls29] distal
20:48:46 [hutals] i think also distal
20:48:52 [acestep1] distal
20:48:53 [Lorena] distal
20:49:10 [Roxanita] I know Mallory Weiss is at the gastro-esophag junction
20:49:24 [hutals] mallor weis is a tear vs a rupture (worse) in boerhave's (lots of blood in latter)
20:49:45 [jwls29] thanks hutals
20:50:09 [acestep1] rox any forced vomit- inc pressure on bvs so they rupture
20:51:55 [Roxanita] yeah, I was just confused with k-aplan book vs <a target=new HREF=http://www.amazon.com/exec/obidos/external-search?tag=valuetheplace-20&keyword=Goljan&mode=books>Goljan</A>
20:52:27 [acestep1] k .np
20:52:28 [Roxanita] sorry
20:52:54 [acestep1] np
20:53:08 [hutals] another interesting tid bit is that first step in management of duodenal ulcer is a flat plate xray which can detect air that escapes....can cause referred pain to shoulder from air that irritates nerve......this would mean its perforated
20:53:56 [hutals] sorry, couldnt think of a good question with that info, but thought it was kinda cool
20:54:05 [Lorena] thanks hutals
20:54:21 [Lorena] causes of hypergastrinemia?
20:54:23 [Roxanita] Adenocarcinomas of the distal esophagus are mostly due to what condition?
20:54:31 [acestep1] yes. v gd hutals i think its air under teh diaphargm
20:54:44 [acestep1] gerd?
20:54:51 [hutals] barrets esophagus
20:54:52 [ninadnashua] barrets
20:55:15 [Lorena] secondary to barrets which is a comlication of GERD
20:55:26 [acestep1] pancreatic ca- lor ?
20:55:49 [acestep1] agree
20:56:49 [hutals] what is the most common cancer in Japan? why?
20:56:56 [Lorena] yes , thats one cause ace very good (zollinger ellison sx)
20:57:09 [Lorena] stomach because of smoked food
20:57:11 [acestep1] stomach ca?
20:57:40 [ninadnashua] stomach due to smoked foods
20:57:42 [acestep1] ty lor can u tell em teh other causes
20:57:48 [hutals] yep, stomach ca due to smoked foods (from preservatives).....good
20:58:02 [Roxanita] Clinically how do you differentiate duodenal peptic ulcer vs gastric peptic ulcer?
20:58:54 [Lorena] gastric it hurts after eating so fear to eat, they lose weight - in contrast duodenal the pain is reloeved with food -they dont loose weight
20:58:55 [acestep1] i think gastric pain inc on eating n opp in duedenal
20:59:10 [acestep1] agree with lor
20:59:40 [Roxanita] acestep1> yes that's how we can differentiate clinically
20:59:49 [hutals] lose weight with gastric, but do not with duod
21:00:20 [acestep1] ok plz coorect me if im wrong other causes of gastric ca r cigrettes , alcohol gastric ulcer , etc
21:00:26 [Lorena] duodenal wakes up the patient at night (because no food for hours)
21:00:36 [acestep1] k
21:01:10 [hutals] dont forget about K pylori as a cause of gastric ca
21:01:28 [hutals] oops, H pylori
21:02:00 [Lorena] yes thanks
21:02:46 [hutals] you know, now that i think about it....that doesnt seem right because H pylori is associated with >90% of duodenal ulcers, but they are not assoc with malignancy??
21:03:51 [acestep1] nono hutals they r with ca
21:04:11 [hutals] duodenal ulcers you mean??
21:04:32 [acestep1] no i think also gastric
21:05:11 [acestep1] cuz gastric ulcers r one of teh causesof ca n ulcer is caused by h.pylori
21:05:22 [Lorena] for gastric ulcers you do biopsy because cancer may be there too , to rule out cancer
21:06:07 [Lorena] they can be together , but ulcer wont turn into cancer if i understood correctly
21:06:10 [jwls29] what you are saying makes sense, hutals
21:06:12 [hutals] if i understand this correctly, duodenal ulcers are not malignant. but they are assoc with H pylori >90% of time. H pylori causes stomach ca. something doesnt add up??
21:06:32 [Lorena] cancer can look like an ulcer
21:07:47 [hutals] i guess h pylori doesnt actually cause the cancer, but they are an indicator because often associated with gastric ulcers which can cause gastric ca.....does that sound right?
21:07:55 [Lorena] yes
21:08:23 [Lorena] H pyloru can cause gastric cancer , not duodenal cancer so no need to byopsy a duodenal ulcer
21:08:26 [hutals] ok, sorry about that....thanks for your patience, we can move on now
21:08:26 [jwls29] yes
21:08:41 [jwls29] that was a good point
21:08:52 [Lorena] yes, very good
21:09:25 [acestep1] ya agree wqith with lor - i just checked
21:09:46 [Lorena] thanks ace
21:09:47 [jwls29] what is the best screening test for malabsorption?
21:09:57 [acestep1] sorry for the typing error
21:10:19 [acestep1] ue welcome - lor . anytime
21:10:29 [ninadnashua] stool for fat.
21:10:31 [Lorena] fat in stool?
21:10:34 [hutals] fat in the stool
21:10:41 [jwls29] yes
21:10:54 [hutals] what is the MCC of bowel obstruction?
21:11:28 [Lorena] stricture?
21:11:32 [jwls29] adhesions from a previous surgery
21:11:51 [ninadnashua] ya
21:12:11 [hutals] adhesions from previous surgery is MCC. if no previous surgery, pick indirect inguinal hernia
21:12:24 [Lorena] ok thanx
21:12:31 [acestep1] k . ty
21:13:31 [hutals] traveler to mexico who 1 week later develops watery diarreah with mucus and blood and colicky bowel movements....diagnosis?
21:13:33 [acestep1] hey guys i gtg now . ill see u guys tom . its ramadan here so i cant study for a long time
21:13:34 [jwls29] what is obstipation?
21:13:47 [acestep1] must go n study
21:13:53 [jwls29] bye ace
21:14:14 [Lorena] take care, see you tomorrow ace
21:14:24 [hutals] chronic constipation leading to blockage
21:14:39 [hutals] bye ace
21:14:56 [jwls29] obstipation is constipation and no gas
21:15:05 [Lorena] when no gas
21:15:20 [Lorena] ok
21:15:21 [jwls29] one of the signs of bowel obstruction
21:15:46 [Lorena] step ladder sign
21:15:46 [jwls29] that and colicky pain with pain free intervals
21:15:47 [hutals] oh yes, reminds me of the funny gas story golijan mentions in his audios
21:16:16 [jwls29] lol
21:16:18 [acestep1] dysentry?
