Chat transcript

[Anonymous]

Chat Transcript Epi and Biostats


00:33:19 eric20k enters this room

00:33:35 eric20k exits from this room

01:41:57 yamini enters this room

05:54:51 acestep1 enters this room

05:56:24 [acestep1] hi guys im really sorry i won t b able 2 make it this week

05:56:48 [acestep1] im leaving this msg in case i cant log in again

05:56:58 [acestep1] take care n ttyl

12:12:04 SMS enters this room

18:29:16 tej enters this room

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18:29:38 tej enters this room

20:49:24 neurodoctor_75 enters this room

20:51:27 neurodoctor_75 exits from this room

20:51:42 neurodoctor_75 enters this room

20:52:13 yamini enters this room

20:56:05 neurodoctor_75 exits from this room

20:56:10 neurodoctor_75 enters this room

20:58:11 Lorena enters this room

20:58:45 Step_1 enters this room

20:58:46 >[Step_1] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite.

20:58:58 [Lorena] hello neurodoctor and yamini

20:59:03 [Lorena] hello step 1

20:59:12 [neurodoctor_75] hi!lorena

20:59:19 [Lorena]

20:59:20 [Step_1] hi everyone

20:59:23 [yamini] hi to everybody

20:59:26 mash enters this room

20:59:45 hutals enters this room

20:59:50 [mash] hi guys

21:00:05 [neurodoctor_75] hi!every one

21:00:13 [Lorena] hi hutals, step 1 ,everybody

21:01:18 [Step_1] hope everyone has been studying hard. this new schedule is great....what do you think?

21:01:41 [Lorena] yes, the schedule is really good

21:01:51 [mash] yep, its gr8

21:01:57 [neurodoctor_75] yes,it is

21:02:00 svaious enters this room

21:02:32 [yamini] yes,its good

21:02:43 [Step_1] hi svaious. good to see ya

21:02:54 [Lorena] today it will be just biostatistics and epidemiology, right?

21:03:00 [Step_1] i guess we can get started and others can join in as they come

21:03:07 [Lorena] the rest will be for saturday?

21:03:09 [Step_1] yes

21:03:21 [Lorena] good

21:03:28 [Lorena] let's s tart then

21:03:46 [svaious] hi guys

21:03:58 [Lorena] hi svaious

21:04:31 [svaious] sorry my computer is experiecing problems

21:04:55 [Step_1] specificity = tp /tp+fn or tn/ tn+fp?

21:05:19 [Step_1] or something different of course

21:05:25 [mash] tn/tn+fp

21:05:31 [Lorena] tp/tp+fp

21:05:46 [svaious] tp/tp+fp

21:06:06 [mash] specificity tells abt healthy pop

21:06:10 [Lorena] sorry

21:06:19 [Step_1] mash is right, its tn/tn+fp

21:06:19 [Lorena] it is true negatives

21:06:24 [mash] so it is tn/tn+fp

21:06:34 [Lorena] agree with mash

21:06:41 [yamini] tn/tn+fp

21:06:55 [mash] wat abt sensitivity?

21:07:19 [Lorena] tp/tp+fn

21:07:21 [yamini] tp/tp+fn

21:07:23 [Step_1] the way to remember is SPECial ppl dont get sick (healthy), so specificity is for healthy ppl which are TN over the TN and FP.....

21:07:41 [Lorena] all the people who have the disease

21:07:59 [Step_1] SENSITIVe ppl get sick so SENSITIVITY is sick ppl and TP /TP+FN

21:08:10 [mash] or u can say diseaesd ppl r sensitive

21:08:46 [Step_1] what about positive predictive value and neg pred value? what is the formula for each?

21:09:08 [svaious] tp/tp+fp is PPV

21:09:09 [mash] ppv = tp/tp+fp

21:09:24 [Lorena] positive pred value is tp/tp+fp

21:09:26 [mash] npv= fp/fn+fp

21:09:31 [yamini] tp/tp+fp &tn/tn+fn

21:09:44 [Lorena] negative pred valuie is tn/tn+fn

21:09:44 [svaious] tn/tn+fn is NPV

21:09:59 [Step_1] yes very good. thats easier to remember because Pos has all the positives and neg has all the negatives

21:09:59 [mash] sorry , npv = tn/fn+tn

21:10:30 [mash] npv is all neg, ppv is all positives

21:11:10 [Lorena] accuracy ?

21:11:22 [Lorena] to complete the set

21:11:44 [Step_1] TP+TN/everything

21:11:46 [mash] tp+tn/tp+tn+fp+fn

21:11:54 [yamini] tn+tp/total screened pts

21:11:59 [svaious] (tp+tn)/(tp+tn+fp+fn)

21:12:16 [Lorena] yes

21:12:35 [Step_1] what if pt asked "what are the chances that my pos HIV test is correct?" which value to use? spec, sensitivity, PPV, NPV?

21:12:48 [mash] ppv

21:13:03 [yamini] ppv

21:13:04 [Lorena] popsitive predictive value

21:13:15 [Step_1] yes PPV is correct

21:13:33 [Lorena] good job guys

21:13:38 [mash] wats d relation b/w prev and ppv/npv

21:14:21 [Lorena] positive pv increases when prevalence increases

21:14:29 Roxanita enters this room

21:14:54 [mash] yeah,prev is dir proportional to ppv and inversely to npv

21:15:18 [Step_1] what effect does lowering the fasting gluc level for diagnosing DM from >140 to >126 have on NPV and PPV?

21:15:20 [mash] and how abt sensitivity n specificity

21:15:34 [Step_1] hi roxanita

21:15:43 nne enters this room

21:15:50 [Step_1] hi nne

21:15:52 [mash] ppv increase n npv decreases

21:15:57 [Roxanita] hi, sorry I am late...

21:15:57 [Lorena] hi roxanita , nice to see you

21:16:15 [svaious] increases senisitivity of the test

21:16:36 [Lorena] screening doesnt assess incidence

21:16:46 [nne] hi, sorry i'm late. My connection is bad

21:17:07 [Step_1] i think its the other way around. more ppl are diagnosed with the dz, so this increases sensitivity and NPV, but decreases spec and PPV

21:17:17 [Lorena] it is ok, we jus started

21:18:05 [Lorena] no

21:19:02 [Step_1] as far as incidence and prevalence, which one is for new cases and which one tells you all cases of present time?

21:19:02 [Lorena] i may be wrong but i think when incidence increase not sensitivity of the test nor PPV have any effect

21:19:24 [Lorena] it is when prevalence does

21:19:29 [yamini] yes lorena is correct

21:19:42 [Lorena] only PPV increases

21:19:55 [mash] if we lower cut off we increase prev => inc prev increases ppv

21:19:57 [Lorena] sensitivity of the test is always the same no matter whow many people are sick

21:19:59 [yamini] yes

21:20:10 [mash] and sensitivity remains d same

21:20:24 [Step_1]>[Lorena] according to goljan, he has an example of the effect of decreasing the upperlimit of normal of the test which increases sensitivity and NPV, but decreases spec and PPV

21:20:25 [nne] yes

21:20:33 [nne] that is true

21:20:35 [Lorena] confusing

21:22:11 [Step_1] the way I see it is that more people will now be diagnose with DM because the limit is lowered (more have >126 than >140). so that means more diseased -> inc sensitivity -> inc NPV

21:22:49 [nne] incidence or new cases and prevalence is for cases present

21:22:49 kokushubila enters this room

21:23:18 [kokushubila] Hello everybody!

21:23:28 [Step_1] it also means that more people with a negative test result are TN

21:23:30 [Lorena] there youare increasing sensitivity, not incidence

21:23:34 [mash] prev is total no of cases new and old

21:23:40 [Step_1] hi kokushubila

21:23:45 [yamini] prevalence is all cases present

21:24:08 [Lorena] the question was the opposite.... the effect of increasing incidence on sensitivity, thats why we got confused

21:24:19 [Step_1] yes, incidence is new cases and prevalence is all cases

21:24:29 [yamini] it is none

21:24:38 [kokushubila] Sorry I am late but I will catch up

21:24:40 [Step_1] sorry, i worded it incorrectly to what i meant

21:24:46 [nne] yes

21:25:15 [Lorena] i think we are looking at theproblem from different perspectives

21:26:27 [Step_1] i'll try to find a good question on it and post it in the forum tomorrow.

21:26:47 [Lorena] good idea

21:26:51 [Step_1] if new effective treatment is initiated how will this effect incidence and prevalence? (inc dec or same for each)

21:26:57 [Lorena] so it is clear for everybody

21:27:19 [Lorena] no change in incidence , prevalence decrease

21:27:30 [yamini] inc no effect

21:27:35 [mash] inc remains d same and orev decreases

21:27:46 [yamini] prev decreases

21:28:16 [Step_1] correct bc new cases not effected, but existing cases (prev) decreases

21:28:39 [Step_1] how about new effective vaccine?

21:28:52 [svaious] incidince decreases

21:28:53 [Lorena]

21:29:02 [svaious] prevalence remains the same

21:29:09 [kokushubila] I am sorry my computer is very DOWN

21:29:09 [mash] both prev n inc dec

21:29:17 [yamini] inc dec&prev dec

21:29:38 [Lorena] agree with mash

21:29:51 [Lorena] and yamini

21:30:06 [nne] in a study, a group of people are exposed to an environmental toxin but are not treated. Instead, they are observed over time on a standard set of measures to ascertain the potential effects of the toxin. This type of study design is called...

