[junglemits] shall we start?
[perhaps] fine by me
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[perhaps] What kind of acid-base diturbance is caused by severe vomiting?
[usmle.doc] met alkalosis
[perhaps] yes
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[perhaps] infant diarrhea, what kind of fluid loss?
[junglemits] met alkalosis
[junglemits] hypotonic loss
[perhaps] yes hypo, adult is iso
[perhaps] Hi everyone! Joe told me he would be a little late today.
[perhaps] patinent has severe fungal infection, took an iv medicine and developed metabolic acidosis with alkline urine, what drug is the pateint taking?
[usmle.doc] ketoconazole??
[perhaps] I am thinking amphoterocine B which leads to type I renal tubular acidosis
[usmle.doc] ok
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[perhaps] why can insulin be helpful during hyperkalemia?
[junglemits] it enhaces the na/k pump
[perhaps] yes, K pumped in
[usmle.doc] it causes potassium to enter into cells
[perhaps] yes
[perhaps] patient took antifreezer, developed kidney stone, what is the stone made of?
[usmle.doc] oxalates
[perhaps] good
[usmle.doc] calcium oxalate
[perhaps] what posioning leads to optic nerve damage?
[usmle.doc] methyl alcohol?
[shanmu] methanol
[perhaps] yes
[perhaps] what acid base disturbance is caused by aspirin, during early phase?
[perhaps] i mean aspirin toxicity early phase
[usmle.doc] met acidosis ?
[drkittu] metabolic acidosis
[perhaps] and also?
[perhaps] meta acidosis is right
[usmle.doc] hyperkalaemia
[perhaps] respriatory alkalosis
[drkittu] resp alkalosis
[perhaps] yes
[usmle.doc] ok
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[perhaps] hi joe!
[josephmedman] hey gys
[junglemits] oops - got disconnected
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[josephmedman] nikki didnt show up today?
[josephmedman] hi jebn
[junglemits] not yet
[josephmedman] jen*
[perhaps] I haven't seen her. don't know why
[josephmedman] oh ok..
[josephmedman] how far have you guys gotten?
[perhaps] a few questions on fluid, acid base. Not too far
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[josephmedman] ok ill start throwing some at you guys then..
[josephmedman] im missing some notes for some reason
[josephmedman] but ill ask what i have..
[josephmedman] ok..
[josephmedman] what level determines oncotic pressure?
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[usmle.doc] plasma proteins mainly albumin
[junglemits] level?
[usmlethings] Albumin
[josephmedman] albumin
[josephmedman] where are Na and glucose limited to?
[junglemits] ecf
[josephmedman] where is K limited to?
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[junglemits] icf
[drkittu] icf
[josephmedman] on the usmle anytime you see serum Na < 120 it is what?
[perhaps] SiADH
[josephmedman] SIADH
[perhaps] What drug can you Rx?
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[josephmedman] with an increase in ADH, which part of the kidney is water reabsorbed in?
[junglemits] cd
[perhaps] Collecting
[usmle.doc] collecting tubule
[josephmedman] what drug perhaps?
[josephmedman] diuretic
[perhaps] demeclocycline (double checked spelling
[josephmedman] which one specifically
[josephmedman] thanks
[perhaps] it blocks ADH receptor
[junglemits] oh yes
[josephmedman] what converts corticosterone into aldosterone?
[junglemits] oh yeah
[usmle.doc] 18 hydroxylase
[josephmedman] good
[josephmedman] what is the role of ANP?
[perhaps] where is this enzyme specifically located in adrenal gland?
[perhaps] oops
[junglemits] decreases bp
[saimakm] anti adh
[perhaps] ANP antagonize Angiotensin II, diuretic basicly
[junglemits] anp is released in response to high bp
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[josephmedman] what activates it though?
[saimakm] decrease aldo
[josephmedman] atrial distension and it inhibits the reabs. of Na.
[perhaps] strech of low pressure receptors in atrium
[shanmu] increased salt intake
[josephmedman] what is the electrolyte state in DKA patients?
[perhaps] hyperOSM, hyperkalemia, increased anion gap acidosis
[josephmedman] hypernatremic..water moving intto the EVCF causes dilutional hyponatremia..decrease in Na
[perhaps] yes thanks!
[perhaps] What infection is particular at risk in DKA?
[saimakm] due to gluco taking control of osm
[josephmedman] umm..
[junglemits] i thought it was hyperglycemia that caused the movedment of water
[junglemits] no?
[perhaps] I agree
[josephmedman] you have osmotic diruesis
[junglemits] yes
[josephmedman] so you are hypernatremic
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[josephmedman] then after that
[josephmedman] you have water moving into the ECF because of the hypernatremia
[saimakm] no dilutional hyponatremia
[junglemits] but then because of water movement from icf to ecf causes
[josephmedman] which causes a dilutional hyponatremia..
