[josephmedman] did you guys do the reading?
[saimakm] yup
[docrosana] hi
[junglemits] yup
[josephmedman] ok good stuff..
[josephmedman] lets start up then..
[junglemits] can i just ask ONE question
[junglemits] before we start
[josephmedman] no prob
[junglemits] totally unrelated (kinda)
[josephmedman] k
[junglemits] are the 2002 notes much different than the 2005 notes from kaplan?
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[josephmedman] only immunology
[josephmedman] that is very different
[junglemits] oh really!? what about the dvd's... they ok?
[junglemits] ok - it's 8:02 now... let's start
[niks] hi joe
[josephmedman] hey niks
[niks] hi everyone
[josephmedman] were you able to do the reading?
[niks] happy birthday
[josephmedman] thanks niks..
[niks] abit
[saimakm] shall we
[josephmedman] yes
[josephmedman] ;ets start
[niks] many warm wishes to u
[niks] ok lets start
[josephmedman] ok..which mediators are responsible for neutrophil adhesion?
[svb] integrins
[saimakm] LFK
[josephmedman] LTB4 and C5a
[usmle.doc] c5a and ltb4
[josephmedman] which ones are resp for endothelial cell adhesion?
[junglemits] icam and lfa1
[niks] ecem 1
[usmle.doc] intercellular adhesion mol and ecam
[josephmedman] whihc are opsonizers?
[junglemits] c3b
[saimakm] c3b
[luckyal] InG
[usmle.doc] ig G and c3b
[niks] IgG and C3b
[luckyal] IgG and C3b
[josephmedman] in teh resp burst what is peroxidase neutralized by?
[josephmedman] oops
[josephmedman] i mean peroxide
[josephmedman] waht is it neutralized by?
[niks] glutathione
[niks] which itself is reduced
[josephmedman] what does perozide combine with to yield chloride?
[saimakm] h2o2
[niks] In mean oxidized
[josephmedman] what disease is associated with an absent respiratory birst?
[niks] hocl
[junglemits] hocl
[luckyal] CGD
[usmle.doc] chronic granulomatious disease
[josephmedman] myeloperoxidase was the answer
[junglemits] chronic granulomatous
[niks] CGDC
[saimakm] cfd
[saimakm] cgd
[josephmedman] what other enzyme can neutralize peroxide?
[niks] oh yea
[usmle.doc] catalse
[svb] catelase
[svb] dismutase
[niks] also SOD
[saimakm] catalase
[drkittu] catalase
[svb] superoxide dismutase
[josephmedman] can leukocytes kill catalase +?
[usmle.doc] yes
[junglemits] yes
[junglemits] but not coagulase +
[josephmedman] no
[niks] no
[saimakm] no
[josephmedman] let me break it down..
[josephmedman] with an example
[josephmedman] thin of staph auresus
[josephmedman] staph aureus releases its own peroxide
[josephmedman] but catalase neutralizes it
[josephmedman] therefore the pt dies of sepsis
[josephmedman] got it?
[junglemits] yes
[niks] yes joe
[josephmedman] leukocytes CAN kill catalase - streptococci
[usmle.doc] i think ur expln works only if there is nadph oxidase def
[josephmedman] what is myeloperoxidase def. and how does it differ from chronic gran disease?
[junglemits] cgd has nadph oxidase deficiency
[josephmedman] MPO def there is a resp burst present but bleach cant be produced..
[josephmedman] CGD is SXR trait
[junglemits] whereas mpo has mpo deficiency
[josephmedman] and MPO def. is an AR trait..
[niks] NBT dye test....positive in mPO
[josephmedman] hey niks
[josephmedman] try to remember like the super high yield stuff for the exam..
[niks] yes joe
[josephmedman] what is chediak higashi syndrome?
[junglemits] phagocytosis problem
[josephmedman] good
[josephmedman] waht type of genetic trait is it?