21:30:07 [svaious] how can prevalence decrease with a new vaccine

21:30:07 [Step_1] both incidence (new) and prevalence (existing) decreases bc vaccine would prevent future diseases

21:30:18 [svaious] oh ok

21:30:32 [Lorena] longitudinal study

21:30:36 [Roxanita] ok

21:30:41 [yamini] prevalent cases

21:30:47 [mash] cohort

21:30:49 [yamini] sorry

21:30:56 [Step_1] cohort

21:31:04 [Roxanita] where are you now?

21:31:19 [nne] lorena, is correct

21:31:59 [kokushubila] It is cohort study

21:32:06 [Lorena] that is a tricky one

21:32:33 [nne] in this study the same group is followed over a long period of time

21:32:38 [kokushubila] it's prospective cohort study

21:33:10 [Step_1] for the studies, i remember it as case control for the past, cross sectional for present, and cohort for prospective. i dont know about the more detailed studies

21:33:32 [kokushubila] cohort (Same group of people)

21:33:41 [nne] and no active intervention is instituted after the initial event, which may be positive or negative

21:33:53 [Lorena] longitudioinal just means the group was followed over a period of time

21:34:37 [mash] ok then it shud be longitudinal coz we r not comparing it with control

21:34:44 [yamini] case control is retrospective study

21:34:52 [Lorena] with this type of questions you usually are given options

21:36:09 [mash] wat is odds ratio?

21:36:37 [nne] yes you are, but lets do some without options so we know how good we are and the question had all the answers given here as options so...

21:36:55 [Lorena] the odds of getting a disease with exposure to a risk factor and compared with a group non exposed

21:36:59 [Step_1] odds of getting a disease with exposure

21:37:14 [Step_1] compared to nonexposure

21:37:40 [yamini] used for case control studies,

21:37:46 [Lorena] yes nne,good strategy

21:38:24 [mash] and wat do we use fr cross sectional studies?

21:38:49 [Lorena] relative risk

21:39:07 [yamini] chi-square charts

21:39:13 [Lorena] opps

21:39:14 [Step_1] prevalence

21:39:15 [mash] nope its chi square

21:39:34 [mash] relative risk is fr cohort

21:39:37 [kokushubila] Relative risk is used for cohort studies

21:39:39 [nne] Chi square

21:39:59 [Step_1] to compare two means, which to use? t-test, chi sqared, anova, other?

21:40:04 [Lorena] RR and AR too right? for cohort

21:40:31 [Roxanita] t-test

21:40:31 [Lorena] t-test to compare 2 means

21:40:53 [Step_1] yes, t-test for 2 means. mneumonic is "mr t is mean"

21:41:20 [Roxanita] ANOVA is used to look for differences between 3 or more variables

21:41:50 [yamini] no 2 or more

21:41:53 [mash] chiN chi square fr nominal data

21:42:21 [Step_1] thats right roxanita, and chi squares will compare percentages

21:43:03 [mash] ANOVA one way is fr 2 or more and repeated measure ANOVA fr more than 3

21:43:22 [mash] i mean more than2

21:43:25 [Roxanita] yup chi-square test is used to examine the differences between frequencies or % in a sample.

21:43:40 [Step_1] what % of sample will fall within 1 standard deviation of the mean?

21:44:00 [mash] 68%

21:44:05 [Lorena] 68%

21:44:08 [nne] A neuropsychologist is studying the effects of Drug A and Drug B on cognitive performance in Alzheimer patients . He administers a memory test to two groups of subjects (those taking drug A and those taking Drug B) and compares their mean scores. What type of statistical test is most appropriate fo

21:44:58 [Step_1] yes, 68%. watch out for the tricky..."what percent 1 SD above the mean?"...that would be half of 68% which is 34%

21:45:12 [Roxanita] 68% for +1/-1 SDs

21:45:22 misha enters this room

21:45:23 [mash] nne ,t test

21:45:40 [Roxanita] 95% for +2/-2 SDs

21:45:55 [Step_1] t test

21:46:04 [Lorena] what is the answer nne?

21:46:12 [nne] t-test correct

21:46:14 [mash] and 99 fr 3sd

21:46:18 [kokushubila] Look <a target=new href=http://www.valuemd.com/amazon/books2_content.php?ASIN=0071429484>FA</a> Pg 117

21:46:43 [Roxanita] everybody remember k-aplan

21:47:05 [nne] Pls explain this 68% . I don't understand

21:48:38 [Lorena] nne, in anormal distribution the % of cases within 1,2 and 3 standard deviations are always 68% within +-1 standard deviation

21:48:46 [Step_1] for the normal distribution curve and Standard deviations (SD), its a bell shaped curve where 68% fall within 1SD above or below mean, 95% within 2SD above or below mean, and 99.7$+% above or below mean

21:49:11 [mash] 68% is constt fr any normal gaussian curve, (within 1sd)

21:49:17 [Lorena] you have to memorize those %

21:49:23 [kokushubila] Nne , There is normal(Gausssian) distribution for standard deviation, You can look the chart at <a target=new href=http://www.valuemd.com/amazon/books2_content.php?ASIN=0071429484>FA</a> pag 117

21:49:45 [nne] Step_1 pls can i have the website for Dr Golijan's 100 pages

21:50:01 [Step_1] check out this thread which has a pic of curve, explanation, and sample question

21:50:04 [Step_1] http://www.valuemd.com/viewtopic.php?t=10278

21:50:52 [Lorena] that s very high yield nnn.... learn it very well

21:51:16 [nne] The 100 pages where can i get it from? thanks guys

21:51:29 [Step_1] for goljans 100 pg notes, its supposed to be http://clix.to/goljan, but it doesnt work for me?? i know the 36 pgs are available in the download area of valuemd

21:51:40 [mash] 3

21:52:23 [mash] coz 0.15 % fall above 3sd and 200 is above 3sd

21:52:31 [Step_1] i agree, they can ask that same question a dozen different ways and they always do. so learn it well cause you're very likely to see it

21:53:39 [Lorena] with what type of study you can determine incidence?

21:54:06 [Step_1] cohort i think

21:54:15 [Lorena] yes

21:54:24 [Lorena] and prevalence?

21:54:32 [yamini] cohort study

21:54:34 misha enters this room

21:54:47 [Lorena] very good step 1 and yamini

21:54:50 [Step_1] cross sectional

21:54:56 [yamini] cross-sectional

21:55:16 [Lorena] causality?

21:55:26 [mash] cohort

21:55:26 [kokushubila] GOOD ,It's TRUE

21:55:32 [Step_1] i just saw in kap lan that cohort and longitudinal studies are synonyms for the same thing, so we were all right earlier

21:55:37 [Lorena] very good job!!!

21:55:51 misha exits from this room

21:55:54 [Step_1] causality is case control and cohort

21:55:56 [kokushubila] YES I saw it too!!!

21:56:22 [mash] case control do not give inc

21:56:26 [Lorena] yes, thtas why i said they usually give you options, because you can have different answers and both be correct

21:56:31 [yamini] no it is only cohort

21:57:14 [Step_1] case control cannot assess incidence or prevalence, only casual relationships

21:57:21 [mash] yup it shud be cohort study

21:57:27 [Lorena] you are right step 1

21:58:19 [yamini] u r right step 1

21:58:30 peoria_doc enters this room

21:58:30 [Roxanita] Is the pooling of many studies to increase statistical power?...

21:58:53 [Lorena] case control and cohort both determine causality

21:59:35 [Lorena] sorry, i dont get your question roxanita

21:59:55 [mash] and neither acn assess prevalence

22:00:01 [Roxanita] that is the question

22:00:21 [Roxanita] that was on a NBME question

22:01:05 [Roxanita] the answer is: Meta Analysis

22:01:32 [Lorena] oh, thanks

22:01:44 [Step_1] yes roxanita is correct, i just found it in 1st aid

22:01:44 [Roxanita] Can anybody explain about the Mean-Median-Mode

22:01:46 [nne] step 1 how do i get to the downloads section, if i get there how do i get to the 36 pages?

22:02:12 [Roxanita] how is it in a positively skewed frequency distribution?

22:02:15 [Step_1] meta analysis is the pooling data from several studies to acieve greater statistical power

22:02:25 roshy04 enters this room

22:03:02 [yamini] it is matgematical litreture review

22:03:20 [yamini] sorry mathematical

22:03:25 [Lorena] positive skew mean>median

22:03:45 [Lorena] mean>median>mode

22:03:54 DrMG enters this room

22:04:18 [mash] median is the best representation of skewed dis.

22:04:27 [Lorena] in anegative skew : mean<median<mode

22:04:31 [Step_1]>[nne] right now it is on the front page of the downloads (2nd or 3rd listed from the recent ones bc it was just updated). once you log into that area with the download nick and pass, click downloads and you will see it

22:06:21 [Step_1] yes, notice they're in alphabetical order to remember easier mean, median, mode

22:06:51 [Step_1] neg points < and positive points >

22:07:23 [nne] City has population of 250,000. Of these, 10,000 have Dxz X, which is inurable. There are 1,000 new caese and 400 deaths each year from this dxz. There are 2,500

22:07:28 [Step_1] what % of cases fall 2 SD below the mean?

22:07:40 [yamini] mean is always sensitive to lesser values

22:07:49 [Lorena] in what situations/cases incidence is equal to prevalence?

22:08:15 [Step_1] acute cases

22:08:15 [Roxanita] ok, so (+) Skewed: Mean> ; (-) Skewed : Mean <

22:08:29 [mash] 47.5%

22:08:37 [nne] 2,500 deaths per year from all causes. What is the prevalence of this dxz and incidence?

22:08:46 [Lorena] yes step 1!