21:17:00 [Lorena] step laddrer because air and liquid levels due to edema and dilation of bowel
21:17:01 [jwls29] enterotoxigenic e coli?
21:17:47 [hutals] what sign will differentiate small bowel obstruction from ischemic colitis (on presentation, not from labs, etc)?
21:18:09 [Lorena] it is amebiasis
21:18:09 [acestep1] byee guys really sorry my comp freezes . came back 2 know huatls ans
21:18:43 [hutals] oops, forgot about that one. the answer was amebiasis
21:19:10 [acestep1] np n thnx tc all of u
21:19:55 [ninadnashua] small bowel clinical is diffuse painabdomen, in ischemic it is only in splenic flexure
21:19:56 [hutals] nite ace
21:20:29 [hutals] travelors on the other hand would be secretory without blood and mucus
21:20:30 [jwls29] is it entamoeba hystolitica?
21:20:55 [hutals] yes jwls....very good
21:21:22 [hutals] and yes nina, that is right. easiest way to differentiate and a giveaway for the exam....very good
21:21:49 [ninadnashua] thanku
21:22:47 [jwls29] difference between crohn's and ulcerative colitis?
21:23:15 [Lorena] ulcerative doesn skip, chron does,
21:23:35 [hutals] chrons has skip lesions, fistulas, right lower quadrant
21:23:42 [Lorena] ulcerative is mucosal and submucosal and chrons is transmural.....
21:24:29 [Lorena] Roxanita> take care
21:24:30 kmonica26 enters this room
21:24:49 [hutals] what are the rule of 2;s for meckels diverticulum?
21:24:58 [Roxanita] guys could u please post the transcript
21:25:01 [hutals] hey mon
21:25:07 [kmonica26] hi guys
21:25:08 [Roxanita] I will see u tomorrow
21:25:17 [jwls29] bye roxanita
21:25:21 [hutals] nite rox
21:25:24 [jwls29] hi monica
21:25:33 [Lorena] hi monika
21:25:41 [Lorena] bye rox, take care
21:25:50 [kmonica26] hi everyone
21:25:58 [Roxanita] tomorrow is: Renal/ lower urinary/STD/Gynecology
21:26:16 [Roxanita] bye guys, you really rock in patho
21:26:17 [Lorena] 2% of the population, 2cm from ileocecal valve and 2cm long
21:26:21 [jwls29] 2 ft from ileocecal valve
21:26:25 [hutals] rule of 2's are 2% children, 2 ft from ileocecal valve, 2 types of tissue, 2 year of age
21:26:28 [jwls29] thanks lore
21:26:39 [hutals] very good
21:27:07 [hutals] we should probably move onto hepato/pancrease because running outta time
21:27:16 [Lorena] ok
21:27:26 [jwls29] ok
21:27:43 [hutals] AST vs ALT. which one associated with alcohol?
21:27:55 [jwls29] AST
21:27:57 [Lorena] AST
21:28:09 [hutals] or i should say MORE associated with alcohol since both will be affected
21:28:13 [jwls29] the s stands for sambuca (which is a liqueor)
21:28:20 [Lorena] because it is mithocondrial , and ALT is cytoplasmic
21:28:26 [hutals] yes, AST
21:28:40 [hutals] good one jwls
21:28:42 [Lorena] very good jwls
21:28:54 [jwls29] ty
21:29:02 [hutals] thanks lor
21:29:55 [hutals] in obstructed liver disease, what enzymes would be elevated? Alk phos, GGT, both, neither?
21:30:09 [Lorena] so remember we were wondering in one of the last chats why LDH was increasd in hemolytic anemias?
21:30:39 [Lorena] both
21:30:57 [jwls29] both
21:31:12 [kmonica26] agree both
21:31:34 [hutals] yes, both correct. alk phos is not very specific, but both together are specific to liver
21:32:29 [hutals] yes lor, we never figured that one out from what i remember
21:33:30 [hutals] Which hep is the most common?
21:33:38 [hutals] overall that is
21:33:43 [jwls29] hep a
21:33:44 [Lorena] LDH is increasd in cell necrosis :liver damage , Myocardial Infarction , hemolytic anemias
21:34:01 [Lorena] agre with jwls
21:34:13 [hutals] it goes in order....A, B, C, D, E
21:34:46 [hutals] which hep MCC from accidental needle stick?
21:34:59 [Lorena] B
21:35:00 [jwls29] Hep B
21:35:18 [hutals] yep Hep B
21:35:29 [hutals] which hep is never chronic?
21:35:45 [kmonica26] A
21:35:49 [ninadnashua] hep a
21:36:02 [jwls29] agree
21:36:10 [Lorena] agree
21:36:15 [hutals] yep hep a. what about E...is this ever chronic (trick question)
21:37:01 [Lorena] no
21:37:10 [jwls29] i think no
21:37:16 [ninadnashua] no
21:37:28 [hutals] E is only chronic in pregnant women....and they will have 20% mortality....so boards love to ask about it.....its not in his notes, but golijan mentioned in audios
21:38:23 [jwls29] thanks hutals
21:38:26 [hutals] which is MCC in day cares?
21:38:43 [jwls29] hep a
21:38:46 [Lorena] a
21:39:00 [hutals] hep A, so vaccine is recommended for children in day cares
21:39:31 [hutals] which are non-parenternal route of transmission?
21:39:57 [kmonica26] feco oral
21:40:00 [jwls29] a and e
21:40:14 [Lorena] a, e
21:40:19 [hutals] yep A and E
21:40:26 [ninadnashua] close contact, blood saliva semen
21:41:00 [hutals] hep B nina?
21:41:29 [ninadnashua] ya
21:41:57 [ninadnashua] im sorry i confuse
21:42:47 [hutals] thats ok, they are all confusing....takes repetition to get them right
21:43:10 [hutals] regarding Hep B.....what is present in window period?
21:43:11 [jwls29] can we go over the markers for hepatitis b?
21:43:12 [Lorena] parasite that may cause cholangiocarcinoma?
21:43:23 [ninadnashua] ya
21:43:39 [ninadnashua] liver fluke
21:43:51 [jwls29] HbCAb?
21:44:04 [hutals] i agree with nina
21:44:06 [Lorena] HBcore antibody
21:44:15 [Lorena] yes ninad and hutals
21:44:42 [hutals] antibody HBc IgM (not IgG)
21:45:27 [hutals] this is tricky, but golijan stresses it.....is the person infective during the window period based on the lab you just gave
21:45:29 [hutals] ?