[junglemits] dilutional hyponatremia
[josephmedman] and a decrease in Na
[junglemits] no?!
[josephmedman] yeah..
[junglemits] ok
[perhaps] I agree with this
[junglemits] i think we just said the same thing
[junglemits]
[junglemits] it's all good
[josephmedman] haha oh sorry
[josephmedman] i was trying to make sense of it
[junglemits] no prob
[josephmedman] because i confused myself for a sec.
[junglemits] yeah - me too
[josephmedman] hey jen
[josephmedman] what infection?
[perhaps] mucor
[perhaps] in the brain
[usmle.doc] mucor
[josephmedman] really?
[josephmedman] wow..
[perhaps] yeah,
[josephmedman] can you explain a little?
[junglemits] oh - didn't know that
[junglemits] yes please explain
[perhaps] I don't know why either.
[perhaps] It is in qbank but didn't give mechanism
[josephmedman] wow..thanks perhaps..
[perhaps] my pleasure
[josephmedman] i did qbank twice and i didnt recall that..
[josephmedman] nice high yield fact..
[josephmedman] what happens to CO iun hypovolemic vs septic shock?
[perhaps] High in septic, low CO in hypovolumic
[usmle.doc] decreases in hypovolemia and high in septic shock
[josephmedman] explain
[perhaps] it has something to do with vasodilation in septic shock, by NO?
[josephmedman] yeah..
[josephmedman] one sec guys..
[perhaps] what are some other causes of high output cardiac failure?
[junglemits] what's the difference between cardiogenic and hypovolemic shock
[usmle.doc] beri beri
[junglemits] only ONE difference
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[junglemits] PWCP
[perhaps] wow, thanks
[junglemits] ecoli causes high output cardiac failure
[perhaps] yes
[josephmedman] what is PWCP?
[perhaps] the wedge pressure
[josephmedman] oh yeah..
[junglemits] there's dec pulmonary wedge capillary pressure
[josephmedman] in which one junglemits?
[saimakm] in cardi
[perhaps] ?
[junglemits] the PWCP in cardiogenic is cardiogenic i think
[perhaps] cardio is increased I am thinking
[junglemits] yeah i think so
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[josephmedman] wait so increased in septic right
[junglemits] i can't remember now
[josephmedman] that swhat i remember
[perhaps] the volume can't be pumped out, so left in left ventricle
[junglemits] yes
[josephmedman] i have it right here
[josephmedman] my next quest actually
[josephmedman] haha
[perhaps]
[junglemits] nice
[josephmedman] well here it says
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[josephmedman] cardiogenic is increased
[junglemits] ok
[josephmedman] hypovolemic is decreased
[perhaps] yes
[junglemits] ok
[josephmedman] and for difference of septic from hypovolemic and cardio
[josephmedman] increased CO, increased MVO2 and decreased TPR
[saimakm] hyper vol
[perhaps] the mixed oxgen of veins
[josephmedman] what isthe MCC of septic shock?
[perhaps] G-, mostly e coli
[usmle.doc] gram negative inf
[josephmedman] remember indwelling catheter though
[junglemits] e coli
[josephmedman] ecoli from catheter
[usmle.doc] ok
[perhaps] yes
[josephmedman] what is the MCC of ARDS and DIC?
[richtian] does localize infection or systemic infection lead to that
[perhaps] systemic?
[josephmedman] no idea rich
[perhaps] septic shock MCC?
[josephmedman] yes perhaps
[josephmedman] what are some causes of respiratory acidosis?
[junglemits] hyperventilation
[richtian] my understanding is that mostly septic shoch is septic, therefore, systemic
[usmle.doc] hypoventilation
[perhaps] respiration problems (polio, central), and lung problem (COPD, etc)
[junglemits] oops wrong one
[josephmedman] barbituates, CNS trauma chest bellow dysfunction, p. lung disease etc.
[josephmedman] what is the MCC of acute epiglottitis?
[josephmedman] in aduylts
[junglemits] h. influ
[josephmedman] and then in children
[josephmedman] what about children?
[perhaps] parainfluenza
[josephmedman] very good
[josephmedman] what type of paralysis in guillian barre?
[richtian] how does it presently in adult
[josephmedman] you get bronchoconstriction
[ppliutcm] acending
[josephmedman] gasping for air
[josephmedman] i think you need an epi shot
[richtian] lmn
[perhaps] demyelination
[josephmedman] lmn?
[josephmedman] whats that?