22:08:51 [peoria_doc] mean is the average , median is the point on the scale that divides the group mode is the most frequently occurring nymber

22:09:51 [kokushubila] Sorry MAsh , How did you get 47.5% Please explain

22:10:01 [mash] i dint get ur ques nne

22:10:05 [Roxanita] In what case: Accuracy= Sen + Spec / 2 ?

22:10:40 [yamini] if prevalence is 50%

22:10:44 [Step_1] incidence = 1000

22:10:54 [Lorena] the answer to your question step 1..is it 2.4%?

22:11:28 [Step_1] yes, its 2.4%....just wanted to make sure that everyone got that important concept....good job lorena

22:11:38 [mash] 34% 1 sd below the mean then 13.5% b/w 1 and 2 sds

22:11:38 [Roxanita] yes Yamini

22:12:10 [Lorena] all of a sudden lots of q's appeared

22:12:17 [nne] Prevalence is 10,000/250,000

22:12:23 vladi enters this room

22:12:57 [nne] incidence is 1,000/250,000

22:13:10 [vladi] hey, guys- i miss you

22:13:20 [kokushubila] Can we please go step by step ?

22:13:38 [Lorena] yes, i dont know what to answer

22:13:46 [Step_1] good question nne....i was still working on prevalence. but that was great question and great concept

22:13:47 [Lorena] vladi!!!

22:13:57 [nne] step1 can't get it. Need help

22:14:17 [roshy04] hi Vladi,how're you doing??

22:14:20 [vladi] yes- i am

22:14:40 [mash] step 1 ur q was 2sd below the mean . had it been below 2sd below the mean it wud ve been 2.4%

22:14:46 [vladi] with you all - just fine

22:15:07 [mash] can u explain?

22:15:09 [Step_1] nne, i will PM the directions for you because there are hundreds of files there for you to look at.

22:15:44 [nne] For the next discussion pls get questions from books orr any other place. We need to work with more questions

22:15:51 [kokushubila] Please step _1 I am drowning in this stuff please explain

22:16:00 [nne] What is PM?

22:16:17 [mash] step 1 plz explain.....

22:16:18 [Lorena] personal message

22:16:45 [nne] where will i find it?

22:16:52 [mash] step 1 can u send me the link too?

22:17:25 [vladi] did you discuss about a and b error- i got it in real exam

22:17:36 [Step_1] yes mash...thats correct it would be 2.4 % because it is the % below 2 SD of the mean. not below and above. if it was below and above the mean it would be around 5%

22:17:47 [roshy04] step 1 me too i need to know how to reach the files??

22:18:04 [Lorena] not yet vladi

22:18:49 [peoria_doc] can i have the files too please

22:19:06 [Lorena] when do you risk of type I error?

22:19:20 [peoria_doc] thnx

22:19:27 [neurodoctor_75] can i have the files too plz

22:19:36 [Step_1] i'll pm you the directions.

22:19:56 [roshy04] what's pm?

22:20:07 [Step_1] private message = pm

22:20:22 [vladi] what mostly consider a-value?

22:20:39 [mash] it wud be 2.55% below 2 sd below the mean

22:20:40 [roshy04] ok so you've our e-mail adresses?

22:20:50 [Roxanita] A type I err or or alpha error states that there is an effective difference, when in fact there is not ?

22:20:56 [neurodoctor_75] thanx

22:21:09 [Roxanita] what is the risk Lorena?

22:21:37 [Lorena] you have a risk of a type I error when you reject the null hypothesis

22:21:44 [Step_1] no, email is somehting different. private messages are like email, but they use log onto valuemd to check it instead of an external email account

22:21:59 [Lorena] you are right roxanita

22:22:01 [Roxanita] Type II error or Beta error states that there is not a difference in groups, when in fact there is

22:22:15 [vladi] roshy- can you email me either- i missed that is that, but i want it anyway as in line at shopping center

22:22:20 [Lorena] exactly!

22:22:52 [Roxanita] Null Hypothesis postulates that there is no difference between groups studied huh?

22:23:31 [peoria_doc] case control study

22:23:49 [roshy04] if i get anything i'll send it to you,but i'm not sure how i'm going to get them??

22:23:56 [vladi] all right generally, but it mostly consider random variation in the data, how about b-value

22:24:11 [Step_1] we can all send private messages to each other if we joined the online study group. when you participate here, you're added to the group automatically.

22:24:23 [mash] alpha is error of commission n beta is error of omission

22:24:28 [Lorena] null hypothesis saya that findings are result of chance or random gfactors

22:24:38 [kokushubila] Null Hypothesis -No association btn the disease and the risk factor

22:24:51 [roshy04] ok step 1 thank you so much

22:25:17 [Step_1] here is the study group and all the private message links (PM) http://www.valuemd.com/groupcp.php?g=11344

22:25:25 [Lorena] b error is when you do not reject the null hypothesis but you should have

22:25:44 [Roxanita] Case control study...nothing to do with prevalence or incidence but causality is relevant

22:25:48 [Lorena] is that right vladi?

22:25:51 [mash] step 1 plz look at dat q again n explain it

22:25:54 [yamini] yes lorena it is true

22:26:21 [Step_1] which question mash?

22:26:46 [mash] 2 sd below the mean

22:26:55 [Lorena] yes roxanita

22:27:13 [vladi] b-value reflects first of all, false acceptance of null hypothesis- you're right

22:27:26 [Lorena] what is worse type I or II error?

22:27:41 [Step_1]>[mash] have you taken a look at the question at http://www.valuemd.com/viewtopic.php?t=10278 ? its similar and has a pic and explanation with it.

22:27:46 [mash] alpha

22:28:14 [Lorena] type I or alfa is considered worse

22:28:20 [vladi] effective screening test should have at least- what?

22:28:34 [yamini] type I ERROR

22:28:53 [Roxanita] ok

22:29:16 [Lorena] remember commission worse than omission

22:29:37 [Lorena] high sensitivity

22:29:41 [mash] i m still confused ..... ok leave it ...i ll check it out once again

22:30:25 [Step_1] 1 SD above and below (+/-) will be 68% combined. 2 SD +/- will be 95.5%. 3 SD +/- mean will be 99.7%. but if you look at only above OR below (+ OR -) it will be half of the value. so.....

22:30:39 [Lorena] for screening high sensitivity, for confirmatory high specificity

22:31:48 [mash] when we say 2 sd below the mean it shud be 1/2 of 95.5% which is 47.75

22:31:51 [Roxanita] Back cross study, what is that?

22:32:55 [Lorena] is it the same than cross over study? when no group is left untreated ?

22:33:46 [vladi] i think also type 1 because reslut is found to be statistically significant by chance in a sample even though there is no effect in the population.

22:34:21 [Step_1] within 1 SD above or below (+ OR -) will be 34%. >1 sd + OR - will be 13.5%. >2 SD + OR - will be 2.4%. >3SD + OR - will be .15%

22:34:22 [vladi] great lorena- for screening just high sensitivity

22:35:43 [kokushubila] Thank you so much step_1 , got it!!!

22:36:06 [vladi] if we have 2 small comparative group of treatment (or w/o) why we can't draw decision making?

22:36:26 [Lorena] croos ovfer study is 2 groups and receive treatment at differnt times so none is left untreated, you can compare with themselves also (when given medicine and then when given placebo)

22:36:31 [Roxanita] I found it in a question... Back Cross Study...and the answer was...A genetic study which involves breeding of a homozygous and heterozygous gene lines to find commonality.

22:37:03 [Lorena] wow, never heard of that roxanita...great info, thanks

22:37:21 [Roxanita] me neither

22:37:27 [Step_1]>[mash] no it means below the line of 2 SD. so anthing past that point which 100-95.5%= about 5 %....and then you cut it in half which is about 2.5%

22:38:11 [mash] alright!

22:38:44 [Roxanita] are we going to review <a target=new href=http://www.valuemd.com/doubleclick/click.php?mgr=aspcode.net&id=52>health insurance</a> on saturday?

22:39:18 [Roxanita] what the.. I wanted to say if are we talking about

22:39:22 [Step_1] i think the remainder of behavioral science is on sat.

22:39:30 [Roxanita] h e a l t h insurance

22:39:36 [Lorena] yes

22:39:37 [Step_1] but we should discuss some epi

22:39:42 [Roxanita] like medicadi, medicare, welfare

22:39:49 [Lorena] it will be lot of material to review

22:39:49 [Roxanita] medicaid

22:40:21 [Lorena] vladi...what is the answer to your question?

22:40:48 [Step_1] doc is known to be the largest prescriber of benzos in the country. doc is also substance abuser. what is the most likely substance being abused?

22:41:30 [Roxanita] young boy 17 y.o. admitted for the 11th time on this year with Dx of Cystic fibrosis as an infant, what type of insurance is covering this guy? was a real question

22:41:32 [vladi] e,g, if we have both group incl. 6 pats etc. - the power of study is low and result may show a selection bias

22:42:06 [vladi] alcohol

22:42:39 [Roxanita] alcohol

22:42:49 [Step_1] this is a trick question that got me the first time. the first part is distractor. the real question is "what is the most commonly abused substance?". the answer is alcohol is the most commonly abused substance in the us by far. good job!

22:42:50 [nne] is this chat going to be posted, 'cos i need to look through this?

22:43:14 [Roxanita] what about my quest?

22:43:15 [Step_1] yes, i'll post it

22:43:33 [Roxanita] nobody?

22:43:36 [Lorena] i have not gone through that roxanita....

22:43:38 [Step_1] medicaid?