21:45:44 [jwls29] what about for acute infection?
21:46:17 [Lorena] no infective because only DNA HB and HBeAg are infective
21:46:49 [hutals] acute infection would have surface Ag, IgM Ab, HBeAg and HBV DNA
21:47:25 [Lorena] agree
21:47:33 [hutals] thats right, they would NOT be infective during window period....that one is a bit tricky, but important
21:48:09 [jwls29] and what do we find in someone who is recovered?
21:48:16 [Lorena] which ab are protective?
21:48:19 [hutals] what if the person only has antibody to HBs?
21:48:29 [jwls29] vaccine
21:48:49 [Lorena] yes
21:48:55 [hutals] recoved would be anti HBc IgG and Ati HBs
21:49:14 [Lorena] very good
21:49:18 [hutals] HBs Ab is protective
21:49:19 [jwls29] yup
21:49:58 [hutals] yes, vaccine would cause someone to have only antibody to HBs and nothing else
21:50:36 [jwls29] and what about a chronic carrier?
21:50:46 [Lorena] no HBcore IgG in vaccinated people then
21:50:53 [hutals] what if HBs Ag for >6mo, but no HBV DNA or HBeAg?
21:51:15 [jwls29] healthy carrier?
21:51:32 [Lorena] HB surface ag for more than 6 months means chonicity
21:52:04 [Lorena] agreewith jwls
21:52:07 [hutals] thats right Lor, no HBcore IgG in vaccinated.....the core IgG would indicate recovery
21:52:34 [jwls29] i thought chronicity was HBsAg, HbEag,and HBV DNA
21:53:07 [hutals] yes, it would be "healthy" chronic carrier, not because pt is healthy (they have hepatitis so not healthy), but because they are not infective....good job
21:53:42 [Lorena] thanks hutals
21:54:57 [hutals] infective chronicity would have the HBeAg and HBV DNA which would make them infective. the "chronicity" is simply from the time of HBs Ag of >6 mo. The infective vs health refers to the infectivity of the chronic carrier
21:54:58 [kmonica26] A 12-year-old girl has had recurrent episodes of scleral icterus, particularly following viral illnesses. She is otherwise well and is taking no medications. Laboratory studies reveal an indirect bilirubin of 58.1 mcmol/L (3.4 mg/dL) and direct bilirubin of 5.13 mcmol/L (0.3 mg/dL). Serum transamin
21:55:19 [kmonica26] Serum transaminase concentrations, prothrombin time, partial thromboplastin time, and serum ammonia levels all are within normal limits.
21:55:34 [kmonica26] Of the following, the MOST likely etiology of this girl's hyperbilirubinemia is
21:56:26 docak enters this room
21:56:54 [hutals] hey docak
21:57:14 [docak] hi guys
21:57:28 [Lorena] hi docak
21:57:39 [jwls29] hi docak
21:57:48 [docak] i'm sorry i did'nt check the schedule
21:58:05 [docak] what's the topic today?
21:58:05 [Lorena] what are the choices monika?
21:58:37 [kmonica26] chronic active hepatitis
21:58:49 [kmonica26] B. Dubin-Johnson syndrome
21:59:00 [hutals] docak, we discussed GI earlier (you can check the transript later) and now discussing hepatic path
21:59:14 [docak] thanks hutals
21:59:17 [kmonica26] gilbert
21:59:27 [kmonica26] hepatitis A infection
21:59:38 [kmonica26] infectious mononucleosis
22:00:11 [Lorena] i would go for Gilbert
22:00:15 [hutals] gilberts disease??
22:00:27 [kmonica26] yep
22:00:28 [jwls29] me too
22:00:34 [jwls29] oh good
22:01:04 [kmonica26] Gilbert syndrome is a benign form of familial hyperbilirubinemia that occurs in 3% to 10% of the population. It is an autosomal dominant disorder, but the hyperbilirubinemia usually is not recognized until after puberty. Bilirubin concentrations are generally below 51 mcmol/L (3 mg/dL), but they ma
22:02:29 [Lorena] thanx monika
22:02:57 [kmonica26] A 16-year-old girl is referred to you for evaluation of right shoulder pain and nausea. Her previous medical history is remarkable for recent treatment of Lyme disease with ceftriaxone. Findings on physical examination of the shoulder are normal.
22:03:13 [kmonica26] the best INITIAL evaluation is
22:03:17 [hutals] the giveaways on that were the very low conjugated bilirubin mixed with jaundice. there is no Rx and you will see the bilirubin double after fasting....thanks mon, great question
22:03:38 [kmonica26] np
22:05:47 [hutals] any choices for the last question?
22:06:36 [kmonica26] A. abdominal ultrasonography to determine whether gallstones are present
22:06:47 [kmonica26] B. bone scan to identify osteomyelitis
22:06:57 [kmonica26] C. magnetic resonance imaging to identify bursitis
22:07:06 [kmonica26] D. radiography to identify a subclinical clavicular fracture
22:07:15 [kmonica26] E. Western blot testing to determine whether recurrent Lyme disease is present
22:08:01 [Lorena] A?
22:08:37 [jwls29] a?
22:08:47 [kmonica26] why?
22:08:47 [docak] Is it E?
22:09:02 [kmonica26] answer is A
22:09:07 [kmonica26] But why?
22:09:07 [hutals] E?
22:10:10 [hutals] wow, i'm stumped on that one....cant put it together....a 16 yo with gallstones
22:10:11 [docak] why A?
22:10:18 [hutals] maybe she has sickle cell?
22:10:43 [kmonica26] The association between the administration of ceftriaxone and the development of cholecystitis in children and adolescents is well recognized. Right shoulder pain, as described in the vignette, is characteristic of referred pain resulting from gallbladder disease.
22:10:44 [jwls29] does she have intrahepatic cholestasis b/c of the ceftriaxone?
22:11:51 [Lorena] great question and explanation
22:13:08 [kmonica26] A 25-year-old woman with sickle cell anemia complains of steady pain
22:13:21 [hutals] didnt know about 16 year olds although children under 8 are known to get that from ceftriaxone binds to albumin causing jaundice leading to gallstone formation
22:13:26 [kmonica26] in her right upper quadrant with radiation to the right shoulder
22:13:49 [kmonica26] especially after large or fatty meals. Her physician diagnoses gallstones.
22:13:54 [hutals] great question mon....a real thinker
22:14:07 [kmonica26] which of the following compounds are these stones most likely composed?
