[josephmedman] i was wondering the mechanism of how you get pulmonary edema as a toxicity of mannitol use..
[bioche2006] i know the answer
[josephmedman] excellent
[bioche2006] mannitol is osmotic diuretic hence it sucks up fluid from systemic circulation and brings back to hear t and loads up pulmonary circulation
[bioche2006] that why in left ventricular failure dont ive mannitol
[josephmedman] but i thought it sucks it up into the tubules
[bioche2006] its does from systemic circulation too
[josephmedman] ahhh..ok
[josephmedman] and one more question
[bioche2006] thats is the reason as i had discussed it when i had doubt with medicne attending
[josephmedman] when they say its use is for shock
[josephmedman] is it hemmorhagic shock or ischemic shock?
[erum] hi all
[josephmedman] because i know it can be used to draw fluid from the brain
[josephmedman] to promote urine excretion..
[bioche2006] hemorrhagic to reduce edema
[niks] taking about mannitol?
[josephmedman] yeah niks
[josephmedman] but biochem answered me..
[josephmedman] no its ok..
[josephmedman] wait..so how does it bring fluid into the systemic circulation?
[niks] yes its given in cerebral edema
[bioche2006] in hemorrhagic storke u use it to suck up fluid
perhaps has joined subroom: USMLE_Step_1
[josephmedman] i know it blocks NACL absorption to bring it into the tubules but can you explain how it is brought into systemic circulation
[niks] yes I know the answer but Im trying to make out what you are asking joe...
[bioche2006] mannitol increses fluid osmolrity so fluid moves from interstium as well intracellular level to systemic
[bioche2006] and then it goes to heart and gets pulmonary circulation loaded
[bioche2006] and pulmonary edema occurs
[bioche2006] thats why u never give mannitol in left entricular failure
[josephmedman] ok i got it now..
[bioche2006] think outside kidney too joseph
[josephmedman] thanks bioch..appreciate it
[josephmedman] let me write this down real quick and well start in a minute
[bioche2006] u r welcome
[josephmedman] ok
[josephmedman] lets start up
[josephmedman] thanks again by the way..
[josephmedman] ok..coxsackie virus..what age does it usually affect?
[bioche2006] young and old
[bioche2006] ?
[josephmedman] mc age is 3-10
[Nedal05] childerns
[josephmedman] how does it present?
[Nedal05] myocarditis
[niks] also diarrhoea
[saimakm] hand foot mouth dis
[usmle.doc] coxsackie a herpangina and hand foot mouth disease and coxsacikie b myocarditis?
[josephmedman] fever vescicles in mouth and extremities
[niks] herpangina
[josephmedman] where does herpes simplex 1 remain dormant usually?
[bioche2006] trigeminal
[josephmedman] where does recurrent usually occur?
[bioche2006] along it distribution og trigeminal
[josephmedman] vermillion border of lip
[Nedal05] lips
[doki] site of primary infection
[erum] uper border lips
[josephmedman] what pre aids lesion does EBV cause? and how does it present..
[perhaps] hairy leukoplasia
[usmle.doc] hairy leukoplakia
[josephmedman] how does it present
[erum] leukilplakia
[perhaps] whitish membrane on tongue
[erum] on tongue
[saimakm] lat border of tongue
[niks] on the lateral border of toungue
[josephmedman] bilateral hairy ex. on lateral border of tongue
[Nedal05] tongue lesion
[josephmedman] are majority of s. pyogenes viral or bacterial?
[saimakm] bac
[josephmedman] no..viral
[saimakm] really
[josephmedman] ok..with candida infection..
[josephmedman] where is it located to be considered preAIDS
[josephmedman] yeah its maj. viral..its tricky..
[erum] esophagus
[usmle.doc] esophagus
[Nedal05] esophagus
[josephmedman] good
[bioche2006] eso
[josephmedman] where does actinomyces israeli have draning sinuses?
[perhaps] jaw
[bioche2006] face area around jaw
[usmle.doc] jaw
[erum] jaw
[Nedal05] fascial
[josephmedman] good..where does it contain its bacteria?
[erum] intracellular
[Nedal05] sliver granules
[josephmedman] sulfur granules..
[usmle.doc] in the sulphur granules bacteria are present
[bioche2006] no they r colonies
[josephmedman] what is the MC site of squamous of thje mouth?
[erum] lower lip
[usmle.doc] lower lip
[Nedal05] lat tongue
[saimakm] palat
[josephmedman] their sulfur granules contain bacteria
[josephmedman] where is it located on lip(squamous)?