22:44:07 [Lorena] i would go for medicaid too

22:44:14 [Roxanita] maybe they wont explain that good...but we have to know this

22:44:53 [Roxanita] "Medicare" is designed for the elderly >65 y.o. and the Chronically ill for ANY Age

22:44:53 [vladi] prevalence will exceed incidence at any particular time unless.....?...?

22:45:38 [Lorena] they die

22:45:46 [Step_1] unless the ppl die quickly

22:46:06 [yamini] or recover

22:46:11 [Lorena] thanks roxanita, i knew medicare was for lederly but not for chronically ill

22:46:27 [Lorena] agree with yamini

22:46:29 [vladi] medicaid

22:47:17 samsung enters this room

22:47:23 [vladi] great step1-unless the disease is uniformly rapidly fatal

22:47:27 [Roxanita] MEDICAID is designed for those on state or federal assistance and the poor people

22:47:52 [Roxanita] Both Medicaid and Medicare programs are supported by "Social Security"

22:48:21 [Step_1] if mother is HIV+, what % of babies will test HIV+ for HIV ABs at birth?. what about after 1 yr?. what about if AZT plus c-section?

22:48:43 [vladi] what is that "intention to treat"

22:49:41 [samsung] 15% chanc HIV + at birth / after 1 yr %increase / AZT Rx ?

22:50:54 [Step_1] 100& babies of HIV mothers will test pos for HIV AB at birth bc they all carry the Ab from mom. but only 20% will have these Ab after one yr. if given AZT and c-section, the percentage will drop to only 5% remaining HIV pos after 1 yr

22:50:59 [vladi] i think about 100% at birth, after 1 year- probably same, with C/S -probably the same because it comes through the blood but not through genitalis like in herpes

22:51:49 [Roxanita] good step 1

22:51:52 [samsung] sorry i gave wrong ans

22:52:02 [Lorena]

22:52:47 [Roxanita] why sorry samsung this is not the exam we can have mistakes

22:52:49 [Lorena] it is time for me to get going

22:52:50 [Step_1] fastest growing population is what age group?

22:53:03 [Lorena] i'll see you on saturday

22:53:09 [samsung]

22:53:17 [Roxanita] >65 yo

22:53:23 [Step_1] ok lorena. thanks again for the great chat.

22:53:27 [kokushubila] YEah sure Roxanita , we are all learning

22:53:41 [Lorena] thanks to all of you

22:53:43 [Lorena] bye

22:53:43 [yamini] >80

22:53:58 [Roxanita] Thanks lorena

22:54:30 [Step_1] actually most got this wrong in the sample questions i posted. its >80 yrs.

22:54:32 [kokushubila] Thank you Lorena

22:54:38 [yamini] bye lorena

22:54:55 [vladi] from 60-80 y.o.- i got this Q from 5000

22:54:57 [yamini] &thanx

22:54:59 [Step_1] good job yamini

22:55:24 [Roxanita] >80? wow this country really has old population

22:55:34 [nne] bye everyone. good chat session . Lets kkep it up. Step 1 remember to give me the info. Thanks

22:55:37 [Step_1] i got it from kap lan, which actually says over 85 yrs

22:55:56 [vladi] step1- are you sure - where did you get this answer from

22:55:59 [Step_1]>[nne] ok, i'll send it to you

22:56:08 [Roxanita] yup that's right

22:56:33 [Step_1] pg 28 of kap lan behavior science "fastest growing cohort = persons over 85"

22:56:57 [Roxanita] it's like 13% population over 65y

22:57:03 [vladi] in 5000 the put from 60-80- i think this is true in average

22:57:31 [Step_1] its fastest growing....not the largest percentage

22:57:36 [Roxanita] Ethnic group that has the highest % of single parent families?

22:58:16 [samsung] jews

22:58:28 [vladi] take the average life expectancy in Western- it's not exceed 85. <a target=new href="http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10000058&type=3 &subid=0" >Kaplan</a> sometimes might be also confusing

22:58:41 [Roxanita] answer: African American 62% >> Hispanic 33% >> caucasian 21%

22:58:49 [Roxanita]

22:59:20 [Roxanita] 83% of those families are headed by a woman

23:00:05 [vladi] jews are pretty family guys, samsung, - Roxanita -you are probably right

23:00:47 [samsung] OK :-/

23:00:50 [Roxanita] Ethnic group with the lowest infant mortality?

23:01:06 [kokushubila] Hello friends Thank you so much for this materilas .

23:01:26 [vladi] that drives me crazy step1- a lot of mismatch between different sources even for a pretty simple Qs

23:01:42 [Step_1] whites

23:01:47 [kokushubila] I have to go now . See you on Saturday .

23:01:48 [vladi] caucasians

23:01:50 [Roxanita] first the highest Infant mortality....

23:02:05 anaid enters this room

23:02:29 [Roxanita] African american >> Native am >>chinese am>>anglo am >> ASIAN AMERICAN

23:03:12 [vladi] e.g. for porphyria- <a target=new href="http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10000058&type=3 &subid=0" >Kaplan</a> states that most common acute intermittent, but princeton- prophyria cutanea tarda

23:03:28 [Step_1] actually, 2 diff questions. in 5000? they ask which has the largest CURRENT popl. the ans is 60-80 yrs. in kap lan they ask for the fastest growing and the ans is >85. even if from 1 to 2%, it is still double in size so very fast growing.

23:04:00 [Step_1] do not type words like kap lan, first aid, f a, amaxon, etc

23:04:24 [Roxanita] health

23:05:01 [Step_1] oh yeah, also health insurance

23:05:14 [Roxanita] Thanks Hutals, i saw your post at usmleforum

23:05:38 [vladi] if you red usmle.net- i did not take the point about foreign body- blackwell states- peannut goes to middle lobe of lung, but Goljan- low lobe. Whom we have to believe. It's terrible, but truly this Q i got on real exam

23:05:57 [hutals] no prob....least i can do since i'm mostly silence observer

23:06:55 [Roxanita] Preventive service that would specifically be most beneficial to alcoholic patients?...

23:07:15 [Step_1] aa

23:07:26 [yamini] AA

23:07:26 [Roxanita] Influenza and Pneumococcal Immunizations

23:07:35 [vladi] step 1- probably you are right about age population, sorry- in 5000 they really ask about largest current population, but anyway for other QS - A LOT OF CONTROVERSY

23:07:52 [Roxanita] after that also TB testing.

23:08:22 [Step_1]>[vladi] i agree, but as goljan would say, "play odds". i would go with goljan between those two because he double checks all his sources.

23:09:07 [Roxanita] What is the goal of the Medicine for chronic diseases?

23:10:05 [vladi] BUT BLACKWELL SEEMS ME ALSO serious stuff

23:10:08 [Step_1] decrease morbidity??

23:10:12 [Roxanita] nobody?

23:10:45 [vladi] maintain the recurrence and quality of life

23:10:51 [Roxanita] the goal of the medicine for chronic disease is INCREASE PREVALENCE

23:11:36 [Roxanita] Did talk about Number needed to treat?

23:11:49 [Step_1] thats the goal? why would you want to inc prevalence? if that was the case, just screen ppl sooner

23:12:18 [vladi] sorry - i wanted to say to maintain the remission and quality of life

23:12:35 [Step_1] what percentage of americans have herpes simplex virus? 5%, 10%, 20% 50%?

23:12:51 [vladi] i also disagree

23:12:54 [Roxanita] when you treat patients what do you do, you just increase the number of people with the chronic disease right?

23:13:06 [Roxanita] I mean chronic patients

23:13:26 [vladi] 20%

23:13:28 [Step_1] i agree about that, but is that really the goal of it?

23:13:35 dani enters this room

23:13:56 [Roxanita] Remember Daugherty? from k-aplan.... He said, if you want to decrease prevalence just shoot your chronic patient next time he come to see you, it was a joke

23:14:21 [Step_1] yes, herpes is prevalent in 20% (1 in 5) americans!?!

23:14:29 [Roxanita] it's a way to say buddy

23:15:13 [vladi] may be it's true- not joke

23:15:19 [Roxanita] that's why we have so many many patients with Diabetes, before they would die after some years

23:15:20 [Step_1] good point rox, i guess it the alternative to shooting the patient ... i actually do remember him saying that.

23:15:52 [Roxanita] Daugherty is a great teacher

23:16:47 [Step_1] he also mentioned that when you say "ppl live longer with diz x" it really means that screening usually just detects it sooner. so you dont live LONGER with the dz, you just know you have it longer

23:16:50 [vladi] just to increase natural survival...

23:17:08 [Roxanita] ok this one I like....How many patients do you need to treat in order to prevent 1 case...If they tell you the Incidence is 1 per 1000

23:18:06 [Roxanita] The Number Needed to Treat "NNT"

23:18:46 [Step_1] 1000? or 1 if its a trick question??

23:19:04 [Roxanita] we just do the Inverse of the Incidence rate.... if the Incidence is 1/1000 then we need to treat 1000 to prevent just one case

23:19:04 [yamini] 999

23:19:11 [vladi] 1000 pats at least

23:19:17 [yamini] K

23:19:27 [Roxanita] If the Incidence is 50/1000....

23:20:04 [Step_1] i take that back, the incidence is already 1/1000 without treatment....and the key is treatment, not prevention

23:20:05 [Roxanita] we need to treat 1000/50 = 20 . 20 just to prevent 1 case

23:20:29 [Roxanita] to prevent a new case

23:21:11 [vladi] i did catch your drift

23:21:29 [Roxanita] that's interesting right ?