22:14:27 [kmonica26] Np
22:14:48 [hutals] calcium bilirubinate
22:14:56 [kmonica26] Yep
22:15:35 [Lorena] ok
22:16:00 [hutals] i only knew that because that was the connection i was trying to make with the last question....sickle cell patients and gallstones
22:16:10 [kmonica26]
22:16:23 [kmonica26] Thats why I put this question
22:16:37 [kmonica26] so that all of us can remember
22:16:42 [Lorena] these type of stiones are present in all he olytic anemias, right?
22:16:50 [kmonica26]
22:17:22 [hutals] extravascular hemolytic anemias....yep
22:17:23 [kmonica26] I think so..makes sense as there is hemolysis
22:17:24 [Lorena] i mean may be present in all hemolytic anemias :thalasemias, etc
22:18:27 [hutals] i think you're right lor
22:18:53 [Lorena] ok
22:19:37 [hutals] bronze diabetes refers to what?
22:19:50 [Lorena] hemochromatosis
22:19:59 [docak] in wilson's disease
22:20:23 [docak] deposition of cu in liver, destroys beta cells
22:20:42 [hutals] yep, hemochromatosis.....seen in diabetic pts who have skin hyperpigmentation
22:21:09 [docak] and decreased insulin, therefore diabetes.
22:21:42 [hutals] thats true docak, but what about the bronze part?
22:22:04 [docak] so its hemochromatosis?
22:22:27 [Lorena] yes
22:23:10 [jwls29] i have to go
22:23:22 [hutals] yes, although you were onto something with wilsons. but the buzz word of bronze diabetes is know for hemochromatosis
22:23:26 [jwls29] see you guys tomorrow....thanks for the chat...it was really good
22:23:27 [Lorena] i have to go tto guys
22:23:28 [kmonica26] bye jwls
22:23:48 [jwls29] goodnite
22:23:54 [Lorena] thank you all , see you tomorrow
22:24:00 [hutals] yes, i have to go as well. lor, will u post transcript?
22:24:02 [docak] thanks lorena, hutals
22:24:18 [docak] bye jwls
22:24:18 [kmonica26] are we done?
22:24:26 [kmonica26] bye guys
22:24:27 [Lorena] please you post the transcript hutals because i had to refresh the oage many times so i lost the beginning
22:24:51 [hutals] no prob lor, i'll post it
22:24:52 [ninadnashua] bye
22:25:04 [kmonica26] what is the topic for tomorrow?
22:25:06 [Lorena] thank you, byeeeeee
22:25:13 [hutals] nite all, c you all tomorrow
22:25:38 [docak] good nite guys.
22:26:08 [hutals] Renal/ Lower Urinary STD / Gynecology for tomorrow
20:18:18 [Roxanita] good
20:18:48 [hutals] what is the most common cause of sqaumous caner in mouth?
20:19:03 [Roxanita] Lorena I put a CT Scan for chronic pancreatitis, check it I like imagens
20:19:13 [Lorena] smoking
20:19:21 [Lorena] yes i saw it, thanks
20:19:47 [Lorena] i am so bad to interpret CT scans
20:19:52 [hutals] smoking is MCC, then alcohol.....very good lorena
20:20:17 [Roxanita] so modest Lorena
20:20:38 [Lorena] if cancer above upper lip then it is basal, right?
20:20:42 [hutals] what type of cancer is most common on upper lip? what about lower lip?
20:20:54 [Roxanita] yes, first cause is smoking and then OH
20:21:01 [hutals] you read my mind lor
20:21:26 [Roxanita] right Lorena
20:21:26 [Lorena] it is true but they say many times you can guess withput looking at the images because of the clinical background...i really hops that will be the case in my exam
20:22:28 [hutals] upper lip = basal and lower lip = squamous. "** comes from your lips" (top to bottom)
20:23:00 [Lorena] lol
20:23:24 [Roxanita] so the base (basal) is on the top (upper)
20:24:18 [hutals] how can you tell if dyspagia is due to mechanical obstruction vs peristalsis problem?
20:25:05 [Lorena] mechanical is dysphagia to solids ....and a peristalsis problem is to both
20:25:54 [Roxanita] right
20:26:06 [hutals] dysphagia for solids NOT liquids is mechanical obstruction whereas dysphagia for solids AND liquids is peristalsis problem......very good lor! what is most common cause if dyspagia to solids and liquids?
20:27:03 [ninadnashua] achalasia
20:27:20 [Lorena] achalasia
20:27:39 [hutals] achalasia is most common cause, then comes things like progressive systemic sclerosis, MG, etc.....good job lor and nina
20:27:43 [jwls29] agree
20:28:01 [hutals] and jwls
20:28:50 [hutals] how to distinguish achalasia from hisrchprungs?
20:28:51 [Roxanita] where do we see the "bird beak" sign?
20:28:57 [Lorena] patient from suth america and has achalasia?
20:29:18 [jwls29] chaga's disease for pt from south america
20:29:23 [Roxanita] CHAGAS
20:29:33 [Lorena] when Lower esophageal sphincter doesnt relax
20:29:51 [jwls29] achalasia is bird beak
20:29:55 [Roxanita] Achalasia
20:30:07 [hutals] chagas
20:30:13 [Lorena] yes, very good ...name oF THE BUG?
20:30:16 [Roxanita] what is the cause for achalasia?
20:30:23 [jwls29] reduvid bug
20:30:47 [hutals] in hirschprungs the proximal bowel is dialated, but there is peristalisis
20:31:05 [hutals] failure of relaxation of the LES sphincter
20:31:06 [jwls29] failure of relaxation of LES due to absent myenteric ganglion cells
20:31:27 [Roxanita] Trypanosoma Cruzi
20:31:48 [hutals] Trypanasoma cruzi
20:32:38 [Lorena] yes, you are all right , reduviv bug is the vector and the causal is T cruzi
20:32:44 [ninadnashua] leishmania
20:32:48 [Roxanita] the insect who spread belongs to the family of Reduviidae
20:33:06 [hutals] what can cause espophagitis in AIDS?
20:33:24 [Lorena] candida
20:33:31 [ninadnashua] fungus candida
20:33:34 [jwls29] candida
20:33:50 [hutals] Candida is MCC, others include Herpes and CMV...very good everyone
20:34:43 [hutals] what vessels are involved with esophageal varices?
20:35:04 [ninadnashua] left gastric vein
20:35:10 [jwls29] left gastric and azygous vein
20:35:17 [Lorena] left gastric vein and azygous
20:35:22 [ninadnashua] azygous vein
20:35:30 [hutals] left gastric and azygous vein....excellent!