[bioche2006] sulfur grnaules are nothing but colonies of bacteria appearing as sulfur granules
[niks] behind the ower lip...side of the mouth and mouth floor
[erum] sulfur granules r the bact colonies
[saimakm] lower lip
[Nedal05] lower
[josephmedman] what is on upper lip?
[perhaps] basal
[bioche2006] basal
[erum] basal cell
[Nedal05] BSC
[usmle.doc] basal cell ca
[josephmedman] where are the polyps of peutz jegherz?
[saimakm] small intes
[niks] good ponits...these are deficient in the stars...
[Nedal05] small intestine
[usmle.doc] in the small intestine
[erum] intestine s
[josephmedman] where else can they present?
[niks] small intestine
[bioche2006] mucosal
[erum] armpits
[josephmedman] sigmoid colon also..
[Nedal05] oral pigmentation
[josephmedman] polyps i asked
[bioche2006] ok
[josephmedman] yes but it presents with hyperpigmentation
[erum] hyperpigmentation in thier
[josephmedman] what is the MC infection of the salivary glands?
[Nedal05] mumps
[josephmedman] mumps..
[erum] mumps
[bioche2006] mumps
[ppliutcm] mumps
[josephmedman] what is the amylase level?
[bioche2006] incresed
[josephmedman] what is the MC tumor?
[Nedal05] high
[bioche2006] mixed
[perhaps] mixed tumor
[josephmedman] good
[Nedal05] mixed
[usmle.doc] pleomorphic adenoma
[erum] mixed
[niks] mied
[josephmedman] what is the MC malig tumor of salivary glands?
[saimakm] pleomorphic
[Nedal05] adeno ca
[josephmedman] mucoepidermoid carcinoma..
[niks] mucoepidermod
[saimakm] mucoepid
[josephmedman] what is it when you have dysphagia for solids but not liquids?
[Nedal05] tumor
[niks] obstruction
[erum] ca
[bioche2006] cancer
[usmle.doc] obstruction
[saimakm] obstructon
[josephmedman] good
[josephmedman] what are some examples
[erum] ca
[Nedal05] ca
[niks] plummer winson
[erum] tumor
[bioche2006] cance strictures
[erum] plumer
[saimakm] esophageal web
[erum] winson
[josephmedman] plummer vinson with esop webs with iron def. anemia, cancer, barrets with ulcer
[Nedal05] stricture
[josephmedman] what is it when you have dysphagia for solids and liquids?
[bioche2006] achalsaisa
[saimakm] motility prob\
[josephmedman] perstalsis problem..MCC achalasia..
[josephmedman] what is achalasia?
[niks] PSS
[bioche2006] faliure of realxn of les
[Nedal05] no ganglion
[erum] abscence of motor neuron
[josephmedman] failure of LES to relax..ganglion cells are destroyed..
[bioche2006] rt
[josephmedman] if you ge t apt. that comews into the hospital and vomits out the food they ate when they goto sleep it is achalasia
[josephmedman] what is TE fistula?
[bioche2006] upper end mmets trachea lower end blindly
[erum] remnant of embryological
[Nedal05] trecha -esophagus connection
[niks] blind proximal end
[josephmedman] what will be present in the mother in pregnancy?
[niks] and distal communicates with trachea
[saimakm] due to polyhyd
[erum] connection
[josephmedman] good
[Nedal05] poly
[erum] polyhtyd
[josephmedman] wait..
[josephmedman] its not due to polyhydramnios
[erum] no but it causes it
[perhaps] it leads to poly
[bioche2006] diabetes
[josephmedman] polyhydramnios is a result of it..
[niks] yes it leads to poly
[saimakm] ok thanks
docmaina2004 has left the chat.
[Nedal05] fistula
[josephmedman] ok
[josephmedman] scenario
[niks] coz baby cant swallow amniotic fluid
[Nedal05] rt
[josephmedman] pt. comes in with fetid odor to breath
[josephmedman] and has dysphagia
[josephmedman] what is it?
[bioche2006] achalasia
[perhaps] zanker reticulaum
[josephmedman] good
[Nedal05] diverticulus
[josephmedman] mc diverticulum in esoph.
[erum] diverticulum z
[perhaps] i spelled wrong
[josephmedman] is there peristalsis in Hirschsprung?
[bioche2006] no
[erum] no
[saimakm] no
[usmle.doc] no
[niks] yes in colon
[niks] no in esophagus
[Nedal05] yes
[josephmedman] YES
[perhaps] yes?
[erum] no
[Nedal05] in upper part
[bioche2006] ?
[josephmedman] proximal bowel is dilated but there IS peristalsis
[Nedal05] achalis no
[josephmedman] exactly
[niks] but in nesophagus hirshprung...proximal bowel dilated but not peristatltic
[josephmedman] what has proximal bowel dilation with NO peristalsis?>
[perhaps] sclerosis
[josephmedman] exactly
[Nedal05] sclerosis
[josephmedman] PSS/CREST
[josephmedman] try to remember that difference..