23:21:42 [Step_1] yes, but the question says "treat".....sorry just paranoid and looking at every word after listering to daughty cause he tries to trick you so you learn

23:21:57 [vladi] another 20

23:22:24 [Roxanita] to treat and cure them

23:23:08 [vladi] it's really sphisticated and closer to paranoid idea- they won't ask us on real exam thism

23:23:25 [Step_1] so it would be 1000 to prevent one in the 1/1000 case and 20 in the 50/1000 case?

23:23:41 [Roxanita] yup just the inverse

23:24:10 [Step_1] good questions. thanks

23:24:54 [Step_1] child abuse, sposal abuse, elder abuse. which are mandatory reportable and which are not?

23:26:09 [yamini] CHILD ABUSE IS MANDATORY

23:26:13 [vladi] what does a one-tailed null hypothesis state?

23:26:15 [Roxanita] child and elder?

23:27:04 [Step_1] child abuse and elder abuse are mandatory reportable (protect legally if no abuse is found). spousal abuse assumes the spouse can report it themselves so not mandatory reportable....just counsel

23:27:20 [yamini] ONE GROUP ISEITHER< OR> THE OTHER

23:27:31 [Roxanita] thanks step 1

23:28:14 [Step_1] 3 leading causes of death in us?

23:28:56 [vladi] right-yamini- it's directional, how about a two-tailed null hypothesis

23:29:25 [Roxanita] yup is directional

23:29:56 [yamini] nondirectional 2 groups r not same

23:30:06 [Roxanita] nondirectional

23:30:17 [Step_1] oops didnt see the question.....agree it is directional or one sided. the one group is either greater or less than the other

23:30:32 [Step_1] that was for one tailed

23:30:43 [vladi] 1- cardio, 2-vascular , 3-cancer

23:31:05 [yamini] heart dis,cancer,cerebrovasculardis

23:31:44 [Step_1] yamini is correct

23:31:51 [vladi] you right, guys, one-tailed- directional, 2-tailed-indirectional

23:32:52 [yamini] what is leading cause of death in children in us

23:34:03 [Step_1] children what age? infant mortality is birth defects

23:34:26 [vladi] thanks guys- i got crzy from PC today. hear you on Saturday

23:34:35 [yamini] ages 1-14

23:36:01 [Step_1] cant find it yamini

23:36:18 [Step_1] accidents?

23:36:44 [Roxanita] neglect?

23:36:56 [yamini] it is accidents,cancer,congenital anam

23:37:19 [Roxanita] Accidents in general?

23:37:35 [yamini] yes

23:38:01 [Step_1] ok valdi, talk to ya on sat

23:38:05 [Roxanita] ok Thanks

23:38:23 [yamini] ok

23:39:21 [Step_1] i think i'll go now too. gotta get up early. thanks for the chat everyone. i'll see everyone on sat night.

23:39:57 [yamini] ok bye

23:40:05 [Roxanita] Step 1 thanks a lot for your enthusiasm

23:41:21 [Step_1] thanks to you. i learned alot! goodnight all. bye.

23:41:32 Step_1 exits from this room

23:44:21 [neurodoctor_75] is the chat over?

23:44:47 [Roxanita] Just one more before we leave...... The Top Cancer Incidence in US

23:45:06 [neurodoctor_75] lung

23:45:32 [yamini] prostate in males

23:45:40 [Roxanita] Males: Prostate 41% >> Lung 13%>> Colorectal 9%

23:45:52 [Roxanita] Female?

23:46:07 [yamini] breast in females

23:46:22 [Roxanita] Female: Breast 31% >> Lung 13% >> colorectal 11%

23:46:53 [Roxanita] don't forget the tops are the one we respectively have

23:47:26 [neurodoctor_75] incidence in the population?

23:47:29 [Roxanita] And about Cancer Mortality?

23:47:40 [yamini] top cancer mortality is lung>prostate>colorectal in males

23:48:00 [Roxanita] yup

23:48:27 [yamini] in females lung>breast>colorectal

23:48:39 [Roxanita] Cancer Mortality: Male: Lung >> Prostate >> Colorectal

23:48:50 [Roxanita] yes Yamini you are completely right

23:50:08 [yamini] ok thank u

23:51:17 [Roxanita] ok guys, I will study better for next chat and bring more questions, i will check the Q-notes

23:52:21 [Roxanita] My friend got many questions from that booklet on her exam so I better check it in advance

23:53:27 [yamini] r covering all other topics of beh sci on saturday

23:53:41 [Roxanita] Thanks Again hutals you are very nice

23:54:12 [Roxanita] Let's try to cover all behavioral science but with directed questions

23:54:56 [Roxanita] in <a target=new href="http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10000058&type=3 &subid=0" >Kaplan</a> they are like 13 chapters

23:55:09 [Roxanita] in k-aplan they are like 13 chapters

23:55:37 [Roxanita] it's 10:55pm here, ok guys it was very nice to see you here

23:55:49 [yamini] ok thank u all i enjoyed my first study session.take care bye

23:56:07 [Roxanita] let's make a nice study group and keep motivate

23:56:19 [Roxanita] For saturday Behavioral Science.

23:56:40 [Roxanita] Good night Guys

23:57:13 [yamini] good night

[Anonymous]

19:44:32 semin enters this room

20:58:39 hutals enters this room

20:59:13 Step_1 enters this room

20:59:14 >[Step_1] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite.

21:01:04 Lorena enters this room

21:01:19 [Lorena] hello guys

21:01:28 [Step_1] hi hutals, lorena

21:01:46 [hutals] hello

21:02:00 [Lorena]

21:02:03 hutals exits from this room

21:02:07 hutals exits from this room

21:02:36 Valentina1 enters this room

21:02:48 hutals enters this room

21:03:16 yamini enters this room

21:03:19 Valentina1 exits from this room

21:03:37 Valentina1 enters this room

21:03:39 [yamini] hi everybody

21:03:51 [Lorena] hi yamini , nice to see you

21:03:55 karlaerika enters this room

21:03:57 [hutals] i have orbits &lt;a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10000206&type=2 &subid=0>QBank&lt;/a><IMG border=0 width=1 height=1 src=http://ad.linksynergy.com/fs-bin/show?id=c97WUMRO5hY&bids=47491&type=2&subid=0 > and posted it in the forum for everyone. i also uploaded it in the downloads. let me know if anyone has trouble finding it

21:04:09 [hutals] oops

21:04:25 [Lorena] thank you hutals

21:04:31 [yamini] nice to see u too

21:04:41 [Step_1] good to see everyone

21:04:52 [Valentina1] what is orbits?

21:05:14 [Valentina1] Hutals what is orbits?

21:06:01 [hutals] orbit is a user from last year, kinda like tommy is today, who wrote a bunch of questions. his questions, like tommys, are available if anyone wants them

21:06:23 [Lorena] cool

21:06:42 [Step_1] thanks hutals...very kind of you

21:07:25 [yamini] thank u hutal

21:07:27 [Lorena] do yuo guys want to start now ?

21:07:29 [Valentina1] Uhm

21:07:37 [Step_1] i hope everyone was able to find the downloads ok....i posted a message with instructions for those asking about it. i also posted further explanations on a couple of issues we had last week

21:08:02 [Lorena] i saw that, thank you very much step 1

21:08:24 [Step_1] ok lorena, ready when you are

21:09:27 [Lorena] disinhibition, emotional lability, slurred speech, ataxia, blackouts, coma....what is it?

21:10:00 crusher enters this room

21:10:03 Roxanita enters this room

21:10:25 [crusher] hi everyone

21:10:28 [Roxanita] hello

21:10:31 [Step_1] sounds like drug intoxication. maybe alcohol?

21:10:35 [Lorena] hi crusher, roxanita

21:10:41 [Step_1] hi crusher and roxanita

21:11:04 [Lorena] yes step 1, alcohol intoxication

21:11:31 [crusher] alcohol intoxication.....

21:11:32 [Roxanita] Hi late again

21:11:43 [Step_1] 24 yo female pt normally describes boyfriend as the best and puts him up on pedistal, but now they broke up so he is "the worst person ever". what defense mech?

21:11:52 [Lorena] we just started roxanita no problem

21:12:05 [Lorena] splitting

21:12:07 [crusher] all good n all bad....

21:12:16 [crusher] splitting

21:12:31 [yamini] splitting

21:12:35 [Roxanita] I agree

21:12:43 [Step_1] this is splitting...good job. see the world as all good or all bad. used by people with borderline

21:13:11 [Lorena] Glenn close in fatal atraction

21:13:32 [Roxanita] we are not covering chapter 3?

21:13:45 [Roxanita] are we?

21:14:04 [Step_1] which is chapter 3?

21:14:09 [Lorena] i though you covered that last week

21:14:23 [Lorena] sorry, not lat week, last chat

21:14:28 [Roxanita] kind of

21:14:40 [crusher] wht are the topics of today

21:14:51 [Step_1] you mean defense mech were covered last week?

21:15:02 [Lorena] behavioral science except biostatistics and epidemiology

21:15:30 [Lorena] no, chapter 3 is social life in USA.... it is epidemiology kind a...

21:15:46 kokushubila enters this room

21:16:28 [Step_1] today is stuff like personality, defense mechs, sleep, child development, phycho testing, etc

21:16:34 [Step_1] right?

21:16:48 [Lorena] yes, right

21:17:06 [Step_1] what is typically the first defense mech seen after bad news such as impending death of a lovered one or self?

21:17:13 [crusher] multiple physical complaints .more common in female,,Dx

21:17:16 [Lorena] denial

21:17:23 [yamini] denial

21:17:26 [crusher] denial

21:17:33 [Roxanita] yup

21:17:37 [Step_1] denial is correct....good job

21:17:52 [Lorena] hypocondriasis

21:18:00 [Step_1] crusher, is that somatic disorder?