20:36:47 [Lorena] MCC of hematemesis?
20:37:19 [ninadnashua] varices
20:37:45 acestep1 enters this room
20:37:56 [jwls29] hi ace
20:38:01 [hutals] hey ace
20:38:02 [ninadnashua] oh duodenal ulcer
20:38:13 [Lorena] hi ace
20:38:21 [hutals] ulcer
20:38:27 [jwls29] mc primary cancer of the esophagus?
20:38:41 [acestep1] hi lor , jwls n hutals
20:38:49 [hutals] duodenal ulcer most common than gastric
20:38:52 [Lorena] yes, duodenal ulcer then gastric ulcer and third is esophageal varices
20:39:07 [hutals] adenocarcinoma
20:39:13 [Lorena] adenocarcinoma
20:39:13 [ninadnashua] ya
20:39:22 [jwls29] yes
20:39:30 [jwls29] and in third world countries?
20:39:31 [hutals] pyloric stenosis vs duodenal atresia....which has bile stained fluid? which assoc with downs? which occurs at birth? which 2-4 weeks after birth? which has double bubble sign? which has polydyramnios?
20:39:46 [hutals] 3rd world would be squamous
20:40:01 [jwls29] yes hutals
20:40:04 [acestep1] k
20:40:27 [Lorena] duodenal atresia associated with downs ocuur right after birth , it has polyhidramnios
20:40:44 [acestep1] i think duodenalk atresia has bile stained
20:40:50 [jwls29] duodenal atresia is associated with down's, double bubble sign and has bile stained fluid and the mother had polyhydramnios
20:40:50 [Lorena] it has double bubble sign
20:41:01 [acestep1] agree with lor
20:41:11 [ninadnashua] agree
20:41:21 [Lorena] pyloric stenosis is soe weeks after birth , non bile stain
20:41:28 [jwls29] congenital pyloric stenosis is 2-4 wks after birth and is non bile stained with an epigastric mass
20:41:32 [acestep1] wht si double bubble sign
20:41:35 [hutals] D-uodenal atresia = D-ouble bubble, D-owns, "D-o have bile". it also happens at birth and causes polyhydramnios.....very good
20:42:01 [jwls29] good mnemonic,hutals...ty
20:42:04 [Lorena] great nemonic hutals
20:42:10 [hutals] double bubble sign on xray means air in stomach
20:42:36 [acestep1] oh yes! thnx hutals
20:42:36 [Lorena] and duodenum
20:42:38 [hutals] also air in prox duodenum....both air bubbles cause double bubble
20:43:01 [ninadnashua] air looks like bubbles
20:43:05 [acestep1] ok
20:43:50 [ninadnashua] pyloroplasty is treatment
20:44:27 [hutals] which should be biopsied....gastric or duodenal ulcer.....or both?
20:44:32 [Lorena] ok
20:44:33 [hutals] or neither
20:44:39 [Lorena] just gastric
20:44:49 [jwls29] gastric
20:45:00 [jwls29] duodenal doesn't need to be biopsied b/c not malignant
20:45:19 [Roxanita] Mallory Weiss syndrome mcc?
20:45:20 [hutals] very good....all correct!
20:45:36 [hutals] alcoholics
20:45:58 [Lorena] bulimia and alcoholics
20:46:02 [hutals] from vomitting
20:46:15 [jwls29] agree
20:46:28 [acestep1] agree
20:46:36 [Roxanita] MWS where is the lession located?
20:46:39 [hutals] an interesting one is the MCC of Boerhaave's?
20:46:56 [hutals] distal esophagus
20:47:09 [acestep1] sgree
20:47:12 [jwls29] tear of distal esophagus
20:47:13 [Lorena] yes, endoscopy ...yikes
20:47:22 [acestep1] agree imean
20:47:41 [hutals] some causes also include alcoholics and bulemia, but MCC is endoscopy....wow. good job
20:48:03 [acestep1] ic
20:48:31 [Roxanita] Boerhaave's, is in distal or proximal esophagus?
20:48:42 [jwls29] distal
20:48:46 [hutals] i think also distal
20:48:52 [acestep1] distal
20:48:53 [Lorena] distal
20:49:10 [Roxanita] I know Mallory Weiss is at the gastro-esophag junction
20:49:24 [hutals] mallor weis is a tear vs a rupture (worse) in boerhave's (lots of blood in latter)
20:49:45 [jwls29] thanks hutals
20:50:09 [acestep1] rox any forced vomit- inc pressure on bvs so they rupture
20:51:55 [Roxanita] yeah, I was just confused with k-aplan book vs <a target=new HREF=http://www.amazon.com/exec/obidos/external-search?tag=valuetheplace-20&keyword=Goljan&mode=books>Goljan</A>
20:52:27 [acestep1] k .np
20:52:28 [Roxanita] sorry
20:52:54 [acestep1] np
20:53:08 [hutals] another interesting tid bit is that first step in management of duodenal ulcer is a flat plate xray which can detect air that escapes....can cause referred pain to shoulder from air that irritates nerve......this would mean its perforated
20:53:56 [hutals] sorry, couldnt think of a good question with that info, but thought it was kinda cool
20:54:05 [Lorena] thanks hutals
20:54:21 [Lorena] causes of hypergastrinemia?
20:54:23 [Roxanita] Adenocarcinomas of the distal esophagus are mostly due to what condition?
20:54:31 [acestep1] yes. v gd hutals i think its air under teh diaphargm
20:54:44 [acestep1] gerd?
20:54:51 [hutals] barrets esophagus
20:54:52 [ninadnashua] barrets
20:55:15 [Lorena] secondary to barrets which is a comlication of GERD
20:55:26 [acestep1] pancreatic ca- lor ?
20:55:49 [acestep1] agree
20:56:49 [hutals] what is the most common cancer in Japan? why?
20:56:56 [Lorena] yes , thats one cause ace very good (zollinger ellison sx)
20:57:09 [Lorena] stomach because of smoked food
20:57:11 [acestep1] stomach ca?
20:57:40 [ninadnashua] stomach due to smoked foods
20:57:42 [acestep1] ty lor can u tell em teh other causes
20:57:48 [hutals] yep, stomach ca due to smoked foods (from preservatives).....good
20:58:02 [Roxanita] Clinically how do you differentiate duodenal peptic ulcer vs gastric peptic ulcer?