[niks] def microtubule polymerization
[usmle.doc] defect in microtubule polymerisation
[josephmedman] good niks..
[niks] thanks
[josephmedman] AR
[niks] oh
[josephmedman] what is carcinoid syndrome?
[josephmedman] what causes it?
[usmle.doc] when there is metastasis from carcinoid tumour from small bowel to liver
[junglemits] it only is symptomatic once there's mets to the liveer
[josephmedman] what is the MC location of carcinoid tumor thoguh?
[josephmedman] good junglemits
[svb] small intestine
[josephmedman] umm no..
[usmle.doc] appendix
[josephmedman] good
[niks] appendix?
[josephmedman] yeah niks
[niks] oh ok
[josephmedman] remember we were confused about that last time
[josephmedman] they may try to trick you with that
[josephmedman] just a good fact to know
[josephmedman] what is symptoms of it?
[ppliutcm] hot flash
[usmle.doc] flushing asthmatic attacks
[junglemits] flushing and then diarrhea
[ppliutcm] diarrhea
[ppliutcm] cramping
[usmle.doc] diarrhoea and stenotic lesions in tricuspid valve
[josephmedman] ok guys im nto goign to go over it
[josephmedman] but i hope you guys memorized hte arachadonic pathway inside and out..
[josephmedman] why does G6PD precipitate hemolysis?
[niks] G6PD is deficient then hemilysis occurs
[perhaps] glutathione is the only mechanism for RBC to remove oxygen free radicials
[josephmedman] why?
[niks] because...
[josephmedman] good..
[niks] the only way to produce NADPH
[usmle.doc] b coz of decreased reduced glutathione and so free radical damage occurs
[niks] is through HMP
[josephmedman] no NADPH therefore no MPO therefore there is infection
[niks] in RBC
[josephmedman] what does zileuton do?
[junglemits] inhibits LTs
[usmle.doc] leukotrine synthesis inhibitor
[luckyal] inhibit synthesis LTs
[josephmedman] inhibits lipooxygenase
[saimakm] inhibits lipoxigenases
[niks] also zifirlucast I think
[josephmedman] so what does that mean?
[josephmedman] what does that inhibition mean?
[saimakm] no it blocks receptor
[usmle.doc] zafirlukast is leukotrine rec antagonist
[niks] I said I think zifirlucast also inhibhits LTs
[josephmedman] nobody?
[junglemits] no LT synth
[niks] ok
[niks] thakns
[niks] corticosteroids
[josephmedman] why would you want to use zileuton?
[niks] do they inhibhit lipoxygenase?
[perhaps] aspirin allergic?
[junglemits] in asthma
[usmle.doc] for asthma to decrease the bronchoconstriction
[niks] as antiinflamatory in asthama
[luckyal] LTs except LTB cause asthama
[junglemits] prevention of bronchoconstriction?
[josephmedman] yeah..
[josephmedman] but does anyone know the clinical use of it?
[junglemits] Leukotrienes are potent bronchoconstrictors and cause airway wall oedema, increasing mucus production. Leukotrienes also attract eosinophils into the tissues and amplify the inflammatory process. Leukotriene antagonists specifically inhibit the production or actions of the inflammatory mediators (leukotrienes C4 and D4
[josephmedman] zileuton blocks lipooxygenase and zafirlukast blocks receptors.
[junglemits] asthma
[josephmedman] great junglemits..
[josephmedman] what does dipyrimidole do and waht would be its clinical use?
[svb] vasodilator
[usmle.doc] it causes vasodilation
[perhaps] inhibit PDE?
[saimakm] anti platelet
[usmle.doc] its antiplatelet drug
[mlemle01] Dipyridamol uses in stress test
[josephmedman] yes antiplatlet
[josephmedman] what is the purpose of cytokines IL1 and TNF?