21:18:20 [crusher] yes its somatization

21:19:16 [Lorena] diferentiate somatoform , malingering and factitious

21:19:21 [crusher] exaggerated concern about health and illneses ....no gender or age difference

21:20:13 [Roxanita] Dopamine Pathway...

21:20:17 [crusher] maligrening.....some personal gain......factitious.....no gain....somatization..multiple physical complaints

21:20:52 [Step_1] as far as syptom and motivation, somatoform is unconscious for both, factitious is interntional for symptoms and unconscious formotivation, malingering is intentional for both

21:21:00 [Roxanita]

21:21:17 [Lorena] somatoform is unconscious, malingering is intentional for sceindary gain and factitious is intentional illness production but unconcious motivation therefore a compulsion

21:21:22 [Lorena] very good!!!

21:21:29 [Step_1] crusher, is that hypochondria

21:21:54 [crusher] yes ur right step1

21:21:58 [Lorena] medial forebrain--- nucleus acumbens---- ventral tegmental

21:22:20 [Roxanita] good...and drugs associated with this pathway?

21:22:51 [Lorena] DA, NE, 5HT and AcH?

21:23:07 [Roxanita] Drugs?

21:23:17 [crusher] dopamine.......ach...

21:23:29 [Step_1] anti pschotics

21:23:54 [Roxanita] Drugs that stimualtes this pathway

21:24:00 [yamini] amphetamines,cocaine,

21:24:10 [Roxanita] yup

21:24:15 [Lorena] agree with yamini

21:24:27 [Roxanita] -OH, Heroin, Apmphetamines, Nicotine, caffeine

21:24:30 [Step_1] amphetamines

21:24:58 [Step_1] cocaine

21:25:16 [Roxanita] Don't forget the DOPAMINE PATHWAY ---> POSITIVE REINFORCEMENT PATHWAY

21:25:37 [Lorena] thats why these drugs are very adictive

21:25:40 [crusher] diff b/w schizopherenia and shizopheriniform disorder]

21:25:47 [Roxanita] stimulate by our own behavioral (normal way) but also can be stimulates by drugs

21:26:38 [Lorena] schizophrenia more than 6 months, schizophreniform less than 6 months

21:26:39 [Step_1] time....1st is over 6 months and 2nd is under 6 mo

21:26:47 [Roxanita] in this case it becomes a "maladaptive addiction pathway"

21:27:08 dia_huq enters this room

21:27:28 [Lorena] what is munchaunsen syndrome by proxy?

21:27:33 [crusher] correct step1

21:28:16 [crusher] difference b/w schizoid and schzotypical disorder

21:28:42 [crusher] i think malingering for some sec gain

21:29:01 [Lorena] schizoid isolated lifestyle, shizotypal eccentric behaviour

21:29:29 [Step_1] 1st they say "go away", 2nd you say "go away"

21:29:55 [Roxanita] Munchausen Sd involves an adult who fakes or induces an illness in a child to receive medical attention

21:30:08 [Roxanita] Munchausen by proxy= baby in crib

21:30:22 [Lorena] very good roxanita

21:30:54 [Roxanita]

21:30:56 [Step_1] apparent deeply caring mother who repeatedly fabricates symptoms or provokes actual illnesses in her helpless infant or child

21:31:12 [crusher] schizoid..>lifelong social withdrawl....schizotypical...>odd thoughts and behavior..all correct..good pnomonic step1

21:31:36 [Lorena]

21:32:08 [Step_1] what does ego-syntonic mean?

21:32:47 [Lorena] the patient doesn know ....subconcious?

21:32:57 [Roxanita] I FEAR LARD = Image of body distorted , Fear of gaining weight, Amenorrhea, Refusal to gain weight , Laxative use, Anhedonia, Restricting type, Denial ?

21:33:12 [Lorena] defense mechanisms are ego syntonic, right?

21:33:27 [yamini] comfortable with oneself

21:33:33 [Lorena] anorexia nervossa

21:33:43 [Step_1] ego-syntonic means they don't think anything is wrong with them, so they seek to change the world instead of self. this is essential for diagnosis of personality disorders. if someone says they're narcassistic, they're not because they can't know they are

21:33:54 [Roxanita] yup

21:34:28 [Lorena] what a great neumonic for anorexia nervossa

21:34:40 [Step_1] yes defense mechs are also ego syntonic

21:34:52 [Roxanita]

21:35:06 [Step_1] good stuff roxanita

21:35:31 [Step_1] main difference between anorexia and bulemia (in real life over mixed)

21:35:47 [Step_1] ?

21:36:59 [Roxanita] A BINGE ... Average 2 binges/week over 3 months, Behavior after consumption compensates for ingestion, Ingestion of large amounts of food (binge eating) , Not ocurring exclusively during anorexia nervosa, Guilty feelings after binge eating, Evaluation of self is unduly based on appearance ?

21:37:08 [Lorena] age, anorexia is in mid teenage years,ad bulimia late adolescence, adulthood? also weight anorexia > 15% ideal body weight , bulimia they are usually normal or a llitle >

21:37:52 [Step_1] very good lorena. the most imp thing is that anorexics will present with significant weight loss >15%. bulemics can be normal body weight or sometimes even overweight.

21:38:35 [Lorena] anorexia can be life threatening, more than bulimia

21:38:37 sweta_chandra enters this room

21:38:38 [yamini] sexual adjustment is poor for anorexics also high mortality

21:38:43 [Roxanita] yup bulimics can have normal weight don't forget in the physical examination the marks on the hands (dorsum)

21:39:23 [Lorena]

21:39:36 [crusher] and staining of teeth cos of acid by vomiting

21:39:52 [Step_1] what is target of treatment? stress they must eat or behavioral therapy for underlying issues?

21:40:21 [Roxanita] yes many cavities because the acid reflux to the mouth

21:40:28 [crusher] stress for behavior issues

21:40:42 [Lorena] both

21:40:51 [Lorena] stabilize weight

21:41:10 [Step_1] sorry, that was confusing....forced nutrition can be necessary for short term treatment in some cases, but behavioral issues is only thing that will work long term...after hospitalization

21:41:13 [crusher] but for anorexia in acute condition need electrolyte balance first

21:41:25 [Lorena] does anybody know why bulimic patients have large parotids? also alcoholics?

21:41:50 [Step_1] has to do with throwing up

21:42:44 [Lorena] i see

21:43:02 [Lorena] thanx

21:43:30 [Step_1] chronic alcoholic pt has amnesia, what is syndrome called and due to which vit def?

21:43:43 [crusher] which elcetrolyte is dangeroulsly low and what effects in acute wt loss in anorexia?

21:43:51 [Lorena] korsakopff, tiamine def

21:44:00 [crusher] korsokof..thiamine def.

21:44:09 [Lorena] potassium?

21:44:29 [yamini] thiamine

21:44:50 [crusher] yes k and causes lethal arrythmias...thats why forced nutrion is necessory

21:44:58 [Step_1] potassium and heart problems for anorexic

21:46:00 [Lorena] euphoria, tachycardia, dilated pupils, hallucinations, sedduen cardiac death....intoxication with?

21:46:00 [Step_1] yes it is korsakoff and thiamine deficiency.....never give glucose in this case without adding thiamine first because glucose will compete in same pathway as thiamine

21:46:25 [Roxanita] K+ --->> Heart problems, what kind?

21:46:37 [crusher] whats the diff b/w bipolar1 and bipolar2 disorder

21:47:13 [yamini] ventricular arrhythmias

21:47:18 [Lorena] bipolar 1, maiac episodes predominate

21:47:40 [Lorena] bipolar 2, depression is more predominant

21:48:10 [Step_1] 2 has milder form of elevated mood

21:48:47 [crusher] cocain

21:49:04 [Lorena] yes, type 2 is hypomania + depression, no maniac episodes

21:49:24 [Lorena] yes crusher, cocaine is right

21:49:43 [Step_1] what is schizoaffective disorder?

21:49:52 [Lorena] roxanita, ventricular arrythmias is the correct answer?

21:50:22 hanyr33 enters this room

21:50:31 [kokushubila] combination of schizoaffective disorder and a mood disorder

21:50:35 [Lorena] schizophrenia + mood disorders?

21:50:48 [kokushubila] sorry schizophrenia

21:51:03 [Step_1] good job......schozoaffective = schizophrenia + a mood disorder (mania, depression)

21:51:20 vladi enters this room

21:51:37 [Roxanita] sorry I went away ...... yes that's good Yamini

21:51:53 [Roxanita] there are many symptoms of Hypokalemia you know and V.A. is one of them

21:52:11 [vladi] hi folks

21:52:15 [Step_1] disregard for and violation of rights of others, criminality, males > females. what diagnosis?

21:52:22 [Step_1] hi vladi

21:52:28 [crusher] hi valdi

21:52:33 [Lorena] antisocial

21:52:40 [Lorena] hi vladi!

21:52:47 [sweta_chandra] antisocial personality

21:52:54 [yamini] metabolic alkalosis??

21:53:13 [crusher] antisocial personality..in childhood conduct disorder

21:54:02 [vladi] who predispose to have antisocial disorder

21:54:06 [Step_1] very good....know that &lt;18 is called conduct disorder, but >18 is antisocial.....same disorder only diff is age

21:54:11 [Roxanita] yes but V.A. is the most important for this paients

21:54:21 [Roxanita] ok

21:54:24 [dia_huq] is this after the first or second reading?