20:58:54 [Lorena] gastric it hurts after eating so fear to eat, they lose weight - in contrast duodenal the pain is reloeved with food -they dont loose weight
20:58:55 [acestep1] i think gastric pain inc on eating n opp in duedenal
20:59:10 [acestep1] agree with lor
20:59:40 [Roxanita] acestep1> yes that's how we can differentiate clinically
20:59:49 [hutals] lose weight with gastric, but do not with duod
21:00:20 [acestep1] ok plz coorect me if im wrong other causes of gastric ca r cigrettes , alcohol gastric ulcer , etc
21:00:26 [Lorena] duodenal wakes up the patient at night (because no food for hours)
21:00:36 [acestep1] k
21:01:10 [hutals] dont forget about K pylori as a cause of gastric ca
21:01:28 [hutals] oops, H pylori
21:02:00 [Lorena] yes thanks
21:02:46 [hutals] you know, now that i think about it....that doesnt seem right because H pylori is associated with >90% of duodenal ulcers, but they are not assoc with malignancy??
21:03:51 [acestep1] nono hutals they r with ca
21:04:11 [hutals] duodenal ulcers you mean??
21:04:32 [acestep1] no i think also gastric
21:05:11 [acestep1] cuz gastric ulcers r one of teh causesof ca n ulcer is caused by h.pylori
21:05:22 [Lorena] for gastric ulcers you do biopsy because cancer may be there too , to rule out cancer
21:06:07 [Lorena] they can be together , but ulcer wont turn into cancer if i understood correctly
21:06:10 [jwls29] what you are saying makes sense, hutals
21:06:12 [hutals] if i understand this correctly, duodenal ulcers are not malignant. but they are assoc with H pylori >90% of time. H pylori causes stomach ca. something doesnt add up??
21:06:32 [Lorena] cancer can look like an ulcer
21:07:47 [hutals] i guess h pylori doesnt actually cause the cancer, but they are an indicator because often associated with gastric ulcers which can cause gastric ca.....does that sound right?
21:07:55 [Lorena] yes
21:08:23 [Lorena] H pyloru can cause gastric cancer , not duodenal cancer so no need to byopsy a duodenal ulcer
21:08:26 [hutals] ok, sorry about that....thanks for your patience, we can move on now
21:08:26 [jwls29] yes
21:08:41 [jwls29] that was a good point
21:08:52 [Lorena] yes, very good
21:09:25 [acestep1] ya agree wqith with lor - i just checked
21:09:46 [Lorena] thanks ace
21:09:47 [jwls29] what is the best screening test for malabsorption?
21:09:57 [acestep1] sorry for the typing error
21:10:19 [acestep1] ue welcome - lor . anytime
21:10:29 [ninadnashua] stool for fat.
21:10:31 [Lorena] fat in stool?
21:10:34 [hutals] fat in the stool
21:10:41 [jwls29] yes
21:10:54 [hutals] what is the MCC of bowel obstruction?
21:11:28 [Lorena] stricture?
21:11:32 [jwls29] adhesions from a previous surgery
21:11:51 [ninadnashua] ya
21:12:11 [hutals] adhesions from previous surgery is MCC. if no previous surgery, pick indirect inguinal hernia
21:12:24 [Lorena] ok thanx
21:12:31 [acestep1] k . ty
21:13:31 [hutals] traveler to mexico who 1 week later develops watery diarreah with mucus and blood and colicky bowel movements....diagnosis?
21:13:33 [acestep1] hey guys i gtg now . ill see u guys tom . its ramadan here so i cant study for a long time
21:13:34 [jwls29] what is obstipation?
21:13:47 [acestep1] must go n study
21:13:53 [jwls29] bye ace
21:14:14 [Lorena] take care, see you tomorrow ace
21:14:24 [hutals] chronic constipation leading to blockage
21:14:39 [hutals] bye ace
21:14:56 [jwls29] obstipation is constipation and no gas
21:15:05 [Lorena] when no gas
21:15:20 [Lorena] ok
21:15:21 [jwls29] one of the signs of bowel obstruction
21:15:46 [Lorena] step ladder sign
21:15:46 [jwls29] that and colicky pain with pain free intervals
21:15:47 [hutals] oh yes, reminds me of the funny gas story golijan mentions in his audios
21:16:16 [jwls29] lol
21:16:18 [acestep1] dysentry?
21:17:00 [Lorena] step laddrer because air and liquid levels due to edema and dilation of bowel
21:17:01 [jwls29] enterotoxigenic e coli?
21:17:47 [hutals] what sign will differentiate small bowel obstruction from ischemic colitis (on presentation, not from labs, etc)?
21:18:09 [Lorena] it is amebiasis
21:18:09 [acestep1] byee guys really sorry my comp freezes . came back 2 know huatls ans
21:18:43 [hutals] oops, forgot about that one. the answer was amebiasis
21:19:10 [acestep1] np n thnx tc all of u
21:19:55 [ninadnashua] small bowel clinical is diffuse painabdomen, in ischemic it is only in splenic flexure
21:19:56 [hutals] nite ace
21:20:29 [hutals] travelors on the other hand would be secretory without blood and mucus
21:20:30 [jwls29] is it entamoeba hystolitica?
21:20:55 [hutals] yes jwls....very good
21:21:22 [hutals] and yes nina, that is right. easiest way to differentiate and a giveaway for the exam....very good
21:21:49 [ninadnashua] thanku
21:22:47 [jwls29] difference between crohn's and ulcerative colitis?
21:23:15 [Lorena] ulcerative doesn skip, chron does,
21:23:35 [hutals] chrons has skip lesions, fistulas, right lower quadrant
21:23:42 [Lorena] ulcerative is mucosal and submucosal and chrons is transmural.....
21:24:29 [Lorena] Roxanita> take care
21:24:30 kmonica26 enters this room
21:24:49 [hutals] what are the rule of 2;s for meckels diverticulum?
21:24:58 [Roxanita] guys could u please post the transcript
21:25:01 [hutals] hey mon
21:25:07 [kmonica26] hi guys
21:25:08 [Roxanita] I will see u tomorrow
21:25:17 [jwls29] bye roxanita
21:25:21 [hutals] nite rox
21:25:24 [jwls29] hi monica
21:25:33 [Lorena] hi monika
21:25:41 [Lorena] bye rox, take care
21:25:50 [kmonica26] hi everyone
21:25:58 [Roxanita] tomorrow is: Renal/ lower urinary/STD/Gynecology
21:26:16 [Roxanita] bye guys, you really rock in patho
21:26:17 [Lorena] 2% of the population, 2cm from ileocecal valve and 2cm long
21:26:21 [jwls29] 2 ft from ileocecal valve
21:26:25 [hutals] rule of 2's are 2% children, 2 ft from ileocecal valve, 2 types of tissue, 2 year of age
21:26:28 [jwls29] thanks lore
21:26:39 [hutals] very good
21:27:07 [hutals] we should probably move onto hepato/pancrease because running outta time
21:27:16 [Lorena] ok
21:27:26 [jwls29] ok
21:27:43 [hutals] AST vs ALT. which one associated with alcohol?