[luckyal] inc cAMP
[saimakm] increases camp
[junglemits] il-1 ---- fever
[josephmedman] what else
[saimakm] inflamation
[svb] neutrophil margination
[josephmedman] stimulate PGE2(fever) activate ICAM and VCAM
[saimakm] cachexia
[josephmedman] what does an increase in cAMP translate to?
[luckyal] dec GPiib/iiia
[kshine] any here taking the boards in the next few months?
[josephmedman] im taking mine in a few weeks
[josephmedman] wait..where did you guys see that?
[kshine] i am just curious
[saimakm] decrease vascular tone
[josephmedman] that it causes an incrase in cAMP
[josephmedman] i cant find that..
[kshine] how long is it suggested that u study for the boards if you r comong from the carribean
[junglemits] keep on topic
[josephmedman] yes please
[josephmedman] can someone answer me?
[josephmedman] how does an increase in cAMP correlate?
[junglemits] ??
[josephmedman] lukyal?
[josephmedman] saimkm?
[luckyal] Sorry, I just saw it in kaplan
[perhaps] Looked up in Lippincolt
[perhaps] iincrese cAMP inhibitsd TXA2
[josephmedman] hmm..so you are saying that TNF and IL! cauise an increase in cAMP?
[perhaps] oops
[luckyal] no
[kshine] NO
[perhaps] i am talking about dipyridamole
[luckyal] I meant the dipyridamole
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[perhaps] yes
[josephmedman] ohhhh
[luckyal] sorry
niks has left the chat.
[josephmedman] haha its ok..i was going crazy here..couldnt get that concept
[josephmedman] what is the purpose of bradykinin?
[kshine] increase permeabilit
[kshine] and vasodilate
[josephmedman] what else
[perhaps] pain
[mlemle01] Pain
[kshine] pain
[josephmedman] waht does it inhibit?
saimakm has left the chat.
[kshine] umm i dont know
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[josephmedman] i think it inhibits ACE II
[junglemits] it causes COUGH
[junglemits] dont' forget!!!
[niks] what inhibhits ACII
[niks] I got disconnected...sorry
[josephmedman] it is responsible for ACE II
[josephmedman] oops
[josephmedman] i mean it is responsible for cought and angioedema for those on ACE II
[niks] yes...
[saimakm] inhibitors
[niks] you're talikng about bradykinin
[niks] right?
[josephmedman] yup niks..
kshine has left the chat.
[niks] yes it does that
[niks] you're right joe
[mlemle01] How to treat thosept?
[josephmedman] what are some antiinflammatory effects of corticosteroids?
[junglemits] bradykinin also causes vasodilation
[josephmedman] whats thosept?
[niks] most common S/E of ACE inhibhotor
[niks] is cough
[josephmedman] whats S/E stand for niks?
[josephmedman] oh side effect
[junglemits] yes b/c it increases bradykinin
[josephmedman] duh..
[niks] side effect
[niks] yes...
[niks] corticosteroid produces lipocortin
[usmle.doc] it inhibits phospholipase and so decreases prostaglandins and leukotriens
[niks] has some antiinflamatory effect through lipocortin
[niks] am I right?
[niks] dont know will check...what I said...dont believe me..aah
[saimakm] inhibits phospholiopases
[josephmedman] yeah what else..
[usmle.doc] it decreases neutrophil adhesion
[perhaps] toxic to lymphocyte
[niks] yes so it causes increased neutrophil count
[josephmedman] it inhibits phospholipas A2 which decreases prostaglandin and LT synthesis
[niks] also decreases eosinophils in blood
[josephmedman] it inhibits macrophage function which decr3eases microbiocidal activity
[josephmedman] inhibits ICAM and VCAM to increase neurtrophil count
[josephmedman] what else c an do this same thing?
[niks] yes...because they are not allowed to adhere to endothelium and remain in the stream
[perhaps] epinephrine?
[josephmedman] epinephrine and norepinephrine
[josephmedman] good perhaps..
[perhaps] thanks
[josephmedman] what is not allowed to adhere niks?