21:54:44 [Lorena] it is more common among relatives

21:54:47 [sweta_chandra] disturbed family..

21:54:59 [Step_1] predisposes to antisocial.....conduct disorder?

21:55:07 [Step_1]

21:55:44 [vladi] right -step 1

21:55:46 [Step_1] 75% of prison populations, alcoholic or abuse in family

21:55:59 [sweta_chandra] rt

21:56:08 [Lorena] i see

21:56:30 [Roxanita] Drugs of abuse: "COCAINE CHOPS" : Cocaine, Opioids, Cannabis, Amphetamines, Inhalants & solvents, Nicotine, Ethanol, Caffeine, Hallucinogens, Other, PCP (phencyclidine), Sedatibe hipnotics

21:57:00 [Step_1] good mneumonic rox....thanks

21:57:11 [Lorena] good rox..

21:57:13 [Roxanita]

21:57:36 [Step_1] what is the main difference between obsessive compulsive personality disorder and obsessive compulsive disorder?

21:57:40 [sweta_chandra] which drug is most commonly "abused drug " in USA?

21:57:41 [Roxanita] Opioid withdrawal?

21:57:49 [Roxanita] OH

21:58:18 [Lorena] alcohol

21:58:39 [sweta_chandra] i meant over the counter abuse?

21:58:43 [Step_1] alcohol is most commonly abused, also caffiene if you want to get technical

21:58:45 [sweta_chandra] it is amphitamine.

21:59:00 [Roxanita] it also costs to US around $100 billion per year

21:59:01 [vladi] alcohol

21:59:49 [Roxanita] yup OH male/female= 4/3

21:59:55 [Lorena] obsessive compulsive personality disorder dont have obsessions!

22:00:05 [sweta_chandra] i said abused drug... not abused substance

22:00:09 [vladi] step1- what is difference- it comes out of my brain

22:00:15 [Step_1] alcohol is the #1 abused substance in U.S., marijuana is the #1 illicit drug abused....right?

22:00:26 [Lorena] obssesive compulsive anxiety disorder has obsessions and compulcsions

22:00:53 [Lorena] agree with you step 1 abaout OH and marijuana

22:01:00 [sweta_chandra] i read it in some quest bank, and there they said amphitamine..

22:01:19 [Roxanita] nope, it's OH from far

22:01:28 [Step_1] the diff is the the personality disorder is lifelong and ego syntonic. OCD is aquired later in life and the pt knows he or she has it and notices its abnormal....just cant help it

22:01:40 [vladi] what stands for OH

22:01:42 [sweta_chandra] marijiuana is not over the counter abused drug.

22:01:51 [Roxanita] hey Opioid withdrawal?

22:02:04 [Lorena] maybe it said abused drug in "raves", ?

22:02:24 [Lorena] anxiety, insomnia, sweating, fever, piloerection, cramps

22:02:33 [yamini] personality dis. r life long and pervasive

22:02:41 [Lorena] OH= alcohol

22:02:42 [Step_1]>[sweta_chandra] i think that the difference is terminiology. substance can mean legal substance. illicit implies illegal. drug would be prescription.

22:02:51 [vladi] i did understand the term egosyntonic- can you explain, step1-thanks

22:03:54 [sweta_chandra] yes. drug is prescription. correct.

22:04:05 [yamini] OCD is focal& acquired

22:04:28 [Step_1] ego syntonic means that the person is not aware there is something wrong. they want to change the world rather than themselves bc they dont see anything wrong with them...just everybody else. so the main difference is that in personality disorder, they dont know, but in OCD, they do and just cant

22:04:36 [Step_1] help themselves with the compulsions

22:05:19 [Lorena] i see , thanx

22:05:30 [Roxanita] Opioid withdrawal: "A MANY PAIN DEAL" : Antagonist precipitates withdrawal, Mood is dysphoric, Aches in muscles and bones, Nausea and/or vomiting, Yawning, Piloerection "gooseflesh" "cold turkey", Agonist removes withdrawal symptoms, Insomnia, Not life threatening, Diarrhea, Elevated temperature,

22:05:38 [Step_1] also OCD will have compulsions towards certain things only (wash hands, lock door, etc), but personality ones have problems with everything all the time in all aspects of life

22:05:53 [Roxanita] Abdominal Cramps, Lacrimation and rhinorrhea.

22:06:36 [yamini] what is characteristic feature of SHAKEN BABY SYNDROME

22:06:45 [yamini] ?

22:06:58 [Lorena] retinal hemorrages or detachment

22:06:59 [crusher] retinal hemmarege in shaken baby

22:07:04 [Step_1] yes give benzos to help with opiod withdrawal. good info rox

22:07:21 [Step_1] retinal hemorrage...i agree

22:07:24 [crusher] withdrawl of heroins sign

22:07:24 [yamini] yes

22:07:35 [vladi] great- i got it, but let's take an example. Myself i double check everything leaving the home- i realize that may be it's something wrong but from other side - it's extra precautuion, what is that- personality or disorder

22:07:54 [Lorena] why REM is called paradoxical sleep?

22:08:56 [yamini] opiod withdrawal we give clonidine

22:09:32 [Step_1] no....that is probably normal, unless you checked it excessively and could not go without checking it. but as dr daugherty (kap lan psych teacher) says, if you think "maybe i have that personality disorder"...you don't because they're egosyntonic.

22:09:55 [Roxanita] uhm...Sleep stages: features: - DElta waves during DEepest sleep (stages 3 & 4, slow-wave), - dREaM during REM sleep.

22:10:00 [Lorena] that s called being cautious

22:10:34 [Lorena] agree with step 1 , vladi

22:11:37 [Lorena] at night BATS Drink Blood (for sleep waves on EEG)

22:11:42 [Step_1] REM is similar to wake state

22:11:51 [Roxanita] REM sleep is an awake brain in a paralyzed body?

22:12:03 [vladi] all right- you made me quiet that i am so not so crazy with this USMLE-stuff

22:12:29 [Lorena] yes, the same EEG pattern than awake, thats why is called paradoxical sleep

22:12:38 [crusher] what stage of sleep we see night terrors and sleep walking

22:12:39 [Step_1] at least in the brain.....body paralized and brain awake. but on other stages the brain is asleep and body paralyzed

22:12:49 [Step_1] stage 4

22:12:59 [Lorena] stages 3&4

22:13:00 [sweta_chandra] nrem stage 4

22:13:25 [Step_1]>[vladi] what do you mean

22:13:31 [vladi] i also like this mneumonic, lorena, that's why may it comes from- it's the same EEG patern, but REM determine the quality of sleep

22:13:33 [Lorena] differentiate night terors from nightmares?

22:13:37 [Roxanita] NARCOLEPSY... this one comes for sure !!!

22:13:41 [crusher] yes stage4 or non resting REM

22:13:51 [yamini] why there is decreased REM sleep in alzheimers?

22:14:13 [crusher] i think REM dec with age

22:14:18 [Step_1] night terror you dont remember, but nightmares you do....i think....i always get them mixed up

22:14:27 [Lorena] agree with crusehr

22:14:56 [sweta_chandra] night terror is in stage 4, night nmare is rem sleep?

22:15:17 [Lorena] yes, you 're right step 1, night terrors you dont remember and it is in stage 3&4 , nightmares is in REM (when brain is more active) you remember

22:15:32 [Lorena] very good sweta chandra

22:15:51 [Roxanita] DSM-IV-TR criteria for Narcolepsy includes?

22:16:03 [crusher] sudden attack of sleep in day time person looses its tone...narcolepsy

22:16:04 [Step_1] it has to do with the neurotransmitter for sleep i think where alzheimers have increase ach or something like that....cant remember

22:16:07 [yamini] SLEEP attacks & EDS:CATAPLEXY

22:16:20 [vladi] people don't remind the night terror because it comes to 3-4 stage of non-REM sleep, but can recAll the nightmare- because it come to REM stage

22:16:42 [crusher] which neurotransmitter induces sleep

22:17:08 [Step_1] serotonin to induce sleep

22:17:20 [sweta_chandra] yes serotonin

22:17:30 [yamini] SLEEP PARALYSIS,HYPNAGOGIC HALLUCINATIONS SEEN IN NARCOPLEXY

22:17:36 [Roxanita] what about Melatonin?

22:17:36 [Lorena] narcoleptic tetrad :sleep attacks, excessive daytime sleepiness, cataplexy, hypnagogic, hypnapompic allucinations, sleep paralysis

22:17:55 [vladi] Ach

22:18:14 [Step_1] alzheimers has dec REM because lower Ach to NE

22:18:15 [Lorena] serotonin

22:18:43 [crusher] its vserotonin..remeber turkey rich in serotonin...so after thankgiving night ppl falls asleep

22:18:43 [yamini] correct step_1

22:18:48 [Roxanita] Narcolepsy: Sleep attacks during the day with abnormal REM sleep

22:18:57 [Lorena] good question yamini

22:19:18 [vladi] serotonin initiates the sleep, but Ach is responsible for REM-stage

22:19:32 [Roxanita] and Melatonin?

22:20:17 [Lorena] i dont remember melatonin

22:20:29 [Step_1] meatonin keeps you awake i think

22:20:51 [Lorena] something to see with the day light....

22:21:14 [sweta_chandra] ya i also remember this

22:21:41 [yamini] melatonin assoc with feelings of sleepiness

22:21:47 [Roxanita] Treatment for Narcolepsy: Modanfinil (nonamphetamine stimulant); Methylphenidate (Ritalin)

22:21:53 [sweta_chandra] that's the reason for jet lahg too

22:22:10 [Step_1] sunlight increases melatonin so that keeps you up, then you have less at night so sleepy. so some take it to regulate sleep cycle....is that right?