[erum] crest
[Nedal05] rt
[josephmedman] what is MC cancer in esophagus?
[Nedal05] SSC
[usmle.doc] squamous
[bioche2006] still squamous
[josephmedman] no
[erum] adeno
[josephmedman] yes
[saimakm] adeno
[niks] adeno
[josephmedman] where does it occur in esophagus?
[Nedal05] which part
[bioche2006] lower
[niks] no its squamous I think
[erum] loer part
[saimakm] lower 4
[niks] are you sure joe?
[saimakm] sorry 3
[bioche2006] yeah i too think squamous
[josephmedman] thats what goljan has niks
[Nedal05] middle SCC
[josephmedman] im just going with it..
[bioche2006] and middle part
[bioche2006] ok
[josephmedman] SCC is in mid esophagus..
[bioche2006] then no question
[niks] ok joe....thanks
[josephmedman] adeno in distal
[Nedal05] lower -adeno
[erum] rt
[erum] due to barrets
[josephmedman] these things are tricky bec. diff. books have diff things
[bioche2006] rt
[Nedal05] rt
[josephmedman] but i have friends that got 99's with goljan
[josephmedman] thats why i like stickign with him
[niks] hey its wierd...my goljan stars says squamous...sorry to interrupt...but its right infront of me
[josephmedman] what is the MCC of nocturnal cough?
[josephmedman] really?
[Nedal05] CHF
[josephmedman] hold up let me check merck
[perhaps] relux
[saimakm] gerd
[erum] gerd
[erum] he said adeno due to barrets
[niks] it says squam-60% and adeno 40%
[perhaps] About the esophagus cancer, I think world wide it is squamous, but in US it is adeno due to Gerd
[Nedal05] rt
[josephmedman] haha
[josephmedman] merk says this
[josephmedman] the most common types of esophageal cancers are squamous cell and adenocarcinoma
[josephmedman] that doesnt help much..
[erum] hehehe
[josephmedman] i think you are right perhaps..
[erum] goljan said adeno
[josephmedman] its like this question
[erum] due to barrets
[josephmedman] let me ask you guys
[josephmedman] what is the MCC of cirrhosis?
[bioche2006] wait joseph the incidence of adeno is rising but still scc is mcc
[bioche2006] alchol
[saimakm] alcohal
[Nedal05] alcholic
[josephmedman] what about worldwide?
[niks] alcohol
[ppliutcm] viral
[bioche2006] scc
[erum] hbv
[josephmedman] HCV
[niks] oh ok...
[niks] haha...
[Nedal05] HBV
[erum] not b?
[josephmedman] no..
[saimakm] hep
[bioche2006] alchol
[josephmedman] what is MCC of esophagitis in AIDS?
[bioche2006] candida
[usmle.doc] candidal
[erum] candidal
[saimakm] can
[Nedal05] CMV
[josephmedman] what is MCCOD as a complication of cirrhosis?
[niks] rupture of varises...
[usmle.doc] varices haemorrhage due to portal hypertension?
[Nedal05] rupture varicesee
[ppliutcm] joe, please confirm right answer.
[josephmedman] what is hammans mediastinal crunch?
[josephmedman] rupture of distal esoph.
[bioche2006] rt
[Nedal05] rupture esophagus
[josephmedman] air dissecting sub cutaneous..
[josephmedman] ok
[niks] oh thanks...
[josephmedman] you have a male 3 yrs of age vomiting non bile stained fluid..palpable mass on RUQ abdomen and there was hyperperistalsis..
[josephmedman] what is it?
[saimakm] pyloricn steno
[niks] pyloric stenosis
[bioche2006] rt
[Nedal05] dudenal atresia
[erum] pyloric srenisis
[bioche2006] pyloric ste
[Nedal05] sorry
[josephmedman] congenital pyloric stenosis
[josephmedman] what about if it was non bile stained?
[Nedal05] rt
[saimakm] it was
[bioche2006] it is non bile stained
[josephmedman] oops
[Nedal05] bile stained -dudenal
[josephmedman] i mean what if it was bile stained?
[erum] stained atresia
[bioche2006] duodenla
[usmle.doc] if it is bile stained it is duodenal atresia
[josephmedman] duodenal atresia..
[niks] if it was bile stained then it would be duodenal atresia
[saimakm] dudenal atresia
[Nedal05] rt
[richtian] cirum pan
[josephmedman] what genetic syndrome has a relationship with duodenal atresia?