21:27:55 [jwls29] AST
21:27:57 [Lorena] AST
21:28:09 [hutals] or i should say MORE associated with alcohol since both will be affected
21:28:13 [jwls29] the s stands for sambuca (which is a liqueor)
21:28:20 [Lorena] because it is mithocondrial , and ALT is cytoplasmic
21:28:26 [hutals] yes, AST
21:28:40 [hutals] good one jwls
21:28:42 [Lorena] very good jwls
21:28:54 [jwls29] ty
21:29:02 [hutals] thanks lor
21:29:55 [hutals] in obstructed liver disease, what enzymes would be elevated? Alk phos, GGT, both, neither?
21:30:09 [Lorena] so remember we were wondering in one of the last chats why LDH was increasd in hemolytic anemias?
21:30:39 [Lorena] both
21:30:57 [jwls29] both
21:31:12 [kmonica26] agree both
21:31:34 [hutals] yes, both correct. alk phos is not very specific, but both together are specific to liver
21:32:29 [hutals] yes lor, we never figured that one out from what i remember
21:33:30 [hutals] Which hep is the most common?
21:33:38 [hutals] overall that is
21:33:43 [jwls29] hep a
21:33:44 [Lorena] LDH is increasd in cell necrosis :liver damage , Myocardial Infarction , hemolytic anemias
21:34:01 [Lorena] agre with jwls
21:34:13 [hutals] it goes in order....A, B, C, D, E
21:34:46 [hutals] which hep MCC from accidental needle stick?
21:34:59 [Lorena] B
21:35:00 [jwls29] Hep B
21:35:18 [hutals] yep Hep B
21:35:29 [hutals] which hep is never chronic?
21:35:45 [kmonica26] A
21:35:49 [ninadnashua] hep a
21:36:02 [jwls29] agree
21:36:10 [Lorena] agree
21:36:15 [hutals] yep hep a. what about E...is this ever chronic (trick question)
21:37:01 [Lorena] no
21:37:10 [jwls29] i think no
21:37:16 [ninadnashua] no
21:37:28 [hutals] E is only chronic in pregnant women....and they will have 20% mortality....so boards love to ask about it.....its not in his notes, but golijan mentioned in audios
21:38:23 [jwls29] thanks hutals
21:38:26 [hutals] which is MCC in day cares?
21:38:43 [jwls29] hep a
21:38:46 [Lorena] a
21:39:00 [hutals] hep A, so vaccine is recommended for children in day cares
21:39:31 [hutals] which are non-parenternal route of transmission?
21:39:57 [kmonica26] feco oral
21:40:00 [jwls29] a and e
21:40:14 [Lorena] a, e
21:40:19 [hutals] yep A and E
21:40:26 [ninadnashua] close contact, blood saliva semen
21:41:00 [hutals] hep B nina?
21:41:29 [ninadnashua] ya
21:41:57 [ninadnashua] im sorry i confuse
21:42:47 [hutals] thats ok, they are all confusing....takes repetition to get them right
21:43:10 [hutals] regarding Hep B.....what is present in window period?
21:43:11 [jwls29] can we go over the markers for hepatitis b?
21:43:12 [Lorena] parasite that may cause cholangiocarcinoma?
21:43:23 [ninadnashua] ya
21:43:39 [ninadnashua] liver fluke
21:43:51 [jwls29] HbCAb?
21:44:04 [hutals] i agree with nina
21:44:06 [Lorena] HBcore antibody
21:44:15 [Lorena] yes ninad and hutals
21:44:42 [hutals] antibody HBc IgM (not IgG)
21:45:27 [hutals] this is tricky, but golijan stresses it.....is the person infective during the window period based on the lab you just gave
21:45:29 [hutals] ?
21:45:44 [jwls29] what about for acute infection?
21:46:17 [Lorena] no infective because only DNA HB and HBeAg are infective
21:46:49 [hutals] acute infection would have surface Ag, IgM Ab, HBeAg and HBV DNA
21:47:25 [Lorena] agree
21:47:33 [hutals] thats right, they would NOT be infective during window period....that one is a bit tricky, but important
21:48:09 [jwls29] and what do we find in someone who is recovered?
21:48:16 [Lorena] which ab are protective?
21:48:19 [hutals] what if the person only has antibody to HBs?
21:48:29 [jwls29] vaccine
21:48:49 [Lorena] yes
21:48:55 [hutals] recoved would be anti HBc IgG and Ati HBs
21:49:14 [Lorena] very good
21:49:18 [hutals] HBs Ab is protective
21:49:19 [jwls29] yup
21:49:58 [hutals] yes, vaccine would cause someone to have only antibody to HBs and nothing else
21:50:36 [jwls29] and what about a chronic carrier?
21:50:46 [Lorena] no HBcore IgG in vaccinated people then
21:50:53 [hutals] what if HBs Ag for >6mo, but no HBV DNA or HBeAg?
21:51:15 [jwls29] healthy carrier?
21:51:32 [Lorena] HB surface ag for more than 6 months means chonicity
21:52:04 [Lorena] agreewith jwls
21:52:07 [hutals] thats right Lor, no HBcore IgG in vaccinated.....the core IgG would indicate recovery
21:52:34 [jwls29] i thought chronicity was HBsAg, HbEag,and HBV DNA
21:53:07 [hutals] yes, it would be "healthy" chronic carrier, not because pt is healthy (they have hepatitis so not healthy), but because they are not infective....good job
21:53:42 [Lorena] thanks hutals
21:54:57 [hutals] infective chronicity would have the HBeAg and HBV DNA which would make them infective. the "chronicity" is simply from the time of HBs Ag of >6 mo. The infective vs health refers to the infectivity of the chronic carrier
21:54:58 [kmonica26] A 12-year-old girl has had recurrent episodes of scleral icterus, particularly following viral illnesses. She is otherwise well and is taking no medications. Laboratory studies reveal an indirect bilirubin of 58.1 mcmol/L (3.4 mg/dL) and direct bilirubin of 5.13 mcmol/L (0.3 mg/dL). Serum transamin
21:55:19 [kmonica26] Serum transaminase concentrations, prothrombin time, partial thromboplastin time, and serum ammonia levels all are within normal limits.