22:22:29 [vladi] what is difference between cataplexy and catalepsy

22:23:11 [Step_1] Cataplexy is a condition that involves a sudden, temporary loss of muscle tone

22:23:25 [Roxanita] Melatonin: it's secretion has a circdian rythm relation, and yup is related to feelings of sleepiness. Also linked to seasonal affective disorder.

22:23:28 [crusher] catplexy person looses its tone and suddenly collasp

22:23:30 [vladi] which neurotransmitter reduces REM sleep

22:23:39 [Lorena] cataplexy is the pathognomonic sign of narcolepsy

22:23:43 [sweta_chandra] yes rt for melatonin

22:23:46 [yamini] NE

22:23:59 [Step_1] It is sometimes confused with catalepsy, the temporary loss of voluntary movement

22:24:02 [Lorena] NE

22:24:33 [vladi] yes-yamini

22:24:36 [Lorena] whic neurotransmitter increases time spent in REM sleep?

22:25:04 [yamini] Ach

22:25:05 [Step_1] ACh

22:25:12 [Roxanita] cataplexy=> sleeping cat

22:25:23 [Lorena] yes

22:26:05 [Step_1] K complexes seen in which stage? what about sleep spindles?

22:26:16 [yamini] which reduces only sleep time?

22:26:30 [Lorena] stage 2

22:26:34 [crusher] stage2

22:26:52 [yamini] Kcomplexes seen in stage 2

22:27:01 [Step_1] yes both are seen in stage 2...good job

22:27:03 [crusher] dreaming occur in which stage of sleep

22:27:11 [Lorena] dopamine?

22:27:31 [yamini] yes lorena u r right

22:27:36 [sweta_chandra] 3&4

22:27:37 [Lorena] in REM

22:27:47 [vladi] exactly- step 1, cataplexy- part of nacrolepsy, catalepsy- just simple and temporary loss of voluntary movement w/0 falling in sleep etc.- do not mix it up- i got it on real exam

22:27:48 [Roxanita] 1

22:27:57 [Step_1] rem?

22:28:05 [yamini] REM,

22:28:40 [Step_1]>[vladi] thats a good point

22:28:46 [Roxanita] d RE a M.........REM

22:28:49 [Lorena] remmeber REM is when the brain is very active, so dreaming, increase in brain oxygen use too

22:29:13 [vladi] i've never heard about K complexes- what is that

22:29:20 [Step_1] you have the best mneumonics rox

22:29:29 [crusher] yes REM iwe see dream..there is penile errection and clitoris errection...inc resp and inc B.P

22:29:32 [Lorena] yo do rox!!!

22:29:35 [Roxanita]

22:29:40 [Lorena]

22:30:34 [Step_1] the spindles are a bunch of waves close together and small. k complexes are a very large spike by themselves. both seen in stage 2 sleep

22:30:41 [Lorena] explanation of rapid eye movements?

22:31:12 [Roxanita] and DELTA sleep is DE eper sleep

22:33:01 Bayda enters this room

22:33:18 [Bayda] hello

22:33:25 [Roxanita] Rapid eye movements?

22:33:32 [Lorena] hello bayda

22:33:44 [Step_1] i was wrong about melatonin. according to kap lan, melatonin, form pineal glad is sesitive to light via pathway from eyes. daylight INHIBITS its release and at night the levels increase dramatically. give pts to help sleep. i stand correct

22:33:51 [vladi] Oh, i found it- sleep spindles and K complexes - it's 2nd stage of non-REN sleep

22:34:30 [Lorena] thanks step 1

22:34:44 [vladi] hi bayda, join us

22:34:57 [Roxanita] That's good step 1

22:35:17 [Bayda] ya thanks you are discussing behav, right?

22:35:29 [yamini] what is the treatment of opioid withdrawal?

22:35:31 [Lorena] i also remember sothing about not giving melatonin for sleep disorders, just tretament with light

22:35:41 [Roxanita] That's why it's related with seasonal affective disorder, like when we feel kind of depress in winter

22:36:16 [Roxanita] i

22:36:17 [Bayda] nalloxone?

22:36:19 [Lorena] exactly rox, tretament for seasonal disorder is with light, not melatonin

22:36:53 [Roxanita] Lorena what's the explanation of rapid eye movement?

22:36:54 [Lorena] naloxone is for intoxication, for withdrawal is bz

22:37:02 [Step_1] naltrexone and benzos?

22:37:07 [yamini] no it is clonidine

22:37:27 [crusher] its benzo

22:37:32 [Step_1] ah yes yamini...forgot about that one

22:37:43 [Lorena] rapid eye movements because high activity of paramedian pontine reticular formation where the conjugate gaze center is

22:37:43 [vladi] on EEG- sleep spindles and K COMPLEXES-onset of sleep with 12-14 cps vltage

22:38:30 [Roxanita] Good Lore

22:38:43 [Lorena]

22:38:51 [Step_1] btw for opiod withdrawal, you also give naloxone and benzos, just not 1st choice

22:39:02 semin enters this room

22:39:11 [Lorena] clonidine is first choice then?

22:39:42 [yamini] no iis clonidine crushert

22:39:57 [yamini] sorry about that

22:40:34 [Step_1] yes, clonidine is 1st choice for opiod withdrawal. naloxone is for the resp depression of opiod use.

22:40:44 [crusher] ok yamni i didnot know that

22:40:56 [Lorena] got it

22:41:23 [Roxanita] what about methadone step 1?

22:41:30 [yamini] i jusyt wanted to clear the doubt

22:41:45 [Lorena] thats for addiction

22:42:19 [yamini] methadone causes subsitute addiction

22:42:30 [kokushubila] Methadone-heroin detoxication longterm maintanance

22:42:47 [Lorena] to treat adiction to heroin

22:42:55 [Step_1] methadone is very highly addictive and must be given in controlled doses for substitute addiction treatment and maintenance treatment. but clonidine is more immediate and 1st drug to give

22:43:02 [Roxanita] but are used to treat withdrawal symptoms?

22:43:11 [yamini] & has longer withdrawal

22:44:20 [Lorena] if your patient is suffering a withdrawal...you give clonidine....to prevent withdrawals in addict heroin patients give methadone

22:44:40 [Lorena] isthat right step 1?

22:45:07 [Step_1] methadone is not for withdrawal symptoms, it just gives your body the satisfaction without as much satisfaction. clonidine is actually for the symptoms, but wont take away addiction

22:45:21 [vladi] what we can use clonidine else for

22:45:52 [Step_1] yes lorena...thats right

22:45:57 [crusher] hypertension v;ladi

22:45:57 [Lorena] hypertension

22:46:32 [crusher] but gluteal with postural hypotension ...its s.e

22:46:46 [yamini] mild to moderate HTN

22:46:54 [Lorena] clonidine acts on alfa 2 receptors on the presynaptical membrane

22:47:02 [vladi] i mean in behavorial disorders

22:47:09 [Roxanita] Ethanol Withdrawal:"PINT OF ASA" Perceptual disturbances (haluucinations or illusions), Insomnia-Irritability, Nausea and or vomiting, Tremor, Onset is fromhours to 3 days after last consumption, Flushing of the face, Autonomic hyperactivity (HR,BP,Temp), Seizures-grand mal(tonic clonic), Agitation

22:47:13 [Lorena] oh sorry

22:47:29 [semin] according to cecil book, withdrawal from opioids can be managed with methadone, which can be given twice daily and tapered over 7-10 days

22:47:32 [Step_1] clonidine is an alpha 2 agonist so it will decrease blood pressure

22:47:49 [crusher] what does alcoholic anonymous means

22:48:00 [semin] alternatively, LAAM

22:48:02 [Lorena] decreases NE release

22:48:42 [semin] clonidine reduces autonomic hyperactivity for withdraw

22:48:57 [Step_1]>[semin] exactly, but its used for long term treatment of withdrawal. for acute treatment of withdrawal symptoms, you give clonidine

22:48:59 Bayda enters this room

22:49:12 [Roxanita] what does it mean?

22:49:39 [semin] yes, agree with step-1

22:49:48 [Lorena] tourette syndrome?

22:49:51 [vladi] for ADHD (second line) and sometimes- Tourette

22:50:13 [Step_1] ritalin?

22:50:44 [Step_1] i take that back...not ritalin

22:51:01 [Lorena] i meant clonidine for tourette syndrome

22:51:33 [Lorena] what does it mean crusher?

22:53:06 [Roxanita] Let's do Child Development, that comes for sure in the exam...

22:53:21 [Step_1] imagine a tourettes patient on ritalin....an overactive person yelling obscenities....ritalin probably not the best choice

22:53:27 [crusher] i,m sorry my internet acting stangly

22:53:44 [Lorena] agree with rox

22:54:02 [crusher] haloperidol is DOC for tourete disorder

22:54:13 [vladi] agree Roxa- it's HY Qs

22:54:47 [Lorena] smile, innate, exogenous and social....what ages?

22:55:14 [semin] 2 mouths

22:55:25 [crusher] 4 month

22:56:23 [Roxanita] 12-16 weeks?

22:56:31 [yamini] 2 MONTHS

22:56:34 [Lorena] innate smile -new born; exogenous 8 weeks and social 12-16 weeks

22:56:57 [Roxanita] ok

22:57:12 [yamini] ok

22:57:29 [Lorena] what does it mean exogenous smile?

22:57:55 [vladi] i said sometimes- of course neuroleptic- first line, crusher

22:58:0