[niks] neutrophils
[josephmedman] good
[josephmedman] jsut to clarify for eveyrone else ya know..
[niks] by preventing ICAM1
[josephmedman] in TB what is the role of macrophages?
[ppliutcm] activate cmi
[josephmedman] cmi???
[niks] giant cells formed by engulfing bacteria...
[luckyal] active th1?
[saimakm] activate cmi
[junglemits] cell mediated immunity
[niks] cmi
[josephmedman] oh ok..
[josephmedman] ok but give me details..
[perhaps] IFN gama
[saimakm] activate il 8
[luckyal] IL-2
[saimakm] sorrt th8
[josephmedman] in TB, macrophages present the antigen to CD4 T helper with class II, release IL-12 which forms TH1 cells and IL1(fever) then TH1 releases IL2 which is self stimulation of t cells, then gamma interferon activates macrophages to kill TB
[niks] thanks joe
[josephmedman] what is dresslers syndrome?
[saimakm] post mi
[usmle.doc] post mi pericarditis
[perhaps] autoimmunme pericarditis 6-8 weeks post MI
[saimakm] pericarditis
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[josephmedman] what kind of pericarditis
[usmle.doc] fibrinous pericarditis
[saimakm] fibrinous
[luckyal] fibrious
[josephmedman] what is the MC organism in sickle cell osteomyelitis?
[usmle.doc] salmonella
[luckyal] Sal
[saimakm] salmonella
[ppliutcm] slamonella
[luckyal] why?
[josephmedman] i forgot the reason
[josephmedman] i used to know it
[perhaps] I think they need spleen to clear salmonella
[perhaps] in sickle, the spleen is gone
[josephmedman] nice
[saimakm] you are right
[luckyal] tahnks
[luckyal] thank
[josephmedman] what else can cause osteomyelitis in sickle cell?
[perhaps]
[luckyal] Psua?
[josephmedman] s aureus
[usmle.doc] staph
[josephmedman] what organism causes cellulitis?
[luckyal] ok
[saimakm] s pyo
[josephmedman] what causes pseudomembranes on throat?
[usmle.doc] strep pyogenes
[niks] diphtheria
[usmle.doc] c diphtheriae
[josephmedman] what causes pseudomembranous colitis?
[usmle.doc] cl difficile
[saimakm] clostridium
[niks] clostridium
[josephmedman] what is ehlers danlos syndrome?
[mlemle01] What to check for diagnosis in C defficili Pt?
[niks] collagen defect
[josephmedman] which types niks?
[luckyal] 1 and 3
[ppliutcm] III
[niks] umm...the one on cartilages...
[josephmedman] and what are the MC cause of death in these pts.?/
[niks] is it 3?
[josephmedman] 1 and 3 is right
[junglemits] cartilage is 2
[niks] oh ok
[junglemits] carTWO lage
[josephmedman] aortic dissection is the MCCOD..
[josephmedman] nice juinglemits..
[junglemits] dissection
[junglemits] (from FA)
[niks] yes dissection....
[junglemits] who else get's dissection
[josephmedman] you can also get bleeding into skin, ecchymosis, hypermobile joints,
[niks] pregnant
[junglemits] marfan's
[niks] marfans
[josephmedman] what cancer is associated with 3rd degree burns?
[perhaps] squamous
[niks] squamous cell Ca....
[usmle.doc] sq cell ca
[josephmedman] very good..
[josephmedman] what is a type II pneumocyte?
[niks] produces surfactant
[sids] that prod surfactant
[josephmedman] good
[junglemits] makes type 1 and surfactant
[josephmedman] thats it guys..
[niks] in lungs
[josephmedman] for today.
[usmle.doc] it produces surfactant and regenerates other cells
[josephmedman] if anyoen could help me out..
[josephmedman] i jsut had one question
[junglemits] yes joe...
[josephmedman] about the increase in cAMP with dypyrimidole..
[niks] yea joe I shall read that and try to answer....