[bioche2006] turner
[Nedal05] down
[niks] downs
[bioche2006] oh yeah down
[saimakm] down
[erum] down
[usmle.doc] downs
[josephmedman] hey biochem
[niks] double bubble sign is seen
[josephmedman] does turner have it too?
[josephmedman] i knwo about downs
[josephmedman] niks can you explain double bubble sign?
[bioche2006] i dont know i t is coaractation
[niks] sure!
[bioche2006] double bubble becoz of gas below and above constriction
[erum] on xray
[bioche2006] with turner coarctation
[josephmedman] what is the level of alpha feto protein in this patient?
[bioche2006] low
[niks] when we have duaodenal atresia..we see a dilated duodenum proximal to the obstruction...just below the stomach.......so it looks like a double bubble( one bubble is stomach air the other is duodenal
[Nedal05] high
[bioche2006] low in down
[josephmedman] yes
[josephmedman] it is low
[Nedal05] sorry low
[josephmedman] where would we have a high level?
[bioche2006] neural tube defects
[josephmedman] and what else..
[saimakm] ntdefects
[bioche2006] hepatolcellaur ca
[Nedal05] anencephaly
[ppliutcm] hcc
[josephmedman] good
[josephmedman] what would you see in the mother with duodenal atresia?
[saimakm] oligo
[perhaps] poly
[bioche2006] poly
[josephmedman] polyhydram.
[Nedal05] polt hydromus
[saimakm] no poly is right
[josephmedman] what is type 1 chronic atrophic gastritis
[bioche2006] cannot drink but urniation occuring hence poly
[saimakm] sotty about that
[usmle.doc] it is auto immune gastritis
[josephmedman] what is MCC of stomach cancer?
[usmle.doc] pyloroantrum
[bioche2006] helico bacter gastric umlcer
[Nedal05] H pylorus
[niks] H pylorus
[josephmedman] what syndrome is assoc. with MEN I?
[josephmedman] and where is this tumor located?
[bioche2006] gastrinoma hyper pth
[Nedal05] PPP
[niks] gastrinoma...
[josephmedman] whats PPP?
[bioche2006] pancrea
[josephmedman] no
[josephmedman] were in GI right now
[Nedal05] Zollinger
[josephmedman] what GI syndrome
[saimakm] duodenal ulcers
[josephmedman] good
[josephmedman] where is it located?
[perhaps] pancreas
[usmle.doc] pancreas
[josephmedman] ZE is the answer
[Nedal05] panc
[josephmedman] what protooncogene did we talk about yesterday
[josephmedman] assoc. with MEN
[perhaps] ret
[saimakm] ret
[josephmedman] good
[usmle.doc] ret
[erum] ret
[josephmedman] haha very good
[bioche2006] men always rt ho ho ho!!!!!!!!!!!!
[erum] hehehhe
[josephmedman] hahaha
[saimakm] that works
[erum] in thier dreams
[niks] hehehe
naive has left the chat.
[erum] but it works
[Nedal05] rt
[josephmedman] haha as long as it gets you the question right..women can be right and it is fine by me..
[josephmedman] HTLV 1 what cancer does it cause?
[perhaps] MALT tumor
[josephmedman] whats that perhaps?
[usmle.doc] human t cell leukemia
[bioche2006] t cell
[josephmedman] stomach cancer
[josephmedman] what country?
usmle.doc has left the chat.
[josephmedman] is MC
[niks] malignanat lymphoma
[bioche2006] japan
[josephmedman] japan
[ppliutcm] japen
[josephmedman] what is malt perhaps?
[perhaps] I think it is wrong. It is some lymphoma
[Nedal05] smoked food
[perhaps] in the GI tract
[bioche2006] mucoa associated lympahtic tissue
[josephmedman] oh ok..
[niks] malt is mucosa associated lymphatic tissue
[bioche2006] i mean git lympahtic tumours are cllawd malt
[josephmedman] MC extranodal site of lymphoma?
[bioche2006] stomach
[niks] stmach
[Nedal05] stomach
[josephmedman] what is the 2nd MC site?
[josephmedman] peyers patches in terminal ilium
[bioche2006] payer patches
[Nedal05] brian
[bioche2006] rt
[josephmedman] what is the MC benign tumor of the Gi tract?
[saimakm] adenoma
[josephmedman] leiomyoma
[Nedal05] adenoma
[niks] oh...
[saimakm] oh ok
[josephmedman] what is the MCC of malabsorption?
[niks] sprue
[erum] celiac
[Nedal05] pancratitis ch
[josephmedman] what is the diff between tropical sprue and celiac?
[richtian] infec
Unregistered has left the chat.
[josephmedman] this is impt actually
[