21:55:34 [kmonica26] Of the following, the MOST likely etiology of this girl's hyperbilirubinemia is
21:56:26 docak enters this room
21:56:54 [hutals] hey docak
21:57:14 [docak] hi guys
21:57:28 [Lorena] hi docak
21:57:39 [jwls29] hi docak
21:57:48 [docak] i'm sorry i did'nt check the schedule
21:58:05 [docak] what's the topic today?
21:58:05 [Lorena] what are the choices monika?
21:58:37 [kmonica26] chronic active hepatitis
21:58:49 [kmonica26] B. Dubin-Johnson syndrome
21:59:00 [hutals] docak, we discussed GI earlier (you can check the transript later) and now discussing hepatic path
21:59:14 [docak] thanks hutals
21:59:17 [kmonica26] gilbert
21:59:27 [kmonica26] hepatitis A infection
21:59:38 [kmonica26] infectious mononucleosis
22:00:11 [Lorena] i would go for Gilbert
22:00:15 [hutals] gilberts disease??
22:00:27 [kmonica26] yep
22:00:28 [jwls29] me too
22:00:34 [jwls29] oh good
22:01:04 [kmonica26] Gilbert syndrome is a benign form of familial hyperbilirubinemia that occurs in 3% to 10% of the population. It is an autosomal dominant disorder, but the hyperbilirubinemia usually is not recognized until after puberty. Bilirubin concentrations are generally below 51 mcmol/L (3 mg/dL), but they ma
22:02:29 [Lorena] thanx monika
22:02:57 [kmonica26] A 16-year-old girl is referred to you for evaluation of right shoulder pain and nausea. Her previous medical history is remarkable for recent treatment of Lyme disease with ceftriaxone. Findings on physical examination of the shoulder are normal.
22:03:13 [kmonica26] the best INITIAL evaluation is
22:03:17 [hutals] the giveaways on that were the very low conjugated bilirubin mixed with jaundice. there is no Rx and you will see the bilirubin double after fasting....thanks mon, great question
22:03:38 [kmonica26] np
22:05:47 [hutals] any choices for the last question?
22:06:36 [kmonica26] A. abdominal ultrasonography to determine whether gallstones are present
22:06:47 [kmonica26] B. bone scan to identify osteomyelitis
22:06:57 [kmonica26] C. magnetic resonance imaging to identify bursitis
22:07:06 [kmonica26] D. radiography to identify a subclinical clavicular fracture
22:07:15 [kmonica26] E. Western blot testing to determine whether recurrent Lyme disease is present
22:08:01 [Lorena] A?
22:08:37 [jwls29] a?
22:08:47 [kmonica26] why?
22:08:47 [docak] Is it E?
22:09:02 [kmonica26] answer is A
22:09:07 [kmonica26] But why?
22:09:07 [hutals] E?
22:10:10 [hutals] wow, i'm stumped on that one....cant put it together....a 16 yo with gallstones
22:10:11 [docak] why A?
22:10:18 [hutals] maybe she has sickle cell?
22:10:43 [kmonica26] The association between the administration of ceftriaxone and the development of cholecystitis in children and adolescents is well recognized. Right shoulder pain, as described in the vignette, is characteristic of referred pain resulting from gallbladder disease.
22:10:44 [jwls29] does she have intrahepatic cholestasis b/c of the ceftriaxone?
22:11:51 [Lorena] great question and explanation
22:13:08 [kmonica26] A 25-year-old woman with sickle cell anemia complains of steady pain
22:13:21 [hutals] didnt know about 16 year olds although children under 8 are known to get that from ceftriaxone binds to albumin causing jaundice leading to gallstone formation
22:13:26 [kmonica26] in her right upper quadrant with radiation to the right shoulder
22:13:49 [kmonica26] especially after large or fatty meals. Her physician diagnoses gallstones.
22:13:54 [hutals] great question mon....a real thinker
22:14:07 [kmonica26] which of the following compounds are these stones most likely composed?
22:14:27 [kmonica26] Np
22:14:48 [hutals] calcium bilirubinate
22:14:56 [kmonica26] Yep
22:15:35 [Lorena] ok
22:16:00 [hutals] i only knew that because that was the connection i was trying to make with the last question....sickle cell patients and gallstones
22:16:10 [kmonica26]
22:16:23 [kmonica26] Thats why I put this question
22:16:37 [kmonica26] so that all of us can remember
22:16:42 [Lorena] these type of stiones are present in all he olytic anemias, right?
22:16:50 [kmonica26]
22:17:22 [hutals] extravascular hemolytic anemias....yep
22:17:23 [kmonica26] I think so..makes sense as there is hemolysis
22:17:24 [Lorena] i mean may be present in all hemolytic anemias :thalasemias, etc
22:18:27 [hutals] i think you're right lor
22:18:53 [Lorena] ok
22:19:37 [hutals] bronze diabetes refers to what?
22:19:50 [Lorena] hemochromatosis
22:19:59 [docak] in wilson's disease
22:20:23 [docak] deposition of cu in liver, destroys beta cells
22:20:42 [hutals] yep, hemochromatosis.....seen in diabetic pts who have skin hyperpigmentation
22:21:09 [docak] and decreased insulin, therefore diabetes.
22:21:42 [hutals] thats true docak, but what about the bronze part?
22:22:04 [docak] so its hemochromatosis?
22:22:27 [Lorena] yes
22:23:10 [jwls29] i have to go
22:23:22 [hutals] yes, although you were onto something with wilsons. but the buzz word of bronze diabetes is know for hemochromatosis
22:23:26 [jwls29] see you guys tomorrow....thanks for the chat...it was really good
22:23:27 [Lorena] i have to go tto guys
22:23:28 [kmonica26] bye jwls
22:23:48 [jwls29] goodnite
22:23:54 [Lorena] thank you all , see you tomorrow
22:24:00 [hutals] yes, i have to go as well. lor, will u post transcript?
22:24:02 [docak] thanks lorena, hutals
22:24:18 [docak] bye jwls
22:24:18 [kmonica26] are we done?
22:24:26 [kmonica26] bye guys
22:24:27 [Lorena] please you post the transcript hutals because i had to refresh the oage many times so i lost the beginning
22:24:51 [hutals] no prob lor, i'll post it
22:24:52 [ninadnashua] bye
22:25:04 [kmonica26] what is the topic for tomorrow?
22:25:06 [Lorena] thank you, byeeeeee
22:25:13 [hutals] nite all, c you all tomorrow
22:25:38 [docak] good nite guys.
22:26:08 [hutals] Renal/ Lower Urinary STD / Gynecology for tomorrow