[josephmedman] ascending paralysis is the answer for guiliian barre
[richtian] so the presentation is the same in both kid and adult/
[josephmedman] yes i think so..
[josephmedman] ive had both in the ER
[josephmedman] both presented the same to me
[josephmedman] but i dont know what hte books have said..
[richtian] but only adult give antibiotic?
[josephmedman] what is the diff. between acute and chronic resp acidosus?
[josephmedman] you must stabalize the pt. first
[perhaps] compensation of renal HCO3
[josephmedman] epinephrine
[josephmedman] possible intubation
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[josephmedman] depends..
[josephmedman] which one is compensation perhaps?
[richtian] why epi help?
[josephmedman] that is part 2 rich
[josephmedman] dont worry
[perhaps] chronic will compensate with metabolic alkalosis
[josephmedman] very good
[josephmedman] what is the MCC of resp alkalosis?
[josephmedman] anxiety
[ppliutcm] high altitute
[perhaps] anxiety?
[perhaps] oh thanks!
[josephmedman] what type of lung disease will cause resp. alkalosis?
[saimakm] copd
[josephmedman] restrictive
[richtian] any type lead to hypoxemia
[josephmedman] what is the MCC of metabolic alkalosis?
[saimakm] restrictive
[junglemits] vomiting
[josephmedman] diuretics
[perhaps] oh yes.
[junglemits] excessive vomiting should be too?!
[josephmedman] what is needed in order to maintain metabolic alkalosis?
[junglemits] but maybe not MCC
[josephmedman] yes jungle
[perhaps] volume depletion
[josephmedman] i asked MC though..
[josephmedman] good
[junglemits] ok
[josephmedman] perhaps can you explain that?
[josephmedman] the colume depletion
[josephmedman] volume*
[perhaps] Goljan said increased reclaimation of HCO3
[junglemits] yeah - i didn't QUITE get that
[perhaps] to maintain alkalosis
[josephmedman] umm..
[perhaps] otherwise, volume depletion will be the backwards of diuretics
[josephmedman] i understand that pottasium can be lost with diuretics
[junglemits] i dno't really get the reclamation of HCO3
[perhaps] reabsorption will increase if volume loss
[josephmedman] oh ok..
[josephmedman] reabsorb of bicarb
[perhaps] then Na, H+ reabsorbed?
[josephmedman] to make it acidic again
[josephmedman] ahh i gotcha..
[josephmedman] so in order to maintain
[josephmedman] you need to cvolume deplete
[josephmedman] to avoid the reclamation of biocarb
[perhaps] I think of it as opposite of diuretics
[josephmedman] gotcha..
[perhaps] ok
[josephmedman] what is the forumla for anion gap?
[junglemits] na - hco3+cl
[josephmedman] na plus (Cl + HCO3
[perhaps] you mean minus
[saimakm] na -
[josephmedman] what is the MCC of normal AG met. acidosis?
[josephmedman] yeah oopps
[josephmedman] sorry
[josephmedman] no no
[usmle.doc] diarrhoea
[josephmedman] its minus
[josephmedman] haha yeah..
[josephmedman] sorry
[josephmedman] diarrhea is the right answer
[josephmedman] what is the MCC of hypokalemia?
[perhaps] diuretics?
[josephmedman] diuretics..
[usmle.doc] diuretic use of loop diretices and thiazides?
[josephmedman] GI losses: diarrhea, vomiting
[junglemits] yeah - i'd say loops diuretics
[josephmedman] what is the MC pathological cause of hyperkalemia?
[junglemits] spironolactone
[junglemits] (oops - not pathological)
[josephmedman] renal failure
[josephmedman] what are signs and symptoms of hypokalemia?
[junglemits] u wave
[perhaps] weak muscle, tetany
[junglemits] tetany
[usmle.doc] muscle weakness
[junglemits] arrythmias
[usmle.doc] prominent u waves
[josephmedman] muscle weakness, aquired nephrogenic diabetes insipidus..
[junglemits] and s/s of hyperK
[josephmedman] what about hyperkalemia?
[junglemits] arrythmias, death
[junglemits] peaked t wave
[josephmedman] so arrhythmias in both right?
[perhaps] yes
[josephmedman] heart stops in diastole
[perhaps] is that hyperK?
[josephmedman] what prevents the formation of arterial vs. venous thrombi?
[junglemits] death due to cvs arrythmias is in both
[josephmedman] yes hyper perhaps
[perhaps] thanks
[perhaps] atrial by aspirin, venous by warfarin, heparin
[perhaps] arterial, sorry, not atria
[josephmedman] wow..nice
[junglemits] 1
[josephmedman] make sure you know diff.
[junglemits] hmmm
[josephmedman] what are risk factors for venous thrombosis?
[junglemits] immobility/surgery
[usmle.doc] prolonged immobilisation
[junglemits] OCP
[josephmedman] good
[josephmedman] number one cause though
[josephmedman] taht i heard boards love
[josephmedman] is hip replacement
[junglemits] long haul flights
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[josephmedman] also other ones are immobility,, obesity, oral contraceptives
[perhaps] yeah
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[junglemits] but hip replacement is just 'cause of long term immobility
[josephmedman] lets see how good you guys are with endo
[junglemits] uhoh
[junglemits] k
[josephmedman] how can oral contraceptives cause venous thrombosis?
[junglemits] inhibit antithrombin 3
[perhaps] it decrease sysntesis of protein S and C, also increase antithrombine
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[josephmedman] increase or inhibit?>
[junglemits] inhibit antithrombin II
[josephmedman] 2 or 3?
[saimakm] 3
[perhaps] sorry you are right
[josephmedman] but it inhibits it doesnt it perhaps?
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[junglemits] III
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[perhaps] yes you are right, i got it backwards
[junglemits] sorry
[junglemits] 3
[josephmedman] good stuff..
[josephmedman] ok..
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[josephmedman] what are risk factors for arterial throbus?
[josephmedman] what is number 1
[josephmedman] and then what are the others..
[saimakm] fibs
[josephmedman] number one is atherosclerosis, then also smoking, HTN, DM..
[josephmedman] what is the MC site for venous thrombosis?
[perhaps] oh thanks
[junglemits] obesity
[junglemits] deep veins in the calf
[josephmedman] deep veins in the calf..
[perhaps] agree
[saimakm] dvt
[josephmedman] what about for arterial?
[junglemits] MCC of thrombus but not embolis
[junglemits] embolism
[junglemits] pelvic veins are most common to embolise
[josephmedman] what about embolism junglemits?
[josephmedman] oh ok..
[saimakm] femoral
[perhaps] abdominal aorta for arterial?
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[josephmedman] coronary arteries for arterial
[junglemits] what? atherosclerosis
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[josephmedman] what about for the left heart?
[josephmedman] oops
[josephmedman] haha
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[josephmedman] i was going to say what is the MC side
[josephmedman] answer is left
[junglemits] most common arterial are mural thromubs
[josephmedman] ok what is the MC arrhythmia pred. to clot and embolize?
[junglemits] atrial myxoma
[josephmedman] no no..thats not an arrhythmia
[josephmedman] thats a tumor
[perhaps] atrial fibrillation
[saimakm] atria
[josephmedman] arrhythmia is atrial fibrillation..
[saimakm] fibs
[josephmedman] vegetations in rhematic fever
[josephmedman] are they infective or non infective?
[junglemits] yes but myxoma does cause embolism
[junglemits] infective
[josephmedman] yes junglemits..
[saimakm] non infec
[josephmedman] definitely
[junglemits] just checking
[josephmedman] no..
[josephmedman] non infective..
[josephmedman] infective are for valvular stenoiss
[josephmedman] usually mitral
[josephmedman] paradoxical emboli are they venous or arterial?
[perhaps] venous, then to ASD
[saimakm] venous to arte
[josephmedman] they pass theu an ASD and you have a hdanger of hemiparesis..
[josephmedman] what happens with amniotic fluid embolization?
[dr_ashima] hi
[usmlear] hi
[saimakm] sudden death
[josephmedman] shock due to DIC..
[josephmedman] is it venous to arterial?
[erum] hi
[josephmedman] for paradoxic emboli?
[saimakm] ok
[josephmedman] can someone verify that?
[junglemits] yes
[josephmedman] ok good
[dr_ashima] any med student from india
[junglemits] definitely due to asd
[perhaps] yes
[josephmedman] in heart failure there is an increase in TBNA and TBW but a greater increase in which of the two?
[usmlear] hi erum,how is micro chat going on..sorry couldn't join bec of other commitments
[perhaps] TBW more
[saimakm] tbw
[josephmedman] good
[josephmedman] you get hyponatremia
[josephmedman] thats it guys..
[josephmedman] sorry i was late today..
[perhaps] Thanks joe, great questions!!!
[josephmedman] great answers..i like the speed we went at..
[saimakm] what about tomorrow
[perhaps] nice
[junglemits] me too
[josephmedman] what section is next?
[josephmedman] im way behind you guys..
[josephmedman] whatever you guys want
[perhaps] same here
[josephmedman] waht comes next in the notes?
[saimakm] renal?
[josephmedman] ok renal it is..
[perhaps] ok
[josephmedman] see you guys tomorrow for renal discussion
[josephmedman] take care..